Inspiring a willingness to try again in the mind of someone who has been let down time and again is the underlying objective of a team of therapists at House of Mercy. To do it, they must be gentle; they must listen carefully, and they must have the resources available when a client is ready to take another leap of faith and take their treatment further.
At House of Mercy, many people wrestling with mental illness have been lost in a system that under the best conditions is difficult to navigate. But without insurance, without ID, without transportation or money, getting help for the homeless is that much harder, explains Caroline Easton PhD, a professor in the College of Health Sciences and Technology at Rochester Institute of Technology.
To make matters worse, she says, in Monroe County there is a shortage of licensed therapists that is about to reach a crisis point. This is one of the reasons RIT developed the outreach program that Dr. Easton spearheads, to address a worsening problem in the community: getting mental health and addiction care to the people who need it most.
“We brought (the care) to them. We view it as non-judgmental. We are sitting down with them: Many of them have been through so much trauma that the fact that any of them would want to talk to us or allow that space for them to share with us, it’s an amazing thing because they have gone through so much already,” Dr. Easton says.
She emphasizes to her interns the beauty of that alliance.
“Some of the traumas that date back to when they were children are so complex and horrific. We tell our interns, ‘They’re going to tell you about some of that and they don’t really know you. The fact that they’re willing to do that is really special.”
Students often tell Dr. Easton this part of their clinical internship—earning their patients’ trust—is one of the most rewarding. The students are in the final phase of their doctoral program to become therapists.
To overcome the logistical and bureaucratic hurdles people must navigate in making and attending their appointments, Dr. Easton’s team developed a TelePsychology and TeleHealth system that allows the homeless to meet with their caregivers virtually. They can do so, for example, through the clinic that RIT has established at House of Mercy.
The program is funded with a $1.4 million grant Dr. Easton received from the U.S. Department of Health and Human Services. The grant helped purchase the teleconferencing technology—video cameras, monitors, tablets—and make the program possible. It was also funded with support Dr. Easton and the House of Mercy raised from Greater Rochester Health Foundation, Farash Foundation and ESL Charitable Foundation.
The telepsychology system became especially useful when the pandemic hit. In response to the quarantine, Dr. Easton’s team did not miss a beat. Therapists were able to talk to clients on the phone, give them emotional support and help them with their cravings.
But when she started three years ago, Dr. Easton didn’t even know if people at House of Mercy would want behavioral help. She conducted focus groups to find out, and realized they did.
“So we developed a clinic. We integrated ourselves there. We knew they were very interested in it, but they had bad experiences in the past,” she says.
As part of their process, counselors collect data from clients at House of Mercy in an in-take form that is immediately followed by a free therapy session.
“Some people don’t want meds, or they don’t want treatment, but they do want emotional support without any strings attached. That’s why we meet them where they’re at, at any point in time,” Dr. Easton says. “They’ve been through so much. We have to be very gentle and respectful of where they’re at.” Many times, people have been prescribed the wrong medication or combination of medication and have trust issues because of it. They need pharmacotherapy management. Without meds, Dr. Easton says, some people with severe mental illness may feel like someone is out to get them or they hear voices.
Bringing people back into a frame of mind where they are willing to take their treatment further with medication or engage with caregivers on an in-patient basis is crucial. To do that, Dr. Easton says, outside institutions have to be ready to accommodate them. Oftentimes they are not.
Dr. Easton remembers one client in particular who was using heroin and cocaine. The team at House of Mercy called him Sunshine for the yellow sneakers he found among the donations there.
“The drugs were helping him with (his) trauma. He was self-medicating, which allowed him to dissociate from what he’s been through. We worked with him to help him understand the negative effects of using and what it could be like if he took a break for a while. We asked if that was something he would consider.”
After working with him day and night, he finally said yes. Dr. Easton and her team were thrilled. “We had the treatment provider on the line, and they had a bed. Sister Rita drove him right over, but by the time they got there, the bed had been filled.
“That’s what we have to deal with. When they’re motivated in the moment, you have to seize that moment. Eventually, he ended up getting another bed,” she recalls. “We were kind of more affected by it than he was because he was used to having that happen to him.”
Going forward, Dr. Easton says she wants to leverage RIT’s program to help guests at House of Mercy secure housing.
“There are all sorts of requirements for housing. It’s confusing for us, the professionals, I can imagine what it is like for a homeless person,” Dr. Easton says. “So, we’re trying to integrate more in residential placement and housing solutions. Our interns function under our license so we can do those mental health evaluations and psych testing needed to help place them in long-term housing.”
Longer-term and more fundamentally, Dr. Easton says, society needs to shed its bias against mental illness and people who struggle with substance use. Radical compassion, for her, is remembering we all are human.
“For me, radical compassion would be stripping down all our titles: We’re two human beings in the room, sharing, caring, having respect for one another and helping each other.”