Breaking Down Barriers – Patient Centered Psychiatry

Dr. Liz Frye of the Emory University Community Psychiatry and Public Health Fellowship program collaborates with Atlanta PATH providers to bring psychiatric services to the streets. In this first of a two-part interview with Dr. Frye, she discusses how she began working with people living on the streets with severe mental illness.

Dr. Liz Frye is enrolled in the Community Psychiatry Fellowship program at Emory University. This post-graduate medical education-training program places emphasis on working with underserved populations in the Atlanta metropolitan area. Dr. Frye’s experiences in this program helped structure a model outreach project to connect underserved populations to mental health services.

How did you get involved in working with people experiencing homelessness and how did your outreach program get started?
I initially became interested in people who have fallen through the cracks of society in high school through my experience with work team trips in Mexico. These trips really sparked a drive to try and do what I can to help people who need it. I moved to the Atlanta area and started a psychiatry residency program at Grady Hospital, a large urban medical center. One of the things I noted when I started my residency program was the lack of services being provided to individuals experiencing homelessness and I wanted to find a way to fill the gaps. There was a specific recognition on my part, and the part of others with whom I was working, that some programs were not engaging people where they were at - directly on the streets, in housing programs, at drop in shelters, and at community feeding programs. The goal of the initial work was to build a bridge between psychiatry and basic social service needs. Our focus was on addressing the gap that exists between patients needs and the services that can help address their needs.

There was intentionality on the part of the United Way of Metropolitan Atlanta and the United Way Regional Commission on Homelessness to include a psychiatrist in the PATH street outreach team. The Regional Commission realized having a team that included a number of different professional disciplines would assist in engaging “hard to reach” homeless populations.

Our program is centered on creating sustainable approaches to delivering care and addressing needs. We started our first clinic in a shelter (City of Refugee). The goal of this initial clinic was to address the gap that existed between community mental health referrals and client needs. Many clients wait four to six weeks for an appointment in a mental health agency or clinic. This phenomenon is not unique to the Atlanta area. Around the country, waiting lists for community mental health services are long because the available services are unable to meet the demand.

All of our staff are volunteers and we currently have a team of six to ten people per week. Our volunteers are medical students, public health students, residents, and attending physicians. On average, we see six to eight clients per week. We collaborate with PATH providers to identify clients with mental health needs and to provide the best care possible. Our team is very holistic and collaborative. We are all working to ensure that people get the evidence-based services they need, in a timely and efficient manner, and in the locations where the services are needed most.

How does your program interact with the PATH programs in the Atlanta area?
PATH focuses strongly on the core values of engagement, relationship and advocacy and we assist with diagnosis and treatment. The PATH providers meet with clients on the streets and build bridges of support and service delivery. Most patients request social services rather than mental health services. My role is to clarify what a psychiatrist can offer to a PATH team and support PATH providers in their work to get clients engaged in mental health services.

Education is the most important resource I provide. I try to educate clients about the resources available to them for treatment. One of the biggest goals of our team is to connect people experiencing homelessness to better alternatives that move them beyond homelessness. We recognize fully that the “alternatives” that exist for many people experiencing homelessness are not really viable alternatives. If the alternative is a crowded shelter infested with bugs and rats, who would not choose a comfy patch of grass? We promote reasonable alternatives such as psychiatric services and/or social supports and services. Our PATH teams work together to meet the clients where they are physically, emotionally, and mentally.

In the next PATH refresh we will hear more from Dr. Frye about how she started the outreach program, the challenges she encountered and her advice for other PATH programs interested in integrating more direct mental health services into their outreach teams.

Publication Date: 
Newton Centre, MA, USA