{"id":427668,"date":"2024-06-04T05:30:00","date_gmt":"2024-06-04T12:30:00","guid":{"rendered":"https:\/\/calmatters.org\/?p=427668"},"modified":"2024-06-03T15:30:08","modified_gmt":"2024-06-03T22:30:08","slug":"california-homeless-street-medicine-injections","status":"publish","type":"post","link":"https:\/\/calmatters.org\/_zh\/housing\/homelessness\/2024\/06\/california-homeless-street-medicine-injections\/","title":{"rendered":"How shots instead of pills could change California’s homeless crisis"},"content":{"rendered":"
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\u603b\u4e4b<\/strong><\/p>\n\t\t\t\t\n\n\t\t\t\t\n\t\t\t\t

Doctors on the front lines of California\u2019s homelessness and mental health crises are using monthly injections to treat psychosis in their most vulnerable patients.<\/p>\n\t\t\t\t\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\n\t\t\n

As Dr. Rishi Patel\u2019s street medicine van bounces over dirt roads and empty fields in rural Kern County, he\u2019s looking for a particular patient he knows is overdue for her shot. <\/p>\n\n\n\n

The woman, who has schizophrenia and has been living outside for five years, has several goals for herself: Start thinking more clearly, stop using meth and get an ID so she can visit her son in jail. Patel hopes the shot \u2014 a long-acting antipsychotic \u2014 will help her meet all of them. <\/p>\n\n\n\n

Patel, medical director of Akido Street Medicine, is one of many street doctors throughout California using these injections as an increasingly common tool to help combat the state\u2019s intertwined homelessness and mental health crises. Typically administered into a patient\u2019s shoulder muscle, the medication slowly releases into the bloodstream over time, providing relief from symptoms of psychosis for a month or longer. The shots replace a patient\u2019s oral medication \u2014 no more taking a pill every day. For people who are homeless and routinely have their pills stolen, can\u2019t make it to a pharmacy for a refill or simply forget to take them, the shots can mean the difference between staying on their medication, or not.<\/p>\n\n\n\n

\"\"
The Akido street medicine team look for unhoused people in a vineyard to provide medical assistance in Arvin on May 28, 2024. Street medicine teams throughout California are increasingly using long-acting injectable antipsychotic medication to stabilize the mental health of people living in homeless encampments. Photo by Larry Valenzuela, CalMatters\/CatchLight Local<\/figcaption><\/figure>\n\n\n\n

\u201cThey\u2019ve been an absolute game-changer,\u201d Patel said.<\/p>\n\n\n\n

Street medicine teams bring the shots directly to their patients wherever they are \u2014 whether it\u2019s in a tent along Skid Row in Los Angeles, in a dugout in the middle of a field in the Central Valley, or along the bank of a stream in Shasta County. Doctors can diagnose someone, prescribe the medication, get their consent and give the shot within a matter of days \u2014 or sometimes even more quickly \u2014 and with minimal paperwork and red tape. They don\u2019t need a psychiatrist\u2019s sign-off. <\/p>\n\n\n\n

It\u2019s estimated that California is home to more than 180,000 homeless residents. How to help<\/a> the sickest of them \u2014 people with severe, untreated psychosis who might wander into traffic or otherwise put themselves in danger \u2014 has become a hot-button issue<\/a>, with Gov. Gavin Newsom and state lawmakers creating new and sometimes controversial ways to get people into treatment. In a recent UCSF survey<\/a> of homeless Californians, 12% reported experiencing hallucinations in the past 30 days, and more than a quarter said they\u2019d ever been hospitalized for a mental health condition. <\/p>\n\n\n\n

Doctors say the goal of giving an antipsychotic shot to someone living in an encampment is to get them thinking clearly, so that they can start engaging with social workers, sign up for benefits and get on housing waitlists. While Newsom\u2019s new CARE Court allows judges to order people into mental health treatment, and other recent legislation makes it easier to put people with a serious mental illness into conservatorships, doctors administering street injections take a different approach. The treatment is voluntary, and people can get help where they are, instead of in a locked facility.<\/p>\n\n\n\n

Some success stories are dramatic. Doctors talk about patients who one day are babbling incoherently, and a week after a shot, are having conversations.<\/p>\n\n\n\n

\u201cIt\u2019s been pretty common that that\u2019s the initiation of, \u2018We\u2019re going indoors,\u2019\u201d said Dr. Coley King, director of homeless health care for the Venice Family Clinic in Los Angeles. He said he\u2019s seen dozens of patients get off the street after taking these shots. <\/p>\n\n\n\n

As with any medication, the shots can have side effects. And while a patient can stop taking a pill and generally put a stop to a negative reaction, once they\u2019ve been given a shot, they have no choice but to wait a month for the drug to wear off. <\/p>\n\n\n\n

Despite some street doctors\u2019 rave reviews, injectable antipsychotics still aren\u2019t reaching everyone who experts say they could help. Street medicine teams report having just a handful of patients on these medications at any one time (King\u2019s team in Los Angeles has about two dozen). Some patients don\u2019t want the shots, balking at the idea of having a drug in their system for an entire month, especially if they have feelings of paranoia related to health care. <\/p>\n\n\n\n

And street doctors complain that hospitals still seem to prefer discharging patients from temporary psychiatric holds with a bottle of pills they may or may not take \u2013 instead of giving them a long-acting shot. <\/p>\n\n\n\n

Losing track of patients<\/h3>\n\n\n\n

One of the biggest challenges street doctors face in administering these shots is following up with patients. <\/p>\n\n\n\n

In Kern County, Patel hasn\u2019t seen the woman he\u2019s looking for since his team gave her first antipsychotic shot almost two months ago. Now she\u2019s past due for another dose.<\/p>\n\n\n\n

It\u2019s worrying, Patel said, \u201cbecause I don\u2019t know how she did on it.\u201d<\/p>\n\n\n\n

The last place they saw her was at an encampment known as \u201cThe Sump\u201d in the Central Valley farming community of Lamont, where she lived in a plywood shack along a muddy ditch behind a farm. But code enforcement recently cleared everyone out of that area, and Patel\u2019s team doesn\u2019t have a phone number or any other way to contact her. <\/p>\n\n\n\n

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\"\"<\/figure>\n\n\n\n
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First: The Akido street medicine team exits their van with their equipment. Last: The Akido Street Medicine team checks on a homeless encampment in a dirt field in Arvin on May 28, 2024. Photos by Larry Valenzuela, CalMatters\/CatchLight Local<\/figcaption><\/figure>\n\n\n\n
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The Akido street medicine team checks for a patient they are looking for in a homeless encampment in a dirt field in Arvin on May 28, 2024. Photo by Larry Valenzuela, CalMatters\/CatchLight Local\n<\/figcaption><\/figure>\n\n\n\n

The first place they look is another encampment known as \u201cthe Shrine,\u201d because it once held a shrine to Santa Muerte, a Mexican saint of death often prayed to by drug dealers. The team drives the van through an empty field of dead, yellow grass. Several people are living in room-sized pits they\u2019ve dug into the dirt and covered with tarps and sheets of metal. Next to the vacant land is a vineyard, with rows of vines dotted with small, green grapes. <\/p>\n\n\n\n

She\u2019s not there, so the team hands out sack lunches and bottles of water, then gets back in the van and leaves.  <\/p>\n\n\n\n

\u201cWe\u2019ve seen results,\u201d said Kirk McGowan, a street medicine nurse with Akido. \u201cBut we\u2019ve seen more failures than successes. That\u2019s just kind of the nature of the situation.\u201d<\/p>\n\n\n\n

Who should prescribe antipsychotic injections?<\/h3>\n\n\n\n

In most cases, the people prescribing and administering antipsychotic shots in homeless encampments are general practice doctors \u2014 not specially trained psychiatrists. That\u2019s because despite the growing prevalence of street medicine, street psychiatrists are still rare, according to a recent USC report<\/a>. <\/p>\n\n\n\n

\u201cYou look over your shoulder and there’s not a psychiatrist there helping you out,\u201d King said. \u201cAnd we want to meet the need. We want to take care of these patients. They\u2019re really, really ill, they’re really disorganized, and suffering and dying on the streets.\u201d<\/p>\n\n\n\n

There are no legal restrictions preventing a general practice doctor from administering these injections. But some practitioners think the responsibility should be reserved for psychiatric providers.<\/p>\n\n\n\n

\u201cThese medications are in there for an extended period of time,\u201d said Keri Weinstock, a psychiatric nurse practitioner who practices street medicine in Shasta County. \u201cThey do come with risks. There are specialty things that come along with some of these specialty meds, and it\u2019s a lot to learn when you have to know everything else, too.\u201d<\/p>\n\n\n\n

Some street doctors who give these shots seek out additional psychiatric training, while others learn on the job \u2014 often with a psychiatrist on speed dial, just in case. <\/p>\n\n\n\n

\u201cI don\u2019t think it\u2019s rocket science to diagnose schizophrenia, as long as we\u2019ve done it with some thoughtfulness,\u201d King said. <\/p>\n\n\n\n

\"Dr.
Dr. Rishi Patel from the Akido street medicine team checks on an unhoused person living in a vineyard in Arvin on May 28, 2024. Street medicine teams throughout California are increasingly using long-acting injectable antipsychotic medication to stabilize the mental health of people living in homeless encampments. Photo by Larry Valenzuela, CalMatters\/CatchLight Local<\/figcaption><\/figure>\n\n\n\n

In-the-field diagnoses aren\u2019t always clear-cut, Patel said. Sometimes, people do such a good job of hiding their symptoms that it\u2019s hard to tell they\u2019re dealing with psychosis. Or, instead of experiencing obvious hallucinations or other symptoms commonly associated with schizophrenia, patients experience \u201cnegative symptoms,\u201d such as extreme social withdrawal.<\/p>\n\n\n\n

When those types of cases arise, Patel calls a psychologist for a second opinion.<\/p>\n\n\n\n

While these drugs are generally considered safe, they do come with a risk of side effects that can include dizziness, sedation, stiffness and decreased mobility. Those symptoms might be no big deal for someone living in a house, but for someone on the street, could be catastrophic, said Dr. Shayan Rab, a street psychiatrist with Los Angeles County\u2019s Homeless Outreach and Mobile Engagement team. It could make someone more vulnerable to being attacked or robbed, or prevent them from accessing food or shelter.<\/p>\n\n\n\n

\u201cIt\u2019s a very serious kind of action that\u2019s being taken and a lot of time needs to be spent before you say, \u2018Hey, this individual is safe for a long-acting injection,\u2019\u201d he said.<\/p>\n\n\n\n

To make sure a patient doesn\u2019t have an adverse reaction, doctors typically give them an oral dose of the same medication for a few days before administering the shot. <\/p>\n\n\n\n

There\u2019s also a risk that after a street doctor gives someone a shot, that patient could later get sent to the hospital on a temporary psychiatric hold. Doctors there might not know the patient already has a long-acting dose of antipsychotic medication in their body, and might give them another dose.<\/p>\n\n\n\n

Before giving someone a shot, Dr. Aislinn Bird wants to be 100% sure their symptoms are actually caused by psychotic disorder, such as schizophrenia, and not complex PTSD, major depressive disorder, methamphetamine use, or something else. Overdiagnosis of psychotic disorders is rampant, especially in the African American community, Bird said. <\/p>\n\n\n\n

\u201cYou have to be sure you really know the correct diagnosis,\u201d said Bird, who serves as director of Integrated Care at Health Care for the Homeless in Alameda County.<\/p>\n\n\n\n

But Dr. Susan Partovi, who practices street medicine on Skid Row in Los Angeles, said that\u2019s an \u201cantiquated way of thinking.\u201d When someone is experiencing psychosis, it\u2019s an emergency that needs to be treated as soon as possible, no matter the cause, she said. Her preference is to treat the symptoms first, and then see if the patient wants to work on other issues, such as substance use.<\/p>\n\n\n\n

\"\"
An Abilify Maintena shot being prepared by the Akido street medicine team at their main office in Bakersfield on May 28, 2024. Street medicine teams throughout California are increasingly using long-acting injectable antipsychotic medication to stabilize the mental health of people living in homeless encampments. Photo by Larry Valenzuela, CalMatters\/CatchLight Local<\/figcaption><\/figure>\n\n\n\n

Antipsychotic injectables, such as Abilify and Invega, tend to be most prevalent in street medicine practices. But street doctors also administer long-acting injectable HIV medication, as well as medication for addiction such as Vivitrol \u2014 an injectable, long-acting medication that can help reduce cravings for opioids and alcohol, and protect against overdose. <\/p>\n\n\n\n

Silencing the voices in his head<\/h3>\n\n\n\n

Ricardo Fonseca Jr., who goes by \u201cRicky,\u201d has been homeless for two years, living in a tent behind a Dollar Tree, then in a park in rural Kern County. The 31-year-old said he was working as a welder until he had a sudden mental breakdown and started hearing voices.<\/p>\n\n\n\n

The voices said horrible things to him. Sometimes they yelled, and he yelled back, scaring those around him. He used methamphetamine to cope.<\/p>\n\n\n\n

\u201cIt was getting to the point where I just felt like killing myself,\u201d Fonseca said. <\/p>\n\n\n\n

Two months ago, Fonseca started taking a monthly shot of the antipsychotic drug Abilify. Since then, \u201ceverything\u2019s changed,\u201d he said.<\/p>\n\n\n\n

Now, Fonseca is staying at a friend\u2019s house and considering going to school. He says he\u2019s stopped using meth. <\/p>\n\n\n\n

\u201cI can finally hear the birds and the crickets,\u201d he said. \u201cI couldn\u2019t hear them before.\u201d<\/p>","protected":false},"excerpt":{"rendered":"

Doctors on the front lines of California\u2019s homelessness and mental health crises are using monthly injections to treat psychosis in their most vulnerable patients.<\/p>","protected":false},"author":288,"featured_media":427655,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"single-feature.php","format":"standard","meta":{"_acf_changed":false,"_stopmodifiedupdate":true,"_modified_date":"","newspack_ads_suppress_ads":false,"newspack_popups_has_disabled_popups":false,"newspack_sponsor_sponsorship_scope":"","newspack_sponsor_native_byline_display":"inherit","newspack_sponsor_native_category_display":"inherit","newspack_sponsor_underwriter_style":"inherit","newspack_sponsor_underwriter_placement":"inherit","apple_news_api_created_at":"2024-06-04T12:31:06Z","apple_news_api_id":"5847a357-e919-4ef3-b8ce-bc50bd3c2513","apple_news_api_modified_at":"2024-06-04T12:31:06Z","apple_news_api_revision":"AAAAAAAAAAD\/\/\/\/\/\/\/\/\/\/w==","apple_news_api_share_url":"https:\/\/apple.news\/AWEejV-kZTvO4zrxQvTwlEw","apple_news_cover_media_provider":"image","apple_news_coverimage":0,"apple_news_coverimage_caption":"","apple_news_cover_video_id":0,"apple_news_cover_video_url":"","apple_news_cover_embedwebvideo_url":"","apple_news_is_hidden":"","apple_news_is_paid":"","apple_news_is_preview":"","apple_news_is_sponsored":"","apple_news_maturity_rating":"","apple_news_metadata":"\"\"","apple_news_pullquote":"","apple_news_pullquote_position":"","apple_news_slug":"","apple_news_sections":[],"apple_news_suppress_video_url":false,"apple_news_use_image_component":false,"_spanish_translation_id":0,"_is_translation":false,"_newspack_byline_active":false,"_newspack_byline":"","newspack_content_restriction_is_exempt":false,"newspack_featured_image_position":"","newspack_post_subtitle":"","newspack_article_summary_title":"Overview:","newspack_article_summary":"","newspack_hide_updated_date":true,"newspack_show_updated_date":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[21449,10],"tags":[1880,2487],"legislator":[],"bill":[],"newspack_spnsrs_tax":[],"coauthors":[63455],"class_list":["post-427668","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-homelessness","category-housing","tag-homelessness","tag-mental-health","entry"],"acf":[],"apple_news_notices":[],"yoast_head":"\nHow shots instead of pills could change California's homeless crisis - 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