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Substance Abuse and Mental Health Services Administration
Spotlight on PATH Practices and Programs: Integrating Mental Health and Primary Health Care
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When you don’t have access to regular meals or a safe place to sleep, preventative medicine is the least of your worries. But malnutrition and sleeping in unsafe places make people who experience homelessness vulnerable to illness and injury. These tips highlight the work of the PATH program at Health Care for the Homeless Milwaukee and their integrated mental health/primary health care outreach team.
PATH programs focus on identifying people experiencing homelessness and serious mental health issues and assisting them in accessing services, resources, and housing. Many consumers face high rates of illness and injury, have difficulty accessing medical care, and must navigate the complications of co-occurring mental illness and substance use as it impacts their health.

Service integration is described as providers working collaboratively in a system of care across disciplines to address the multiple needs of individuals. Service integration is accomplished through various approaches. Integrating services can occur when a nurse from a primary health care clinic co-locates in a PATH program that provides assessment and services with direct links to medical care. Service integration is also represented by the work of an interdisciplinary team of medical, mental health, social, and addiction providers who give coordinated care to a person who is experiencing homelessness.

Health Care for the Homeless in Milwaukee (HCHM) operates the PATH program in that community. HCHM employs four PATH outreach workers and subcontracts two additional PATH positions to the Milwaukee Chapter of the American Red Cross. The two PATH staff members at the Red Cross, one RN and one outreach worker, provide services to people who are experiencing homelessness and serious mental illness in the city’s shelters and meal programs. The four PATH outreach workers employed by HCHM engage individuals on the streets, under the bridges, and in the parks of greater Milwaukee. Once a week, the PATH team conducts a 3:30 am visit of the areas where people are sleeping outside. The PATH outreach workers from HCHM and the Red Cross overlap shelter sites occasionally and meet to discuss mutual clients. All of the PATH workers have access to the integrated primary and behavioral health care available through the HCHM-supported clinics.

The PATH Technical Assistance Center interviewed the PATH program at HCHM about their work integrating primary medical care and mental health care. They identified the following strategies for effective service delivery.

Staff outreach teams with both mental health and medical care expertise. Providing joint outreach with a nurse from another agency, or training outreach workers to recognize medical issues and have medical expertise readily available to assist as needed can accomplish this.

Locate mental health outreach staff in clinics that provide primary care. Co-locate staff through working agreements among agencies. Mental health staff can provide the case management, service broker services, and follow-up planning for PATH consumers that many health clinics are not able to offer.

Interdisciplinary treatment team meetings can occur across organizations with the consumer’s consent and involvement. This collaboration can lead to a broader understanding of the consumer’s needs and the services that are already being offered.

Provide a “no wrong door” approach for access to mental health and medical services.
A no wrong door approach is respectful to the service desires of the consumer and can readily link and engage other services as needed and requested without requiring the consumer to access services only through specific points of entry.

For more tips or to learn more about the Milwaukee PATH program at Health Care for the Homeless download the full PATH Spotlight.

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