Viewpoint: Medical needs can contribute homelessness

Rachel Jaquith

In Missoula, houselessness is the topic of significant discussion and debate. As a registered nurse providing care to Missoulians experiencing houselessness (sometimes called ‘street medicine’) I want to add a critical element to these discussions: stories of real people.

In my work I have built incredible relationships with many of my patients. I have seen them reach their personal health goals, regain autonomy, and improve their mental health through collaboration and resilience. I have also witnessed incredible sadness, trauma, grief, and heartbreak. During the past month alone, I lost two patients, both of whom were on the cusp of being housed. I would like to tell you about my experience working with them.

The first is a patient I worked with over the past year and a half. When I first met this gentleman, he was experiencing delusions related to an untreated mental health condition. Tall and burly, he could look pretty intimidating, but once I got to know him, he was kind, sweet, and full of character. Between his life circumstances and arguing with the voices in his head, he could never remember my name.

This significantly impacted his ability to care for himself, form relationships, and maintain housing. Over the first 6 months of working together he would yell at me in gibberish as I approached his tent with medical supplies. Over the next 6 months, we were able to get him medication to support his mental health. With that support, he started calling me Raquel. That change was a huge step in our relationship, his care, and the success we began to see with him.

Flash forward another 6 months. As the patient and I were leaving an appointment, he stopped in the hallway and said, “Rachel, thank you for bringing me here.” That was the first time he called me by my real name. This was a breakthrough moment for his path to health and wellbeing, and an unforgettable triumph for me as a medical provider.

Throughout our time working together, this man continued to make improvements to his overall health. By May, he even found out he was going to be housed. For the first time in several years, he was going to have a warm, safe place to call his own. Two weeks later, he died alone in a park.

The second patient was a gruff man with a hard outer shell, shaped by a life living on the streets and significant trauma. He was a prominent figure of his community, most folks knew him, and few messed with him. From what his street family shared, he always stood up for himself and supported his friends and family.

Living on the streets can make it hard to trust, but my co-workers and I worked diligently to build a relationship with him; just enough to chip away at some housing goals. After so many years of houselessness, and the trauma and physical damage that comes with that, this patient found out in the beginning of May that he was going to get housing. He was also going to have a warm, safe, place to call home. A few weeks later, this patient died on the streets downtown.

The two stories shared in this letter are heartbreaking, and not new. I am sharing them for two reasons. First, because the human side of houselessness is a story that too often goes untold. These two men were people I cared about. They were members of our community – Missoulians just like you and me.

The second reason I am sharing these stories is to highlight the work being done in our community. Our team, along with many other organizations and individuals, are working to lift up our neighbors experiencing houselessness. Many of these interventions help reduce jail and ER utilization. When we center our efforts on the compassion and dignity that all people deserve, we can transform lives and strengthen our community.

Long term houslessness is a huge barrier to accessing critical healthcare services, employment, and safety. The best “prescription” or treatment for houslessness is housing. Housing is a public health issue, and by addressing it we can prevent people from dying alone on the streets.

These patients’ deaths were especially painful because they were so close to getting a place of their own. These losses illustrate the chasm we have to bridge; the chasm between being unhoused for many years and housing options. We start building that bridge by recognizing that housing is healthcare and health care is a human right.

Rachel Jaquith is registered nurse for the Community Care Team at Partnership Health Center.