How shots instead of pills could change California’s homeless crisis
BAKERSFIELD, Calif. (AP) — As Dr. Rishi Patel’s street medicine van bounces over dirt roads and empty fields in rural Kern County, he’s looking for a particular patient he knows is overdue for her shot.
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 — a long-acting antipsychotic — will help her meet all of them.
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’s intertwined homelessness and mental health crises. Typically administered into a patient’s 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’s oral medication — no more taking a pill every day. For people who are homeless and routinely have their pills stolen, can’t 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.
“They’ve been an absolute game-changer,” Patel said.
Street medicine teams bring the shots directly to their patients wherever they are — whether it’s 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 — or sometimes even more quickly — and with minimal paperwork and red tape. They don’t need a psychiatrist’s sign-off.
It’s estimated that California is home to more than 180,000 homeless residents. How to help the sickest of them — people with severe, untreated psychosis who might wander into traffic or otherwise put themselves in danger — has become a hot-button issue, with Gov. Gavin Newsom and state lawmakers creating new and sometimes controversial ways to get people into treatment. In a recent UCSF survey of homeless Californians, 12% reported experiencing hallucinations in the past 30 days, and more than a quarter said they’d ever been hospitalized for a mental health condition.
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’s 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.
Some success stories are dramatic. Doctors talk about patients who one day are babbling incoherently, and a week after a shot, are having conversations.
“It’s been pretty common that that’s the initiation of, ‘We’re going indoors,’” said Dr. Coley King, director of homeless health care for the Venice Family Clinic in Los Angeles. He said he’s seen dozens of patients get o¡ the street after taking these shots.