Bridging the Gap: Bringing Vital Healthcare to Bloomington’s Streets

July 15, 2024

Bloomington, like many other communities, faces immensely complex challenges when it comes to addressing the healthcare inequities that exist for our unhoused population.

Last year alone, more than 6,000 people were unhoused in Indiana, and Bloomington has seen its own uptick in community members experiencing homelessness.

For a transient population with many reasons for instability, getting access to the health care they need when they need it is difficult—insurance hurdles, transportation issues, hesitation to brick and mortar visits, and awareness gaps to name a few. And barriers that prevent people from getting the care they need can further exacerbate the health issues they face, including mental health and substance use disorders.

So what are we doing about it?

Empowering Our Community Through Street Medicine

HealthNet Homeless Initiative Program, a Federally Qualified Health Center that provides primary care health services to the medically underserved, has started a Street Medicine Team to break down barriers to healthcare access, particularly for Bloomington’s homeless population. Their holistic approach marks an important step in providing equitable care, preventing disease, and improving mental health outcomes in the community.

The Street Medicine Team is composed of Street Outreach Case Managers, two Family Nurse Practitioners, one Psychiatric Nurse Practitioner, and one Program Coordinator. Their approach involves providing medical and psychiatric care directly on the streets, in shelters, and in other community locations.

People who are unhoused may be hesitant to utilize brick-and-mortar medical care due to past traumatic experiences. They may also struggle with mental health and substance abuse issues – adding additional challenges for them to see practitioners. That’s why the Street Medicine Team wants to meet people where they are, providing healthcare in an environment that is safe, comfortable, and easily accessible for their clients.

While the initial focus is to assess their clients’ needs and provide care, the team makes sure to do so with empathy and compassion for the circumstances they may be facing. Many people treat the homeless population with disdain or disregard, leading to a feeling of distrust among their community. But the Street Medicine Team sees them as people first, and wants to build trusting connections – as this will help them feel more inclined to receive care.

“We just try to have conversations with them, and once they know us as human beings, they feel more comfortable with us and feel more comfortable to tell us what they’re going through,” says Hannah Gorman, one of the team’s street outreach case managers.

The Complexity of the Challenges

Through these conversations, the Street Medicine Team often discovers underlying mental health struggles in their clients, which may stem from past trauma or be the result of a neglected life-long condition. To help cope with trauma and untreated mental health symptoms, many people resort to substance use, which often turns consistent and harmful. One of the goals of the team is to provide them with the correct medications for their diagnosis and help them quiet the noise in a healthy way.

“I have clients that have been able to abstain completely and are now employed and housed. And this was all because they were able to access the psychiatric medications to quiet all the stuff in their head down. So if you can take care of that mental health component, then the decision making changes entirely, and maybe you don’t need to use so much to feel better because you’re already feeling better,” says Evelyn Quigley, the team’s psychiatric nurse practitioner.

Because homelessness is the part of the complex web of reasons individuals aren’t receiving the care they need for both mental and physical health, the Street Medicine Team also works to find housing for many of their clients.

Many shelters in Bloomington have restrictions about how long people can stay, often having to rotate out before they can return. And for a variety of reasons, encampments are frequently moved or closed, forcing people to relocate to other areas and leave behind important documents and medications.

“There’s no safe place for people to go. And a lot of the clients handle it with such grace and they’re just like, ‘Okay, I have to move again.’ But I don’t think people understand that if you have to move your house every week, you can’t really have a stable life,” says Gorman.

This instability poses many challenges for the Street Medicine team in maintaining consistent contact with their clients or getting them the medications they need. And often, they must make tough decisions about who is the most vulnerable when a housing opportunity arises. But the team is dedicated to overcoming these barriers, using as much time and as many resources as possible to help their clients find stability.

The Importance of a Collaborative Approach

As part of BHF’s dedication to serving the community, we have partnered with HealthNet Homeless Initiative Program to help foster the holistic care that the Street Medicine Team provides. In the last two years, our grant has allowed the team to grow with an additional nurse practitioner and case manager, helping them provide medical care to more clients.

Initially, the Street Medicine Team ran into barriers when collaborating with healthcare providers due to disparities in confidentiality agreements and tracking systems – which makes it difficult for them to work together in establishing efficient and successful care. In light of this, BHF is working with community partners to explore a universal release system that allows physicians, social service organizations, and other care providers to see and create comprehensive care plans.

As we are working to remove these barriers, BHF is also taking a collaborative approach to addressing healthcare disparities, specifically in mental health and substance abuse.

We recognize the importance of providing accessible and inclusive mental health services to everyone, especially to those – like the vulnerable individuals served by the Street Medicine Team – for whom it is a significant barrier in receiving other types of medical care. By facilitating the collaboration of government agencies, nonprofits, healthcare providers, and community organizations, we can address the underlying issues of mental health and substance abuse, understand how they contribute to challenges like homelessness, and create pathways to recovery and stability.

Making a Difference the Bloomington Community

Our partnership with the Street Medicine Team has proven that with dedication and a compassionate approach, we can work to create a healthier community. The unhoused community faces many challenges that lead to distrust, substance use, and hesitation to accept care. But by having empathy for their circumstances and increasing the number of people out in the field, the Street Medicine Team was able to build connections with their clients and provide them with essential care.

The team has created a positive impact on many individuals’ lives – seen through the testimonials from clients who were previously unhoused or struggling with mental health and substance abuse issues and are now in stable housing and employment. And every day, more individuals are becoming receptive to the help of the Street Medicine Team. Celebrating these wins is what helps the team remain dedicated to helping as many people as possible.

“The street clientele has really gotten used to me and Hannah has been really helpful for that. People are even approaching me now for medicine. That didn’t initially happen, so it’s really great that that’s even a possibility. So I’m grateful to the foundation, and I’m grateful to my employer that I’ve been empowered to be able to do this for people,” says Quigley.

A Street Medicine Success Story
Shared by Melissa Burgess, HealthNet’s Resource Coordinator 

A woman living in an encampment in the Bloomington area has been unhoused, living with her partner, for more than a year. She developed some medical issues over the last few months that required a painful surgery. While it was an outpatient procedure, she would require ongoing medical attention and would need time, as well as a clean, safe place to heal afterward. 

The HealthNet team worked with her to schedule a consultation with the surgeon and to set up the procedure for her. We checked in on her frequently and assisted with getting her necessary supplies for her surgery prep. Because of the nature of the procedure, we worked with a local non-profit, Hotels for Homeless, who acquired her and her partner a room at a local motel for a few days to prep and recover from the surgery. 

We were able to get her to the motel for the prep and returned the next morning to take her the surgery, which was scheduled outside of Bloomington in a nearby city. There were some issues upon arrival, so we needed to come back the next day. The following day, we transported her to the location where she received the surgery, waited for surgery completion, and provided transportation back to the motel for a few days of recovery.

As of now, she is still recovering slowly, but is doing better each day. Along with many obstacles, the primary challenge of getting her the surgery was the lack of housing. She had open wounds and trying to recover in a tent in the middle of the woods is far less than ideal for any procedure.

This story highlights the many challenges of necessary life-changing medical procedures and the support needed from our team in working with the unhoused community.

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