A Proposed Expansion of Mobile Crisis Teams Aims to Deliver Mental Health Treatment Where It’s Needed Most—on the Streets
Across the city of Philadelphia, the needs of unsheltered homeless people continue to go unmet.
Experts in the field say that when a situation like homelessness threatens survival, needs that feel most immediate (like food, clothing, and shelter) take precedence, while needs that feel less urgent (such as prioritizing mental and physical health) fall by the wayside. However, both are part of the same system and are equally important to the quality of life.
Today, we spoke with the Director of Elwyn’s Mobile Crisis Unit, Bruce Anthony Lockett, to learn about a new proposal that would bring mental health care directly to people where they are.
The Proposal: Street Medicine for the Mind
Street medicine has been around for decades. Since the 1990s, mobile crisis teams have delivered care directly to people experiencing homelessness, often on the street corners where they live.
Street medicine teams use a range of multidisciplinary approaches to deliver care. Their work has been shown to save lives, improve health equity, and lead to better health outcomes.
Beyond immediate care, street medicine can support recovery, boost energy levels, and help people re-engage in daily life and social activity. By treating both physical and behavioral health needs in close proximity, these teams remove many of the barriers that often prevent people from accessing care. For example, a prescription that might have taken years to receive can be administered immediately.
In the City of Brotherly Love, where homelessness and addiction are highly visible, particularly along Kensington Avenue, a team of crisis counselors is proposing a kind of street medicine that would heavily emphasize and prioritize mental health therapy. Here’s what they have on the table.
“The proposal is an effort from the city of Philadelphia to have a more streamlined approach to mental health and substance abuse,” said Lockett. “This initiative has been under consideration for several years now. We have mobile crisis teams in place to support individuals who are experiencing a crisis from mental health, domestic issues, being unhoused, or any type of substance abuse. However, we do not currently have a street program within that framework. This is what we’d like to add.”
The Foundation for Great Innovation: Identifying a Need and Filling It
“This initiative is aimed at addressing all issues with people in crisis, regardless of their housing status,” Lockett said. “We already have nurses on our mobile crisis teams in Philadelphia. The city has identified a population of people who are in between primary care physicians, they’re in between appointments, they’ve run out of medication, and we have linked them to the status of being unhoused. They kind of fall through the cracks when it comes to medication, mental health assistance, and transportation.”
Elwyn boasts Philly’s largest and most well-resourced mobile crisis team. The portable unit is already traveling to calls, bringing vulnerable communities a wealth of experience and services to keep them afloat in times of extreme hardship. The proposal extends those same services to street corners, a citywide concept of street medicine for the mind.
“The city is currently weighing the pros and cons of this idea,” Lockett said. “It’s not enacted yet, but if it comes to fruition, it would mean that mobile crisis teams, along with the nurses on those teams, go out to the streets and bridge the gap for unhoused people who have run out of medication, who need a mental health injectable medication, who don’t have a primary care physician, and who currently lack transportation to pharmacies to pick up this medication.”
Lockett continued: “Also, individuals who are unhoused and don’t have an address to have their medication delivered to them could find assistance through the program. This could eventually become something that’s city-wide, statewide, and even nationwide, if it is successfully implemented.”
Shattering Stereotypes: Most Unsheltered Philadelphians Are Not Getting Healthcare or Services
Let’s talk about stigma for a moment. Despite a common perception that most unhoused Philadelphians are receiving free health care and services, Lockett said that isn’t the reality.
The truth is “they are not,” Lockett said. “A lot of people who are unhoused don’t know that they are eligible for certain things, or they don’t have the transportation, or they’re not in a mental space to get to these programs or even to receive them because they’re not receiving the proper mental health or medical care.”
Barriers to Treatment: Why Mental Health Services Are Often Denied for Our Homeless Neighbors
“It seems that a lot of unhoused people fall into the order of operations of safety and just being. Going every day, not knowing where you’re going to sleep or what you’re going to eat can put their mental health and their medication on the lower end of the importance scale,” Lockett said. “They think about shelter, food, clothing, safety.”
“With this proposal being part of a citywide initiative, it becomes a way of including the unhoused community,” he continued. “So rarely do we speak about this population in discussions of inclusivity, but unhoused Philadelphians are part of our community, too. We have a duty to include them, particularly in accessing mental health care, because all aspects of life depend on having a healthy mind.”
Lockett said that he and other mental health professionals have observed major barriers to mental healthcare for unsheltered locals, including the inability to refill mental health prescriptions and the lack of access to transportation for mental health appointments.
How Close is This Concept to Becoming Reality?
“I think that we are almost there as far as getting this implemented, but we’re still some steps away from implementation,” Lockett explained.
“To take this concept to the next level, we have to have the city on board. We have to adhere to regulations. We would need to have nurse practitioners co-signing medications. Plus, we need to meet all of the legal criteria,” he said. “For example, a nurse practitioner has to have a license, an NPI number, or a tax ID to call in the medications. We also need teams on hand to pick up and deliver.”
Lockett said the program already has many of the foundational pieces in place, including teams made up of therapists, social workers, counselors, and professionals with experience working directly with people experiencing homelessness both on the streets and in shelter systems.
While the focus remains on mental health, he explained that the inclusion of nurses would allow teams to assess a broader range of needs, including:
- Mental health triggers
- Signs of physical health deterioration
- Blood pressure levels
- Blood sugar levels
- Minor skin conditions
- A person’s current location and living environment
Lockett said the approach could be a “real gamechanger” if the program is fully implemented.
Voice Your Support for Street Medicine of the Mind
Lockett says the biggest obstacle standing in the way of this street team is public support. Speak up for your unhoused neighbors by contacting your city officials and letting them know where you stand on this issue today.
