Bridging the Gap in Mental Healthcare for People Experiencing Homelessness

Homeless Healthcare Los Angeles

Our partner Homeless Health Care Los Angeles (HHCLA) helps our neighbors experiencing homelessness with their mental health needs every day.

“The experience of losing your home itself is emotionally distressing,” said JoAnn Hemstreet, LCSW, Clinical Director of Behavioral Health Programs at HHCLA. “While some people experiencing homelessness are struggling with more severe mental health challenges, I think almost everyone who has gone through the experience of losing their home has some level of emotional distress. So mental health needs are pervasive in this work and everyone needs support.”

Access to housing provides the stability that people experiencing homelessness need. That’s the key insight behind the “Housing First” approach. Once housed, they can begin to work on their mental health and wellness—and more.

“When people’s basic needs of safety, housing and food are met they start to think about what else they want,” JoAnn said. “They start connecting to school, vocation, volunteering, developing their potential and their intellect. Many are artists, went to college, were chefs, they just need someone to encourage and believe in them and a safe space to build that again.”

HHCLA started decades ago as a grassroots advocacy and training organization. It evolved to provide services like syringe exchange, center for housing, and outpatient treatment.

We meet people where they are to remove as many barriers as possible and get people the support they need.

JoAnn Hemstreet, LCSW, Clinical Director of Behavioral Health Programs at HHCLA

JoAnn described their approach as rooted in harm reduction, meaning that quitting substance use is not a precondition to receiving services or care rather their efforts focus on safety. “We just want people to be safe and feel there’s someone who cares about them.”

Throughout the pandemic HHCLA has kept their doors open and added telehealth services. They also modified their group programs to be COVID-safe. “We have not changed the work we do but how,” JoAnn said. 

JoAnn also noted the struggles many of their clients faced during the pandemic. “A lot of people in our community who are more in recovery related to substance use let us know how they were feeling triggered and experiencing increased isolation during the pandemic, so we tried to build more supportive treatment services to create that sense of community and support.”

Understanding People’s Unique Experiences

“I’m in love with people’s stories,” JoAnn states as she describes her work. “Every person has a story and reasons they’re in the situation and having that experience.”

JoAnn talks to everyone she meets about her work in mental healthcare to increase understanding and combat stigmas one conversation at a time. “I wish people understood that it isn’t anybody’s fault. Yes, people have agency, but they are a product of their environment.”

JoAnn also describes the internalized blame she sees in many clients. The criminal justice system and aspects of the mental health system often ask people to look at their own morality as a consequence of their circumstances instead of looking at trauma and external factors.

“I see a lot of people starting substance use to alleviate psychiatric or physical pain. Substances help people cope.” she said. “Also,when people are just a paycheck away from losing housing, if you have a health issue it’s a waterfall effect.”

Health Pathways

United Way has partnered with HHCLA for years. The most recent engagement was around the Health Pathways Expansion grant last summer. HHCLA is the behavioral health partner among 16 grantees for this program to expand care for people experiencing homelessness.

“It’s been great to have a collaborative partner in United Way with a solid understanding of homelessness who can also think outside the box,” JoAnn stated. “They’re flexible and allow us to put our client needs first.”

The Health Pathways Expansion funds allowed HHCLA to hire a coordinator role which allows them to bridge clients with clinical staff. They increased access by adding four hours for a psychiatrist each week. This allows for hundreds of additional evaluations and assessments as well as bringing full wrap around services to more than 80 additional people. 

“We’ve seen engagement and retention increase for our clients because of the funding from United Way,” JoAnn said. “Retention helps clients stabilize. Sometimes you connect with someone and the follow-up is months and even years down the road. This is helping us keep people engaged.”

JoAnn recalls many different people that HHCLA helped over the course of the pandemic. For one woman, a placement in a Project Roomkey site led to permanent housing within 6 months. Housing, combined with HHCLA’s outpatient treatment program, has led her to a journey of realizing and working on her own goals. Another individual helped through the Health Pathways grant was able to get connected to psychiatry services and the support of the agency’s outreach team, creating a comprehensive team to support her individualized goals.

Final Thought On Workforce

Throughout the pandemic, mental health needs and the demand for services have increased. “I consider it a privilege to be in a position to give someone the resources to grow,” JoAnna said. “We need more compassionate people in the workforce. Kindness will do wonders at the end of the day.”

JoAnn encourages people of all ages and walks of life to join the field. 

“Working in mental healthcare is an opportunity to create a relationship with someone and create a real impact. It’s a chance to be a positive support in someone’s life.”