About five years ago, Sara Koenig-Langston was working as a psychiatric nurse practitioner in Dallas when she met a pre-med student enrolled in classes for a master’s degree in chemistry.
“He ended up developing symptoms of schizophrenia and within a couple of weeks of his first psychotic break, he was sleeping in dumpsters in the Dallas area,” Koenig-Langston told the San Antonio Report.
“His family was supportive [but] they were really struggling to get him help,” she said. “Where do you keep your medication when you’re living in dumpsters?”
After years of treatment with injections of antipsychotic medication, he’s now living in a group home and gearing up to become a substitute teacher.
“He’s going home for Thanksgiving,” said Koenig-Langston, who works at a clinic in New Braunfels and will soon also work at Christian Assistance Ministry in downtown San Antonio. “He is functioning well enough on this long-acting injectable to be able to do that. It’s taken him out of a dumpster and into real life again.”
The social service nonprofit is now launching a new, on-site program aimed at providing that kind of life-altering transformation for hundreds of people experiencing chronic homelessness due to mental health issues.
CAMpassion Care, set to launch in January, was born out of frustration with the barriers within the mental health system that chronically homeless individuals face. It doesn’t knock down every barrier, but it takes a big swing at one of the tallest: Mental health, organizers said.
“Let’s just try something, even if it helps five people,” said Debbie Jennings, a nurse practitioner and assistant professor at UT Health Science Center.
‘Fighting off voices’
Imagine you have a serious illness that causes auditory and visual hallucinations, Koenig-Langston suggested.
Try making and remembering an appointment with a psychiatrist — which could take weeks or months — and paying for the medication without insurance, income, a photo ID or transportation. Oh, and try to find a place to live and keep your belongings at the same time (and keep in mind that the City of San Antonio has ramped up encampment sweeps).
“When you’re fighting off voices, a house is the last thing on your mind,” Koenig-Langston said.
CAM President and CEO Dawn White-Fosdick, plus Koenig-Langston and Jennings decided to do something about that. The CAMpassion program is an attempt to avoid costly — and often violent — arrests or involuntary detentions by removing barriers for people living on the streets and in encampments.
While the “housing first” approach works for many people experiencing homelessness sometimes a “health first” or “people first” approach is needed, Koenig-Langston said.
“If somebody was laying on the ground bleeding out, you wouldn’t say: Oh, you know what we need to get them? An apartment,” she said, and it’s the same with chronic, long-term mental health issues.
The CAMpassion Care program — supported by a two-year, $350,000 grant from the First Day Foundation — will occupy CAM’s small chapel room on Tuesdays and Thursdays.
Koenig-Langston, with the help of at least one student studying to become a nurse practitioner, will diagnose CAM clients’ illnesses and prescribe them various medications (none of which are controlled substances).
An area pharmacy has agreed to deliver prescriptions to the small clinic, so diagnosis and treatment can happen all in one place.
‘We see them every day’
CAM provides food, clothing and showers for about 250-300 unhoused or low-income people per day, White-Fosdick said. Each year they serve about 1,100 people who are unsheltered or chronically homeless. A count conducted on one night earlier this year found that 888 people were unsheltered in Bexar County.
“We see them every day,” Dawn-Fosdick said. “They get a sack lunch here, they take a shower.”
At least at first, the program will only serve CAM clients or people referred from other trusted resource hubs and shelters such as Haven for Hope or Corazón Ministries, which operates the adjacent day center inside Grace Lutheran Church as well as a harm reduction program. Haven for Hope has similar mental health offerings on its West Side campus, but many East Side clients of CAM decline to go there.
“The whole methodology … is that we’ll serve someone who naturally comes here every single day and who we could observe in real time if their [medication] is working,” White-Fosdick said.
And CAM staff, such as social worker Tarvis Brown who works on the homeless response team, have built-in relationships with the people they serve.
“These relationships are very, very, very important in facilitating this,” Brown said, noting that the staff can give nurses a head start toward diagnosing clients’ illnesses by describing, with a client’s permission, their behavior and providing background about their lives. “It’s not easy for people to just let you into their world,” he added.
On Wednesday, a man Brown has been working with for a long time finally shared a deep, childhood trauma that they believe causes his angry, vocal outbursts.
“I appreciate him trusting me with that,” Brown said, and that’s one of the first steps to getting help.
“Our goal is to get them to be help-seeking,” said Jennings, who founded a health literacy company Doin’ Well. “Right now, [many] don’t even know that they need help.”
CAMpassion Care is not intended to provide long-term health care or replace agencies that provide that, White-Fosdick said.
The intention is to get people stable enough to find and keep that long-term care — whether that’s young adult services at Haven for Hope, permanent supportive housing at Towne Twin Village or with SAMMinistries, outpatient care at Center for Health Care Services or inpatient care at San Antonio Behavioral Healthcare Hospital.
The program is unique in San Antonio, so there will likely be a learning curve, Jennings said. “We need this to be nimble … we’ll be working out the kinks as we’re making it.”
The man who was sleeping in a Dallas dumpster who Koenig-Langston helped was a student with a family, Jennings noted.
The people sleeping under highways and in drainage ditches across the U.S. were not born there, she added, “who knows who they were six months ago — and whose mother and father and sister and son?”
In the social safety net world of nonprofits, there’s a lot of talk about “upstream” interventions, things done to prevent crises, and “downstream” responses after trauma has occurred — that’s where CAMpassion fits, Jennings said.
But being “downstream” doesn’t mean that is permanent.
“You might be downstream from your trauma,” she said, quoting a friend, “but you’re upstream from your potential.”
