Homeless New Yorkers with severe mental illness often cycle between the street, the hospital and the shelter system. It’s a revolving door that’s long frustrated homeless advocates, clinical workers and city leaders.
But a new program started by the city’s municipal hospital system is successfully interrupting that cycle: it offers homeless New Yorkers with severe mental illness a home-like environment where they can live with support following a hospital stay.
“ We're that intervening layer that didn't exist before,” said Dr. Ted Long, chief medical officer for clinical services and population health at NYC Health and Hospitals.
Rather than discharging homeless patients back to the street or shelter, they’re referred to a repurposed hotel in Midtown where they get 24-hour clinical care, their own room with a TV, access to food, clothing, housing assistance — and their psychiatrist just downstairs. The goal is to get them ready to move into an apartment within a year.
The Bridge to Home program began last year and already moved 18 people into permanent housing. On Tuesday, the Mamdani administration will open a new location for 46 residents in Crown Heights, Brooklyn and announce an expansion to one site in Queens. The program’s expansion comes as the city’s street homeless numbers reached record highs last year and amid calls from state and local lawmakers to better help homeless people in crisis.
A room at the Crown Heights, Brooklyn location for the Bridge to Home program set to open Oct. 1.
Courtesy, NYC Health and Hospitals
At Bridge to Home, there are no curfews and each of the 42 residents has a microwave, their own closets for their belongings and bathrooms in their rooms.
Clinical and support staff are right in the building. Residents can be seen by a nurse, meet with their psychiatrist, pick up their medication or get injectable medications all on site. About 80% of patients attend weekly clinical visits, 70% have completed housing applications and 65% are taking their monthly injectable medications, according to NYC Health and Hospitals.
Melissa Shoupe, the site’s director and a licensed clinical social worker said a big difference is the accessibility — and proximity — of clinical staff who can come knock on a resident’s front door and say, “‘Hey, remember we’re meeting today.’”
“Because often they don't remember, and so they're not going to spend their last $3 on an Omni card to go to the doctor's office and make that appointment if they even do recall that they have it.”
Mark Thomas Jr., 30, recently moved into his own apartment in the Bronx after 11 months at the Bridge to Home program.
“ I went from being hospitalized, unable to walk, homeless, and unsure of what my future would look like, to having housing, working, giving back to my community, and preparing a career for where I can help others,” he said.
New beginnings
Chris Clayton, the medical director and in-house psychiatrist at Bridge to Home, used to work on the psychiatric ward at Bellevue hospital. He said he would stabilize homeless patients and get them on medication but when they were ready to be discharged, they often had nowhere to go.
Clayton said he would give the name of the city’s homeless intake shelter on a piece of paper.
“ Maybe they made it there, maybe they didn't,” he said, adding that social workers often told him that the patients had tossed their medication in the trash. He added that many of his patients had rejected the shelter system and went back out to the street.
He said it was difficult when those same patients returned but in worse condition.
“You start to see them deteriorate in front of you,” he said. “More and more injury from living on the street. So frostbite, cold exposure, infected leg wounds, amputations.”
Now, at Bridge to Home, he’s helped some of those same patients he discharged back to the street find a place to live. He said being immersed with his patients who come knock on his door all day, join his exercise group and see him commuting into work has also made him realize how his treatment plans weren’t realistic.
He’d often discharge patients with eight medications or pills that were too large or that had to be taken throughout the day. He’s now trying to prescribe more nightly medications making them easier to take and giving out smaller doses and fewer prescriptions because he can monitor people daily, and adjust their doses.
“For a lot of these guys, it's the first time where they've been in a community of people who are all receiving mental health services outside of a locked or involuntary environment,” Clayton said.
And for some, it’s the first time they’ve had friends, he added.
“People start to connect with each other and have not had social interaction in a long time and they're able to start to link that stability and those gains to being enrolled in treatment and taking it seriously.”
Joseph, who asked Gothamist not to use his last name because he feared getting deported, said he’s now taking his medication for his schizophrenia and participating in group activities that talk about everything from how to get a job to the best restaurants in the city.
“ I owe it to myself to better off my life not to go back to being homeless,” he said.
He said after being in a shelter in 2012 and homeless again last year, he could finally see himself living on his own again.
“ I plan to really make the staff here proud of helping us here as the guests. I plan to make them proud by being someone successful in society and trouble-free,” he said.