Mental health and medical care go mobile for Clark County homeless community

Columbia River Mental Health Services is bringing medical care and mental health treatment directly to the unhoused community in Clark County. The group hopes to build relationships and establish trust with the homeless population. Mike Delay is the Program Director for Substance Use Disorders and Mobile Services and Reinhardt Ryden is a peer support counselor for Columbia River Mental Health Services.

This transcript was created by a computer and edited by a volunteer.

Dave Miller: Columbia River Mental Health Services is bringing medical care and mental health treatment directly to members of Clark County’s unhoused community. Four days a week, a multidisciplinary team goes out in a van to provide services where people are living. Mike Delay is a Program Director for Substance Use Disorders and Mobile Services. Reinhardt Ryden is a member of the team. He is a certified peer support counselor. They both join me now. It’s good to have both of you on Think Out Loud. Mike Delay, why create this new program?

Mike Delay: I think the need is obvious. We have a significant number of individuals that are unhoused in our community that aren’t able to engage in traditional service. They’re unable to access brick and mortar service providers. Bringing the services to the encampments and places where folks are actually living makes a lot of sense because they’re still in need. They’re oftentimes the most unique individuals in our community and providing them access to that service, helping them navigate the different systems of care and helping them navigate the barriers that have prevented them from accessing services makes a lot of sense. It helps to stabilize them in their environment. As they transition from one house to house, they have a better chance of being successful in the long term.

Miller: My understanding is that there is already some kind of street response team available. How is that different from what you’re providing?

Delay: We do. We have a really robust system of homeless outreach teams in Clark County. There’s some fantastic organizations doing some really strong work. However, this is the first truly interdisciplinary team that’s solely focused on this population/ What we’re trying to do is add value to the programs that are already out there. Combining physical health and wellness with behavioral health and wellness, is kind of a unique opportunity that hasn’t been explored.  It’s been discussed but it hasn’t really been able to fully launch in our community.

Miller:  Reinhardt Ryden, I mentioned that you’re a peer support counselor as a member of this team. What is a peer support counselor?

Reinhardt Ryden: A peer support counselor is somebody that has lived experiences. So I have to be relatable. When we’re out there connecting with people, I share my own recovery story with substance use and also my own mental health. It allows me to get that friendship talk with them and find out what they’re in need of and not trying to tell them what they need.

Miller: This has been in operation for about two weeks. You’ve been going out now for a number of days, can you give us a sense for how it starts, how you approach somebody and what you say at the very beginning?

Ryden: It’s: ‘Morning, how we doing?’ Then introducing ourselves. We’ve gone to some of the same places already in Clark County, in the Vancouver area. The people that end up knowing who we are, they’re going to say our names. ‘Hey Reinhardt, hey Lauren,” which is really cool. It also allows us to let them know what we’re doing. They’re able to ask questions, but they don’t have to commit to anything because they know we’re going to come back. Letting them know that we’re not out there giving lip service and are actually here to suit up and show up has been huge.

A lot of times when people go do “outreaching,” some people think they’re being good stewards, especially around the holiday season. They think they’re doing good deeds by giving people a bag of food, but it might be freezer burn food in their freezer. Someone on the streets might think: ‘well why are you gonna give me something you’re not going to eat?’

When we go out there and listen to them, we’re truly able to find the best way we’re able to support them. Sometimes it’s just a listening ear.

Miller: As you noted, the whole idea of peer support is that you have your own lived experience with the situations that the people you’re trying to help are dealing with, substance use disorders or mental health issues. How and when do you bring up your own experience when talking with people you meet?

Ryden: It kind of flows with the conversation. I won’t go in there and announce: ‘Hey, I’m in recovery. I know how you feel’, because that is just off-putting. You definitely can’t patronize someone, but just talk to someone like they’re real. If they end up saying ‘this is how I feel’ and I will say, ‘I know how you feel because…’ and then I’ll share a part of my story with them. It’s really making it about the person you’re talking to and not making it all about me: ‘I hear you, I know what you’re saying. How can I help you get to that next level?’

Miller: When you do say: ‘Yeah, I actually know what you mean because I’ve experienced that as well.’ Have you seen a difference? Have you seen people’s guards let down or them being more receptive to your offers to help?

Ryden: They’re definitely open to us helping. It’s one of the things that when you’re in recovery, you know when people are being genuine and authentic and when people are just trying to sell you wolf tickets. Go in there and be honest with them. Personally, I’ve never been on the streets and I’ll let them know. I’ve been close.  I want to empower them with the fact that they’re so strong because they’re still living. They’re still striving for that next day.

Miller: Can you make somebody want to get in recovery? I ask because it’s one of the things we’ve talked about so often over the years when we talk about drug abuse. What we’ve heard a lot is that it has to come first and foremost from the person who makes the decision to say ‘yes, I want to try (maybe for the first time or maybe for the 20th) time to get clean.’ I’m wondering what you can do as an outsider to get them closer to that moment?

Ryden: There are so many stigmas and stereotypes and conformity when it comes to recovery. Recovery itself is how we define it. If somebody is having struggles and ends up continuously using but they’re still trying to succeed... if they define that recovery and maybe did a little bit less today than yesterday, then it’s up to them. I think a lot of times when it comes to recovery, people are on this abstinent model or an almost institutionalized way of thinking, by  going to meetings, doing this [12] step work, when really they need to [figure out] how to get from where they’re at to the next step. That’s all the recovery is. We’re telling our story. If somebody ends up going and they are still using… I understand. What’s your goal and how can we get there? Sometimes it’s just setting smaller goals. It may not be getting clean today but maybe just doing a little less today than I did yesterday.

Miller: Mike Delay, you’ve been up and running for two weeks right now. In the big picture, what’s it been like for you?

Delay: This is incredibly exciting. I’ve been working around in this field for about a decade in Clark County and seeing this team come together the way it has to provide the services that they do has been rewarding. It’s nice to see a long term goal come to fruition. To piggyback a little bit off of what Reinhart said, what I think is unique is we really operate from a harm reduction model for not only substance use but mental health. The goal isn’t to force people to accept the model of treatment or service engagement that fits what we believe it should be. It’s tailoring the experience and the therapeutic interventions to what they believe they need and allowing them to be not only the experts in their own experience, but the drivers of their recovery vision.

We really believe in the medical model of addiction. It’s a long term progressive chronic disorder that can be treated but not necessarily cured. It needs to be addressed and supported otherwise it results in long term disability and sometimes death. We approach it from that perspective. I think it opens a lot more doors to individuals that are hesitant to engage in treatment services. Seeing this team work with community members and generate that buy-in and provide that education and experience really opens the unhoused population’s eyes to what recovery can look like.

Miller: Are people requesting your services or are you proactively seeking people out and calling to them inside their tents? Or finding people wherever they are and saying, ‘hey, we’re here, this is what we’re offering?’

Delay: Both. We started off by doing the initial outreach and engagement piece where we show up at places and introduce ourselves to members of the community. We also have individuals referring other members of their community to our services, as well as other service providers. We’ve had a lot of crossover and referral from Vancouver’s Heart team which includes Vancouver Police Department representation as well as city employees that are focused on homeless services. They’ve been a great referral source. They’ll do warm handoffs with individuals that they’ve been working on accessing services for. It’s really been a community collaboration as far as how we access folks.

Miller: We’ve been hearing for months now that hiring in a lot of employment sectors has been really challenging recently in healthcare, in education, retail, hospitality. People talk about this as the great resignation. Was it difficult for you to put your team together?

Delay: Yes and no. We were really fortunate that we had a lot of internal interest from current staff of the agency that wanted to get out and do something different and really provide service to this population. I unabashedly steal other departments’ qualified staff.

Miller:  Make it somebody else’s problem.

Delay: Exactly. We managed to get Reinhardt, he was the only new hire for this first team and we were fortunate to get him. While there is a workforce deficit in this particular area, one of the things that I think benefits us is this is a unique program with a different structure than what you typically see and I think that generates a lot of interest. Folks who maybe wouldn’t be interested in continuing the field or maybe hadn’t been interested in returning to the field, see this as something different and exciting, really something that they want to be a part of. That’s definitely been to our benefit.

Miller: Reinhardt, back to you. If I understand both of you correctly, a success is when you can measure even in incremental ways, and maybe smaller than the general public sometimes talks about or thinks about recovery. What do you see as a failure? What does it look like if the team hasn’t accomplished what you wanted to?

Ryden: I think the big thing would be losing focus of what we’re actually out here to do. We’re out here to support and when you support, you gotta let the people who you’re looking to support lead the way. If we try going and forcing people into doing things, then that’s when we’re really going to lose sight of it. Or, if we don’t actively listen to what people say they need and we try to put something else on them, that’s when we’re going to fail. People, when they’re on the streets, they know what they need and they know what they’re not getting. They know if you’re true or not.

A lot of people that we’ve been able to support and even do assessments out in the field with, are people that we’ve had to go see 3 or 4 times because I keep coming back. If we tell someone that we’re going to come back and we don’t come back, then we failed. Then we’ve broken a promise. We’ve got to make sure that we let them know that we see them, we hear them and  we’re here to help you and support them in any way we can. If we end up losing that passion, then it’s going to be time for us to go because then we’re going to be doing harm instead of reducing harm.

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