Telemental Health for the Homeless Population: Lessons Learned when Leveraging Care

Abstract

Purpose of Review The purpose of this paper is to review key lessons when using telehealth within the context of mental health and homelessness. We examine technological and bandwidth issues the homeless population might face when getting telehealth services, discuss clinical process adaption needed for working remotely, and highlight the lessons learned when leveraging mental health services to homeless patients across telehealth platforms. Recent Findings Homelessness is associated with chronic, mental health disparities and access to mental health services is often less accessible among communities with unstable housing. Telehealth provides “OnDemand” treatment options while removing specific barriers found with in-person health care such as transportation, overwhelmed mental health facilities, i.e., appointment availability, and office hour limitations while reducing costs for both providers and patients. Summary We provide two case examples to demonstrate successful delivery of telemental health services to homeless patients and review lessons learned when leveraging care.

Using the Plan-Do-Study-Act Evaluation Framework to Improve the Recruitment of Women Experiencing Homelessness

“…Given the invasive nature of conducting research among vulnerable populations, the inclusion of virtual telephone options helped reduce privacy concerns, 26 which is especially concerning for women in this study who may be doubled-up with other family or friends who may not want to reveal their personal space on video or invite researchers to their current nighttime residence. The extent to which participants experiencing homelessness prioritize privacy, access to the interviewer, or ease of technological use may vary; 27,28 therefore, having flexibility in options is important. Furthermore, providing participants with different options for compensation (eg, via email, in person) based on their technological and transportation needs appeared to reduce participant burden.…”

Understanding the barriers and facilitators to implementing and sustaining Mobile Overdose Response Services from the perspective of Canadian key interest groups: A qualitative study.

“…During the interviews, some participants voiced the concern that lack of access to appropriate technology may serve as an additional barrier for the utilization of MORS, especially if PWUS resided in rural areas where cell service may not be easily available. Studies are reporting that there is increased ownership of mobile devices among the unhoused population, but practical problems such as connection to wi /cell service, theft, and limited battery life still remain as sources of limitation (27). Furthermore, while young unhoused individuals are more likely to use telehealth and automated phone interventions, older individuals are less likely to do so due to lower digital literacy and psychological aging (27).…”

“…Studies are reporting that there is increased ownership of mobile devices among the unhoused population, but practical problems such as connection to wi /cell service, theft, and limited battery life still remain as sources of limitation (27). Furthermore, while young unhoused individuals are more likely to use telehealth and automated phone interventions, older individuals are less likely to do so due to lower digital literacy and psychological aging (27). MORS operators should investigate ways to reach people who lack access to mobile devices or struggle to use conventional applications.…”