Mental health and material needs

Also: The largest-ever map of the human brain; changing health care's carbon footprint [Donate ❤️]( [View in Browser](  October 17, 2023 Hi CommonHealth reader, I’ve spent several months [covering Massachusetts’ family shelter system](. And it seems like each family I talk to has a harrowing story of how they arrived in a shelter. I’ve heard about domestic violence and gang violence, natural disasters and family separations. I often find myself hoping that whomever I’ve spoken to has access to high-quality mental health care. But do they? This question comes at a time when the state-funded family shelter system is [extremely strained](. With roughly 23,000 parents and children in shelters, the caseload has [more than doubled]( since last year and the state has [run out of shelter units and shelter providers](. Just yesterday, Gov. Maura Healey said the state is hitting capacity and she'll [stop guaranteeing shelter]( to eligible families at the end of the month. I decided to ask Danielle Ferrier about access to mental health resources in shelters. That's because Ferrier is not only at the helm of Heading Home — a shelter provider that contracts with the state to provide roughly 350 family shelter units in the Boston and Lawrence areas — but she also used to work as a therapist for 15 years. And she wasn’t just any therapist, she was a trauma therapist for kids.  “I have yet to ever meet somebody — in my now several decades of work — that is homeless who hasn't experienced a trauma of some sort,” Ferrier said. She added that often the source of trauma is ongoing and the entrance into a shelter is tough. “If you've made it to the shelter system, all other systems haven't worked,” explained Ferrier. “You're truly at your deepest level of poverty. So folks come distressed, what I would call clinically crisis mode.” Now, my instinct would be to get them mental health counseling immediately, but Ferrier said that's often not what's needed first. Instead, she said, the emphasis is on stabilizing the situation as quickly as possible and meeting the family's basic material needs. "Multiple services can get overwhelming for families," she said. "Families are just trying to figure out: I need to get a job. I need to figure out how I'm going to pay for my own housing. Those are often the pressure points." But her team does ask shelter residents to identify who they would feel safe talking to if they need support. For some, it's a religious organization. But for those that want a therapist, case workers can help connect them to services. However, Ferrier said residents often have to wait for many months. During the pandemic, Ferrier said the waitlists to see a therapist were so long that Heading Home created an in-house clinical triage team. The team of social workers supports frontline staff as they help any shelter residents in an acute mental health crises — perhaps a parent not being able to get out of bed or a child having a lot of tantrums. "We are not designed to be an agency that provides therapy. So our clinical team is really meant for triage," she said. But Ferrier emphasized the vast majority of their shelter residents are not in acute mental health crisis. Instead, it's those material needs that are most time-sensitive and critical. Ferrier said her own career path — from providing therapy to providing basic needs like shelter — is an acknowledgement of that. "What became clear was they just didn't have $5 to put in the gas tank. It wasn't always about countertransference, if I'm really honest," she said. "If your clients don’t have secure housing, secure food, then it doesn't matter how good of a therapist you are, they are truly in survival mode." Ferrier admits there are likely plenty of unmet needs, both psychological and basic. "Our system is so overburdened right now, there is no way we're meeting every need just from a very practical perspective," she said. I expect the situation will only get harder come November if the state does indeed [stop guaranteeing shelter]( and starts placing families on a waitlist instead, especially as we head into the colder months. Gabrielle Emanuel Health reporter [Follow]( Support the news  This Week's Must Reads [Scientists built the largest-ever map of the human brain. Here's what they found]( A new atlas of the human brain could help explain abilities like language – and vulnerabilities, like Alzheimer's disease. [Read more.]( [Scientists built the largest-ever map of the human brain. Here's what they found]( A new atlas of the human brain could help explain abilities like language – and vulnerabilities, like Alzheimer's disease. 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