We can optimize mental health, addiction care for most vulnerable

As a longstanding primary care and addiction medicine physician in Boston, I see a tremendous opportunity to properly address the significant health disparities brought to light by the COVID-19 pandemic, the surge in opioid overdoses, and the inadequate responses to mental health crisis situations in our region. All these challenges demand a more comprehensive and humanistic approach to optimize the physical and mental health and safety of our most vulnerable citizens.

This would be accomplished by bringing these vital services directly into the homes and neighborhoods of our residents by Mobile Integrated Community Care Units (MICCUs). MICCUs could serve as extensions of the local Community Health Centers in Boston with close partnership with the Boston Public Health Commission and all Boston hospitals.

These units would be staffed by an EMT-Paramedic, a clinical social worker, and an alcohol and drug counselor. They would have immediate and direct access for consultations with the behavioral health and addiction care teams as well as from primary care providers at their respective Community Health Centers and local hospitals when needed.

MICCUs would help broaden the scope of public health and safety responses for Boston residents with a particular focus on those areas in critical need such as the Mass and Cass neighborhoods. These units would provide more integrated services with specialty trained and unarmed crews in situations that include crisis intervention, behavioral health care, housing emergencies, and substance use disorder care.

MICCUs would become imbedded in each neighborhood to develop strong relationships with frequent 911 callers and their family members. This will include applying de-escalation techniques during all domestic and street mental health crisis encounters as well as provide safe transport to a higher level of care if needed.

MICCUs would also be instrumental in performing motivational interviewing and coaching techniques on those afflicted with substance use disorders and most vulnerable for fatal overdosing. They will also carry out drop-in wellness checks on those recently discharged from rehab facilities and offer immediate referrals and transport to appropriate Medication Assisted Treatment (MAT) Programs or detox facilities when warranted.

Additionally, MICCU’s would help alleviate the tremendous deficiencies and inequities in our current health care and public safety delivery systems and limit costly ER visits and hospitalizations. These units will perform home safety checks and serve as extenders of the primary care team to help manage conditions such as hypertension, diabetes, obesity, lung disease, and behavioral health issues that have been responsible for many of the poor health outcomes in those infected with COVID-19.

I wholeheartedly support the recent proposal from the Massachusetts Senate to study the efficacy of converting a decommissioned ship into The Floating Hospital for mental health, substance abuse and recovery. This is a novel therapeutic strategy that truly complements this special mission of the MICCUs. These units could also serve as extensions of the Floating Hospital including immediate consultations with specialty care providers there.

Boston attracts many patients from afar to our world-renowned medical facilities. It is time to bring exceptional “concierge” type medical and crisis care services to our own medically disadvantaged residents, while also offering direct access to a state-of the-art facility in our harbor. This includes Boston’s elderly, handicapped, homebound, homeless, recently incarcerated, and people of color as well as those suffering with mental health issues, substance use disorders, multiple chronic illnesses, and limited access to primary care providers.