Unexpected

For the past two weeks in my psych clinic, I have been talking with a woman who has been homeless since 2004. "According to the Substance Abuse and Mental Health Services Administration, 20 to 25% of the homeless population in the United States suffers from some form of severe mental illness. In comparison, only 6% of Americans are severely mentally ill." (Link to data here). So far this semester, I have struggled in my psych clinicals to feel any sense of calling to that population in an intentional way. We have been reminded several times that wherever we go as nurses, in whatever field we chose, there will ALWAYS be patients that we will come across with mental health disorders... OB/GYN, Peds, Surgical, General Medicine, Cardiac, Home Health, Schools, Public Health, etc... So it IS important for nursing students to have this experience. It's usually the least favorite clinical, but I think for me, it has served it's purpose of opening my eyes to the plight of those who suffer from mental illness. And it makes me especially grateful for my stress and trauma-free childhood and adolescence years and for my parent's loving attention as they taught me how to live and cope with what life throws my way.

Today, my client's story really got to me. While her mental illness does significantly complicate things for her, I was struck by the plight of the homeless...and even more so, the homeless with mental illness.  Imagine losing your home. Imagine not having any family or friends that can provide shelter or assistance. Imagine sleeping on park benches in DC. Imagine having your belongings stolen as you sleep. Imagine having your ID lost or stolen. Imagine not being able to change your circumstances (with a job or schooling) because you don't have any way of proving your identity or education. Imagine being physically and sexually assaulted. Imagine living on the streets alone having hallucinations or delusions or paranoia due to a psychiatric disorder. Imagine not having any personal means to feed yourself, buy medicines, or get a shower.  Imagine not having a mailing address (which is important for any paperwork or government assistance - most of which require proof of domicile).  

Today I asked my client to list out some positives of staying at the psychiatric hospital (most of them want to leave!).  While she does not want to be there, she listed the following as positives, in order of importance to her):

1. Soft bed!!!
2. Inside protected from elements and extreme temperatures.
3. BINGO (chance to win good, useful prizes - like calling cards, personal care items, snacks...)
4. Three solid meals a day
5. Getting a chance to talk to people (other patients) and freedom to voice my opinion
6. Safe.
7. Fresh air (occasionally going outside--not common at the jail where she came from)
8. Access to medications.

Telling huh? Certainly all things that I take for granted on a daily basis!

Anyways, her story left me wondering what I could do as a nurse for the homeless population? What would it look like to be a nurse that primarily serves that population?  Would it be something I could do full-time? or is it more as a volunteer?  What programs exist in the major cities (with large numbers of the homeless) that utilize RNs in their list of services/programs?

I was kinda shocked when I started having thoughts like this while talking to her. Does this mean I should be considering psychiatric nursing as a field to pursue? I'm not sure. I still don't feel called to psychiatric nursing in general, but perhaps there's something here that I need to continue thinking about and researching. There are certainly opportunities to work with the homeless in my community now. And while I can't really add volunteer work during the semester, perhaps I can do some shadowing or exploring of opportunities over Christmas break.  I always have lofty goals of shadowing, but they rarely seem to come to fruition. I still haven't gotten to the jail/detention center yet or to the funeral home to witness embalming.  :( However, EVENTUALLY, it will happen!  Maybe I am just am too optimistic when it comes to my time?