Improving Care for Folks We'll Never Meet

On my way to Union Station after IPS: The Mental Health Services Conference, I sat next to a tiny elderly woman for five stops. Without warning, between stops two and three, she started shrugging to herself and chatting to nobody in particular, waving her palm-up hand in a sort of world-weary cocktail party type gesture.

At the stop before mine she stood and dragged a two-wheeled shopping cart out the door behind her, still whispering. I last saw her on the escalator, rising out of sight into a rainy DC afternoon.

Where was she going? How old was she? What was that paperback in her cart, turned so the cover faced inward? Is that jacket tweed? Was she hearing voices?

And if she did have a psychiatric diagnosis, was she getting the care she needed?

At the stop before mine she stood and dragged a two-wheeled shopping cart out the door behind her, still whispering. I last saw her on the escalator, rising out of sight into a rainy DC afternoon."

Kristin S. Budde, M.D., M.P.H.

Post-IPS, my answer was a hopeful yes. I’m lucky enough to be a public psychiatry fellow, and we’d spent the last few days considering how people are improving care in DC and around the continent.

First, the conference itself. It was encyclopedic: buprenorphine, migrant health, telepsychiatry, structural competency, all the things. I tried to plan out my days using the “my agenda” portion of the app, but found myself adding every session to my list and totally defeating the purpose.

Then we headed out to the community. At Whitman-Walker Health, we got a glimpse of just how good integrated care can be. The clinic has been around for decades, providing HIV and general health and mental health care to DC residents. Our tour guide? Savvy and sassy. The care? Pretty darn comprehensive. The building and view? Gorgeous.

So my IPS experience was a trip through public psychiatry, from research and innovation, to boots-on-the-ground care delivery. When I left, my head was buzzing with MACRA and HIPAA and FQHCs and so many other five-letter challenges and opportunities. There’s so much to think about it’s easy to forget why we’re doing it.

But then I saw the woman on the train. I wondered whether she’d had some interaction with the mental health system. What was it like? How do we make things better for her, and for all the patients we won’t see face-to-face?

The challenges can seem overwhelming. But I think a world where she can access care easily and without discrimination is a world worth fighting for.

Good to know there are so many other brilliant folks who want the same thing.

About the Author

kristin-budde

Kristin S. Budde, M.D., M.P.H.
PGY3 | Yale University School of Medicine
2016-2018 Public Psychiatry Fellow

Oct
2018
04
2018 IPS: The Mental Health Services Conference
  • Chicago, Ill.
  • Thur,  Oct  04 - Sun,  Oct  07
May
2019
18
2019 Annual Meeting
  • San Francisco, Calif.
  • Sat,  May  18 - Wed,  May  22
Oct
2019
03
2019 IPS: The Mental Health Services Conference
  • New York, N.Y.
  • Thur,  Oct  03 - Sun,  Oct  06