Reflections from the Streets: The Paradox of High Morbidity Despite Frequent Utilization of Health Services among Boston’s Rough Sleepers

Individuals sleeping on the streets of our urban cities are highly visible but poorly understood. This sub-group of the chronically homeless population bears a disproportionate burden of medical, mental health, and substance abuse problems, and lacks access to integrated and continuous health care services. The results of a longitudinal study of a cohort of chronic rough sleepers in Boston will be reviewed, emphasizing the vexing paradox of high morbidity and mortality despite extraordinary numbers of encounters with health care clinicians in emergency rooms and hospitals. An integrated medical and mental health team approach to caring for this population will be reviewed, including an effort to offer continuity of care from street corner to hospital to respite care to housing.

James O’Connell, MD graduated from Harvard Medical School in 1982, and completed his residency in Internal Medicine at Massachusetts General Hospital in 1985. In 1985, Dr. O'Connell began fulltime clinical work with homeless individuals as the founding physician of the Boston Health Care for the Homeless Program. Dr. O’Connell is now president of the program, which now serves over 11,000 homeless persons each year in three hospital-based clinics and over 80 shelters and other outreach sites in Boston. In 1993, Dr. O’Connell founded BHCHP’s Barbara McInnis House, a freestanding medical respite program which has grown to 104 beds and that provides acute, sub-acute, peri-operative,rehabilitative, recuperative, and palliative end-of-life care for homeless men and women who would otherwise require costly acute care hospitalizations. Working with the MGH Laboratory of Computer Science, Dr. O’Connell designed and implemented the nation’s first computerized medical record for a homeless program in 1995. From 1989 until 1996, Dr. O'Connell served as the National Program Director of the Homeless Families Program of the Robert Wood Johnson Foundation and the U.S. Department of Housing and Urban Development. Dr. O’Connell is the editor of The Health Care of Homeless Persons: A Manual of Communicable Diseases and Common Problems in Shelters and on the Streets, and an editor of A Practical Approach to Pulmonary Medicine. His articles have appeared in the New England Journal of Medicine, the Journal of the American Medical Association, Circulation, the Journal of Clinical Ethics, and several other medical journals. He was featured on ABC’s Nightline, and has received numerous awards during his career, including the Richard and Hinda Rosenthal Foundation Award from the American College of Physicians.

Click here for Audio of Jim O'Connell's Presentation