Baltimore Health Department Helps Affected Citizens After Riots

In July, Baltimore City health officials and others continued their response to the physical and mental health needs of people affected by the riots and arson following the death in police custody of Freddie Gray.

AP Photo/David Goldman

Their work began in the midst of the unrest on the night of April 27, when the Baltimore City Health Department developed a security plan and an operational list of local hospitals, Commissioner Leana Wen, M.D., M.Sc., told Psychiatric News. The department then turned its attention to people in the affected neighborhoods who were already receiving medical care but who had been disconnected from routine appointments and lost access to medications. Several pharmacies and about 200 other small stores were burned by looters.

“We developed a medication-access plan to get people the blood pressure, diabetes, or mental health medications they needed if they had lost their pharmacies,” said Wen, who trained as an emergency physician. “We also drew up a list of places that were still open and set up an appointment line to get people to routine appointments.”

Mark Dennis

The department then found ways to link people distressed by the traumatic events with free crisis counseling for adults and children. As part of a larger recovery plan, the department encouraged the use of “healing circles” in schools, churches, and community centers, to which they sent trained mental health professionals as facilitators.

Wen said that she expected that there were also people who experienced trauma but were too burdened by more immediate concerns to deal with that trauma but would need help eventually.

The actual delivery of public mental health and substance-abuse services in the city falls not to the department itself, but to the quasi-governmental Behavioral Health System of Baltimore (BHSB). There is an “extremely close” relationship between the two entities, exemplified by Wen’s place as chair of the BHSB’s board.

The system sees about 32,000 adults per year and 16,000 children and adolescents. It provides both inpatient and outpatient care and includes a crisis response unit.

“We are engaged in teaching providers around the city in trauma-informed health care because we see all of our residents as victims of trauma in one way or another,” she said.

Baltimore has made progress in important aspects of the city’s overall health—such as reducing lead poisoning rates and expanding access to opioid-use treatment—but continuing disparities remain across its 55 neighborhoods. Providing treatment and support for mental illness and substance use disorders are a priority, said Wen. Others agreed that mental health issues required ongoing attention.

Aaron Levin

“There is not just incident trauma but also pervasive trauma and repeated trauma,” said Philip Leaf, Ph.D., a professor of mental health and director of the Center for Prevention of Youth Violence at Johns Hopkins Bloomberg School of Public Health.

“Even those who are physically unharmed may have friends or relatives who were victims,” Leaf told Psychiatric News. “As a result, there is not just a need to provide care but also for trauma-informed thinking among clinicians and other community leaders.”

Before the April rioting, city schools already had disaster protocols in place, led by social workers and mental health professionals, but they also needed additional resources to help both teachers and students afterward, said Leaf. Religious leaders are another potential asset for recovery. Ministers and church lay leaders recognize the presence of trauma among their congregants and have asked for more help to deal with it.

At the city’s other academic hospital, one emergency department surgeon is working to cut off violent trauma at its source.

Carnell Cooper, M.D., an associate professor of surgery, created the Violence Intervention Project (VIP) to try to keep victims of violence from becoming repeat visitors.

University of Maryland

Each day, case workers seek out patients in the hospital’s famed Shock Trauma Center, explained Cooper. They discuss the VIP program and, if patients agree, conduct a 100-question survey that helps tailor appropriate services to the individual. Such services may include education, training, employment, substance abuse, and mental health services.

“We take advantage of a teachable moment,” Cooper said. “They are off the streets, in a safe place, and may have the insight to understand that they could have died.”

The lead person on the VIP team is a social worker, who does one-to-one therapy sessions and can refer a patient to a University of Maryland psychiatrist if the patient is on medications or is unstable or unsafe.

Mental health plays an underappreciated role in the path to violent injuries, Cooper said. “Practitioners haven’t documented how many of our patients wind up in jails because of behavioral problems, and few get the treatment they need there.”

At the same time, mental illness and behavioral health care carry a stigma in low-income neighborhoods and, coupled with an inadequate supply of clinicians, too many people go untreated.

Cooper’s team has followed participants for three years and found that they were less likely to return to the hospital or become involved in crime. He would like to do a 10-year follow-up study to look at longer-term effects.

The riots following the death of Freddie Gray were not a surprise to Cooper.

“There was already a powder keg in the neighborhoods, and it took one incident to ignite the fuse,” he said. “Now we need to reach out more to the parts of the city that we have not reached in the past.” ■