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Mayo Clinic psychiatry resident finds education among hours spent helping others at The Landing

Post-Bulletin - 1/23/2024

Jan. 23—ROCHESTER — Casimir Klim said approximately half of the people he visits at The Landing MN day center suffer from post-traumatic stress disorder.

A fourth-year Mayo Clinic psychiatry resident, he said the percentage outpaces national averages for people experiencing homelessness, but it's not surprising to him.

"People that are experiencing homelessness are more at risk for the traumatic events, like physical violence or sexual assault, that can lead to the development of PTSD," he said.

He said PTSD is not the only mental health struggle that can be spurred by homelessness, which can add to a person's struggle to find housing and employment.

"Almost all psychiatric disorders can be brought on by, or exacerbated by, psychosocial stressors," he said. "Becoming homeless and being homeless is an intensely stressful situation for most people and is associated with many other stressors."

Those stressors, including social stigma, violence, sexual assault and hunger, can lead to or worsen depression, anxiety and psychotic disorders like schizophrenia, he said.

Klim began visiting The Landing weekly in July 2023, offering mental health care alongside growing access to health care at the 426 Third Ave. SE day center.

"This is an area of psychiatry that I'm extremely interested in and have been for a long time, so I kind of jumped at the opportunity," he said of responding to a request from Landing co-founders Dan and Holly Fifield.

Hoping to move into a Sacramento-based community psychiatry position to serve a similar population this summer, Klim said the time at The Landing has provided a variety of learning opportunities as he's helped others with their mental health needs.

He said the work is vastly different from the other clinical experiences he's had during his training.

"Most of my patients at the other clinic have a phone," he said. "They have a fixed address where we can send mail. They have reliable transportation.

"Most of my patients at The Landing do not have any of those things, and it makes some of the logistically challenging treatments that we do in psychiatry even more logistically challenging."

Since some "gold standard" medications require lab testing, EKGs and other work before being prescribed, Klim said the lack of transportation or the ability to schedule clinic visits can be tricky.

On top of that, he said, clients struggling with a lack of housing are frequently hesitant to try new medications.

"Another thing I have learned about from my patients, that I had never thought about, is that some psychiatric medications are sedating," he said. "Oftentimes if people are having trouble sleeping, it can be a welcoming side effect, but if you are sleeping on the street or sleeping in a shelter, that can make you vulnerable and make people afraid they are going to be vulnerable."

The potential vulnerability is already a concern for people struggling to find housing, he added.

While homelessness can be a byproduct of mental illness in some cases, Klim said the lack of housing can also trigger mental health struggles, such as PTSD, which is a diagnosis linked to traumatic events that are life-threatening or extremely disturbing.

"Being homeless puts you at a higher risk of that," he said of actions that can lead to the development of PTSD.

Monica Taylor-Desir, a Mayo Clinic psychiatrist and assistant professor, said the fact that mental illness can be both a result and cause of homelessness makes the work important.

"There is a bidirectional nature of homelessness increasing mental health conditions, such as PTSD," she said. "What we see is that people are more vulnerable and at risk."

As a participant on the local Assertive Community Treatment team, Taylor-Desir has seen firsthand that outreach can make a difference in people's lives and the community.

"As a model, it's been shown to improve housing stability," she said of the broader community work being done.

Klim said the work's complexity means he relies on Taylor-Desir and others while seeking to help people at The Landing.

"I definitely have availed myself with the crisis line, calling on speaker phone with a patient," he said of the regional mental health crisis response available by calling 1-844-CRISIS2.

He said the connections with other services and support have also been key, especially since he's only available on Fridays at The Landing.

"I think I spend a lot of time educating people — educating myself — about what services there are in the community," he said.

With more than 100 people seeking safe space at The Landing daily, Dan Fifield said Klim's work is a blessing.

"Just being homeless by nature is going to give you a whole lot of anxiety and a whole lot of trauma," he said. "It's not a safe existence."

While PTSD is among the most common diagnoses Klim has seen during his Friday office hours at The Landing, he said a wide range of needs come through the door.

"I often care for patients with depressive disorders, anxiety disorders, and substance use disorders," Klim said. "Most patients I see have more than one psychiatric diagnosis."

Fifield said changes are being seen, especially among clients who have long histories of trauma and mental illness.

"One of them got back on his meds and stabilized and was able to gain housing," Fifield said. "We were able to get him housed, which was huge. He's in a supportive situation right now, and from what I hear, he's doing great."

Fifield said he worries such connections could be lost after Klim graduates in June, but Klim said he's already talking to younger Mayo Clinic psychiatry residents, who have expressed interest in working with The Landing.

"I think there is a need out there that we can help with, but also it's been a unique learning experience for me," he said.

Taylor-Desir voiced support for seeking avenues to continue the work, pointing out that Klim has established the framework for making a difference.

Fifield said he's hoping to broaden the on-site services in the future, building on Klim's voluntary effort.

"It's been very beneficial to our clients. ... If we can get someone here on a more regular basis, we'll be able to do much more good," he said.

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