By Agnes Kwak, M2
Eastern Virginia Medical School
Norfolk, VA
“Debra” spoke of thoughts of harming herself. She had made an appointment with us seeking help for her mental health crisis. I listened as the student volunteers presented her case to the attending, who led the team in creating a plan for this patient. We provided her with a medication refill, spoke with her support network, with her permission, connected her with the local hospital, and alerted the night resident on shift. A month later, she came to see us again, this time with no suicidal ideation and an improvement in her mood.
As a new medical student at Eastern Virginia Medical School, this encounter was my introduction to the HOPES Mental Health clinic. I was inspired by the way we were able to help “Debra” in her crisis, provide her with a plan and a (short-term) solution, and ultimately, witness her mental health improve.
For many medical students like myself, HOPES (Health Outreach Partnership of EVMS Students) is an invaluable opportunity to get early exposure to working in a clinic and collaborating in a team. As we serve the members of our community, we learn how to confront health disparities and address social determinants of health. HOPES is the first student-run free clinic in Virginia and the only free clinic in Norfolk. Since its establishment in 2011, more than 8,000 uninsured individuals have received care at HOPES, most of whom are Spanish-speaking. Mental Health (MH) is one of HOPES’ many specialty clinics.
HOPES MH was started in 2017 to address the Hampton Roads community’s alarming mental health needs. For the past several years, mental health has been, and continues to be, one of the top concerns identified by Sentara Norfolk General Hospital’s Community Health Needs Assessment. HOPES MH provides an essential avenue of care for uninsured/underinsured, homeless, and undocumented patients who suffer from mental health issues. In the last six years, the clinic has served over 100 patients. We have the capacity to see 4-8 patients per month. Under the supervision of an attending and resident, two teams of senior clinicians (M3 and M4 students) and junior clinicians (eligible M1 and M2 students) meet with patients and discuss assessments and plans. Being student-run, HOPES MH provides students with the opportunity to learn and lead, and residents and attendings with the chance to teach. As Clinic Coordinator, I plan clinic dates, recruit attendings and residents, and manage volunteers. Our Continuity Coordinators are responsible for scheduling appointments, maintaining the patient roster, and sharing resources with patients.
Established by the community and for the community, HOPES MH works locally. We collaborate with nearby institutions to connect patients to free services. We refer individuals who request therapy services to Lifestyle Counseling, where they are seen by mental health counseling interns at Old Dominion University who are overseen by Dr. Kyulee Park of EVMS Family & Community Medicine. We also receive referrals from Street Health, the EVMS student-run free clinic for homeless individuals. We work with in-person and virtual translators for our large Spanish-speaking population. For patients on our appointment waitlist, we provide information on additional resources, such as the Norfolk Community Services Board and The Up Center, that they can explore as they wait to be seen.
In 2020, the COVID-19 pandemic shut down many clinics and our wait list has only continued to grow. We adapted to these challenges by seeing patients virtually for the past three years. The incorporation of telemedicine has afforded our patients the necessary flexibility to attend appointments without concerns about transportation, time off work, and exposure to COVID-19. Some patients who live in Virginia Beach video call in without commuting, and others telephone into their sessions during breaks from work. We have also noticed an increase in the number of patients that attend their appointments, a notable point for a population that already struggles with access to care. As we move into the Fall 2023 semester, HOPES MH has decided to adopt a hybrid clinic model, taking into consideration the value of an in-person environment for students and patients, as well as the needs of our patient population, who often rely on the convenience of telemedicine.
Some patients like “Debra” come into HOPES MH with a mental health crisis, others see us for medication management or basic psychiatric intake. All leave with a sense of gratitude. It is rewarding to be a part of this experience. Working with HOPES MH is a way for us to connect with the people we will one day be serving as doctors. Moreover, we have a chance to advocate for the mental health needs of all individuals.
