Rough Sleepers: Dr. Jim O'Connell’s Urgent Mission to Bring Healing to Homeless People

As medicine becomes increasingly competitive, privatized, and corporate, the Health Care for the Homeless Program grows with more freedom, as it’s not beholden to rigorous standards in the same way as standardized business models. This means that the team is free to spend time with their patients, getting to know them even if they aren’t receiving treatment. Harrison, for example, won’t let Jim check his vitals—but Jim is able to see when Harrison’s health begins to fail. Jim refers to this kind of exploratory medicine as “upside-down medicine” (91).

After the grant funding runs out, the program moves to Medicaid funding—which requires Jim’s team to learn the complex requirements necessary to receive funding. Once Jim hires Linda Brown, she is able to navigate the requirements, and the program continues to expand. This expansion doesn’t come without criticism, however—many people feel their tax dollars are being spent on people who don’t give back to society. To Kidder, and anyone on the Street Team, the benefits seem quite obvious. Kidder argues that the program actually lessens the burden on health care systems and, in the long run, saves money.

Because of Medicaid, the program is still thriving by 1995. However, Medicaid begins demanding the same kind of productivity expected from medical institutions around the country, which threatens the way the program practices medicine. The program isn’t impacted negatively by these changes in part due to Bruce Bullen, the Medicaid director, and because they hire a clinical psychologist named Bob Taube as executive director. In the end, however, Jim feels that medicine and efficiency aren’t conducive to a truly successful practice.

As the Health Care for the Homeless Program grows, Kidder describes the still staggering rates at which rough sleepers die. In 2005, the Street Team considers another solution: housing vouchers given to the program through an initiative called “Housing First.” Jim and his team begin prescribing these vouchers to patients who’d been with them the longest in the hopes that they will experience the same rates of success as those in “Housing First” had. Kidder writes that, after five years, 88% of the people who participated in the program remained housed (101).

The Street Team doesn’t have access to the same kinds of resources as Housing First. Additionally, transitioning from living on the streets to living in a home is sometimes a rough change, and many people struggle to adapt. Kidder writes, “People who had adapted to the exigencies of street life had no idea how to fill their time indoors,” and he describes a man who pitches a tent in his living room (102). The results aren’t always what the Street Team hoped. Kidder writes that “over ten years, seventy-three different people had used the twenty-four vouchers, 45 percent had died, and only 12 percent of the survivors had remained housed” (103). However, there are still people that thrive after receiving housing.

Barbara McInnis, Jim’s teacher and long-time friend, dies from complications in surgery following an accident in 2003—but the impact she’s made in Boston continues to reverberate across the medical and unhoused communities. A new building for the Health Care for the Homeless Program’s headquarters and another respite hospital, named for Barbara, is built as the program grows—called “Seven-Eighty” by its patients and the medical team.

When Kidder visits Seven-Eighty with Jim in 2017, the narcotics epidemic visibly alters the scene. Kidder describes used needles littering the ground with people using, selling, and overdosing everywhere on the block. Kidder includes a description of harm reduction therapy, where users can safely detox or come down from the drugs they’ve ingested.

By 2017, Jim is married to his previous assistant, Jill, and they have a daughter named Gabriella. Kidder details Jim’s life now that the Health Care for the Homeless Program has expanded—he devotes much of his time to the Street Team, riding in the van on Monday nights and working in the Street Clinic on Thursdays. What started as a small, grassroots clinic has—by 2017—turned into “the country’s largest medical system wholly devoted to the care of homeless people” (114). Though Jim tells Kidder he feels redundant, Kidder writes that Jim remains an integral part of the program.