It pours down rain as a medical team pulls into the parking lot of a fast-food restaurant in East Austin to meet 58-year-old Denzil Wooten for a regular checkup.
The team, known as M3 for Mobile, Medical and Mental Health Care Team, has been tracking down Wooten about two times a week for the past three years.
"We meet people where they're at and we say, 'Hey, where are we going today?"' says Tony Nunez, M3's team leader.
Wooten has been living on the streets for the past 15 years. He says his mother's death sent him into a deep depression and he became addicted to drugs and alcohol. He was unable to hold a job, which led to a life of panhandling and sleeping under bridges.
It's only since M3 intervened that he’s been getting consistent treatment for bipolar disorder and addiction.
“They’ve become like family,” Wooten says. “Even when I don't want it, they still help. Even when I'm fed up and I'm mad and I don't want to talk to anybody, they're still there.”
Nunez flips open his laptop and begins to check on Wooten’s prescriptions and upcoming doctor appointments for a host of chronic conditions. He says you can’t expect this population to make it into a clinic without assistance.
“Case in point: Today, it's raining," he says. "So for some of the folks that we serve, they might not come into a doctor's appointment because they will say, 'Hey, my encampment just got rained out, so I have to dry out all of my belongings.'”
Ashley Sharma, a registered nurse with the team, says since M3 patients don’t have addresses, they have to follow-up creatively.
”Sometimes it'll be like, 'Oh, we meet by that tree,'” she says. “It's funny because questions like, where do you go when you're going to go get a soda in the middle of the day? Which gas station would you go to? Those become health care-related questions."
Taking medicine to the street
Dr. Tim Mercer, a professor at Dell Medical School and primary care doctor at CommUnity Care, launched M3 in 2019. He said there had to be a more coordinated way to reach people living without shelter, noting their average lifespan is 53 years old.
“The health system is hard to navigate for anyone,” he says. “So for people experiencing homelessness, the barriers stack up and compete with their daily survival needs of where they are going to put their stuff or leave their pets or can they make their medical appointment or do they go get lunch somewhere.”
M3 was created through a partnership between Dell Medical School, Integral Care and CommUnityCare Health Centers to provide this population comprehensive care that includes mental health treatment and specialty care.
A grant from the federal Substance Abuse and Mental Health Services Administration helps fund a current staff of 12, which includes nurses and case managers dedicated to taking medicine to the streets and coordinating care for each patient.
Patients are enrolled in Medicare or Medicaid disability coverage if they qualify. Care is also subsidized by Travis County taxpayers through safety-net programs already in place for indigent care. Some services are donated.
While there are an estimated 4,000 people experiencing homelessness in Austin, M3 is currently able to enroll only 50 patients into its program. To become an M3 patient, candidates must meet four criteria.
“We're targeting people experiencing chronic homelessness, a serious mental illness, a substance abuse disorder, and a chronic medical condition,” Mercer says.
He says there has already been a reduction in ER visits among M3 patients.
No time limit on care
Wooten’s progress has not been linear, but he’s made significant strides. While Sharma checks his blood pressure under an awning by the parking lot, Wooten proudly announces: “I've got 69 days clean and sober today.”
Consistent care seems to be changing his life trajectory.
“My life is completely turned around,” he says. “I've got a job now; I start tonight. I'm going to be in janitorial service.”
Before Nunez closes his laptop, they discuss an apartment that’s expected to be available before the end of the year.
Despite the progress, Sharma says, Wooten is not “graduating” from the program. The team wants to make sure patients’ success will be sustainable, and for that, there is no time limit.
“We have the luxury of time, of constant gentle pressure over the course of months and years to just support them and they get there,” she says.
“I can look at myself in the mirror, and I love myself today," Wooten says.
He credits M3 for helping him envision a different life.
“I still have something to give to the world.”
