What Most People Get Wrong About Homelessness (From a Doctor on the Streets)

Street medicine is the practice of bringing medical care, mental health support, and addiction services directly to people experiencing homelessness, on the streets where they are. Instead of waiting for patients to walk into a clinic, street medicine teams walk out to them, building trust over time and meeting people where they are. Midwest Street Medicine operates this way in Sioux Falls, Rapid City, Aberdeen, and is expanding to Pierre.

Dr. Mo Dittberner says it depends on what you trust the person to do with it. If you care about where the money goes and would not feel okay handing it over, do not give it. If you trust that the person will get whatever they need today, you can give and feel fine about it. Help itself does not enable. The framing that all giving is enabling is a myth that keeps people from helping at all.

No. The bootstraps narrative misses what actually keeps someone on the street: no phone, no ID, no bank account, no permanent address an employer will accept, untreated addiction or mental illness, lost documentation, or a recent incarceration. Compassion is the start. Removing the barriers is the work.

Most jobs require a phone, a permanent address, an ID, a bank account, and reliable transportation. Many people experiencing homelessness do not have any of these. An address at a shelter is something many employers see and pass on. Plus, untreated addiction, mental illness, and chronic health conditions make work intermittent at best. The gap between motivation and employability is much wider than most people realize.

Harm reduction is a public health approach that meets people where they are and reduces the risks of behaviors that are already happening. The classic example: a bar is a harm reduction center. The padding on the bar, the four-drink limit, the bartender cutting someone off, the rules around driving, are all designed to reduce harm from a behavior people will do anyway. In addiction care, harm reduction looks like clean supplies, naloxone access, and lower-barrier treatment options.

Wound care, alcohol withdrawal management, mental health triage, chemical dependency assessments, medication-assisted treatment for opioid use disorder, and connection to longer-term care. Mo calls Midwest Street Medicine a conduit to care, not a replacement clinic. The goal is to stabilize people on the street and connect them into the existing care system in Sioux Falls and the surrounding communities.

An estimated two million dollars in unnecessary emergency room visits in Sioux Falls in the last year. Street medicine catches issues earlier, in setting where treatment is appropriate, rather than waiting for them to escalate into ER visits. That savings benefits hospitals, insurance, and the public, in addition to the person receiving care.

Volunteer with Midwest Street Medicine, donate the items they currently need most (check midweststreetmedicine.org for the current list), or refer someone in need directly. The public library is one of the team's key access points because so many people without housing spend time there. If you encounter someone who needs help on the street, you can also call or text 988 for free 24/7 mental health support.

Visit midweststreetmedicine.org for the current donation list and the volunteer signup form. Phone: 605-250-1000. Email: info@midweststreetmedicine.org. The team operates in Sioux Falls, Rapid City, Aberdeen, and is expanding to Pierre. Volunteers come from all backgrounds; clinical training is not required for many roles.