A magazine for friends of the Warren Alpert Medical School of Brown University.

Caring for Patients Beyond Hospital Walls


The demedicalization of mental illness often leaves the homeless in the lurch.

An article published in the New England Journal of Medicine discusses the case of a homeless California man who was a frequent visitor to a local emergency room. Six times over the course of a few months the man, who had been previously diagnosed with schizophrenia, presented with auditory hallucinations and suicidal thoughts after losing his medication. Each time, he was released back to the streets without extended psychiatric care.

The article—by Luke Messac RES’22, MD, and Joel Braslow, MD, PhD, a professor of neuroscience history at the University of California, Los Angeles—argues that this case and countless others like it happen because many of the consequences of mental illness, including homelessness, have been “demedicalized,” or seen as falling outside the scope of medical care. All too often, as in the case of the California man, the criminal justice system ends up filling the void left by demedicalization, the authors say. The man they described was later jailed on a felony charge.

The article is part of a new series in NEJM called “Case Studies in Social Medicine,” which aims to bring social science perspectives into the medical field. Messac, a resident in the Department of Emergency Medicine, discussed the article in an interview.

Read the Q&A with Luke Messac here.


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