Access is the first clinical intervention

A few hours into my first day at the Henry, an SRO in SoMa where Episcopal Community Services does primary care, the shape of the place came into focus. Care here did not look like clinic care. It looked like sitting with a resident in the lobby because they would not have come up to the second-floor exam room, and going room to room with a blood-pressure cuff because the room was as far as someone could walk that day.

What we call “care” in a hospital is mostly the visible tip of a much larger structure of access. Payment, transportation, language, trust, and the chance that a prescription gets filled. When that structure is broken, no clinic visit fixes it. The Narcan in the kit matters. The phone number that gets answered matters more.

Mental wellness is not possible without a roof, a prescription someone can fill, and a neighborhood that does not poison them.