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Dr. Julie McKay: Supporting Jacksonville’s Unhoused with OCD

by | Sep 15, 2022 | Articles | 0 comments

We must do more for Carlton! The burden is ours…


Originally published as an “Opinion” in The Florida Times Union

I glanced at the clock hanging in the hallway. Only three more patients to go before the lunch break. I desperately needed my daily dash to the safety of my Covid-free car, so I could rip off my N95 mask and breathe deeply. This is the pattern of my day as the Lead Physician at the Unhoused Shelter in my town.

Finding Commonality with Carlton

The next patient up was “Carlton.” As I entered the exam room, I saw that Carlton had tried. His matted hair had been patted down to a semblance of order. He had turned his worn t-shirt inside out to the less dirty side. Carlton had probably not had benefit of a shower for months in the Jacksonville heat. Still, he was a person in need of care. I shook his hand and made eye contact.

I ask gentle questions to find a thread of commonality as we began our relationship. How did Carlton become so depleted? My curiosity is a daily checkpoint, ensuring I am not headed down the same path. Every story is different but being unhoused can happen to anyone.

Unhoused People & OCD – Carlton’s Story

Carlton began telling me about his past. He was the former CEO of a Fortune 500 company. He flew on private corporate jets and had a yacht. Carlton even showed me a wrinkled picture of his beautiful ex-wife and two children. The kids wore matching designer outfits, and Carlton wore pink shorts with little green whales. He described his mansion, zero-edge pool, and his fleet of cars.

So, what happened to Carlton?

Carlton continued his sophisticated life story, telling me how the pressure at work was very intense. His kid needed an expensive tutor, and both of his parents died unexpectedly, leaving him the self-assigned leader of both extended families. One evening he got carjacked. And after this happened, he started scrubbing his hands and washing everything around him. The long-suppressed OCD tendencies from his youth roared back to life and devoured him like a lion.

Dr. Julie McCay

Ramifications of his “odd, unexplained” behavior

This odd and unexplained behavior freaked out his naïve young wife. She bolted with the children to a different CEO and remarried once their divorce was complete. Carlton’s career faltered. He could no longer make decisions. All the while he cleaned his office space obsessively. Eventually his company fired him.

Of course, one by one, everything he worked for evaporated, and Carlton found himself living on the street. It was probably the worst situation for an OCD sufferer struggling with contamination triggers. The mobile shower van broke or did not show up. As with others living unhoused, he found it challenging to take a bath in the public library sink. Without the ability to keep clean, he deteriorated physically, mentally, and spiritually.

Medical Exam

I listened as he recanted his fall from superstar status. His family disowned him; he had not seen his children for two years. Then we plowed through the medical questions, the exam, and the treatment plan. I promised we would see each other in a month. I promised to try to figure out housing, a stable food source, and better shower access. And to my surprise, Carlton reached over and hugged me quickly. It felt like we had won a minor victory in the trust game.

I finished up the morning patients, but Carlton weighed heavily on my mind. I raced to my car and ripped off the N95. By the time I reached my sanctuary, I was sobbing. Some of the tears were of profound gratitude to the Lord for sparing me from Carlton’s grief and pain. But mostly, I was just overwhelmingly sad.

The Weary Community Medical and Psychiatry System

I failed Carlton that day. The weary community psychiatry system and medical community failed Carlton too. I had nothing to offer him through this OCD crisis except an occasional shower and a clean t-shirt. It was woefully too little. 

In the combined Duval and Clay Counties, there are approximately 1,222 unhoused people at any given time. Of these, a large percentage suffer from mental illness. It is a catastrophic burden on a community to provide adequate care for unhoused people who are also suffering from mental illness. We must do better as a society to provide affordable, available mental health care. Doing so will prevent drastic downward spirals like Carlton’s. 

Ironically, if Carlton had suffered from one of many other life-threatening illnesses, I would have ready access to offer treatment. HIV/AIDS, cancer, coronary artery disease, and Diabetes have adequate funding available. Why is his OCD treatment underfunded and limited in availability?

We Must Do More for Unhoused People*

You might think OCD is not life-threatening. I supposed it is not typically fatal to the human body, but Carlton is a dead man walking. We must do more to help unhoused people, support legislation that improves funding and access to therapies and training for OCD, such as ERP treatment. Lastly, we must NOT continue to fail Carlton. The burden is ours.


*JACK Board member, Dr. Julie Mc Kay, wrote this powerful opinion piece about OCD in the unsheltered community. As a call to action, JACK Mental Health Advocacy has made a donation to the Behavioral Therapy Training Institute (BTTI) Scholarship Fund at The International OCD Foundation. Our hope is that more clinicians who treat underserved populations will get training in treating OCD and related disorders. 
To access more information on BTTI Scholarships:


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