Social Work at the Haight-Ashbury Free Clinics: An Interview with Dr. David E. Smith

By Brad Forenza, Ph.D.

     The San Francisco counterculture of the late 1960s birthed new ways of thinking about the world through music, politics, and art, but it also birthed a new way of treating social issues like substance use, mental health, and sexual health. In 1967—amidst the Summer of Love—San Francisco physician, Dr. David E. Smith, founded the Haight-Ashbury Free Clinics (HAFC) to do exactly that. Dr. Smith’s clinics were first-in-the-nation to provide free medical services to those in need. The clinics established a foundation for today’s free clinic model and, in the nearly 50 years since their inception, the clinics have employed social workers every step of the way.

     “Community health and addiction treatment is based on a healthcare team approach,” says Dr. Smith. “The social worker is a crucial part of that team.”

     Smith’s sentiment is reflective of most thoughts on medical social work. In times of crisis, clients will always need a helping professional to facilitate their optimal care. This may involve a social worker’s direct counseling with a client or outreach to a client’s family and extended network (per the client’s consent). In the absence of a free clinic model, medical social workers may provide outreach and education to the client about her or his medical rights and entitlements. “At the community level, medical and social work professionals work in a holistic approach,” Smith notes.

     Regarding the state of contemporary healthcare and the advent of the Affordable Care Act’s individual mandate, which states that every American must have health insurance, Smith still foresees a place for free clinics and the holistic care they provide. “Many free clinics have adapted to Obamacare,” he suggests. “There will always be a population that prefers free clinic-style ‘non-judgmental’ medicine.” Smith also notes that some clients “won’t or can’t deal with the paperwork (of health insurance),” an observation that poses another opportunity for medical social workers (working with clients to enroll them in health plans).

     The Affordable Care Act is, perhaps, the most comprehensive healthcare policy since Medicare and Medicaid, which were enacted two years prior to Dr. Smith’s founding of the HAFC and, by extension, the free clinic movement. When asked about the impact of healthcare policies on practice, Smith concedes that “policy has high input on practice,” although he asserts that his goal is “to maintain free clinic principles” with the individuals he sees and the programs with which he consults.

     Today, “The HAFCs still provide many of their early services,” Smith says, “but they have merged with Walden House to form HealthRIGHT 360.” HealthRIGHT 360, where Dr. Smith is a volunteer physician, provides substance use, mental health, physical health, and outreach/mobile services to underserved populations, with special emphasis on those who happen to be incarcerated or criminal justice-involved.

     Almost 50 years after the Summer of Love (and on the cusp of the first federal income tax cycle in which Americans will be penalized for being uninsured), Dr. Smith and his associates remain visionaries in the medical and social services. They also remain champions for the healthcare needs of at-risk populations. During National Social Work Month, we salute Dr. Smith and his free clinic model for their advancement of healthcare as a basic, human right.

Brad Forenza, MSSW, Ph.D., is an assistant professor at Montclair State University, where his research foci include social policy, civil society, and youth development. He is an active member of his community, and in his free time, he enjoys writing and performing. He is a graduate of Ithaca College (B.S.) and Columbia University (M.S.S.W), and received his Ph.D. from the Rutgers University School of Social Work.