deinstitutionalization

Let me start by saying that I realize I'm touching on a controversial subject.  I'm going to talk about it anyway.  

A few nights ago I was at a meeting about disability rights legislation.  Yay advocacy and policy development!  Anyway, at the end, for the "check out" (gotta love meetings run by social workers...) we had to share a barrier we thought was faced by the disabled community or that we were currently facing.  I talked about lack of adequate access to mental health care, some people talked about attitudes, others about accessability and employment, all the normal things.  What surprised me, was the number of people who talked about institutionalization and how important it was that we continue with deinstitutionalization.  

I'm not sure why it surprised me.  It's not exactly an unfamiliar concept for me, and for that matter it is something our government is currently working on.  Our newest Assertive Community Treatment team was set up to take referrals only from the long term mental health care facility, at least in it's initial stages.  In otherwords, it was designed to be intensive support for deinsitutionalization.  

The thing is, in my experience, institutionalization, in some way, is necessary, until we come up with better options for psychiatric treatment.  I spent eight months doing practicum in Assertive Community Treatment, the most intensive form of community mental health care my province has to offer.  The clients have a team of professionals and twenty four hour on call support.  They have daily contact, sometimes twice daily, observed meds and assistance with just about anything you could need assistance with.  Unfortunately, even with this very intensive level of support it was necessary to make two referrals to the long term care facility during my eight months.  Of course during that time we had many success stories as well.  

See the thing is, despite everything the team was doing, these clients simply could not be maintained in the community.  One woman was living in a rodent infested house with rotting floors, sleeping in a urine soaked bed, the house was in and out with drug dealers and the dirt was incredible.  She absolutely refused to take meds or to move.  Eventually the police had to remove her from the home and the public trustee made the decision to stop paying her rent.  The last time I saw her, she was doing okay in hospital, but certainly not well enough to live out again.  Another was so mentally ill and so drug addicted she jumped off a bridge, thankfully not too high up.  The courts didn't know what to do with her many crimminal charges and once release from jail or hospital she'd disappear for days at a time without taking her meds.  Because of her spinal injuries, she was referred to long term for her own safety.  

And then there are the forensic patients.  We have a special locked ward for them.  And seriously, I've been on the "worst" ward in the long term care facility.  The patients there are very, very mentally ill.  They are affected in ways that I cannot even begin to imagine.  Maybe with time, and patience and new treatments something will change, but until then... where will they go if their insitution is shut down?  

Finally there are the geriatric patients.  I've got news for you, schizophrenia doesn't end with middle adult hood, brain injuries don't magically heal.  And while we do have specialized homecare services, some clients just need more then that.  

So, i do agree with deinsitutionalization.  I want to be very clear about that.  I also don't agree with the institutions of the past, however, I want to make it very clear that there is a time and place in which long term psychiatric care facilities are necessary, and I don't think closing them all, especially without replacing them, will do the community a whole lot of good. 

another sad story

In a way, I feel like I'm trying to purge myself of some of the stories, some of the events, some of the experiences I've had at the shelter before I move on.  I feel like there's so much that's still unsaid, so many people, so many lives.  What's sticking in my mind right now seems to be the sad stories, hopefully as I distance myself a little, I'll be able to focus more on the happy ones, because there are so many of those too.  

One of the things we do at night is drive around in our van.  We hand out condoms, drive people home, give out blankets, look for people passed out places and help prevent people from freezing to death.  Naturally, I see a lot of pretty horrible things.  One of the things that can be hard is handing out condoms to the girls (and transgendered, and males) working the street.  Two girls struck me especially this week.  

As we pulled up to the two girls on the corner, it struck me just how young they looked.  It also struck me that they must be new, because they didn't have that burned out hollow look in their eyes, they still looked like girls.  When I offered them condoms, they were so enthusiastic, "do you have any dark ones" the first girl asked?  Those are my favourite.  And so, we went through the condom bag together.  The girls were so engaging, conversing with us as they poked around for their favourite colours.  When we left them, they were giggling about being able to trade around so they had just the right combination of colours.  

It just blew my mind.  Picking the right coloured condoms for their John's should NOT be what girls this age are thinking about.  Awkard first sexual experiences with boyfriends, maybe, but not this.  How long before it's not fun anymore.  How long before it catches up with them.  Or maybe it has, maybe this is their way of coping.  Either way, it's terribly sad.  And yet, I'll miss it.  I'm going to miss being out there, talking to them, becoming more familiar with them, driving them home, and taking them into the van when they're crying, abandoned in a parking lot with nothing.  That shouldn't have to be anyone's life.  

the night of 18 turnaways

As a write this, the Sophie cat is high on cat nip... I'm such a drug pusher, lol.  It's a lot easier to laugh at her antics though, and encourage her to "use" then it is to deal with the human consequences of drug and alochol abuse and addiction.  A perhaps little known fact is that there is that the number of people seeking shelter changes every day and there is a definite pattern to it all.  We turn away far, far more people on the weekend then we do during the week.  More homeless on the weekend?  Not exactly, a lot of it comes down to alcohol... 

It happens like this.  While there is a definitely a poorer area in my city, there are social housing developments spread out in various areas of the city.  All of these are accessible by bus...during the day, but at night, when the buses stop running, it's a lot harder to get there.  It seems, that more people drink on the weekends.  I'm sure this is true anywhere.  While the bars and hotels on the strip are full of business everyday, on the weekends they're just nuts.  And here's the thing, the bars close after the buses stop running.  SO when last call comes and everyone's leaving, suddenly there seem to be a whole lot of people who simply have no way to get home and many of them seem to wind up on the steps of the shelter.  

When we get someone come to the door who hasn't stayed with us in a long time or stays with us only sporadically we ask them some questions, for starters, "where do you live?"  Most people tend to say "nowhere", but then comes the question, well, where did you stay last night, last week, last month, because you didn't stay here.  Most of us hate doing this, but really, we're not a crash spot for people too drunk to remember to go home... we just can't be that.  We don't have the room or the funding... 

But it's hard.  I can easily turn away 15+ people, and generally they're far too intoxicated for the sober shelters.  This is one of the things which shows me just how real addiction is.  When you're so drunk that you just have no way to get home and you're down to the point of sleeping in the shelter or on the street.  When do you say to yourself "wow, I slept in a bus shelter last night, this is out of control".  People get so mad at us too, because we're supposed to be the shelter and what good are we if all we do is turn people away.  It's hard for people to see the big picture when they're caught up in addiction, there's a sense of intitlement and a need for immediate gratification.  

None of us are sure exactly what to do about this... as I've posted about many times, when does having the shelter just become enabling, when does it allow people to continue on destructive life style paths and live of the system, who gets to judge that anyway? I hate having to judge who is more and less deserving of shelter, we're supposed to do it by "level of vulnerability" but it's not like we have a formula.  It's true though, I'll squish in a regular who I know is completely falling part far sooner then I'll squish in a younger intoxicated male who doesn't stay with us... but maybe it should be the other way, we are an "emergency" shelter after all.

none of the answers are easy, not even the process is... 

harm reduction

I'm a firm believer in harm reduction.  I really am.  I definitely promote safer use, safer sex, safer life, safer whatever, but every now and then I feel like screaming JUST STOP DOING IT ALREADY!  

On van patrol we hand out condoms to the girls, guys and transgendered that work our cities streets.  We don't ask questions, we don't ask for names, we just drive up, roll down the window, and check in with people.  We're not the only organization that hands out condoms, but for once people have talked, and we all cover different times of day.  

I really like what we do.  I think condoms are important, but sometimes I feel like saying, "get off the  street, there's another way".  See here's the thing though, you can't have that conversation right off the top, there's a whole lot of conversations that have to come first, and those conversations can begin with condoms.  

The more we drive around, the more familiar we become with the girls etc on the street.  The more times we stop and offer condoms, the more contacts we have, the more likely people are to trust us, and trust is not an easy thing.  Conversations have to begin somewhere though!  I see so much value in this first step.  Our second step is that we have the opportunity to drive some of these people home, off the street.  Having them in our van gives us the opportunity to chat a bit, about nothing, or about something (this is how I learned just how creepy our van looks...)  A third step might happen if someone asked for help with something more serious, like getting into a shelter instead of going back home... but these steps take time.  

I can understand why people find harm reduction hard to understand.  Sometimes I do feel like I'm tacitly agreeing with the explotation of young women and girls.  More often however I feel like I'm doing something good, and that even though what I'm doing is small, it's part of a bigger picture.  There are lots of organizations out there to help, and if we can build a little trust, that can become so much more.  

and to think, it could all start with a condom...