old and drunk

Whenever pension cheques come out the drunk tank fills up with those over sixty five, many of whom are definitely elderly.  Some of them are still quite spry, but others are just WAY to old to be sleeping in a cold cell on an inch thick mat.  And yet, every pension day, there they are, drunk as anything and creating a fuss or making a "nusiance" of themselves somewhere.  Often it's as simple as they can't get themselves home because they're too drunk to walk.  I have one person who forgets to use her walker when she's drinking and forget's she can't walk well without it.  She holds it in one hand and carries it.  

And then, then there's mr. nicholas.  Somehow, he manages to get drunk almost every day.  He hobbles in with his walker, usually after passing out somewhere, landing at the hospital and getting picked up by the police.  Everyone knows mr. nicholas, he's a fixture.  And sadly, he has no memory left.  He often does not remember that he has an apartment in a nice area or even where that area might be.  What he remembers, is how to drink, and drink he does.  I'm not sure there's a record for drunk tank admissions, but I think he'd probably get it.  

What do you do with a person like that?  He spent some time in psych after being declared incompetant, but you can't hold him forever.  Once he was "stabalized" he was found really nice housing and set free.  He returned right back to where he was, drinking on the strip.  If he was placed in a nursing home I suppose he'd have to be locked in the way my grandmother is.  Only in her case, she thinks the nursing home is a nice hotel and that she still lives at home.  

The thing is, the guy is happy.  This is his life, and this is what he likes to do.  The problem is, it's a drain on the system.  He drinks, he passes out, someone calls an ambulance, then there's the hospital work up, then the police car ride and then the drunk tank fee.  And once he's released, the cycle starts all over again.  

and again

and again

and again

reflections on who I am

Today during yoga I was reflecting on things and I started thinking a lot about how shy I am.  Reading that may surprise some of you who read my blog, because I'm fairly sure that I don't come across as shy... or maybe I do, who knows.  

The thing is, my shyness doesn't come across in my work at all.  At the beginning of my first social work practicum it totally did.  I could barely say a word to the clients and picking up the phone was terrifying.  I'm sure my first supervisor still remembers me as the girl who would do ANYTHING to send an email instead of use a telephone.  Now though, I'll phone just about anywhere with barely a second thought... as long as I'm at work, and I'll talk to just about anyone... as long as I'm at work.  Same thing when I started volunteering with the homeless.  I stuck to talking to the people who made an effort to talk to me, I certainly never reached out, now I'm standing there at the door and sitting down at random tables.  But then, there's the rest of my life. 

It occured to me as I was walking to yoga, that the reason I still haven't manged to make it to a class I really want to is because I'm too scared of something new.  It's in a different room then my normal yoga and so I don't want to go there on my own.  Bestest bud came to my first yoga class with me, and since then I've been fine, but seriously, I sometimes feel like telling myself "get a grip".  I can't talk to the new people at church, I can't talk to clerks in stores, I can't even phone my own friends have the time.  It's ridiculous, and when my anxiety gets worse, so does the shyness.  I have no idea what I'm scared of, but it's paralysing sometimes.  

anyway, just some randomness about me as I reflect... 

Sophie cat takes a bath

Somehow my pictures posted backwards, the one at the bottom is supposed to be the first one etc... but in anycase, it was time to give the Sophie cat a bath today.  She REALLY needed one, she smelled all dusty/musty.  Maybe that's a sign I should vacuum more, but I'm going to blame it on the cat.  She was surpringly good in the bath, I just plunked her in with me (wearing long pants and long sleeve to prevent being clawed to death), closed the curtain and soaped her up.  She was pretty displeased afterwards though, as witnessed by these pictures (which she wouldn't pose for).  I think she's recovered now, but she wouldn't let me help dry her at all.  Apparently she thinks this is what her tongue is for! 

What I'm Reading this Week

I decided that since I read a lot I should start writing about what I'm reading if for no other reason then making me process what I read.  I often pick non fiction from the new non-fiction books at the local library and this book stood out to me because of the giant title.  The fact that entire cover is words should have given me an idea of what the book would be like... And so, my completely non academic review.  

Breggin, P.R. (2008). Medication madness: A psychiatrist exposes the dangers of mood altering medication. New York, NY: St. Martin's Press.  

This book made me laugh.  Not because of the subject matter, but because the author thinks he knows everything.  The book's subject matter, and indeed the intended tone of the book is infact very serious.  The psychiatrist who wrote it is completely against psychiatric drugs... completely.  Infact, his entire practice is about taking people off psychiatric medications.  Breggin also has a side business testifying in cases about what he calls medication spellbinding.  

Breggin shares case studies from his experience in which people have done crazy violent things while under the influence of psychiatrict medication.  He then, if they were still alive, took them off their medication and they became imediately remorseful and wondered how they could ever do such a thing.  I don't doubt these case studies existed and that Breggin has seen people do horrible things while on psych meds.  What I don't like is his black and white attitude.  

On the positive side however, it's nice to hear a psychiatrist talk about the over prescribing of psych meds.  Medications seem to be the answer to everything in this day and age and it's nice to hear a different perspective... especially from a medical practioner.  I do believe that medications are over prescribed and that psych meds can be seen as a fix all for everything.  I think it's awesome that Breggin has a practice which encourages people to try and come off medications and supports them while they do so.  Breggin also makes it very clear that he doesn't want his readers to cold turkey their meds unsupervised after reading the book, something that's very important.  

What i find lacking from the book is the discussion of schizophrenia.  I'm not sure he mentions the word once and it's not in the index.  I'd really like to know what he has to say about this confusing and frustrating disease.  I'd love to see what he would do with my client's from Assertive Community Treatment, and I mean that in all seriousness, not sarcastically.  I'm interested to know if he advocates that people who have been able to function in society because of their meds should be taken off them if they wind up sinking to a place where they sit catatonically and rock.  

So all and all, if you're looking to read something really anti medication or need to balance out a paper, this is a good book.  If you're looking for a discussion of pros and cons, head somewhere else.  

the end. 

self determination

I've noticed an interesting trend since I started working at the shelter.  I suppose in reality I understood the theory of this, but I never really understood just how true it can be until I started working.  

People need to make their own decisions.  

That sounds like such a simple thing, but it is HARD when you're watching people circling the drain, so to speak.  We can encourage, provide, talk etc... but when people are ready to change, they're going to do it.  

It's like this.  We have a detox program.  Many of our regular shelter clients have gone through it time and time again.  It's easy for them to get into, and because it's in the building it's not necessarily a step out of their comfort zone.  They come in, take a break from using, sleeping in a bed and eat real food for a while and then after their ten days are up it's back to the street and the substances.  This can be a good thing, and it's an important part of harm reduction, but it can be frustrating to watch.  

The thing is though, when the clients really want to change, when they want to stop, they do.  Without any detox at all!  Yesterday one of my clients was very excited to show me that he had tremors, this showed he was in withdrawl, and he did it all on his own.  

Another example is housing.  We try very hard to encourage people to find housing, we have a special staff person who'll help them find it, we have housing resources etc...  when people want a place, they find it.  If they don't, nothing we do will help.  I think people are generally a lot more resourceful then we want to give them credit for!  

So, the lesson to be learned?  Don't beat yourself up when people won't change the way we want them to.  If it's right for them, they'll get there. 

why they stay

I tried to blog last week about how hard it is for people to leave the shelter... it didn't come across quite the way I wanted it to though.  I really shouldn't blog when I'm so tired my eyes keep closing.  So, my thoughts on why people don't leave the shelter...I'll get to empowerment later, or another day.  

1. The shelter is "safe".  

Interestingly enough, the opposite of this is why some people won't come into the shelter - they're scared and find them dangerous.  The shelter is safe because there are always people there, there are staff to take care of things and your friends are literally right beside you.  Living in a rooming house or an apartment on the other hand, who knows what's going on.  If you're lucky, there is one security guard for a building with 18 floors... most have no one.  

2. The shelter provides structure.

Again, something people don't like about shelters.  At the shelter there's a schedule and you have to follow it, you have no choice.  For people who grew up in places like residential schools and group homes, they may have always had a structured life.  Living on their own brings a lack of structure which can be overwhelming.  

3. The shelter provides. 

Most shelters provide food and clothing - at least in limited quanities.  They also provide staff who listen and pay attention (for the most part).  

4. The shelter is tolerant (at least our shelter)

This varies from place to place as every shelter has different rules.  Some shelters have little tolerance for anything, but ours tolerates pretty much anything.  While we don't allow drinking and sniffing in the building, the punishment is just a 24 hour suspension and you're allowed to come in intoxicated as long as you're quiet.  We'll put up with your unwashed body, your long hair, your talking to yourself, your parania, your lack of emotion, your mania, whatever it is, we'll deal with it.  

5.  Finding a place is hard

For me, finding an apartment is a chore, but realistically it's not that hard.  For starters, I can read, which means i can read the for rent adds.  I have ready access to a phone and voicemail so I can leave messages about viewings and have someone call me back.  I have a semi flexible budget and can afford a little leeway with my rent.  I have money in the bank for a damage deposit.  I have good references, and my parents still cosign for me if necessary.  For many people moving into lower income buildings they are required to provide first and last months rent as well as a damage deposit.  This can seem unreachable for someone on a fixed income living on the street.  Further many of the street people aren't recieving any social assistance at all and must first overcome that hurdle.  

6. Addiction

Many people on the street have serious addictions.  It's hard to give your money to rent when you know you could buy (insert your substance of choice here) with it.  Whatever we label this, it's a hard truth of a large percentage of the population in the shelter.  Further, many people get evicted time and time again for consequences of substance use making finding a place harder and harder. 

7. Mental Illness

People living on the streets have a higher then average rate of mental illness.  For those of you who've been depressed, you know how hard it is to do anything, anything at all.  Getting off your mat, going out, and looking for a place to live can seem totally unmanageable when faced with overwhelming depression or anxiety.  Then of course we have uncontroled psychotic disorders; living in another reality can mean housing doesn't figure into anything for you.  Overmedication is another problem and someone recieving large amount of Haldol (because yes, people still do take Haldol) may have trouble moving at all, let alone moving in somewhere.  

8. Family Atmosphere

Some of the people I work with have never been alone.  They've had large families, been in foster care, lived in group homes or residential schools, spent time insitutionalized and in hospitals and have never, ever, been completely alone.  It can be incredibly disconcerting to suddenly be all on your own when you've spent your entire life with other people.  However, moving in with friends can backfire too as if you've never learned to "work and play well with others" without the staff to act as referees you may find yourself in over your head. 

9. Lack of life skills

I've definitely posted about this before.  Imagine if no one ever taught you to clean a toilet, boil water, read directions, make your bed, do laundry etc... What if no one ever taught you how to mop the floor, that things need dusting, that food goes back when left on the counter.  How do you learn how to do that stuff?  And then of course there's the money thing.  When living on a fixed income budgeting and being thrifty tend to be important.  Spending all your money on the first of the month may seem like a good idea at the time, but how do you get through the rest of the month.  I definitely learned skills like this from my parents (much as I don't like to admit it) and can't imagine not having thing. 

10. Lack of decent affordable housing

Then there's this one, which becomes more political.  There is no good housing for the amount social assistance gives for rent.  Actually, there is NO housing for this, the most you can hope to get is a room in a falling down rooming house with a common bathroom, or perhaps a room in a hotel that literally holds just a bed.  Then of course there's the bed bugs, the mice etc... Many of these places are extremely dangerous besides just being completely disgusting.  I'm not sure i could walk down the hall to the bathroom in the middle of the night... There are some options in terms of government housing, but the waiting lists are 2+ years long and there are still bedbugs, and mice, and danger.  The only difference is the lone security guard sitting on a chair in the entry.  For all the shelter is gross, there are no bed bugs and it's disinfected every single day.  

and there you have it.  10 reasons that people stay in shelters, or at least in the shelter I work at.  

crazy dream

 I have always had really vivid dreams.  It sort of goes in cycles for me.  I'll have crazy dreams for a few weeks and then not remember a thing for months, then come to a dream cycle again.  I also have dreams when I hit the snooze button, and that's where this crazy dream came from.  

I walk into church late.  The theater is quite full (my church actually does meet in a movie theater).  I have to go quite near the front, and I discover that my friends did not save a place for me to sit.  I got to sit down infront of them when I realize the roof is leaking, drip, drip, drip.  So I sit down a little ways over.  

As I try and join in the singing I notice that we have a whole new sound system set up and our projection is really quite intense.  Instead of just having the words to the songs on the screen there are people or cartoons doing what the congregation is supposed to be doing.  Unfortunately, the people on the screen are not clapping at the same beat as the song and it is driving me CRAZY!

The next thing you know, someone says my name "Still Dreaming"!  I can't figure out what they want, but it's obviously urgent.  Next thing you know everyone is screaming my name, urgently, as if they want help, or want to alert me to something.  I can't figure it out.  Then people start pouring out of the doors at the top, running from the theater.  I finally realize that there must be a fire, and shout "fire".  I try and evacuate the first three rows of the theater as well as the worship team at the front.  We can leave through the door at the front.  But, the worship team doesn't want to go.  Our drummer doesn't want to leave his drums and everyone else is wandering around in a fog.  

The movie theater people come in with a big vaccum which somehow ends the crisis and people come in again.  I say to my friend "was I on fire"?  Is that why you were screaming my name?  They have no answer for me.  Then there's some other stuff involving a video and some random people I know, but it wasn't freaky.  No, the freaking thing was every screaming at me and wanting something.  

Oh, and in my dream, after I hit snooze one more time I started interpreting it as a giant metaphor that I had to tell my pastor about.  Still asleep and dreaming, I figured out that the people screaming at me, instead of yelling "fire" is supposed to represent people coming to him with concerns and questions and without being specific wanting him to fix things.  My pastor thinks it's about how I'm going to be a minister later in life and it's actually about baptism by water and fire (which does actually make sense).  

So anyway, that's my crazy dream.  Just thought I'd share, for something different from all this healthcare stuff!  

sick and homeless

This week seems to be healthcare week on the blog, or maybe ill health week, or something like that...  The image on the left is rhinovirus, or the common cold.  One of those things we all get, all hate, and most of us get over pretty quickly.  I've been blessed enough that I haven't had a cold yet this winter (no wait, I did, that one I had before I got strep throat...) In anycase though, whatever cold I did or didn't have is such a distant memory that I can't remember it (what a sentance).  

There are a lot of things most of us take for granted when we're sick.  Things like being able to buy ourselves some cold medicine, make some tea and curl up in a warm bed - even if we do drag ourselves to work.  We can look our symptoms up on the internet and get an idea of what's what (although this can backfire...trust me).  Most of us have friends or family who can drive us to the doctor, or the hospital if we're really sick.  People who'll help take care of us or our families if we need a little help.  Gosh, most of us know that if we've got a stomach bug we can at least have the privacy of our own bathroom to puke our guts out in.  

When your homeless, things change.  Homeless shelters are definitely NOT the place to be staying if you're sick, but for some people there are no other options.  I have a client right now who has cancer and has to have some major surgery.  She and her partner are looking for a place to live because once she gets out of the hospital recovery will take some time and she knows the shelter really isn't the best place to do it.  We try and be understanding of people's dificulties but the fact of the matter is we are only open 21 hours a day and people need to find someplace else to be during those 3 hours.  

Another thing about the shelter is how germs spread.  While we do our best to keep things clean the truth is people are still sleeping on mats side by side on the floor.  So when one person gets sick, well, everyone's getting sick.  That's one thing about the shelter, it's never quite.  There is always someone coughing, wretching, gagging etc...  One night there wasn't and I was worried and when around and checked to make sure people were breathing, fortunately it started up again.  

Recovering from being sick is a lot different when you don't have a safe comfortable place to do it and when you don't have healthy nutrious food to eat.  Illnesses seem to last longer or just never go away.  I know for some of my clients they haven't felt "healthy" in years.  

once again, a post with no answers... 

health issues and homelessness

Everyday I am amazed by the number of people who come into the drunk tank with serious health issues who are on no medications other than pain killers.  When a person is intaked we have to ask them about health issues as well as their medications so that if anything happens we have complete information to give the paramedics and we can chose to monitor them more closely if we're concerned.  

The one the bothers me the most is the number of people I work with who have untreated HIV.  Of course, there is no cure for AIDS, but in today's day and age there are effective ways of controlling it. Antiretrovirals should be assessable for everyone in Canada considering we have public heathcare and government funded prescriptions for those who cannot afford medications.  And they are, but there's a segment of the population that is totally missed.  I'm not going to blame this on the healthcare system.  Well, that's not completely true, I think there is more the healthcare system could be doing, but I also see tons of good things going on and this isn't going to turn into a rant about the heathcare system.   

Today, I'm going to write about personal responsibility.  Oh, I agree there are many barriers facing the homeless, and I will write for hours about them, but not today.  The truth is, people need to take responsibility for taking their medications.  Of course there are a variety of reasons why they don't, but seriously, if you're HIV positive, take your meds, it's really not that hard!  If you don't have meds, go to one of the MANY clinics available to you and get on some.  

One sad fact though, after talking to some people about this, one of the reasons many people don't take their meds, is because they don't care if they live or die, or they simply want to die.  Many people are so beaten down that they just don't care anymore.  You can't make someone care.  A doctor can prescribe all the meds in the world, but they can't make that person fill the prescription, and even if it's filled, they can't make them take their meds.  We can provide all the HIV education in the world, but it doesn't provide a sense of self esteem and self worth.  

Health is a lot more complicated then diagnosis and prescriptions... 

frequent caller

  One of the things we try and work on at the shelter is cutting back on the number of 911 calls and wasted emergency room visits among the homeless.  Studies of my city have shown that there is a group of homeless/mentally ill/both citizens make up an average of 1 in 7 visits to the downtown hospital and each one comes in an average of once a week; mostly for non-emergency situations.  We try and help people find other ways to deal with their situations.  

Right now though we have a client who is seriously abusing the 911 system which is of course a strain of resources and costs the public a whole ton of money.  It's one thing to call 911 because you have a real emergency, that's a good thing, that's what it's there for.  Then there are the people who call 911 for non emergencies because they have no transport to get to the hospital or don't really comprehend the non-severity of the situation.  Then there's calling 911 and making up complaints for an unknown reason, that's what this client is doing.  

The most likely reason the client is doing this, is that they need something.  The thing is, calling 911 telling them you can't breath and getting an ambulance to the hospital doesn't provide anything in the long term.  When you're hurting, and lonely, and lacking personal attention this works really well, in the short term.  You get paramedics, nurses and a doctor (or probably nurse practitioner) looking after you.  In the short term you probably get at least a bit of TLC.  Although, if this is the 5th time this week tempers may be getting shorter.  We're trying to work with the emergency call center to cut down on unnecessary ambulances, but then this client just goes to another drop in, and there are many in the area.  So what can be done?  

There's no easy answer in a situation like this.  Obviously the 911/hospital system is not the place for this client to have her needs addressed, but I'm not sure that such a place currently exists.  If group homes were actually group homes that might work, but warehousing her somewhere else really won't do any good.  I think maybe we should give her the number of a crisis line and see if she can call that sometimes instead of 911, and we should also try and pay a little attention to her.  

What will happen, is that social assistance will stop paying her ambulance bills, she'll wind up with a huge amount of debt and start getting less and less on her welfare cheque.  As this will give her less money to fund her substance abuse this may actually get her attention.  However, there are other ways of getting alcohol and again, it really doesn't address the route of her problem.  The hospital staff will get sick of her, and she may resort to more extreme measures to get the attention (or whatever it is) she needs.  

This post has no answers, only more questions...