duldrums

If you ask me, there's always a let down when you come back from vacation.  Sometimes I'm home sick, but not this time.  This time I just wanted my holiday to go on forever.  I missed Sophie cat, and my church, but really, I was soooooo happy to be away from everything.  

I'm full of feelings today.  I go back to work in 12 minutes or so, or well, that's when I need to get off the couch and start the car, but I'm just not sure I'm ready.  I feel like I could sit here, on this couch, for a few days longer and be quite content.  The thing about being full of feelings, is that I'm having a hard time naming them/identifying them.  I just feel... heavy.  

My therapist used to try and get me to figure out where I was feeling things in my body, we did tons of Internal Family Systems work (IFS) and it was incredibly frustrating to me.  I just was NOT that in touch with myself.  The rest of IFS was awesome and really changed me, but finding things in my body... well, if I had to find things in my body today, I'd say I felt all this in my head.  Maybe it's a sign I'm getting a sinus infection or ear infections, but I don't know.  I just know that I feel heavy and my head feels heavy and full.  

I kind of feel like this is a time when I should be reaching out to my support systems, but I'm not sure what I would say.  There's nothing actually wrong, I just know something's not right.  I think part of me is also hoping that once I get back to work and see my clients and catch up on things it will be better as well.  Maybe once I have a cup of coffee??  

(ps. that's me up there)

What I'm reading this week: Prozac Diary

Slater, L. (1999).  Prozac diary. New York, NY. Random House. 

I realize this makes two book reviews in a row about medication, and I promise the next one won’t be (although it is about healthcare, and then comes suicide, it is a social work blog after all).  I tend to have many books on the go at once, and I happened to finish 4 almost at the same time. 

 

I liked Prozac Diary.  I enjoy reading memoirs about people who have dealt with mental illness, disease, disability, abuse etc... I find that I learn a lot more from people’s stories then from any text book I’ve ever read or lecture I’ve attended.  That being  said, Prozac Diary was almost a little too “booky” for my liking.  I don’t tend to consider myself a linear thinker, but I’m beginning to think I like my books that way.  My main complaint about the book was that it jumped from past to distant past to present, and had some sections which seemed to be a bit metaphorical. 

The book talks about the author, Lauren Slater’s life as a child and then as an adult as she begins taking Prozac before Prozac became a “thing”.  After spending time in hospitals and trying a variety of the other medications out there, Slater finds that Prozac is her “answer”.  Almost immediately after starting Prozac, the author begins to find relief from her overwhelming OCD symptoms.  She no longer has to wash her hands multiple times or perform rituals simply to get out of bed.  Despite her doctor’s assurance that Prozac could not be working so quickly, Slater knows it has changed her life forever. 

 

By exploring Slater’s childhood, the reader learns that Slater’s issues began at a young age and were not precipitated by any one event.  However, it is easy to see how the author’s family constellation had an effect on her emotional wellbeing.  Through 10 years of Prozac we see Slater experience drug poop out, the party scene, a PhD and meeting the man of her dreams. 

 

While the book isn’t exciting exactly, it provides a nice middle ground, an “average” experience on anti-depressants one might say.  At the end of the book, Slater isn’t cured, and she still takes those little pills while struggling with the ups and downs of life and mental illness.  While it wasn’t my favourite, it’s definitely worth looking into if you or a client is struggling with the idea of taking medication long term. 

  

Oh how I miss Social Work supervision aka all the things I wish there’d been time to say

For the most part, I’ve been doing pretty well working without any proper supervision.  As I’ve said before, it’s nice not to have to over analyze every single little thing I do.  Most of the people I work with are completely uninterested in debrief and reflection and are simply there to do their job and go home again.  I really wish there was something more though.  After the whole CPR thing my boss got me to come “check in” with him about how I was doing, but it just felt, empty... So now, you get to hear all the things I wish I could have said to my boss or supervisor (oh wait, I was the supervisor that night... well, to my boss anyway). 

 

For starters, I feel like I handled the whole situation really well.  I’m quite proud of myself actually.  I’ve been put in this position of authority with no extra training, no extra feedback, no nothing, only “seniority” which really isn’t very much.  It’s just been expected of me that I’d be in charge, because I’ve been there longer than other people.  This particular night showed me that I can be a good leader, but that there are also areas that I need to work on.  Yes, the CPR/live saving/hero thing was a part of that night, but it wasn’t the only part of that night, and it was actually one of the least frustrating parts, if I was honest. 

 

I am not pleased with the way I treated one of my coworkers.  I’m not upset with what I did persay, because I think it was necessary, but I still wish I’d been able to do things differently.  Asking me about letting the drop in clients in for coffee when I’m literally in the middle of doing chest compressions just doesn’t sit well with me.  I’m sorry, it doesn’t.  And while I’m not a rude person generally, it’s hard for me to be polite when I have a guy with no heartbeat on the floor beneath me.  So, yes, I snapped at you, but seriously, can you say bad timing?? 

 

I’d love to talk about whether that was where I should have been.  I have a tendency to insert myself into situations, although I’m really trying to work on that.  As the shift manager, should I have been down in a drunk tank cell doing CPR when there was still the rest of the building to worry about.  If I’d been upstairs and sent this co-worker down, there wouldn’t have been any questions to snap at, but is it right to ask someone to do CPR? I mean, it’s part of our job, but I also know they’ve been a bit lax on that lately, and I remember him saying recently that he was “about” to take his training... I am confident in my CPR abilities (and managed to remember lots of important stuff – even head tilt/chin lifts).  So I felt like I needed to be there.  Plus, I sort of stumbled on it when I went to check on what was happening.  So, what exactly should the role of the shift manager be, or is it again situational, as I wrote about a few days ago. 

 

Finally, there’s the fact that only 1 in 7 people whose hearts have stopped and CPR is performed on will live.  So realistically, if this happens again, and if I stay at my job, it will, the person probably won’t live to try and assault the paramedics. 

 

Things to ponder, things to ponder...

I felt his pulse stop...

Most of the people reading this have probably taken CPR at some point in their lives.  Most employers require it these days and even if they don’t, many people take it for personal interest.  Most of the people reading this have never had to perform CPR... I used to count myself in that number. 

 

It always sucks to be short staffed on a Friday, and when it came to me to be shift manager on Friday the 13^th I had this nagging feeling that something was going to go wrong.  Of course, I didn’t want to be so convinced of this that it would up becoming a self fulfilling prophesy, but still, there was something that told me the night just wasn’t go off as planned... and it didn’t, but even though we were busy, things stayed calm until around six in the morning when I overheard the phrase “I’m calling 911”.  This is never a good sign as we try and avoid calling it as much as we possibly can.  So I went down to the drunk tank...

In the drunk tank, one of the staff had a discovered a c/n not breathing when they went to check on them (this being why we check on people every 15 minutes).  The staff member had already begun CPR and the client had started breathing again... and stopped again, twice.  So I joined in.  2 person CPR is SO much easier then 1 person CPR and my co-worker was just a little panicked.  And when I say a little, I mean he was definitely in need of a deep breath.  So I got him to do the breathing, because you have to take slow deep breaths. 

 

After the third or fourth time we revived him I felt his pulse with my fingers, to time it, and to reassure myself that it was there...and it was, until it stopped.  My co-worker started doing chest compressions and I could feel those, each one created a pulse of its own (which I find fascinating, even though I know that’s what it’s supposed to do).  I lost count, but my co-worker says we revived the man seven times.  By the time the paramedics finally got there he was sitting up, conscious, holding my hands as we breathed, in and out, together. 

 

Then the paramedics arrived.  And the guy FREAKED out.  It took six people to hold him down while they gave him some haldol.  I have NO idea what he was on, or how a person can go from no heart beat to seemingly psychotic within such a short amount of time, but he did.  I’ve never seen anything like it, and I hopefully never will again.  

Actions and Consequences

When I was a child, my parents taught me that there was a consequence to each of my actions, good or bad, and often, if I did the wrong thing, they were the ones to enforce the consequence.  For example, leaving my room in a mess despite repeated warnings to clean it up might result in not being allowed to watch TV until it was clean.  And more serious for me, my mom almost took my entire collection of books away because she caught me reading after lights out one too many times.  As adults, there’s no parent standing over us handing down consequences, but that doesn’t mean they are no longer there.  Bestest bud, for example, expected the house to be clean when she house sat this week and so because I hadn’t cleaned in ages I had to spend the two days leading up to my vacation cleaning like mad trying to make a dent in months of clutter. 

 

Many people believe that the homeless are simply living out the consequences of their actions and because of that they do not need our help.  Rather, they simply need to take new actions which will have more positive consequences.  If unemployment led to loss of housing, finding yourself employment will then lead to housing.  This way of looking at things looks at things on a more macro level and is easily generalized to many different situations. 

On a micro level however we look at individuals, their situations, their actions and what the consequences of those actions are.  It can become easy for my coworkers and I to take on a parental role (often quite unintentionally) and become the one who hands out consequences.  A client does something wrong, we punish them.  Sniff in the shelter, kicked out for 24 hours for example.  One would expect this to be a deterrent, but if losing housing wasn’t enough to force someone to find employment will 24 hours outside force someone to stop sniffing?  I think that’s what gets to a lot of us.  We kick people out over and over and over and over again, and they’re mad, really mad, and yet month, or a week or even the next day, they’re doing it again. 

 

One reason for this is addiction.  Addiction is very powerful.  I didn’t really just how powerful until I started working in detox.  I hear people whose hearts are just breaking because of the horrible consequences of their addictions, who want more than anything to stop, and yet are somehow still held captive by their substance of choice.  Further, after you use drugs/alcohol for a while your brain starts to go.  You actually kill brain cells and damage parts of your brain, including your memory.  Further you may not remember what happened as you “blacked out” from drinking. 

 

Another reason is FASD and/or other brain damage.  One of the frustrating things about working with children with FASD is their inability to understand the consequences of their actions.  This is true for adults with FASD as well, only we expect adults to have mastered this concept.  No matter how many times we tell someone, they may simply not get it (one of the reasons we tend not to use sliding punishment scales in which the punishment increases each time the action occurs).

A third reason people do not seem to learn from their consequences as we expect them to is mental illness, bet that depression, anxiety, schizophrenia or anything else along the spectrum.  It’s hard to care about the consequences when you don’t exist in the same reality as the one who makes the rules.  Sometimes a person can be so depressed they just don’t care, don’t care at all.  Watching that can be scary, people with zero regard for their own lives are not only a danger to themselves but to those around them as well. 

 

So, how then do we create a safe environment for all people?  

Situational Ethics: A Case Study

Jared is a man whose burned a lot of bridges, and when I say a lot of bridges, I mean it.  Jared is not welcome, ever, at any of the other shelters in town, and has been permanently restricted from many of the hotels, medical clinics and rooming houses along the strip.  There are not a lot of places left where Jared is able to go.  He’s been given a lot of chances, but this physically disabled man has done A LOT of horrible things in his life, and he’s not even all that old.  I mean, it takes soooo much to get yourself a lifetime ban from our services, and he did it. 

 

Of course, it is always possible to appeal your ban, and so with the help of a hospital social worker, he did just that.  See the thing is, when Jared isn’t drinking, or sniffing, or smoking crack or taking whatever the substance of the day is, he’s a nice guy!  However, he’s one of the very few clients I am actually afraid of, very afraid of.  See the thing is, staff have seen Jared sexually assault another client...but, since she didn’t press charges...

So, Jared’s back in.  He uses our services just like any other client and gets the same punishments for drinking/using in the shelter as every other client, 24 hrs out.  What happens when Jared sexually assaults another client, this time in the shelter, in front of witnesses and under a camera?  What happens when the police say there’s not enough evidence despite the camera?  There’s no charges, what do we do with Jared then? 

 

Personally, I want to see Jared out.  Out. Out. Out. Out. Out.  But, as I said before, I’m scared of him, and I like to defend the little guy.  Management doesn’t agree with me.  Management wants him to sober up.  See, the night of the assault, Jared spent the night on the street in frigid temperatures.  He begged ambulances to take him to the hospital, he tried to assault police so that he could get thrown in jail.  But no one would do anything for him.  By morning, Jared was a freezing cold, sober, sad person who begged my coworker to let him back in, just to warm up... and how could we not?  And then, then he said he didn’t remember a thing.  He claimed to have to memory at all of anything until sometime in the middle of the night when we wouldn’t let him in (looking at this, even my language shows my bias). 

 

So, what do you do in a situation like this?  Because it is situational... if it was summer, or if he wasn’t disabled, or if he wasn’t kicked out of everywhere else, or if he acknowledged wrong doing, or if there was better evidence, or if there were charges, or if, or if, or if...

 

Living on the streets is not easy, it’s really not... 

Situational Reactions (ethics)

One of the convenient things about having the drunk tank located half a flight of stairs away from the shelter is that when clients are intoxicated and behaving badly it’s very easy to have police or downtown watch who are dropping someone else of put them in there.  For the most part they’re fine to do it and don’t ask a lot of questions, they simply trust us that they’re being disruptive and need some time to sober up.  The thing is, that we of course do not have all clients who are not following the rules thrown in the drunk tank, and I was thinking about how the situation really determines our course of action rather than a set policy.  Some people might even call this situational ethics...

The last person I had put in the drunk tank was not so much being loud as just unable to settle down.  They were up and down (and all around) and despite repeated warnings, had not laid down to go to sleep.  This person was just stupid drunk, not particularly violent or insulting, but I have to admit, they were just plain annoying.  Factors which led me to ask the police to put them in there:  It was a quiet night so the drunk tank was not anywhere near full, it was really cold out so I didn’t want to throw them out in the snow, they were keeping other people from sleeping, I thought it would be really good for them to have a chance to become fully sober before using again (see and that, is where my bias comes in, what I think).  Another shift manager in my same situation might have simply thrown the person out, or, being more patient then me might have just allowed them to continue and given them some more chances until they sobered up enough to calm down.  

So, what’s the right answer?  When does having the drunk tank give us inappropriate power?  As usual, I’m not sure there is an answer.  I truly believe it all comes down to the situation.  Other people might disagree with me, looking instead for a black and white answer, but I really don’t think there is a check list of things that mean someone gets kicked out, locked up, or allowed to sleep.  That’s where experience comes in, and I often don’t feel like I have enough of it to be left in charge.  

update

I'm tired.  I'm going on vacation in two (2) count them TWO days!!!  I can't wait.  I also have good library books, and new shoes.  Things are looking up.  I have many real things to post about, but right now the idea of actually writing something seems rather daunting.  Instead, I'm trying to get my house cleaned up for bestest bud who'll be looking after the grumpy mass of fat and fur pictured above and get packed for my visit to best friend.  Just two more shifts and I'm THERE!!!  

self injury and personal bias

Self evaluation and reflection is a good thing.  It helps us become better at our jobs and it helps us become better people.  When I was in school we had to spend copious amounts of time examining our attitudes and our biases.  It's not that I've forgotten about that, but I had an experience recently that made me remember to be cautious and showed me an area I'm bias about.  

When most of us think about self injury/self harm we probably think about similar things as portrayed in the picture above (or maybe not, I know I do at least).  A young white female struggling with depression/body image stuff.  That's what most of the books are about, the population the studies have been done on etc... I've gotten used to seeing the evidence of self injury on females from all walks of life, but even though they say at least 10% of people who self injure are male, and that it's probably higher, I tend to miss it when it comes to men.  

I had a person come into the drunk tank who defied all my stereo types.  I was shift manager (yet again, sigh) and so my coworker doing the intake got me to come down and decide if we would accept this particular person or if we would insist the police take him to the hospital.  The only acute injury seemed to be a slightly bleeding nose, but, the shirtless youth, was covered in cuts and scrapes and scars.  My first though was that he was a gang member, who had seen a little too much action lately.  But as I talked to the police, and to him, it became evident that the cuts and scars were self inflicted.  And it really changed my perspective.  

I suddenly saw this man, younger then myself, as a victim instead of an offender.  Here he was, broken, and in pain, getting thrown into the drunk tank once again.  Maybe he is in a gang, maybe he does get in fights, but there's more going on there.  It gave me cause to think about WHY.  I got my coworker to write up a crisis referral suggestion for him to, while he may not use it, at least it's something...  

unexpected lessons

I have this thing when I'm shift manager.  I won't ask someone to do something that I'm unwilling to do myself.  That means that when it comes to the things I don't want to do most, unless there's someone else who wants to do them, I have to do them myself (except of course that time with the sour milk, but I just can't do sour milk, i can't, can't, can't).  Therefore when the person in detox called me and asked for a female to come unplug the girls toilet, off I went.  I really couldn't pawn that off on the other girl there... 

See the problem however, was that I've never unplugged a toilet in my life... I used a plunger, once, on a sink... I think?  So realistically, I had no idea what I was doing.  My coworker informed that I just needed to "stick it in there and push it up and down"... I tried, but I couldn't even make it move.  Thankfully, one of the female clients knew just what to do.  She came in and somehow it magically worked.  The plunger went up and down, then she flushed, and just like that, the toilet was working again.  I thanked her profusely.  

And so, thanks to work, I now know how to unclog a toilet.  I'm thinking of buying a plunger.  I'm not sure how I've been blessed with clog free plumbing for so long, but the luck will run out some time, and I'd like to be prepared, because somehow I don't think the Sophie cat will be much help.  

sometimes life lessons come in the strangest forms at the strangest times... 

label mania

I freely admit these days that I am addicted to coffee... not just any coffee in particular, but double-double's from Tim Hortons.  For those of you not lucky enough to live in Canada where this milk of the God's exists, that's coffee with two cream and two sugars (you can look it up, it's even in our dictionaries!)  Fortunately, I am also lucky enough to be able to afford said double-double pretty much every day of the week.  I also drink Starbucks, but it's more expensive, and quite inferior when it comes to coffee (except that Pike blend, I like that).  My clients however, are not always so lucky. 

Something I've noticed recently is the large number of my clients walking around with coffee cups from Tim Hortons.  Now often you here people panhandling who say "spare money for a cup of coffee"?  So I figured they were just actually buying coffee.  And seriously, with the way the coffee in the shelter tastes, I can totally, totally understand that.  To say the coffee in the shelter tastes bad, would be a serious, serious understatement... and since I've sampled the coffee at more then one shelter, I wouldn't be all that surprised if it tasted horrible pretty much everywhere... bleck.  

It came to my attention however that appearances are not always worth believing.  I discovered, that what many people are actually doing, is filling their cups with coffee from the shelter and reusing the same Tim Horton's cup over and over again.  Why would any one do this you ask?  Well, it actually makes a great deal of sense.  Having coffee from Tim's implies you have money.  Having money tends to imply that you're not homeless and that you are "worth something".  It's about the label and the brand name.  Just as kids like to sport the Nike shoes or whatever, these adults work on fitting in with society by carrying around their Tim Horton's coffee cups (which seriously, is a huge deal where I live).  

It's interesting when you think about it, the things people do to fit in... 

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...