(Almost) Back

So I’m back in the real world (and the blog world) after a (mostly) lovely Christmas vacation. AM is still off, so the kiddo is home with him today, meaning that my first morning back run-around was significantly simpler than usual. Between that, and the lighter holiday season traffic, I was at work pretty early. So early in fact, that, ah, there was no one here…and the door was locked. There was a Very Helpful Sign on the door that said “Dear tenants, the building will be closed on December 27 and 28, 2010 for statutory holidays.”

Uh, yeah. See Christmas and Boxing both fell on a weekend this year, so there apparently had been some variation in how companies worked this out – my agency gave us Friday and Monday as stats, and the building company apparently decided that Monday and TUESDAY would be better. I returned to my car, and parked with a view of the door to see if anyone else showed up. They did, and apparently had some super-secret, special way of getting in the building (how was I to know that our swipe cards would work for the outer door too?) and I followed them in. So everything worked out, but for arriving so early, I won’t also get to leave as early as I thought I would at end of day, since I didn’t start working until later. *grumble grumble*

Can’t wait till Friday, when we’re off for New Years. And at least I’ll know what to do NEXT week when the building will be closed on MONDAY.

No more sleeps

Today is my last day of work before I take some much needed vacation time. It's been a busy week (as usual) and I've tried to ensure that I would have everything in order before I went away, as I didn't want to spend today rushing to finish. I had a nice, quiet office day planned, with only one in office intake, and a supervision meeting in the afternoon. So I admit it: when I walked in this morning and saw my phone flashing with a voicemail message, I rolled my eyes. My brain wondered what kind of emergency or last minute mini-crisis was going to disrupt my day...

Turns out, it was just a client calling to say "Merry Christmas!"

Worry? Me? Nah.

Voicemail left by a client:

"…I know I asked you for that taxi voucher thing last week so I could go to the food bank? But I was just calling to ask you if I could use it to go to my doctor for my stomach instead, I can get to the food bank, I don’t know if you know that guy George? He’s that kind of blind guy that goes there a lot, but he drives around and I can get a ride with him. So I just wanted to call you to tell you don’t worry about it. Call me back!"

How Time Flies

It's started. I'm writing January 3, 2010 2011 on client appointment cards. We'll see if I can break the habit sooner rather than later. Mid-February would be impressive!

National Day of Remembrance and Action on Violence Against Women

December 6. I couldn’t let the whole day go by without remembering that it has been 21 years since the Montreal Massacre at Ecole Polytechnique. Vigils will be held across Canada today to remember the woman who were killed or injured, and to recognize the National Day of Remembrance and Action on Violence Against Women.




Throughout this year the ongoing debate about the long gun registry has reached a fever pitch. The registry was put in place after the events of December 6, 1989 in hopes of preventing future tragedies. I hope this story doesn’t trump important discussions of femicide and violence around this time.



It seems more encouraging to highlight things like the December 6 fund, an initiative of the YWCA offering interest free loans to women leaving violent and abusive homes. We know that finances are one of the major reasons that women may not leave an abusive relationship. Initiatives like this that offer women the opportunity to use their own ideas and skills to create a new life are invaluable. I’ve known a couple women who have benefited from this fund, and they continue to be grateful.



So here’s to an end to all gender-based violence, and a rose to remember the women who have suffered it.

Let it...

Hmm, first major snowfall of the year.  I'm gonna go out on a limb here and bet that my new intake is going to be a no-show.

December Rush

December is here, the busiest time of year for many. Those of us working in social services are certainly not exempt (it’s not as bad now as when I was working for the Salvation Army, but that’s a story for another day) so what a time for by Blackberry calendar to stop synching properly!


I’ve already been double booked once due to this technological fail, and as a result had to beg on hands and knees to get a taxi approved for my client so she can go to the food bank before Christmas.

Only 15 days until vacation…

Que Sera

Finally got word that my current contract position will not be extended. Up until now, there was some vague possibility that it would, and I admit, I hung onto that hope pretty tightly! Ah, c’est la vie. I will still be employed, but it means going back to a position that I’m less than enthusiastic about. It’s no shock, but still a disappointment.


Of course, just as I started to despair about this, a lovely little job posting showed up in my mailbox notices today. Time to refresh that resume again! Sometimes I just need a little sign to remain hopeful and positive, and I guess this is it, teeny tiny as it may be. Wish me luck.

The Most Valuable Currency a Social Worker Has

NO! I do NOT have any more bus tickets, so STOP ASKING!

So much work to do...

"My husband when he was alive would get violent. It was abusive. But it's okay - it's normal."

Beware those California Crazies!

I have to re-assess my clients twice a year. At that time they are given the opportunity to assess themselves and their own progress. They are given a questionnaire which they can fill out by themselves, or work through with my help. Some questions beg more interesting answers than others. A couple of my recent favourites to this question:

Is culture (heritage) an important part of your life?

(speaking to me)
-“Damn right!” (rolls up sleeve to show me tattoo of the Scottish flag)

(written answer returned to me)
-“Not really. You could be from California and still be mental.”

I can't believe I made it to...

Seriously.  I really didn't know if I would stick to it with this blog long enough, but I'm glad I have.  I still find it cathartic and enjoyable to post into the great nether-world of the web my daily notions and mutterings to an audience of whomever happens to stumble across it.  That's good enough for me! 

I thought that to mark this special occasion, some good news was in order.  Edmond Place in the Parkdale neighbourhood of Toronto will be having an open house this week.  This remarkable housing project was completed in only three years due to community collaboration and support from the municipal government.  The project is named for Edmond Yu, a man with paranoid schizophrenia who lived in the building when it was a derelict rooming house in the 1990's.  He was evicted, and was later shot and killed by police when he caused a disturbance on a city bus.  The building suffered a fire in 1998 leaving many more homeless. 

I sincerly believe that supporting people with mental illness to stay safely housed can help to avoid such tragedies.  Of course there are other benefits as well - Saving money to the health care system, safer neighbourhoods, community and dignity for the people living there.

I look forward to seeing more projects like this.

Waitlists...

...are the bane of my existence. I hate the look on people's faces when I tell them it will be a year until they can get service.

Free Giveaway

A client of mine was recently given a couch by a neighbour. It was in good shape, and she badly needed some new furniture. She had arranged said couch in her living room, and been enjoying it for a couple of hours, when she noticed the sound of some muffled meows.


This client does have a cat, but she could see him pleasantly napping on the other side of the room. After a few moments confusion, she realized what was going on – the neighbours cat was stuck IN the couch. She pulled off all the cushions and fished the poor thing out from within the structure of the sofa. Apparently, the feline was none the worse for wear, and was safely returned to his owners. The neighbours swore up and down that they had no idea he was in there.

Drinking and Driving (seperately of course)

Note to self: remove all Beer Store receipts from the passenger seat before transporting a client.

*headdesk*

Also...

I updated the blogroll, which was loooong overdue. If anyone knows of some stellar mental health/social work-y themed blogs to suggest, I'm looking to add more.

Worth Reading?

We were lied to, it's true. The paperless society we were all promised sometime back in the mid-90's never came to be. Unfortunately, some people slacked off and decided that it wasn't worth developing legible handwriting since it was supposedly going to become obsolete. Not so, my friend. I only know who you are because your chicken scratch is so distinctive, and also because you refer to us frequently.

Since we are such good friends, maybe you could help me out. On the referral you sent for "Deerkani Ssghur", on "Oct 27/2u10", you indicate that the reason for referral is "To mountain mental lealth, stubilix, incrcase activation. You also note a primary diagnosis of "Dszchxtie NOS". Now, since I've known you and your handwriting for so long, I think I can make out most of what you meant, but please tell me, what are we activating? Admittely, I'm a little scared to find out.

Your cooperation is appreciated, and we look forward to working with you again in the future. Tkhks for yuur timme.

Who'll Be the Lucky Winner?

Following the disgusting and disturbing trend of cosmetic surgery as acceptable self-improvement method, à la Bridalplasty, I just heard a commercial on the radio advertizing that a local night club is offering free breast implants as a raffle prize tonight. Please note the picture of the conventionally attractive, slim, young, white woman with the breast that seems to be bigger than her head, apparently advertizing said prize. Message received: big boobs=HOT, and we women will should seize any opportunity to be HOT. It’s what WE really want. It makes us happy.

I can’t even begin to discuss this in a reasonable manner, so I’ll just assume everyone here understands why I think this is offensive and ridiculous, unless I’m informed otherwise.

I’d rather have the motorcycle.

TGIF

I woke up. I was dark, and I had to pee. Shuffled my feet along the cold, cold floor with my eyes half open, making a point of not looking at the clock. I know that if I look at the clock and see the time, my brain will start calculating how many hours and minutes of sleep time are left, and I won’t GET back to sleep. I’ve learned this lesson well, and have my shuffle to the bathroom down pat at half-asleep mode.

Get to the bathroom, head back to bed and JUST (just!) lay my head down when the alarm goes off.

No kidding.

Downstairs a few minutes later and still more or less asleep, I poured juice onto my cereal. That’s what sort of day it’s setting up to be.

Daylight savings time cannot end soon enough!

Suggestions Needed!

Is there a proper term for the buzzers in apartment buildings? The other day I caught myself writing this in my client notes: “I buzzed Charles* unit, but there was no response.”

Uh, that does NOT sound right. I changed it to “I buzzed Charles apartment” which is definitely an improvement, but I’d still rather use another word! Since I tend to rely on repeating simple phrases as a way to make my note writing go more quickly, I can’t help but wonder how many times I’ve written that sentence in other client’s notes. Oh dear.

Help, anyone?



*obviously not his real name

Really? Cuz that would seem to take all the fun out of it.

“I would die to be a 30”




Overheard at work, one of my co-workers, participating in our office’s “Biggest Loser” challenge.



I find this type of statement so disturbing, particularly from social workers. Am I wrong to think we should know better?

Dia de la Muerte*

I think I have a halloween hangover.



 

It SNOWED yesterday, and was freezing cold, so we didn't get as many trick or treaters as last year. Lots and lots of left over candy. Too much of it consumed by me. At least I deserved it - I was more dressed up that a lot of the kids!



*which I realize is actually Nov 2 *shrug*

For Hire

In my travels around town today, I drove past a plaza with one of those temp agency jobs places. On the street corner at the end of the plaza was a middle aged guy walking around wearing a weather-beaten and very sorry looking bristol-board sign advertizing “Jobs! Jobs! Jobs! AAA-111 Employment Agency!!!”

Somebody drew the short straw at the jobs office this morning.

Queue Jumping

(winding up a lengthy intake assessment) …our program has a twelve month waiting list right now. I’m going to take your information to our intake committee, and I should be able to call you within the next week to let you know if you’ve been accepted.
Mr. Konfused: so I start next week?

*headdesk*

Peer Reviews

I just got two requests to do peer-reviews for my co-workers. This will make #8 and #9 that I have done this year. When we do our yearly evaluations, we have to submit the names of two co-workers that we would like to submit an evaluation. If you want to provide useful input, they can be quite time consuming.

I understand the importance of these reviews, but I’m getting a little tired of them. And to be honest, I’m not sure why everyone keeps picking me! I know that I am friendly and personable with my coworkers, but around the office, I tend to stick to myself. I never have quite warmed up to this place, or the idea of working in a setting that is not expressly a shared team model. Also, it’s not really my thing to share a lot of personal information, or gossip. I’ve always been someone who listens from the sidelines.

So why do they pick me? I don’t know. Perhaps I appear to be a neutral party? Maybe they think I’m “nice” so I’ll just say good things? Perhaps they get that I’m thoughtful and introspective, so feel I will give them a worthwhile evaluation. Or maybe it’s just a coincidence.

All I know, is it’s another stack of paperwork to add to the pile.

Fill In The Blank Friday

From the little things we do via Social Worker Mom:

1. I am doing a poor job at focusing on my work today.
2. I wish it was 5:00 and I had a big bottle of wine already.
3. I like red wine.
4. I can sing really well.
5. I hope it’s not this bloody cold all weekend.
6. I think I should get back to work.
7. I was going to finish some notes, but I got distracted.

Anything Else to Add?

Check all that apply:

Concurrent Disorder (Substance Abuse)

Dual Diagnosis (Developmental Disability)

Other Chronic Illness and/or physical disabilities

First time I’ve checked ‘em all. Oh yeah, and throw in an Acquired Brain Injury to boot. For a guy diagnosed with Bipolar and PTSD. Actually, truth be told, I'm kind of surprised it took until now.

Standard of Care

I’ve been absent.

Thanksgiving weekend was spent mostly in bed, feeling sick. I took the Friday before and the Tuesday after off work, all for a stupid little cold.

I think work burn out had something to do with my reduced immune system.

One of my clients has recently been diagnosed with cancer, and I’ve been putting a lot of energy into supporting him. Practical stuff has been taking up most of our time – getting to appointments, arranging new supports, making sure he has food in the house. I saw or spoke to him 2-3 times every day for about three weeks.

One bright spot in this experience has been visiting the oncology unit. That sounds so wrong, but wow! What a difference from the mental health units! Prior to this, they were the only parts of this particular hospital I had been in.

I walked in to a sunny, bright reception area. The nurses’ desk was open, and there was somebody to greet me, who actually looked me in the eye, and didn’t just pretend that they couldn’t see me through the glass while they type away on their computer. In fact, there was no glass! The nurses were happy to admit me in, without having met me before.

They came over to check on my client while I was there speaking to him. The nurse introduced herself, and talked about how we could support him together. My client had lots of space and privacy (well, as much privacy as a curtain can offer, but still…) while he received his chemo treatment. When leaving, the nurses told me to call if I needed any information.

I did call later in the week, and someone got back to me the same day with helpful information. The following day when I went in with my client, the nurses remembered who I was, and helped us right away with what we’d come for.

Everything about this experience is the polar opposite of how things go in mental health.

It really makes me wonder about how the treatment of these different (although some times the same) patients is valued, and what are the expected outcomes.

Cloudy Day

Inspired by this post over at Social Work Blogs, I decided it would be fun to make a Wordle of my own. I decided to use my client notes for the month of September.

A couple things I found interesting. The words that turn up frequently in my notes seem very formal: scheduled, meeting, information, reported. If I were to do a wordle of the words and phrases often used to describe mental health work, I bet it would look very different. Also, I decided about half way through the month to break my habit of using “client” instead of a person’s proper name. It’s an out dated practice, and a bit of a hang over from when I used to write notes in third person. I’ve gradually been shifting out of that mode since I did a bunch of legal & documentation training where I learned that it’s really not necessary, and often confusing. If I took notes from any previous months, the words Client and client would have been twice as enormous. By the same token, I learned at that training that “stated” is a valuable tool, because it makes it clear that you are not directly quoting the person, and also that you are reflecting their own ideas and not imposing or assuming anything. Obviously, I use it a lot.


The prevalence of certain words reminds me just how much I rely on a certain set of phrases and terms to help me get through my notes quickly, and hopefully write them in a way that will be clear to others.

I could go on a lot more, but I realize this analysis probably a lot more interesting to me than any one else! Identifying information has been removed, natch.

Good Advice

(my coworker, Ms. Calmtone on the phone with a client)
No, it’s pretty nice outside, I don’t think you’ll need a jacket.  Just a shirt…yes just a shirt…(long pause)…yes, please wear pants too!

At which point the whole office cracked up, because we had all tuned in.  Remarkably, Ms. Calmtone kept her cool until she hung up the phone.

Buckle Up

So here’s the story.Sometime last week I got a call to do a telephone job interview (yay!) at it was arranged for Monday at 12:30.  Since I had a client appointment right before that, I figured I would book my ‘lunch’ on my calendar at the office, and take the call in my car.

So the day came, and I motored on over to one of my favourite parking spots (somewhere I’ve pulled over for actual lunch many times before) only to find the lot COMPLETELY full of cars and trailers for some movie shoot that was happening in town.  Crap.  I scrambled to figure out another quiet place I could go, that I could get to quickly enough to avoid missing the call while driving.

I pulled in to a local park where my only company seemed to be a couple dog walkers and a woman reapplying the chalk lines to the baseball diamond.  With minutes to spare.  Perfect.

So I start arranging myself, getting out a notepad and pen, a copy of my resume for reference, a bottle of water, put the seat into a good position, everything.  I review the job posting that I originally replied to, and make notes of a couple questions I might ask them.  I am soooooo organized.  And then I wait. 

The clock switches to 12:30 and I definitely have little butterflies in my stomach.  I know that I interview well face to face, but this is my first time interviewing on the phone, and I’m nervous.  This would be a good time to disclose that I actually have a LOT of anxiety around the phone.  Making calls and sometimes even answering calls takes a lot of energy for me sometimes.  My ultimate dream in life is to get a job where I have a receptionist, and I never have to answer the phone again. 

To push this all out of mind, I put on some music.  Pantera (not my CD) comes blaring out at me, and I quickly switch to something more soothing (John Lennon, New York City).  Unfortunately, I’m noticing that the butterflies in my stomach have transformed into an increasing need to go pee.  Oh well, the interview I was told would only take about 20 minutes, I can hold it.

But now it’s 12:51.  Still the phone has not rung.  I open the car windows slightly in order to get some air, and hum along to ‘Real Love’ to calm down and distract myself from the discomfort of my bladder (sorry, tmi?)

Just then, I hear the wheels of a car rolling up behind me, and turn around to see – what else – an approaching police cruiser.  Great.  My first thought is “did I miss a ‘private parking’ sign somewhere?” followed closely by “oh shit, what if my interview calls and I have to tell them I have to finish some business with the cops before I can speak to them?!?”  Not a good first impression.The officer came up, and I rolled the window further down.  He asked what I was doing there, and I told him I was waiting for a phone call.  This had to have been plausible, as I was sitting with a blank notebook open on my lap, and a cell phone ready in hand.  He asked to see my license anyway and I obliged since I really just wanted to get this over with, and also was pretty sure I had nothing to hide.  He took my card back to the car, while my eyes darted back and forth from the clock on the dash to my phone, clock, phone, clock, phone.  The officer returned my license and told me to have a nice day.  As an aside, I will keep this “waiting for a phone call” explanation in mind in case I’m ever approached by police again.  I figure since the ban on cell phones while driving has been instituted, they’ll consider this a smart choice on my part.By this point, it’s almost 1:00 and still no call. 

I get out my blackberry, and check the emails that had been sent back and forth confirming the date and time.  Yup, I had all my information correct.  This provides little reassurance, and in any case, I can’t really think about it because now I REALLY need to pee.

Fortunately, my parents live nearby so I decide to take a chance and drive over to their place to use the facilities.  I connect my phone to my Bluetooth just in case.

At mum and dads I’m feeling better after a quick trip to the loo, but the discomfort of needing to go has quickly been replaced by sheer panic about this interview. I log on to my parents computer and check the emails again.  I also look up the number of the woman who was supposed to call me, and decide it’s time I give them a ring. I dial the number, punch in the extension and…the voice mail is full.

Hmm.  Maybe she’s not in the office – should this make me feel better?  I there anyone else I can speak to?  There is no operator, and I don’t want to call through the crisis line.  I settle for sending an email along the lines of “I waited for your call but it didn’t come and I’m hoping we can reschedule because I’m still really interested in this opportunity I hope everything is okay and please let me know if there is anything I can do to resolve this situation have a nice day I’m just going to remain calm and remember that you don’t owe me anything and the ball is really in your court so I’ll bite my tongue about what I’m really thinking and I hope you notice the very professional tone of this email and feel impressed enough to call and offer me a job right away”.  Or something like that.

By Tuesday, I’d had no response.  I was sure of this after checking my email about a billion times.

I tried calling again, and this time I was able to leave a message.  What did THAT mean?  Presumably this woman was in the office enough to check her messages, so didn’t she read her email?  I did my best to sound professional in the voice message.

It’s now day three, and nothing.  WTF?  Maybe I don’t even want to work for these people – they clearly don’t have their shit together.  Except I haven’t totally given up hope yet.  But WHY oh WHY did the first response I’ve had to a job application in over A YEAR have to go down like this?

*sigh* If anything else does come of this, I’ll keep you posted.  If not, well… 

That About Sums It Up

Client Quote of the Day

"I'm so broke I can't afford to pay attention."

Is that sort of like a “sundial?”

Today's referral:

Mental Health Diagnosis
Primary: Sciphennia
Secondary: B. Polar

Safety Concerns
Suicidial

Hopefully NOT a sign of things to come.

Walked face first into the bathroom door at 6:30 this morning. Way to start the day, champ!

Breaking News

Yesterday on my lunch break, I decided to go to my old credit union to close an account. It was an old savings account with a couple hundred bucks sitting in it, that had been inactive for a couple years. The credit union is a little out of the way (part of the reason I stopped going there) so I had been putting this task off for some time.

They’d had some major renovations since I was there last, and had sleek new counters and fancy leather couches. They had also installed some of those clear markers of 21st century affluence, flat screen TVs. These days of course, we can watch TV everywhere from the queue in the coffee shop, to the self-serve gas pump. Much like all those other places, these screens (the one in particular that I could see while waiting for the teller to process my information) displayed a combination of ads for the credit union and their products, and “news headlines” from an online source.

My eyes invariably fell for this trap, and wandered over to the screen as I waited at the counter. I read “Martin Streek, the Toronto DJ respected for his knowledge of the alternative rock scene, has been found dead in his Toronto home.” Hmm. I thought that guy died a while ago. Maybe I’m thinking of the wrong person.
“Prime Minister Steven Harper should not have accepted communion at Romeo Leblanc’s state funeral.” Now I know that didn’t just happen. Several other “news items” popped up, confirming my suspicion – these headlines are over a year old! I looked them up when I got back to the office – yup, we’re talking July 8, 2009! Was I the only one seeing this?

Ah, technology: the way of the future. Needless to say, I was happy to walk out the door with my cash in hand, enjoying having the last laugh on this financial institution.

T.G.I.Funny.

It’s Friday (in case you hadn’t noticed) and I’m feeling a little burnt out. Being the excellent mental health worker that I am, I know this means I should try to do some “self-care”. So I figured in order to lighten things up, I’d find something funny to post to the ol’blog.

Unfortunately, my .02187345 second internet search revealed that good humour about mental health is hard to find. I decided anyway to go with this classic, borrowed from bouldertherapist.com:

Hello, and welcome to the mental health hotline:

If you are obsessive-compulsive, press 1 repeatedly.

If you are co-dependent, please ask someone to press 2 for you.

If you have multiple personalities, press 3, 4, 5 and 6.

If you are paranoid, we know who you are and what you want. Stay on the line so we can trace your call.

If you are delusional, press 7 and your call will be transferred to the mother ship.

If you are schizophrenic, listen carefully and a small voice will tell you which number to press.

If you are manic-depressive, it doesn’t matter which number you press – no one will answer.

If you are dyslexic, press 96969696969696.

If you have a nervous disorder, please fidget with the hash key until a representative come on line.

If you have amnesia press 8 and state your name, address, phone number, date of birth, social security number and your mother’s maiden name.

If you have post-traumatic stress disorder, slowly and carefully press 000.

If you have bi-polar disorder, please leave a message after the beep or before the beep. Or after the beep. Please wait for the beep.

If you have short-term memory loss, press 9. If you have short-term memory loss, press 9. If you have short-term memory loss, press 9.

If you have low self-esteem, please hang up. All our operators are too busy to talk to you.


Hopefully in the near future, I’ll be able to check out the new Toronto Stand Up for Mental Health and hear some better material!

15) Staying at a job for two years is a ‘long time’*

It’s hard to believe I’ve been at this job for almost two years now. I’ve worked that long (and longer) elsewhere before, but this is the first job I ever had providing long-term support to clients. Most of my caseload now has been with me for the entire time I’ve been here.

In the last two months especially, I’ve started to notice things in my working relationship with my clients which I think are the result of being able to have this on-going support. Clients sharing personal information because they finally feel comfortable. New insights being gained through reflecting together on the past two years of their life. For me, know what times of year are hard for a particular person, and anticipating triggering events. It’s kind of cool, and weird.

Not having done this before, I’m always learning as I go how to balance the intensity of my professional relationship with clients and my personal boundaries. “Relationship” doesn’t even seem like the right word. I’m more keenly aware as I work with individuals longer that the whole thing is so one sided. I’m uncomfortable with the unbalanced power dynamic, and yet it’s so necessary. I admit, I resent my clients sometimes for how much energy it takes to support them. But I know it takes a lot of their energy too to do the hard emotional work I put them up to.

In a few months the intake part of my job will end, and I’ll be back to full-time housing worker. I’m curious/anxious to start fresh with several new clients all at once. In that case, it’s a bit of a comfort knowing I’ll still have my old stand-bys to give me some (unconventional) predictability and a feeling of (sometimes) stable progress. Assuming I’m still here for them.

*See here

I take it back.

I’ve changed my mind.

Quote of the day for August 31 goes to the pharmacist I called yesterday:
Me: Um, hi, I’m calling to see if some medications could be made ready for me to pick up.Pharmacist: What’s your name?Me: They’re not for me, they’re for my client Mr. Lotsofmeds.Pharmacist (presumably looking up Mr. Lotsofmeds refills): He’s got some good ones here, are you sure you don’t want them?
Maybe I was in poor humour, but it seems to me that pharmacist making jokes about giving away serious meds to random people should kinda be like making a joke about a bomb when you’re in an airport.  Don’t even go there!
And all this as it’s all over the news that Ontario has the highest rates of Oxycontin addiction in Canada, one of the highest rates of abuse in the world! 
A place to live, a place to grow, Ontari-ari-ari-o!(sorry, anyone who wasn’t in an Ontario public school in the latter half of the 20th century might not get that song reference.  Consider yourselves lucky!)

Client Quote of the Day

(to me) "You look better, like you gained some weight or something..."

Whoa, Stop the Presses!

Or maybe "hold the phone!" would be a better choice of phrase, as the presses do seem to be working which is precisely the point of this post.

Ah, maybe I should just get to said point.

I faxed some consent to release information forms out today in hopes of getting some hospital records for a file before I present it on Wednesday, knowing full well I'll be extremely lucky to see them before the end of the week.

But lo and behold, one hospital faxed the records to us within the hour! Within the hour!

I have never seen this before. I was so excited I wanted to tell somebody, and since my partner-in-crime is on vacation I went to make my supervisor my witness (I'm sure she didn't have more important things to do).

Of course they weren't the psychiatric records, they were some medical records we wanted as supporting documentation. It would have to be a medical hospital that we almost never NEED records from who would be timely about it. But hey, I'll take what thrills I can get! (sad, isn't it?)

Luddite Moment

$!*&^@**#!!! photocopier!

That is all.

I'm Back!

Let me rephrase that: I’m back.

While I’m not totally loathe to return to work after a delightful two weeks off (thanks for asking) I don’t totally dread it.

It turns out I missed some serious office place drama, which I’m kinda glad of. I’m not comfortable going into details at this point.

Coming back, I’m doing a lot of thinking about going forward. In the next few months, my current contract will end and I go back to my old position. I can’t say the thought really pleases me.

I’ve had a vague goal in mind of landing a new gig before that happens. However, that’s easier said than done, a reality that’s rearing its ugly head the closer I come to that deadline.

So I’m trying to handle this in the most social worky-way I know how: reframing! How can I make this job likeable? How can I make it work for me???

Only time will tell whether I’m helping myself, or prolonging the pain.

And of course, my fingers are still crossed that fate will smile on me and the perfect job will just fall into my lap from somewhere.

A girl can dream, can’t she?

En Vacances

Be back in two weeks!

Pause for Thought

Check this out --> Feminist Activists Find Peace in Thailand

I wanted to link to this article for a couple of reasons.  For one, feminism and VAW (violence against women) work are very important to me.  My training background is actually in assaulted women’s counselling, not mental health, although the two have obvious intersections.  I love learning about what feminist activism looks like around the world.

The other reason is that I found as I read this, I was contrasting the “retreat” experience they describe with the professional trainings and workshops I attend here in Canada.  The focus on “self-love and self-worth as an essential part of their work in the world” sounds really in line with my philosophy, but not my practice.  I certainly haven’t had many experiences in my professional life where there is such an emphasis on this sort of thing.  The perks offered to us at trainings usually max out at a free lunch, and possibly getting to go home a bit early. 

I don’t know much about Thai society or the culture of social service work there, so I can’t really comment on whether the needs of these workers would be different than where I am, and what they might make of their retreat experience.  But as the writer says, seeing “15 women grown napping together on the floor of a conference room after a lively plenary” would be “odd” to see in the U.S. (and I’m considering the U.S. and Canada to be more or less the same in this respect). 

It sounds nice.  But would it work?  Would anyone go for it?  I can imagine the mixed reactions of my co-workers – divided between feeling uncomfortable, and griping about how they could be making phone calls or getting assessments done instead.

Is this because we really don’t value self-care?  We talk a lot about avoiding compassion fatigue, but the general consensus seems to often be that we are responsible for this on our own time. 

On the other hand, is it because sleeping or meditating would be considered a private activity, and we would be asked to let our guard down to such a degree in a very public and shared space?  A lot of what they describe would be strikingly different from our typical professional activities and behaviours, and would (I think) demand a lot of openness to the experience.  Would this cross my boundaries?

I don’t know.  But I’m curious.

Has anyone experienced something like this?

Sibling Slip-up

When I meet clients for an intake assessment, I make notes on an unofficial “intake form.” It has prompting questions under headings like “medication” and “family history” with boxes giving me lots of space to write. I use it as a reference to complete the proper assessment on our electronic database later on. I often end up jotting things down in random boxes, as clients don’t always stick to the script.

So sometimes this happens:

Q: Are there any current family/marital issues?
A: brother, step-brother, step-sister.

My stomach in crisis

Emergency!

Where did all the office snacks go?!? They were here on Friday when I left, but now they seem to have disappeared…

I need something to get me though all these assessments.

I think there are some anxiety issues we should talk about...

No, just because you leave me SIX messages before the office is even open does not mean that I will meet with you four hours ahead of schedule.  You can pace around the waiting area all you like.

Couldn't resist another one...

“No ma’am, I don’t think they could fumigate the hospital and take your husbands clothes but leave him in the room.”

-co-worker on the phone with a woman whose husband apparently “took a bunch of pills” and somehow ended up in a psych hospital at the other end of the province. He called his wife complaining that “men in white coats”* removed all his belongings but left him in the room while they sprayed some sort of noxious gas, and she in turn was looking to us for help. She also wanted to know what “rights” she had if the doctor said he would call her with an update at 3:00 and it was 3:01.

Wish I could have heard the whole conversation!

*apparently not just a terrible stereotype anymore!

Thanks, Doc

Note in hospital records that my desk-mate was reading today:

“...this woman did not appear to be very bright”

...

Seriously? Is this considered a “professional” or “medical” opinion?

I’m going to start a training program entitled “Appropriate Note Writing for Dummies Psychiatrists.

P.S. thanks to a couple new "followers" for tagging along! Hi!

The Whole Story

Ontario is having municipal elections this year. I read this article this morning about one of the leading candidates in Toronto, Rob Ford. While I’m not sure who I’m going cast my vote for yet, I can’t say I’m a big fan of Ford. His general platform seems to be of the ‘cut taxes, cut services’ variety, and to be frank, he seems like a real blowhard. Not exactly my style.

I bring this up because I think the article does a good job highlighting some of the challenges that come up time and again when trying to fund social programs. We know (or most people in social services know anyway) that things like poverty, addiction and homelessness are difficult issues to address. Positive change will only come from systemic changes in supports, programs, and people’s attitudes.

It may be very easy for Ford to rail against thousands of dollars being spent on cigarettes and “to give free wine to homeless people” but it is short sighted, and it definitely doesn’t tell the whole story. He gives a line similar to what we hear from those who oppose things like harm reduction, safe injection sites and the special diet allowance (an issue which Ford has also had his say on, and really made a mess)

I’m reminded of many stories, but one in particular of a woman I helped support when I was working on a homeless outreach program. She had been chronically homeless, had schizophrenia, diabetes, and crack addiction. Naturally, she had a long back story that I won’t go into here. After she stabilized somewhat during a lengthy shelter stay, we were able to find her suitable housing. The trick was making sure she got her injection of medication every two weeks so she stayed well enough to maintain that housing. The only way our nurse could guarantee to see her every two weeks was to bring her a coffee and a pack of cigarettes. Now surely this was cheaper than paying for her to be in a shelter, hospital, or detox clinic all the time? Surely this helped her to live a better quality of life!

I really wish some people would take the time to look at the whole picture.

Family Dynamics

So last week I received a referral from one of the hospital social workers for a new client. I called the social worker, because sometimes the client is still in the hospital, and we can meet them there. It tends to really increase our chances of a successful follow up.

This client had already been discharged, but the social worker gave me some additional background and his impressions of the client (patient in his case, I guess). He tells me that this client was recently diagnosed with schizophrenia. He’s a truck driver, lives alone, his family is all in the US, but they are very supportive.
His father is a psychiatrist. His sister is a doctor. The other sister is a social worker. His brother is a development worker.

And I can’t help but wonder how the onset of a serious mental illness would play out in the family dynamics. Is it more frustrating than usual for the family to feel like they can’t help him? More importantly, how will this affect the client? Will he feel that understanding and support from his family, or perhaps like a failure and an outcast?

I know that it is not unusual for families to be challenged or seriously disrupted by something like schizophrenia. Feelings of failure and disappointment crop up on both sides of the equation.

I know that most of us have someone in our network of friends/family/acquaintances who has a mental illness. I have people close to me who live with/have survived eating disorders, alcoholism, SAD and more.

This case just struck me as particularly potent.

Clients without phones...

...make for a lot of work.

WHERE ARE YOU??!?!?

Dear Random Social Worker,

Thank you for referring your client to us. We would have called you back sooner, but we have only just received the referral form. We likely would have responded more quickly if you had faxed or emailed it as indicated on the top of the form. Instead, you left it sitting out on a desk in our rural office, you know, the one that is only staffed part time, and is shared with another community group? I’m sure your client’s information is safe though since you had the forethought to fold the paper in half. And I guess you couldn’t have known that our staff who works in that office was on vacation for two weeks, so again, our apologies.

Now, I realize that you must be a very busy woman (aren’t we all!) but if it’s not too much trouble, maybe you could take the extra couple of seconds to write in your complete phone number? A bit of information about the client would be helpful too – maybe more than “needs support – monthly visits”.

Oh, and by the way – Primary diagnosis: schizophrenia/bipolar. Well, which is it? I guess the client may have both (poor thing) but then I’m guessing one of those is the secondary diagnosis, and it’s just a little hard to tell which considering how you’ve squished it all into the one little box there.

Well, I hear from your outgoing message that you are out of the office for the next three days (how nice for you!) so I guess I’ll call you back next week.

Ta-ta for now!

Pills

I've just decided.

My main hope goal in life: to never have a med list as long as those of some of my clients.

Yikes.

Get that "deep cleaning tingle!"

This was something I had never seen before.

I showed up the other day to see a client for a home visit and to drop off his medications which I pick up for him once a month. He’s an older guy with schizophrenia, who is also extremely obese. For the past year we’ve been working a lot on housekeeping and personal hygiene, both of which he has trouble looking after and issues which could put his housing at risk (there have been complaints to the building manager several times because of severe malodour).

We’ve had some great success of late. He has budgeted and scheduled for a cleaner to come once every two weeks and clean his apartment. He also got some help to install an air conditioning unit, which has really improved a space that I once had to leave in order to not pass out from the heat and smells.

So, back to the original point of this story – I show up the other day and he’s got blood all over his legs, from the knees down. I asked him what happened, and he says casually that his legs were itchy.

What?!?

I needed some more explanation.

Apparently, he had soaked his feet for upwards of two hours in a chemical household cleaning solution in an effort to get them clean. He said that he stopped, and realized this was maybe not the best idea when his feet and legs started ITCHING and BURNING. “The cleaning lady wears gloves when she uses that stuff” he knowingly informed me.

O. M. G.

He seemed very non plussed by the whole thing, but then, that’s how he is with most every thing. I pleaded with him to wash his legs with some cool, clean water once I left, and asked him to please call his doctor or get some medical attention if the itching or burning came back.

Maybe I should have offered to get him a proper pedicure kit for next time. Although it might be a little sore to use a pumice stone for while yet...

Lazy, Hazy, Crazy Days of Summer

Okay, okay, so I know I’ve been a little neglectful of my little blog here lately (I can hear all 4 people who read it collectively nodding their heads) but I have good reason!

1) It’s summer, so I’m outside doing stuff
2) It’s summer, so it’s hot and I have less energy
3) And this is the real kicker – my home laptop crashed and has yet to be suitably replaced.

I haven’t even had time to keep up with reading all the blogs I follow, which is saying a lot because it is usually a highlight of my day.

I promised some way back that I would follow up with a book review of Voluntary Madness, and I will get to it. I also want to get back to talking more about the work at hand, as I’ve been recently distracted by certain international photo-ops and spectacles – although I can’t promise it won’t happen again.

For now, I’m wimping out and posting this list that made the rounds of Facebook recently and was emailed to me by a co-worker. Even if you’ve read it before, it may be good for laugh, and isn’t laughter really the best medicine?

Onward! -->

You know you’re a social worker when…

1) You think $40,000 a year is “really making it”.

2) You don’t really know what it’s like to work with men.

3) You know all the latest lingo for drugs, where to get them, and how much they cost.

4) You’ve started a sentence with “So what I hear you saying is…”

5) You’ve had two or more jobs at one time just to pay the bills.

6) You tell people what you do and they say “that’s so noble”.

7) You have had to explain to people that not all social workers take away kids.

8) You use the words ‘validate’, ‘appropriate’ and ‘intervention’ daily.

9) You spend more than half your day documenting and doing paperwork.

10) You think nothing of discussing child abuse over dinner.

11) People have said to you “I don’t know how you do what you do”.

12) You’ve never been on a business trip or had an expense account.

13) You know a lot of other social workers who have left the profession for another.

14) You’re very familiar with the concept of entitlement.

15) Staying at a job for two years is ‘a long time’.

16) Your phone number is unlisted for good reason.

17) Your professional newsletters always have articles about raising salaries…but you still haven’t seen it.

18) You’re very familiar with the term ‘budget cut’.

19) You can’t imagine working at a bank or crunching numbers all day.

20) You’ve had client who liked you just a little too much.

21) Having lunch is a luxury some days.

22) You’ve been cursed at or threatened…and it doesn’t bother you.

23) Your job orientation has included self defense.

24) You have the best stories at any cocktail party.

25) Your parents don’t know half of the stuff that you’ve dealt with at your job.

26) You know all the excuses client use for a failed drug test by heart.

27) People think it’s a compliment if they mistake you for a psychologist.

28) It’s a common occurrence to walk through metal detectors.

29) You’re thankful that you have a license without having to go to school for umpteen years like a psychologist*

30) You work odd hours and wonder why others can’t also be as flexible, or why we have to be the only ones who work strange hours.

31) Despite the poor reputation of a social worker you job has you interacting with those in higher authority positions (lawyers, doctors, judges, government representatives, superintendants, directors, etc)…and they come looking for you in a panic when they need you…

32) You can make just about anything a client does into a ‘strength’.

33) You laugh at things “normal” people would be shocked by.

34) You constantly struggle with the work/life balance.

35) You find it hard to get babysitters as you don’t trust anyone with your children.

36) You’re exhausted but you keep smiling!!

37) Hearing the worst news stories does not shock you in the least bit.

38) You think nothing of saying the words vagina, penis, or anus in a daily conversation.

39) You assess your date (in your head) while out on a date just to see if they meet criteria for any DSM IV diagnosis.

40) Your mother tells people you’re a psychiatrist or a psychologist. For the umpteenth time, I’m a social worker.

41) Your significant other has learned that when someone greets you in public not to ask “who was that?”

42) You know the suicide crisis phone number, the food shelf and the community shelter phone numbers off the top of your head.

43) Your family/friends/acquaintances/co-workers will approach you with a “hypothetical problem” to help them with and you can’t charge them for your advice.

44) When people ask for your help, they expect you to have all the answers and solution to problems that do not even exist, immediately. We’re social workers, not magicians.

45) You know where to find ‘free’ anything (clothes, food, equipment, transportation) but you are not eligible for any of them yourself.

46) You are considered an “expert” in financial assistance for your low-income clients but you can’t keep your own cheque book balanced.

47) You have a file or a list posted in your office on “Stress Reducing Techniques.”

48) After a long week of solving other people’s problems, you recognize that you haven’t dealt with your own at home.

49) You don’t know what “sick days” are and you call your vacation times “long mental health breaks” or “burnout prevention days”.

50) The clinical staff find the patient/family situation appalling and in urgent need of intervention and in your “social work” opinion, you don’t really think it’s all that bad. You’re pretty sure you’ve seen worse.

51) You love/loathe the idea of role-plays and know that they are not necessarily something kinky.

52) You’ve found yourself in a group situation with other social workers discussing a super deep topic, and someone says that they’re happy they were able to have the conversation with other people who “get it” and everyone immediately agrees.

53) You really do have the best gossip around, but have to make sure to remove any possibly identifying information first.

54) You really know how to enjoy a good bottle of wine!

*I'm assuming this was originated in the USA, as social workers are not 'licenced' where I live.

Oh, you witty social workers

I’ll preface this by saying that I don’t usually wear shorts, but I did today.

Me, gabbing with my manager today: Wow, I never realized I had so many bruises all over my legs
Sarcastic supervisor: Nectarine, is this your way of telling me you have something you need to talk about?

*eyeroll*

G-20

So, needless to say, even though I’ve been looking for a job closer to downtown for the past two years, I’m glad to be nowhere near the inner city this week.
I haven’t seen the fence, but I hear it’s big.

As I was discussing with some friends the other day, I don’t really know how to feel about the whole thing.

Back in 2002 when the G7 met in Kananaskis, Alberta, and 2001 when the Summit of the Americas was held in Quebec City, I was involved in a lot of activism and many people I knew attended protests at those events (or as near as the “designated protest zone” was allowed). We were anti-globalization and opposed fair-trade. The issues seemed clear, and we wanted specific alternatives to what the summit members were proposing.

Now, I don’t really know what summit leaders will be talking about. The more I read the news, the more confused I get. If, as Harper says “the discussion should be less about new agreements than accountability for existing ones” couldn’t this have been done on the phone?

Initially, I was frustrated that the news media seemed to be focusing on logistics and risk of violence when talking about protestors and seemingly not paying any attention to the reason the protestors are actually there. But I wonder now if it’s because there is no one good reason the protestors are there.

I’m sure many are well intentioned. I’m sure their issues are important. But when everyone is there yelling hundreds of different and unrelated slogans, I fear the message will get lost.

Am I disillusioned and out of touch? I do still think that public protest and peaceful civil disobedience has its place and can be an effective tool for change. I just don’t see it happening this time.

Given all this, there are only two things I am sure of: 1) $1.2 billion is waaaay too much and so not worth it and 2) this weekend, I will be anywhere but downtown.

Please, just go pt. 2

The housing transfer saga continues.
I met with the client. She had yet to make up her mind. She was highly anxious, and unfocussed and I could barely get a word in. I haven’t seen her like this in several months, although it used to be constant.

She wanted to know what I thought she should do. I wanted to tell her, but I didn’t. I reinforced that it was her decision, and tried to outline some pro’s and con’s.

Eventually, I ended the meeting since we were talking in circles. I suggested she call her worker at the housing agency and discuss it with her to figure out a final decision. We only have so much time.

Today, another message from her in the wee hours of the morning. She still hasn’t decided. I have a lot of thoughts and theories and hunches about this and about what I think she should do. But I’m getting too personally involved. This is counter-transference baby. I haven’t been able to connect with my supervisor for the past two days and I know I need to debrief with her, so I haven’t called the client back yet. I feel guilty about that.

This is rare for me. I’m usually pretty consistent about my boundaries, and I generally find it pretty easy to keep a healthy sense of detachment between me and my clients. But it’s bound to happen sometime, right?

Aarrgh! I really thought she was going to go for it.

Please, just go

I’m crossing all my fingers and toes today. A client of mine has been on a housing transfer list since 2006. She has been in supportive housing since 2004, when the housing agency made an “in situ” arrangement for a family member to rent to her, as he was going to let her live in the first and second floor of a semi-detached that he owns. This seemed ideal at the time (I’m told) because she has two children of disparate ages and three bedroom housing stock is low.

The situation has not worked out. He constantly asks her for money over and above the rent to pay for household bills, utilities, and improvements. She frequently gives in because, hey: she doesn’t want the lights to go out of the heat turned off. She has multiple complex health issues, and is on disability so she has funded this largely through a line of credit and credit cards. She is in DEEP debt. And majorly stressed. The effects on her mental health and family life have been devastating. I would go so far as to say there has been financial and emotional abuse happening.

About one year ago I started calling the housing agency to get an update on her transfer. Somewhat understandably, these things are not always a priority compared to new client’s who haven’t even been housed yet. The agency was able to show her one unit, but she didn’t take it. It was in a neighbourhood far removed from just about everything, and her daughter would not be able to get to her high school (she attends a special program). Understandable, but frustrating for all that it didn’t work out.

Fast forward one year. She’s been doing relatively well given the circumstances, and we’ve been working a lot on goal plans. We realized together that the housing issue is creating a huge obstacle to most of her other goals and aspirations. Since it’s been a year, I call the housing agency for updates, and to impress on them how urgent this situation has become. I do an email follow up and cc: the manager just to make sure we aren’t forgotten about.

Well that did the trick!

Two days later a unit has been found for her to view. We went to see it yesterday. It’s in a great neighbourhood, near the schools, nicely kept building and clean, good sized unit. She seemed to like it, but had one major concern which I’m really hoping will not sabotage the whole venture. If she says no to this one, she only gets one more chance.

Our work is supposed to be client driven, but I admit I was not unbiased with my client yesterday. I talked up what I thought were the good points, I printed out a map for her of the area, highlighting access to services, routes to school etc. I suggested ways that I thought we could work around her ONE concern.

She has to decide today. I hope she takes it.

Quote of the Day

"How can I be a mental health worker when I don't even know how to spell 'psychiatrist' or 'schizophrenia'?!?!

Thank you, unnamed co-worker, for making me laugh.

Why I Hate Being an Administrative Bearer of Bad News

Or “Being Part of the System”

Me: I should let you know that we have a six month waiting list.
New intake: Six months is no good, I won’t be here.
Me: Oh, where are you going?
New intake: I’ll be dead.

**

(I do however, love these new blogger template options)

The World Cares About Homelessness

As with most major events of its kind, when Canada hosted the Olympics in Vancouver a few months ago, there was much skepticism about the benefits of the event to the city. The population was divided between those excited to be on the world stage, and those who felt strongly that resources would be better put towards dealing with the highest HIV rate in North America, a growing homeless population, and other social issues in the city.

While I for one really do like to believe that these events can offer a chance for a positive legacy in a city, I was appalled but not totally shocked when I read this article about the “affordable housing units” that are now up for rent in Vancouver. They were constructed as part of the Olympic Village development plan, and were promised to be turned into badly needed “social housing” for the city.

Please tell me how teachers, paramedics, police, and public sector workers are being discriminated against by landlords, or facing chronic rates of homelessness? Why on earth would these professionals be the target population for any “social housing” project? And can even they afford the $1600 rent (for only 640 sq. ft.)!!!!!!!

Canada has been "working on" a national housing strategy to end homelessness for 17 years now. Is this as far as we've come?

In related news, street children in South Africa are being forcibly moved to remote areas prior to the World Cup tournament.

Bipolar Rhymes

Had a client rap to me about his hallucinations in an intake assessment yesterday. Twice! I stopped him before he could get up to show me his dance moves.

The Housing Worker’s Conundrum

Where I work, I am one of three designated “housing workers”. This means that my clients meet the basic criteria for our case management program* and were also at risk of homelessness (or actually homeless) thereby meeting the criteria for subsidized rent. Put it all together, and you’ve got Supportive Housing!

Supportive Housing can be really great for clients, because it is so much easier to recover in your mental health when you have a safe and comfortable roof over your head, and it’s easier to maintain your housing when you’ve got a dedicated worker (that’s me!) and program supports helping to keep you on track. I’ve seen it make all the difference for quite a few people.

The whole goal of Case Management is “recovery”. We are “recovery-focussed”. We promote “client recovery”. Although we provide long term services without a set discharge date, we expect and hope that we will support our clients to the point where they can do well with a decreased level of support i.e. we don’t want to be there FOREVER.

Eventually, this becomes at odds with the actual “housing” aspect of supportive housing. Just because a client can keep their own appointments, is actively volunteering in the community, has been connected with community supports and has learned how not to burn the house down does not mean that they can afford market rent. And if we remove their rental supports, this is most often going to cause some kind of mental health crisis.

Can you see where this is going?

A number of my clients fit in this category. They have toiled away with case management supports for years, and are doing very well thankyouverymuch. But there are no processes in place for me to withdraw from providing them with case management services, as it’s tied to their housing. In fact, their tenancy agreement states that I need to see them in their unit at least once a month. But they don’t want to let me in, because they don’t need me any more. Or they do want me to come, and I end up playing friendly visitor, or worse, having tedious appointments where I feel like some kind of safety inspector. It’s intrusive, and I always feel disrespectful of my client’s when I do this. Not to mention, it's a waste of everyone's time.

I get the sense that a good solution has not been reached because this is one of the remaining elements of fallout from deinstitutionalization. Supportive Housing my particular region has only been around about 15 years, so we're just starting to see clients as this point in their recovery. What I would love to see is a position created for a dedicated follow-up worker who could do occasional housing inspections with these kind of clients, and provide emergency support or referrals should they experience a relapse.

For now, I’m off to what I know will be another 10-15 minute appointment that will sound pretty much like this:
“Hi, how are you? Anything new? Mind if I look in your kitchen? Sorry, I’ll get out of your way now. See you in July.”

There must be other ideas or models out there. Any you know of?


*live in our catchment area, have symptoms of major mental illness, needs assistance in basic life skills/keeping safe in home or community/maintaining employment or vocation

Reading Material

I’ve never really done much reading about ‘mental health’. Truth be told, its not the field that I was trained in, and I find most publications by professionals to be boring, jargon-laced jibberish.

That said, I do find it insightful to check out books by consumers and survivors of the mental health system.

One of my favourites is local hero Pat Capponi, who wrote Upstairs in the Crazy House among others, and has also begun publishing a series of fictional detective mysteries set in a mental health group home.

I’ve just started reading a book called Voluntary Madness which a friend recommended to me.

So far it’s very engaging, and causing my mind to flip-flop between the consumer and service provider perspectives. My mind is running so quickly through the things I always question about the “mental health system”. Why do we continue to rely so heavily on medications? Are “diagnoses” really to be trusted? Has deinstitutionalization just dumped a bunch of people out on the street without sufficient supports and resources? What is “crazy” anyway, and who gets to decide?

Maybe I’ll attempt a bit of a book review when I’ve finished it.

Don't jump! Good boy!

So sometime last week AM and I were out taking Dogface for a walk. He’s about 9 months old now and “maturing” but not fixed (yet) so he is sometimes aggressive with other dogs. We’re trying to better socialize him, so when we take him out we are always on the lookout for other dogs, so we can figure out the best course of action before he freaks out (there is a relevant, mental health part to this story. Trust me, I’m getting there).

We head down a neighbourhood street and hear another dog barking from somewhere. It’s pretty loud, but we can’t see where it’s coming from. All of a sudden, AM realizes there is a dog – some kind of basset hound or beagle maybe – ON THE ROOF of the house! An upstairs window was open, and the poor dog was barking its head off from the roof above the front porch. We look at each other, and I decide I should go knock on the door to let someone know that their dog got out on the roof.
As I approach the house, I see that there is a young adult couple sitting on the front steps.

“Ah, do you know that your dog is out on the roof?”
Nodding and laughing

“Is that okay? Does he go out there on his own?”
Yeah, wave and nod at me again. Still laughing. (at me? Because I don’t understand dogs natural affinity for heights, or in confusion wondering what this strange woman is talking about?)

“Aren’t you afraid that he will fall off?”
It’s okay, they say.

I left so confused. Now tell me where the mental health concern lies. Is the dog suicidal and/or trying to make some kind of threat to the other neighbourhood canines, or do these people need their heads checked?

The good news is, Dogface never noticed this roof dweller, saving us from at least one tricky doggie-social-interaction lesson.

Sticky notes are also unacceptable

Note to self:

Do not write client's med lists on little scraps of paper. You WILL lose them!

*headdesk*

Totally off topic post warning!

Car idling is a HUGE pet peeve of mine. But what bothers me even more is that I don’t feel I can do anything about it.

I was sitting in the car this morning in a parking lot between home visits. I had some time, so I was checking my messages and making notes.

A car pulled up beside me and a woman got out with a little dog. She seemed to be giving it a little rest stop on the lawn of this building. Fine. But she left her car running the whole time!

I got nosy and peered through the window and checked – there were no other people or animals in the car. Even if there were, it’s a beautiful sunny day out, so could be absolutely no need to keep the heat running. If she was concerned about the car getting too hot, she could have opened the windows. I don’t get it! She was out of the car at least 15 minutes.

I briefly considered confronting her when she came back to her car, but couldn’t figure out a way that it wouldn’t sound really rude – let’s face it, that’s not going to get me anywhere, even if it would be fun. I fantasized about hopping in her car and driving away, since she had so kindly left the keys for me – but I’m not really interested in incurring criminal charges while on the job.

I wrote her a note: Please do not idle your car. There is no reason for it.

I stuck it on the windshield, then drove away before she could come back.

I can only hope she will take it to heart, and not just discard it on the ground. But I wouldn’t put it past such a serious car-idler (idler? is this a word?) to be a little bug as well.

*we will return shortly with your regularly scheduled blog*

Closet Bettor

“Do you gamble?”

   “Yes, when things get really bad, those times when I’m hiding in the closet”

“How do you do that?”

   “Oh, I used to collect cards. I keep them in the closet.”

Get Yourself Together Man!

So you know how sometimes someone will leave a message on your voicemail, and then fail to hang up the phone afterwards? Sometimes all you end up hearing is what television program they're watching, or the rumpled sound of being tossed into a pocket or purse. Sometimes however you are lucky enough to hear something a little more exciting! These calls seem to happen a lot when working in mental health.

Today’s such message goes like this:

(msg left by a client for a coworker on my voicemail, my comments in italics)
Hi Liz it’s Mr. Defective. I tried to call you earlier, but I couldn’t find your number (duh). I’m wondering if you could send me a taxi, I really don’t want to miss this appointment (he’s calling at 1:24 for a 1:00). If you could call me back that would be good.

(apparently this is where he thought the call ended)


…f**k, what is this shit?.........ah-choo!.........BURP…this is such shit, I was going to call before, but…ah-choo!............ah-choo!......ah-choo, ah-choo, ah-choooo!!!!!!

My co-worker is not here today, so I don’t even know if he made it in on Friday. I kindly forwarded the message to her ;)

Assessment Answers

Is culture (heritage) an important part of your life?
No. Am Scottish, no kilt.

Welfare Goes Plastic

An interesting idea

Manitoba looks at debit cards for welfare recipients

It seems to me that the greatest advantage would be for the people who currently lose up to 25% of their cheque in fees to MoneyMart and the like.

Hospital Record Gaffe

"Her psychiatrist in the committee is Dr. Mechanical"

Assuming that "committee" here is supposed to be "community". And I know the good doctor's proper name is not "Mechanical" (but I can't tell you what it really is, can I?)

Gotta hope this was the fault of some kind of dictation machine.

Case Study #2

Client histories never cease to be interesting and surprising. Although I know we should always view our clients as a “whole” person who is dealing with an illness, when you have only known a person while they are SICK it can be easy to forget that they also have/had a LIFE.

One client on my case load is a 50-ish man originally from Vietnam. In the time I have known him, he has been very stable but somewhat “low” functioning. He struggles with comprehension, insight, and ADL’s. On the other hand, he’s got incredible financial management skills, and exceptionally beautiful handwriting. He hasn’t been able to maintain employment for many years at this point, although we’re working on that.

In the late 70’s in Vietnam, he was a young man studying physics and math at university. I knew from his hospital records and his own reports that he and most of his family came to Canada in 1980, and he had to leave university without completing his degree. He was diagnosed with schizophrenia several years after immigrating, and eventually dealing with his illness contributed to the break-up of his marriage, and caused him to lose contact with his son.

Blame it on my youth, but I somehow never put it together that the time he talks about in Vietnam was just post-war. And he lived through whatever terrors that had brought. Obviously I don’t have any details, but this all came to mind when I was listening to a recent CBC Rewind broadcast about Vietnamese boat people. This was his experience too. I don’t know if he came on a boat or what, but I know he was sponsored by a Mennonite group, who were among the earliest supporters of the refugees.

Knowing this will not likely do much to change how I work with this person week after week. And I understand that this general knowledge doesn’t provide any insight as to his individual experience. But it does provide me with some new perspective when he talks about his past. And it’s a good reminder (for me) just to keep in mind that this guy has had struggles other than trying to keep his kitchen clean.

The Closed-minded Co-worker

I got snappy with a co-worker this morning. We’ve had some donations in the office and as a “joke” he put a set of flower patterned sheets on a male managers desk. When it was figured out who did it, he started loudly proclaiming that it was a joke because “no man should have to sleep on flowered sheets” looking for collaboration from the rest of us. I shot back “where do you get these close-minded ideas?” Another female co-worker laughed and said “okay, I’m not the only one who was thinking that!”

This was a small occurrence, but he says sexist things like this a lot. And it gets on my nerves. A lot.

It’s not that he’s saying anything that would constitute harassment or whatever, but it is annoying. I especially don’t understand this kind of attitude in a social work setting.

It’s not that I can’t take a joke. I do have a sense of humour. I do! It’s the thoughtlessness behind these comments that gets me going “please, just SHUT UP!”

I could lay all kinds of “anti-oppression framework” or gendered analysis on this one, or I could talk about how in this line of work we all have to explore our own privileged and social location etc, etc.

But it's friday, and I don’t want to. Is it too much to ask for people to think before they speak and check their prejudice at the door?

Social Work Brain Fart

I had hopes of getting into the office today between client visits, but no such luck. WHY? I have to fit in an extra visit because I forgot to bring a client his meds on Tuesday.

*headdesk*

Fortunately, I remembered yesterday and called him, and he hadn't run out yet.

*sigh* this is what happens when you rely on memory and don't check your calendar. You forget what Tuesday it is.

Off to the pharmacy!

Maybe I'm Not Such a Bad Influence

My six year old (blessedly) has learned to get up on her own on weekends. I can usually count on her entertaining herself for an hour or two before I need to get out of bed. So this Saturday when I awoke particularly late to a quiet house, I knew she must be really engrossed in something. My first thought was “what kind of mess am I going to walk into downstairs?”

I arrive in the living room to see that she has been setting up a “store”. She was very thoughtful and attentive to detail, setting up displays, keeping a little broom and dustpan for cleanup, making a sign for the store (“Baby Fiatt” which apparently is her creative spelling for “Baby Fit” as it was all her baby doll stuff) and getting out her toy cash register.

Next to the register, she had a little bowl to which she had taped a sign (I’ll spare you more creative spelling): Please help the homeless people.

When my sister came over later with my baby nephew, she was made to “shop” the store, and instructed to put her “change” in the bowl.

Au secours!

Just deleted half a completed assessment!!! (insert your favourite expletive here)
And I can't even blame the computer, it was totally my fault.

Sorry for the slow posting week. I promise I'll be back at it, just as soon as I crawl out from under this giganormous pile of assessments.

(see you next year!)

Bipolar Breakthrough

A little more about this intake from yesterday.

Despite all the crying, the appointment went well. This woman has a lot going on, including being diagnosed with bipolar and PTSD. She seemed to have great insight when describing what she feels is problematic in her life, discussing symptoms, and acknowledging that she feels ready to get help.

Which is why I was surprised when an hour and a half in she says “it’s like I get these real highs, and then I just go so low. Does that have something to do with bipolar?”

Uh, yeah, I say. That pretty much sums it up. We discuss this a little bit more, and she says “you know, now I know what bipolar is. I was diagnosed over a year ago, and I didn’t know what it was. I will remember this as the day I learned what it was all about!” (cue crying episode #47)

WHAT? How is it you go a whole year with this diagnosis, and no one tells you what the bloody word even means? She received this diagnosis from her psychiatrist whom she’s been seeing for about 14 years!

Granted, her psych is a dinosaur who has announced his retirement about 3 times, but has yet to actually leave the building.

Here is a woman with a)great insight b)no cognitive issues c)lots of support d)a willingness to work with the mental health care system. It’s not as though she lacks the capacity to understand. Is this something that only happens to psych patients?

Now I’M feeling drained!

I think the intake I just had beat the record for “number of times bursting into tears”. I wish I’d kept track so I could be sure.

Some lighter fare for a friday

Since I'm getting all heavy handed and political here, I'd like to share this bit of medical insight from a client yesterday:

"My doctor says I have high cholesterol, but I eat a lot of yogurt, so I don't know what he's talking about!"

(yes, the same person who gave me this gem)


P.S. thanks SocialWrk24/7, btrflygal, Reinasecorpion, cbear71 for the add!

P.P.S. yes, I realize there is some evidence that yogurt can help lower your cholesterol, but the doctor is going by her blood work numbers.

Soapbox pt. 2

So I figured if I could blog about it, I could also do something more productive. Write a letter. This is what I have written to the premier:*

April 23, 2010

Dear Premier,

I was very encouraged when I heard the recent announcement of the changes being introduced to Ontario’s curriculum regarding sex education. I understand that this is a sensitive and therefore particularly challenging subject matter, and I felt that your plan did a good job reflecting the diverse experiences of children and families in Ontario. It was disappointing then when you decided to place these changes on hold.

I am the parent of a six year old who attends public school. As a mother, I have a great responsibility to impart my knowledge and values to my child, but I also recognize that she is constantly being influenced by other sources. Between sexist and homophobic messages in popular culture, hyper-sexualized images in the media, and often misguided information from her peers, I would like to trust that the education system is a place where she and other children can receive sound knowledge and resources. It is not helpful to her or the other students to continue using language in the classroom that is vague or non-inclusive.

I sincerely hope that the government of Ontario will proceed with the proposed changes to the elementary curriculum. Cultural attitudes and information available about sex and relationships are always changing, and the curriculum needs to keep pace. Our schools provide a safe environment for children to hear these messages.

Sincerely,

(Nectarine)

Also, I tried to find some groups or articles supporting the change, but have come up short so far. I did find this informative comparison.

*feel free to copy/paste/share/plagirize!

Is that a soapbox? Let me at it!

So this is what I get for procrastinating on posting.

I kept meaning to blog something about how pleased I was with the government of Ontario’s new changes to the sex ed curriculum. It involved a new focus on teaching younger students the correct terms for their body parts including genitals, and using more inclusive language throughout the curriculum to recognize families and relationships outside the heterosexual norm. This would include not using terms like “mother and father” or “husband and wife” exclusively when talking about relationships and sex. It would also weave this information throughout the school curriculum to normalize it, instead of confining it to the giggling sessions of health class.

Apparently, this new curriculum has been posted on the government’s website for months, although I can’t find the link. It was formally announced this week, and drew the expected criticisms from social conservative and religious groups. At first, the premier defended the changes, but now he has backed down and “shelved” the curriculum until “further consultation with parents”.

Now, I have a lot to say about this but I’ll focus on one thing for now. It really irks me that social conservatives seem to have a strangle hold on the word “family”. The opposition to this plan is continually referred to in the media as “family values focused”, “pro-family” etc. as though there is only one definition of “family values” and anything else is amoral.

Look, just because we don’t all have a mommy and a daddy who got married in a church and then planned and had some babies and will stay together forever, doesn’t mean we don’t care for and love one another and comprise a FAMILY. And because of this, it means kids need to have a safe and well-informed environment to learn about sex and relationships.

Bear with me, I may have more on this later.

Case Study #1

A bit of a backgrounder on barf-bag guy.*

Dude was a hard rocker in his younger days. Played sports, partied hard. Drank a lot, used marijuana and coke. As an adult got a decent job driving a forklift, and enjoyed watched football with his drinking buddies. He’s a big guy who loves beer and greasy food. His parents both died fairly young of cancer, leaving him extremely broken, a feeling he drowned in about a weeks worth of tequila after the second funeral.

Eventually, he got married to a woman with a young daughter whom he loved like his own. A couple years in, his wife comes out as a lesbian and says that she and the daughter will be leaving.

This is just too much for him, and so he slits his wrists, getting himself an all-expenses-paid five day trip to the hospital. He comes home to find that his family has indeed left with most of the couples belongings, including several pets. They kindly left a pile of debt in their wake. So, here comes the second suicide attempt, the wrists again. Hospital stay, take 2.

Long story short, the guy lived, but did a number on his wrists, leaving him with limited feeling and movement in his hands. Years of sports and hard living have taken their toll too, resulting in bad knees, back, shoulder, and carrying around an extra 200 pounds or so. He wasn’t able to work after the separation and the suicide attempts due to his rapid decline of physical and mental health. So he winds up on welfare, then gets disability support, still hardly paying enough to look after himself in a healthy way.

He’s doing reasonably well now since he got a government subsidized apartment. He meets with his counselor, has a few friends, and is good with is money.

But this man is only 45, and looks at least 20 years older. He can now barely walk, is in all kinds of pain, has a myriad of GI problems (ick) and still deals with depression.

He’s a smart and nice guy with a good sense of humour, but I often feel at a loss of how to support him. How do I work with him to accept that he is basically like a senior citizen? That he may need some in-home care, a pass for the wheel chair bus, and some serious medical interventions?

Really, he knows all this. But he also does not want to give in, and has sort of resigned himself to suffering. I totally believe in a client’s right to self-determination, but it doesn’t make it any easier to watch. I’m trained to cope with and offer support to people in all kinds of mental and emotional distress, with whatever social factors working against them. But physical deterioration? Out of my scope. We’re meeting with his GP this week, and I’m anxious to see how it goes.

*and no, he didn’t end up puking in my car. We had to pull over for him to get some air, but fortunately it didn’t get any grosser.

Prediction

My intake is not gonna show. I'm calling it now.
She's scheduled for 2:00. Current time: 1:54.


Update as of 2:23: called it!

6-5-4-3-2-1-switch!

Since I have been sitting here at my desk for 2+ hours with my eyes clouding over, my head swimming, my palms sweating, and I am not getting ANYTHING done at work, I'm going to stick with posting the song that inspired this blog's title.

Gotta love Sharon, Lois, and Bram!

And watch the upholstery!

Community visit check list:

Sensible shoes with closed toe and flat soles? Check.

Comfortable clothes that can be stripped off and washed of all pet hair, lingering cigarette smoke and unidentified sticky substances IMMEDIATELY upon returning home? Check.

Hand sanitizer? Check.

Lint brush to remove endless tufts of cat hair from clothes and car seat? Check.

Bed bug spray? Check. (yes, apparently this exists and is supposed to protect me. Yeah right.)

Disinfecting wipes for hard surfaces in vehicle if transporting client? Check.

Well organized binder including notebook, client folders, pens and any standard forms client may need to sign? Check.

List of local resources for handy referrals? Check.

Contact information for supervisors, crisis line, and emergency responders? Check.

Business cards? Check.

Keys attached somewhere on my person with a karabiner? Check.

Left all valuables at home? Check.

Blackberry at the ready for any and all emergencies? Check.

Tim’s card for when self or client needs caffeine therapy? Check.

Purse securely locked in trunk? Check.

More hand sanitizer? Check.

Face masks left over from the H1N1 scare? Check.

Barf bags? BARF BAGS?!? Dude, get OUT OF MY CAR! You do NOT need to go to the drug store so badly that you can’t cancel your appointment when you’re HEAVING!