Monday, June 7, 2010

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

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