Mental Health *headdesk* Moments

How how HOW does a client who tried to kill himself TWICE this week and was brought in to hospital BY THE CRISIS TEAM, who found him intoxicated and holding a knife get discharged from emerg without ever getting admitted?!?!?

Up In Smoke

It's got to be one of my least favourite thing about my job - my hair and clothes smelling like smoke after doing home visits*.  Many clients are courteous, and don't smoke while I visit.  Some just find it too difficult to  it though the appointment without smoking.  In summer we often accommodate this by meeting outside.  But it's currently winter here in Canada, and temperatures are too cold for that.

Some job postings in this field state that the candidate should be aware they will be in smoking-environments.  Mine didn't but I've long recognized it as an unavoidable workplace hazard.  Sure, if I really wanted I could try to insist that clients meet me elsewhere, but the home visit plays an important role in my work, puts focus on me rather than the client, and possibly makes them feel guilty.  That's not what I'm trying to do folks.  Besides, it's their room/apartment/house.

Not so fun fact: rates of smoking for people with schizophrenia are estimated at about 88% - three times that of the general population.  And smoking cessation is just not high on the list of goals or priorities for most of my clients, who are busy trying to manage their symptoms, maintain their housing and survive on a few hundred bucks a month.

So until this changes, you'll see my huddled in my big coat and hat, driving with my windows down in winter trying to air myself out.

*not every home visit.  About half my current clients are smokers

Taking the Long View

I remember when I interviewed for my current job and was asked how I would handle transitioning to providing “long-term supports” - I was already working for this agency doing short term and crisis response work.  The director who was interviewing me stressed how challenging it can be for both worker and client to maintain hope, focus and direction over a long time.  I hadn’t really thought about it before, but must have come up with a reasonable answer, since here I am as a long term case manager.

I’ve now been in this role three, almost four years.  Some of my clients have been with me as long.  One of my very first clients has had problems with her housing situation since before I began working with her.  She also had mental health and physical health problems, family and financial issues amongst other challenges.  Basically, we both realized that until she had more suitable housing, it would be difficult to focus on her recovery, and I could basically only help her to “get by” in all the other areas mentioned.  Right from the get go I got heavily involved in working to address the housing problem.  There were family members, multiple agencies and her own issues to consider in this work.  What she needed was a first floor apartment (safety and accessibility issues) with three bedrooms (two kids of disparate ages and genders) in a particular area of town (so one child could attend a special needs school) with no carpet (severe allergy problems) and that would be eligible for the rent subsidy she receives (landlord would have to agree to work with that program, program would have to approve it and have the funds for it).  Like finding decent housing isn’t hard enough!

 

I won’t go into detail about all the ups and downs in this process over the past few years.  I will just say that a couple weeks ago, I got a call from a staff member at the housing agency.  I could hear excitement in her voice as she told me that she was looking at an apartment that she thought would fit all my client’s needs and criteria.  She could arrange a viewing in a couple days. 

The client came, kids in tow and looked around.  She couldn’t have been in the place more than 3 minutes.  It wasn’t going to work she said.  Why, I asked, as it had everything she wanted.  Did she want to take the kids to the park so we could sit and talk about it?  No, she wanted to catch the next bus, everyone was hot and she wanted to get home.

That was Friday, and on the Monday I met with her.  It went back and forth, she could see the advantage of the place, but there were certain problems…could she view it again?  I made the call and set this up.  My hopes were high, because I hadn’t even expected this much.  This time she came alone, left the kids at home.  Took a little more time looking around.  In my head I’m making plans about how to apply for grants to help cover the moving expenses, when I’m going to fit in an appointment to take her to get the key…the housing worker tells her she will need to know by the end of the day if she will take it.  I will call her in a couple hours to see what she has decided. 

When I do, she’s not ready.  Can I call later?  Of course I can.  This happens a couple times, until finally I tell her I can’t wait any longer and give her the housing worker’s number and tell her she will have to call directly.  I try to put it out of my mind as I go home that night.

Come the next morning, there are no messages for me.  It’s not until halfway through the day that the housing worker calls me to say that she will need a signed letter of refusal from the client, because she didn’t take the place.  The reason she ultimately gave was that the bedroom furniture wouldn’t fit.

I spent plenty of time that afternoon debriefing about this situation with my supervisor.  It’s times like these that it is difficult to remind myself of all those social work-y truisms – about client directed service, and individual right to determination and all that.  I will still be there to support this client either way, but I have to say I was mad.  As much as I can rationalize about her reasons, and empathize because of her history, I was mad.  Four years of work, for what?  I gave this woman my best and felt like it was totally disregarded that day. 

I know it’s not about me.  But this was one of those situations where BECAUSE I care, I couldn’t just forget about it.  It’s hard to think about possibly several more years of working with this client after this has happened.  This is where the long-term gets really tough.  This is where I start to feel tired and stuck.

The fact is, that what I need in order to keep going here are the same messages we use when talking about recovery.  Patience...hope...a willingness to fail in order to learn.  Finding the small successes that mark our progress.  Letting go of the things we cannot change.  Moving forward, because you can’t go back.  This is what will get me through the next four years of trying and trying again.  I can only hope that I will be able to inspire the same in my client.  After all, she is the one who must continue to live in her current situation.  And ultimately, she will be the one who determines when and how it changes.  Maybe I will even be there to cheer her on.

Friday the 13th resolutions*

So I realize I'm a little late to the game, but I've decided it's time to make some resolutions for 2012.  Not for my personal life which is practically perfect in every way (or not, whatever) but for my professional life. 

It actually makes more sense to do this now that on January 1st. 

On January 1st I was in full-blown vacation mode.  Driving along country roads gazing at the snow dusted fields, fresh from enjoying a cozy night with some friends in an old farm house.  Pleased with myself for downing enough water and eating half a loaf of olive bread to soak up the booze so I didn't feel too hung over.  Spending the rest of the day snuggling on the couch....ahem, what was I talking about again?  Oh yeah, resolutions. 

So anyway, things were rosy at New Years giving me no impetus to change.  By now I've been back to work for a week, and admittedly it's made me a bit of a grumpy bear (that's what AM would call me in his most mock-caring voice).  This attitude sucks.  For me, and everyone around me.  I'm sure this doesn't exlude my clients.  I care about them, I really do, and I don't like to feel that this doesn't come through in my work.

So I'm working on resolving this (ha, see what I did there?) or perhaps to put it in some more social-worky terms I'm trying to develop some strengths-based goals for myself.    In some cases I'm just renewing old goals.  Here's what I've got so far:

1. Practice positive thinking, not just for clients but for myself
2. Better self-care: always
3. Learn to say NO to things that will only drag me down (I really suck at this currently)
4. Keep up the job search, the right one WILL come along
5. Find creative ways to get involved at this job that will promote a better experience
6. Be thankful for what I have - be happy

They're not exactly SMART goals yet (10 points if you know what that is) but like I said, I'm working on it.

So what about you, any professional or personal resolutions this year?  

*I know there is some kind of joke about bad luck in here, it's just not coming to me.  TGIF

Recovery 101 - Series Kick Off

This post is a part of the Recovery 101 blog series. The series will explore ideas, philosophies, language, tools, and questions about mental health recovery.  Submit any ideas for topics in the comments section of any tagged post.



I’ve mentioned that when I started working in this field, I heard the word recovery tossed around a lot, but there didn’t seem to be any substance to it. I specifically remember being asked in my job interview about “recovery” – I think I said something about “believing that it is possible to get better” from a mental illness. The exchange was pretty vague on both sides.

I now think that part of the reason for this hazy understanding of recovery was precisely because it is so hard to pin down. Mental health recovery is different for each individual. But good community/social workers have always known that each patient/client/member has different needs and strengths, so there must be more to it than that.

From what I’ve learned so far:
-recovery is about living a full life (however you define it) not just getting by, coping, or managing
-it requires an individual to take responsibility for their own wellbeing
-a healthy, supportive, and empathetic environment makes so much difference
-it requires people to make choices for themselves. This may will include choices which lead to both successes and failures.
-the systems currently in place - hospitals, community mental health supports, families - although often well intentioned, may hinder as well as help
-recovery always involves HOPE.  This is probably the most key ingredient.

How do you define recovery?  What does it take?

Nectarine's Day Off

It's friday before a long weekend (Canadian Thanksgiving).

All 3 of my supervisors are off today.

Our whole network at the office is down.

I am going to try reeeaally hard to maintain a "client focus" today, but I must admit it is extremely tempting to play hookey. :)

Back to the Grind

I've just had a lovely extra long weekend.  I took last Friday off, and yesterday was a holiday for us (Family Day).  I got lots of sleep and am recovered from my cold.  So now I'm all refreshed and ready for...training. 

Actually, it's an ongoing session I've been attending about concurrent disorders (mental health and substance abuse - I understand in the U.S. this is referred to as dual disorders, co-occurring disorders or dual diagnosis.  Which is extra confusing, because "dual diagnosis" here means mental health and developmental disability).  This is not an area of expertise for me, and I've really been enjoying the sessions.  Plus, lunch is provided - BONUS!

Later in the week I will also be attending "recovery" training.  Add to these a team meeting and monthly supervision and I have time for precisely two client appointments this week.  Yes, TWO. 

We're keeping that "client focus" alive.