What Makes Me Happy

This is about a client I had when I first started this job. I may have reflected on this story before in my blog, so bear with me if it sounds familiar.

He had been in the system for years, and had previously been supported by a coworker who left for another job.  He was a young man with schizophrenia and developmental delays.  He lived with his family (who wanted the best for him) including his grandmother who brushed his teeth for him even though he could do it himself.  It is fair to say there was a lot of learned helplessness going on.  

I was a little more eager and a lot less experienced then.  This man was more ill than anyone I had worked with previously.  My normal tactics did not work.  We were down to real basics - getting him to remember who I was, and remember his appointments.  Our appointments consisted of me trying desperately to make some kind of conversation while he was more interested in watching soccer or getting me to take him out for pizza.  All the while granny is knitting in the background and making me hyper aware of my youth and inexperience.  

I don't remember what the incident was, but somehow he ended up in hospital.  The family and I worked with the doctors to get a med review and he was started on Clozapine.  While he was still admitted I advocated to get him in with our ACTT program (Assertive  Community Treatment team - a more intensive level of support than what I provide) and he was accepted, so I never really saw him after his discharge from hospital.

Until one day I was in the waiting area of a psychiatrists office with another client.  I recognized this man's sister and then he came out from his appointment.  He looked me straight in the eye and said "Hi Nectarine" and then proceeded on his way.  

That was it.  But it was so much!  This person, who had met me at the door with a blank face week after week, giggled when he couldn't remember my name for months over a year prior at this time had said HI and addressed me by name!  He now attends one of our drop in programs and I see him over there from time to time.  Every time this same thing happens.  He says hello to me the same way, and then walks away.  It's all I'm likely to get, but it's so much.  It makes my day every time.  

Will this client continue to recover?  Probably.  Will he recover to a level that other people find "normal"?  Probably not, but to me, all the work he and his supports have done is so worth it to bring this human being out of the bubble his illness and medications had put him in.  I'm grateful to have been a small part of it.

With Grateful Thanks

So.  I've been a little blase about posting lately.  I think this is because I've hit the doldrums again, struggling to feel motivated in my job and wishing I were (working) somewhere else.  The thing is, I'm here for now so I need to make the best of it.  With Canadian Thanksgiving coming up this weekend I've decided to think of all the things I am grateful for about my work.

• I have a job.  And compared to other social service sector agencies, mine pays decently well
• lots of vacation time - I've been working here 5 years and now get 5 weeks vacation
• Experience - I have the opportunity to work with a great diversity of clients
• the environment here is by and large supportive and positive
• I have the ability to set my own schedule much of the time (within bounds)
• I have a lot of freedom to decide how to work with my clients
• most of the buildings my client's live in have working elevators
• I like my manager and supervisor
• I'm provided with lots of opportunities for training
• the agency has taken up a "recovery" based philosophy

What are you grateful for in your work?

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.

What Inspires Recovery?

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.


Stories of success in mental health recovery often include a moment of inspiration.  An action by a friend or family member, a life event, a misfortune or a random bit of information learned may act as a catalyst to change in an individual's life.  The stories I have heard often describe a change in the individual's thinking which promotes a drive or motivation to recover.  They reframe their thinking.  They gain hope or a positive outlook.  They create a goal for themselves. 

As workers or support figures we are often searching to find this source of inspiration for our clients or friends.  Doubtless mental illness suffers are seeking it for themselves too.

Last week saw Bell Let's Talk day get lots of attention.  I decided not to write about it at the time due to it being a corporate sponsored event, and I don't have much to say about Bell.  The next day however one of my clients talked about watching a TV interview with Let's Talk spokesperson Clara Hughes along with other famous sports figures talking about their experiences with mental illness (depression and PTSD were covered as far as I remember) and how they recovered.  This client himself suffers with depression.  He told me that watching the show made him feel even worse.  He said they each talked about how their spouse or partner helped them get through - he does not have a spouse, and when he did she was more cause for pain than support.  He said they talked about how despite their various successes (Olympic medals, major trophies and awards) they still suffered.  His take?  If he didn't even have these type of awards, how much worse off does that make him?

Not the intended effect of the program I'm sure.  What was meant to inspire in this case, really didn't help. 

On the other hand I have taken clients to hear recovery stories shared by those in their community and they have reported feeling hopeful in their own lives as a result.  One woman I worked with who has bipolar disorder described watching coverage of Charlie Sheen go off the rails as inspiration for her to get better because she "didn't want to end up like that guy".  There are stories of people going to their doctor, support worker, family member and hearing the same message every day until finally "click!" something registered that was their moment of inspiration.

The moment of inspiration does not result in life getting fixed over night.  Things may not look any different for a while.  But down the road, further along the recovery journey it's the moment that someone looks back on and says "that's when everything changed for me.  That's when I knew I could get better." 

It's the moment that makes all the difference.  Because we can be surrounded by the most well-meaning people in the world, all the praise and validation one could ask for.  But if we are suffering inside, true change will not come until we are open to it.  And the key to open the door may come in all kinds of strange and unpredictable forms.

Recovery Defined?

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.

Somebody recently send me this link to an LA Times article from last month about a new definition for recovery. While not introducing any new concepts, it is newly agreed upon by the Substance Abuse and Mental Health Services Administration in the U.S. The definition is thus:

“A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.”

I have to say I kind of like it. It’s open-ended as it doesn’t specify those who suffer from some particular ailment or circumstance, and it’s free of loaded language like “meaningful activity”. It refers to people, not clients/patients.

Here are some other definitions of recovery:

The ability to live well in the presence or absence of mental illness - or whatever the person chooses to term their experience (Mental Health Commission, NZ)

Recovery is the personal process that people with mental illness go through in gaining control, meaning and purpose in their lives... (CMHA Ontario)

The goal of recovery is to become the unique, awesome, never to be repeated human being that we are called to be (Pat Deegan)

Language Matters: Non-compliant

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.

We in social services know the importance of language. We know that words can hurt or empower. We know that labels may stigmatize. And yet so often our work comes from a place, system or history that promotes these very problems. As one part of the Recovery 101 series I want to explore the language and word that hurt the work we do, as well as the people we work with.


One of my greatest pet peeves is the term “non-compliant”. Direct from the medical and clinic model of treatment, it is usually used to refer to someone who stops taking their medication against medical advice. It may also refer to refusal to participate in other forms of treatment.

When I hear non-compliant I hear:
1) that medication is the sole or primary method of improvement
2) that the treating physician knows what is best
3) that the patient or person is doing something WRONG or even deviant
4) that the patient or person does not have the right to determine how they want to recover
5) the reasons the person has for not taking medications are insignificant compared to what professionals or others perceive as the benefits of the medication
6) the patient or person is sick and must be made better

What alternatives exist to these words:
1) person has decided not to take the prescribed medication
2) person does not find the medication effective, or finds the side-effects unpleasant and is seeking alternative methods
3) the person is comfortable/prefers not taking medications at this time
4) the person has difficulty taking their medications consistently and may need help in this area

How do you view or support clients or others in their decisions around taking medications? Do you use the term non-compliant or have an alternative to suggest? Have you as a patient or person dealing with mental illness felt you have agency or decision making power with regards to medical treatment?

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?

What makes a Social Worker?

I have a confession to make: I am not a social worker.

That is, I don’t have a Bachelor of Social Work (BSW) or a Masters of Social Work (MSW). I’m not even a registered Social Service Worker, which is a two year diploma.

This does not stop my clients, or even friends and family from referring to me as a social worker.

I did go to school. One year of a Bachelor of Fine Arts (dropped out) and a diploma in Assaulted Women and Children’s Counselling and Advocacy (AWCCA). It’s an awkwardly titled and unique program, but I learned more there than in any other school I’ve attended my whole life. And it is in the Community Services department.

I believe in a recovery model of mental health work. Recovery is a word I’ve heard kicked around in mental health departments for a long time, but a lot of the time it seemed to be more of vague notion of an ideal rather than an actual working philosophy or model. It’s only been in the past year or so that I have really learned how the concept of recovery can be used to help clients and improve the work that I do.

I took to the recovery model very quickly, because it jives well with my feminist and anti-oppression perspective. These are things I learned in the good ol’ AWCCA, as well as my life experiences. 

Most of the time, I feel pretty well prepared to handle the work I do. I attribute this to my training, but also to my ‘lived experience’ - the things you don’t get out of a book. The recovery model values this highly. It emphasizes the importance of lived experience and in particular peer-support in doing mental health work.

Meanwhile, the social work sector seems to be headed for increased professionalization. I don’t really have numbers to back this up, but I have certainly noticed it from my constant perusing of job postings. More and more jobs are requiring BSW’s and even MSW’s for community work that has often been done by people like me. While I strongly believe that further education is a good thing, I do question whether this trend can be congruent with the recovery model.

I also would never want to disrespect or devalue the years of effort and hard work that others have put into their professional designations. Goodness knows I was proud when I graduated my program (with honours thankyouverymuch) but is completing a two or four or five year degree the only way to be a Social Worker?

More to come in a new blog series I am going to call Recovery 101.

Breaking Up Is Hard To Do

I’m breaking up with a client. At least that’s what I’m trying to do.

I’ve been seeing her for two and a half years. I picked her up from another program, and she has had case management support since 2002.

She doesn’t need me anymore. She’s said as much herself: she’s got an active life in her community, great family and professional supports, medication that works well for her. But she sticks around because she wants a ride. I drive her twice a month to her trustee, which is a fair way from her house.

This arrangement made sense when she started it with her previous case manager. She needed help not to miss the appointments, and to understand the information she was given when there. But not any more. She’s had time to learn and get used to the process, and she can do it by herself, but doesn’t want to. I can hardly blame her. Why spend money on a taxi when you can get a ride for free? And taking the bus is a pain. That, and the fact that my “support” is tied to her housing makes it difficult for me to disengage.

This is the bigger (systemic) problem. More and more the focus in community mental health services is on “recovery” and this is definitely the right idea. People don’t need to stay sick forever, and support from people like me is supposed to help. This woman has had an incredible recovery, but as it stands our supportive housing program provides no exit as long as she relies on the rent subsidy. I would never say that her subsidy should be removed before she can afford it, as having safe and stable housing is obviously a huge contributing factor to keeping her well. She can afford (IMO) to do without me.

After having explored this issue from every angle with my supervisor for months and months, examining myself for counter-tranference, and trying everything to be sure we were not under-serving her or missing ways that we could connect or provide support, my supervisor told me that I have her backing to start withdrawing transportation support. I have no desire to leave her high and dry, so I will propose that we agree on a timeline in which we can develop a new transportation plan and then I will stop chauffeuring driving her. I began practicing in my head how the conversation would go, and how I will handle her possible reactions.

I went to pick her up yesterday. She was dressed very nice and had a big smile on her face. I wished her a happy belated mother’s day and she thanked me. Then she informed me “and it’s my birthday today!” Oh crap.

I couldn’t do it. I couldn’t rain on her birthday parade with my difficult news. Put plainly, I chickened out.

We meet again in two weeks. I’ll do it then, I swear. Otherwise, I know I’m only prolonging the pain.

The Long Haul

How do you help a client who has been the recipient of case management supports for 14 years, and does not yet understand why she is receiving the service and what is its purpose? She can tell me exactly the number of visits she’s had (108 from me over the past 2.5 years, 784 total from all CM’s) but not why they are happening.

Careful of becoming frustrated, I go into empathetic mode. “You seem to have some questions…” “I hear that this is distressing you…” “Is there help you would like that you don’t feel you are getting…”

I’m not sure she hears what I say, as she would like to reinforce her previous statements, and repeats what she’s said before I am finished. Then repeats it again. We are testing the limits of the “recovery model” profoundly here.

So I call in the reinforcements. Her “natural supports” (dad) to keep him in the loop. He really wants to help, but doesn’t always know how. The “formal supports” (housing provider) to give a heads up and some background on the angry and frustrated phone call(s) they will inevitably be receiving. My supervisor so I can check my feelings about the situation, and get the help I need to figure out clinical solutions that may work here.

I really do believe in recovery. A situation like this makes me wonder if there was a failure in the system along the way, something early on perhaps that did not help this person gain understanding and a sense of control over their life situation (answer=probably). Perhaps it’s the set up, the fact that by accepting a rent supplement, she is bound to the “support” aspect of supportive housing. This policy has always troubled me as it is so far from “recovery” based.

On the other hand, maybe this is what recovery looks like for her. She’s been able to live in a place she likes for all those years. She has hobbies and things she likes to do, however sporadically she does them. She tells me she never wants to return to work, and does not want anything drastically different in her life.

Or instead, that could mean we haven’t done a good enough job of instilling hope and conveying a sense of what is possible.

Perhaps her journey is just a painstakingly slow long one. Maybe 14 years has just not been enough to create a new sense of self and new way of living after (what I understand to be) many years of neglect, abuse, illness and loss.

Sometimes it is just too hard to know.

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.