Updates

I really do love getting updates about my old clients.  Especially when it is good news - like hearing that they finally got a subsidized apartment we were waiting for/fighting for for the past 2 years! (she was waiting 10 years for housing, I was only around for the last 2)  Or got promoted to a full-time position at work, when last I saw them they were considering quitting the part-time position, as they were sure the employer was unimpressed with them.

Keep the good news coming!

If only *this* was what we dealt with as housing workers

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.

Vehicle of DOOM!!!

Just exactly what you DON'T want to see when you pull into the parking lot at a client's building.

First day back from vacay, 9:01am

This is what greets me...

Problem: My client rents a basement apartment where the landlord and his family live upstairs. They went away for more than 3 weeks and did not leave her with contact information if anything goes wrong. They also did not leave her with any way to get her mail as it is delivered to their post box (to which they have the key). She has bills due, but does not know the names of the companies, or the amount of the bills.

Solution(?): She wants me to come and hang around the post box all afternoon to intercept Canada Post and obtain her mail.* She figures they will give it to me (as opposed to her) because I'm her "worker". Sometimes I wish that pseudo-title held half as much weight as many clients seem to think it does.



*NO, I am not going to do this (as if I even had time). I'm seeing her ASAP to help sort something out, and determine if she will let me talk to the landlord when he returns. Oy.

Lost in Translation

I subscribe to an online discussion forum for housing workers in my area. I often skim the discussion notices I get in my in-box, however the following caught my attention:


User 1: Hello, we are searching for a Ga-speaking mental health outreach worker for one of our Ghanaian tenants who is struggling with schizophrenia. We've contacted a number of MH service agencies and settlement service agencies, but have had no luck. Any contacts would be much appreciated.
thanks

User 2: you can try Multilingual Community Interrupter Service who would be able to support you!!!

User 3: I believe the spelling is Interpreter. An interrupter service would be the polar opposite of that provided by MCIS.

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.

Conned?

Well, in case you hadn’t heard yet it’s election time in Canada. Inevitably, election talk comes up with clients. I’m consistently surprised by the number of my clients who profess to support the Conservative party. Everything I’ve ever learned tells me that the Tory’s do the least for the issues that I think of as relevant to my clients, ie., failing to create the promised National Housing Strategy, cancelling Universal Child Care, “tough on crime” policies.

Still, I’m glad when anyone is engaged enough to vote. Hey, maybe I’ve been too brainwashed by the socialist, left-wing nuts (I’ve been a bleeding heart all my life) who seem to abound in social services to ever see what the appeal might be.

Of course, I put on my best non-partisan face during these discussions. Despite how much strain that may put on my face (it hurts!) Maybe I should just ask...what they like about the party, that is...just out of curiosity's sake. Yeah, I think I might be able to get away with that.

I can’t stop thinking about this since one woman told me today that she is considering volunteering for the Harper campaign. Even though she has declared this a “Seinfeld election”.

Go figure.

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.

Celebrate the Small Stuff

It's really easy to get bogged down by negativity and frustration in this line of work.  Sometimes you just can't help but feel that recovery is impossibly slow, and "the system" is nothing but a big nasty mess serving only to keep people down.  It doesn't help when all over the news there are stories of families who lock their mother suffering with dementia in the garage, and Community Housing Corporations with big spending problems.

This is why it is so important to celebrate the successes.  Even the small stuff. 

Yesterday a client of mine officially received a Regional rent subsidy on her apartment (not from the troubled TCHC).  This is the first client I have even been working with that I have seen come to the top of the list!  She had been waiting for 14 years.  Despite all the paperwork (which this client in particular has zero patience for) she was very excited, as was I. 

Next week we're going to Roll up the Rim to celebrate.

Extremely Cold Attitudes (Toward Homeless)

It's -27 celcius today, and snowing. Many of my client's find it difficult to get out of the house much at this time of year. I find myself less and less enthused about bundling up to get in the car and head out to see them.

My thoughts mostly are with the group I used to work with - the homeless and underhoused. An extreme cold weather alert has been called, but we know that some will still be outside.

An older gentleman that I support was distraught last year after his brother died on the steets of Calgary. He was found in a snowbank.

At least that city seems to have a plan in place to address the issue of homelessness, a plan that seems to be making progress.

Calgary's 10 Year Plan seems to be simple and straightforward. First, create permenant affordable housing for individuals and families. Provide support for mental health and addictions. Recognize the systemic issues that create homelessness, and acknowledge the economic toll that it takes on a community. It's great to see such an honest discussion of the problem occuring at a civic level. Several cities in the U.S. have similar plans and report largely positive changes so far.

I only wish that this was a conversation that City Hall in Toronto would have ears for. Instead, we have new Mayor Rob Ford's recent suggestion that social workers should be made security guards of the steets and force homeless people into shelters during extreme cold. Mayor Ford made no comments regarding plans for these folks once the weather warms (to greater than -15). As a city councillor, Ford made his feelings on the matter quite clear stating "People do not want government housing built in the city of Toronto. They want roads fixed, more police presence, but they don't want more government housing that will depreciate the value of their property."
He also cried that it would be "an insult" to his constituents to even discuss having a homeless shelter built in his ward.

So I guess it's up to us - front line agencies, community activists, and the people who need the housing around here to keep up the fight. To find the allies we undoubtedly have in city hall and elsewhere. Not that that is anything new.

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.

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...

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.

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.

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