John, the support worker says, “I can’t help him. He’s bat shit crazy.”
Elaine, the case manager says, “He was in the army. He’s a trained killer. When he’s off his meds I won’t go near him.”
Tony, the case advocate says, “She’s always drunk. There’s no point trying to do a home visit if she’s smashed.”
Alex, the peer worker says, “Until he hits rock bottom like I did, there’s no point in even trying.”
Know what the problem I have with all of these? None of them are truly person-centered. Each one is an excuse of why not to serve someone. None of them exhibit the creativity and tenacity I expect to see in housing support programs if success is to be achieved.
It has been said that success is a lot like pregnancy. People want to congratulate you when you achieve it. But they don’t know how many times you’ve been screwed to get there.
No housing support process is perfect. But that doesn’t mean we can’t keep focused on success regardless of how many issues, missteps or barriers come up along the way. It is up to us to address and solve these issues to work effectively with our clients, not expect them to be someone they are not.
These and other excuses for not providing excellent service have been known to come up when I do training. I want to take just a few moments to dissect some of the critical steps that have to be taken to help ensure success in service delivery – whether that be helping people enter into housing or supporting them once there.
It is true that people have to provide informed consent to participate in a housing support program. Undoubtedly, some people with severe mental illness may have smaller windows of lucidity to enter into such a conversation. But that has more to do with us trying to find those opportunities rather than being consistently dismissive and thinking they will never be able to consent or actively participate.
When a person does have compromised mental wellness and is in the program, I also want to know what steps have been taken to help support the individual. Is the case manager trained on the Recovery orientation to effective service delivery? Do they know how to create a WRAP or DREEM with their client? Is there an up to date crisis plan in place? Has there been brokering and advocacy to community-based resources, from peer supports to mental health professionals?
All clients present potential risks to case workers, whether that is in community or doing home visits. Oh, and strangers present risks too in places like buses, night clubs, grocery stores, shopping malls, gas stations, rest stops, public parks, etc. It is up to us to practice impeccable community worker safety strategies and perform risk assessments that allow us to better identify what the specific risk may be and then determine the person, process or technology that will help lessen that risk. All human interactions come with some risks. It is also a fallacy that persons with mental illness are any more violent than the rest of society.
Some workers/organizations place a strong emphasis on their clients taking their medications. That is more about compliance than being person-centered, or in the case of mental illness, truly understanding or expressing empathy when it comes to psychotropic medications. The side effects of some of the most common medications are quite astounding and vary from medication to medication. How comfortable would you be with things like weight gain, dry mouth, constipation, unusual dreams, muscle spasms, menstrual irregularity, lack of sexual desire, lethargy – or a host of other things that can greatly impact your day to day life? I’m not suggesting we should not be encouraging people to consider their medication options, but let us appreciate that it ain’t all sunshine and roses, and that you too – if you were in the same position – may be carefully weighing the impacts of the medications with its potential side effects.
When supporting someone who chronically uses substances like alcohol, I ask workers how they have changed their schedule to meet the needs of the client instead of unrealistically expecting sobriety at any point during the day? This is one of the reasons why a 9-5, Monday to Friday approach to doing this work really isn’t effective. Doing so implies that the people we are supporting can and will adjust their behaviors and daily cycles to our schedule. It may be that the person who drinks heavily needs you to come in the morning after they have had one or two to get rid of the shakes but before they are intoxicated. Or maybe they need you to come late in the afternoon or early evening after they have had a nap for their day drinks but before they ramp up for using in the evening.
And then there is good ol’ “rock bottom”. There is no commonly accepted clinical definition of “rock bottom”. People are capable of change regardless of where they are at in their behavior patterns. It is up to find ways to engage, without thinking any two people are the same. Being person-centered requires us to truly be focused on the individual; not to be comparing them to ourselves or other clients past or present.
Truth is, we can come up with effective strategies to succeed, or we can hide behind excuses to not properly perform the required job. I ask (beg?) housing support workers to embrace effective strategies. When success happens it no doubt will have come with some setbacks and missteps along the way…but success is still success nonetheless.