Recidivism in a System Context

Recently I was in a community where a rather large service provider proclaimed that less than 10 of the households they served in the past year experienced recidivism. I was in awe. I wanted to know more. This could be the secret sauce! The holy grail of homelessness! The Colonel’s secret recipe!

But alas, it was all for nothing.

Like so many times before when I have heard about apparently amazing and effective programs, the truth of the matter is that the service provider totally misunderstood what recidivism is in a homeless system. I don’t blame them. I want to educate them.

Recidivism comes from the Latin word recidivus, which means to fall or to fall back. Some dictionaries will focus attention on falling back into crime. If it isn’t obvious to people familiar with me, and my blogs, I don’t equate homelessness with criminal activity.

So, to fall back. Let’s work with that.

What the service provider really meant was that they had less than 10 households that had fallen back to them. To them.

In communities with limited data systems, this may be the only way to track recidivism by organization, but it is a very limited way of tracking recidivism and one that isn’t true in a system context, especially in medium and large cities.  A service provider may know how many households fell back to them, but it doesn’t accurately tell us how many households fell back into homelessness.

Further investigation in this particular example revealed that there were many, many, many, many (did I mention, “many”?) more households that returned to homelessness. Those households just didn’t return to the same organization.

So, let’s make a distinction in recidivism – falling back into homelessness is the more important concern; not falling back to the same organization (which is important, but not as important).

Think about it from the client’s point of view. If you had – what you perceive to be – a failed outcome with a particular service provider, and you had a choice, would you return to them? All the while, that service provider may think they are doing a better job than they really are at supporting households out of homelessness. If ignorance is bliss, some service providers are orgasmic because not knowing and thinking they are doing well supersedes knowledge of the truth.

This isn’t a critique of service providers. Frankly, until there is a shared, open data system in every community that is focused on the needs of clients, this sort of thing will persist. But in the meantime, let us explore further (respectfully) when service providers tell us about their recidivism rate. Until we know what that means in a system context we may not know much at all about the effectiveness of our services and investments. We may be telling clients, other service providers and elected officials that programs are doing better than they are really doing – not with malicious intent, but because of lack of information.

Improving the use of Empathy in Recovery-Oriented Conversations

This week I am unveiling our new Recovery-oriented Housing Support Training. One of the areas I felt it necessary to add more time and attention is related to the importance of expressing and exercising empathetic conversation. Being appreciative of the client’s thoughts, feelings and experience is important to meaningful support, but too often I have seen well-intentioned support workers miss the boat when it comes to creating an environment conducive to an empathetic connection.

What are some of the common mistakes?

Interrupting is a big one. Sometimes it is to provide advice or try to provide a solution or make suggestions when it is unsolicited. I think some support workers think this is helpful and uses their time better. But if recovery is a process and a journey then we need to take time to let it unravel. This may mean multiple interactions over time.

Making demands of people rather than honoring decision-making and empowering people with information that they can discern is another common mistake. Part of recovery is respecting that people will make mistakes and then engaging with them to debrief on what has been learned. I think it is often out of these protective instincts that I have seen workers order, direct, warn, threat, moralize or preach to their clients. The action of making a demand on someone is laden with authority and power that disrespect the equality that is necessary in empathetic conversations.

Another big one for me is judgment. We all have our personal values, norms and perceptions in life. These differences are important to recognize and respectfully discuss. We should accept and respect diversity, and see “diversity” as having deeper meaning than “variety”. Through judgment comes feelings of being critiqued or blamed. This is unhelpful.

Using humor seems like a light-hearted engagement technique and surely it has a time and place in all good working relationships. But in a recovery-focused conversation it can be a distraction, viewed as dismissive or an unwillingness to engage in a discussion that may be uncomfortable. It can also be misconstrued as what the client is sharing is unimportant – even if that wasn’t the intent of being humorous.

Sympathy can creep in when people are trying to express empathy. Support workers can take on a consoling or pitying role. This may be done to try and make clients feel better, but it can interrupt the flow of conversation where the individual is explaining their experiences and feelings.

So what should be done?

Off the bat, let’s be transparent with the people we work with that different interactions will have different communication styles. There is no point in tricking people or thinking that if we just ask the right questions in the right order that everything will be alright.

Let’s focus on listening – actively and patiently listening – rather than telling. When the time is right in the conversation, present information for the individual to consider and discern, and avoid (as best as possible) requirement of immediate decisions based upon the presentation of information. The knowledge we share should be supportive and without pre-determined conclusion.

Let us offer compliments and acknowledge success when it is warranted. Do not be trite or condescending. Respecting the effort that people put into decision-making is important. Done in the right way, the acknowledgement of effort will enhance the collaboration and openness to discussion and help the client appreciate (perhaps intuitively) that you are being supportive and non-judgmental.

Finally, we can’t force people to talk or engage in conversation that allows us to express empathy. The best we can do is create environments for dialogue. If people understand that we are entering into conversation rather than demanding information from them, the process goes smoother.

Qualities of Some Amazing Outreach Workers

Last night I had the chance to ride along with an outreach team in Calgary. It was pretty darn cold…less than -25C with the wind chill. I love doing outreach. It takes me back to my days doing community development work and street outreach. It helps me stay grounded in that part of the reality of the front line.

The people I did outreach with were two fabulous women. I’d like to dedicate this blog to the elements of them that I was so impressed by.

Grace – they honored the people they served through their action, tone of voice and commitment.

Dignity – they humbly made people feel worthy of service and reinforced the importance of how much each person deserved a safe place out of the cold.

Patience – they demonstrated the capacity to accept delay, trouble, suffering, strife, belligerence, anger, incoherence, difficulty communicating, poor hygiene – and more – without ever getting angry or upset.

Humility – they viewed their contributions with meekness and humbleness, genuinely deflecting praise.

Logistics – they navigated calls for service with precision in how best to get through traffic and around the city in the most efficient and effective way possible.

Solution Focus – they seamlessly and without intrusion focused discussions on the best way to meet each person’s needs, while also reinforcing longer term ways to end their homelessness.

Politeness – more than good manners, they genuinely embodied respectful and considerate behavior with people calling the van, passengers, colleagues and other professionals.

Empathy – they showed through actions and words how it is possible to relate to someone and understand their feelings without pity or sympathy.

Intelligence – more than facts and figures and locations and people and system knowledge, they demonstrated how to apply all of this information in tangible ways to problem solve and make the lives of the people they were serving better.

Humor – they knew that humor shared with each other helps them manage the stressors of the job, but also used humor to make the experience of receiving outreach less intense.

Teamwork – they knew – perhaps intuitively – that the combined actions of the two of them together far exceeded the contributions of either of them solo in doing their work the most effectively.

There are more qualities that I could go on about, but these are the ones that lept to the surface for me last night. I appreciated the time I spent with them and each homeless person in the van. The outreach team is definitely worthy of my highest esteem and respect.

Transitional Housing?

For more than a decade, in the role of policy-development, as a service practitioner and as a researcher, I have been investigating and trying to understand the allure of Transitional Housing. I have been interested in the outputs and outcomes that Transitional Housing can demonstrate relative to other housing models. I have been interested in the planning processes used for Transitional Housing – from the needs analysis to understanding the population to be served to securing financing to the urban planning and architectural features of Transitional Housing. From a system perspective I have been working to comprehend where it fits in, for which populations and under what circumstances.

Throughout my travels I have seen different models of Transitional Housing and different approaches to delivering services in Transitional Housing. I have seen congregate Transitional Housing – some for individuals, some for families, and some blended – that range in size from a handful of units to hundreds of units. I have seen scattered site Transitional Housing through head-lease arrangements. I have seen rented motel rooms that service providers have structured and labeled as Transitional Housing. I have visited some Transitional Housing that has a very fixed length of stay such as 6 months, 1 year or 2 years; and have also visited some Transitional Housing where people can stay indefinitely so long as they are progressing towards a future transition (though what that means is, in my experience, rarely defined). I have seen population-specific Transitional Housing such as for veterans, youth, single-parent households leaving domestic violence, Aboriginal persons, people in addiction recovery and chronically homeless persons – to name a few. I have seen some Transitional Housing that has 24/7 staffing, some with resident managers, some with daytime supports and some that has staff drop by a few times a week or on an as-needed basis. The multiple interpretations of what constitutes Transitional Housing can make it difficult to truly understand what the housing model is intending to be and what it is trying to achieve.

I find the hard evidence to support Transitional Housing – regardless of the model or population or size or length of stay or staffing intensity – hard to come by. The conclusion I have come to is that Transitional Housing isn’t all that necessary when compared to the alternatives. Let me make my case…

I am a skeptical empiricist. I look for data and evidence to guide my decision-making and the recommendations that I make to communities. I have never seen a peer reviewed piece of literature that proves people get better long-term housing outcomes through Transitional Housing than moving directly into permanent housing with supports. In fact, just about every piece of literature I have seen – whether it is Tsemberis’ work comparing Housing First to usual housing and treatment processes or Gerstel et al. with their awesomely titled article “The Therapeutic Incarceration of Homeless Families” – the argument is pretty clear that prolonging people’s involvement in “the system” is not helpful and doesn’t produce better housing outcomes. Read between the lines and I think Culhane et al. in “Testing a Typology of Family Homelessness Based on Patterns of Public Shelter Utilization in Four U.S. Jurisdictions: Implications for Policy and Program Planning” also provides a useful perspective on Transitional Housing.

In my quest for knowledge I am always open to new information to challenge and refine my thinking. If you know of any published studies that indicate that Transitional Housing is fantastic when compared to moving into permanent housing (including Permanent Supportive Housing), please let me know.

I know there is an argument that some providers and policy-makers have been known to use, which is that some people are just not “housing ready” and therefore Transitional Housing is needed to help make them “housing ready”. I have difficulty with this line of thinking. First of all, we never asked these folks if they were “homeless ready” which I think would be a much more difficult threshold of preparedness to meet. Cheekiness aside, what is it that we plan to model, teach, share in a Transitional Housing environment that we cannot do in Permanent Housing? Why is it that we want people to demonstrate a certain amount of success only to require them to move if they do well? And why would we want yet another environment that has a bunch of rules that will likely result in people being asked to leave if they don’t comply with them?

There is a pervasive opinion that the continuum approach to service delivery works – that homeless people should move from outreach to shelter, shelter to transitional housing and from transitional housing to permanent housing. Each is a step that has its own set of rules and requirements. Ultimately permanent housing is a reward for success along the way. I have a hard time using a basic human need as a reward – especially when the evidence to support the success of a continuum is non-existent and there is very clear evidence that people can move directly from the street into housing. While the continuum approach is the dominant service paradigm (still) in many communities, it too lacks empirical evidence to support it.

From a cost perspective, I have never seen a business case that supports Transitional Housing as being fiscally wise. I recently looked at some data shared on a sample community’s cost analysis on individuals and families that showed the cost of exit from Transitional Housing to Permanent Housing to be 8 times more costly than Rapid Re-housing into Permanent Housing and 2 times more costly than Emergency Shelter into Permanent Housing. It is cheaper to move people directly into Permanent Housing and support them than it is to create an intervening Transitional Housing step.

There is also the matter of successful outputs from Transitional Housing. So many communities I have worked with have the same question – transition to where? Good question. I have reviewed oodles of data in different communities and it breaks my heart the number of times people move from Transitional Housing to an unknown destination or back into homelessness because their time was up or they couldn’t follow the rules in the Transitional Housing. When there have been enough data points to undertake a longitudinal analysis, those individuals and families that have had Transitional Housing stays tend to demonstrate even more bleak longer-term housing retention outcomes than their Permanent Housing counterparts.

On a tour through Minnesota a few months back there were some strong advocates for Transitional Housing that said it was necessary because it provided a non-shelter place for families to go to while sorting out income so that the family could move into Permanent Housing. In this case, I can appreciate the logic of their argument. I appreciate that they wanted a non-shelter environment for families. But it also seems to me that a rather expensive Transitional Housing infrastructure was put into place to address what was actually an access to income supports issue. I can’t help but wonder if the same efforts applied to making adjustments to the income support system or in providing bridge financing in permanent housing by way of a short-term rent supplement wouldn’t be better than the capital and operating costs required for the Transitional Housing.

In other communities I have heard that Transitional Housing is required because there is a lack of housing in the community that an individual or family can otherwise afford. In this instance I can see how Transitional Housing is being used as a band-aid, short-term approach to provide time-limited housing, but I don’t at all see how it is addressing the issue of market affordability. What happens when housing doesn’t become more affordable while people are staying in Transitional Housing? Transitional Housing, as best as I can tell from research, was never intended to address broader economic and market issues. In this case the Transitional Housing seems to be used more as a short-term affordable housing opportunity that ultimately isn’t sustainable. Wouldn’t the resources put into Transitional Housing be better used creating more permanent affordable housing or rent supplements or vouchers for people to access housing in the private market?

More and more communities, whether it is through their 10 Year Plan or preparation for the HEARTH Act, are moving towards a systems-orientation in how they look at the array of services in their community. I applaud this and have been able to work with many communities in making some of the necessary design changes for their system to be successful. In every single one of these assignment the discussion has come up regarding the role of Transitional Housing. No doubt there are some communities that remain conflicted about Transitional Housing. Truthfully, I think this conflict is healthy as it is encouraging an important discussion on how Transitional Housing fits with trying to end homelessness…how it fits with reducing length of homelessness…how it fits with reducing recidivism…how it fits with increasing access to jobs and income (in those circumstances where there is a specific income threshold that cannot be surpassed to be eligible for the Transitional Housing)…

I don’t think proponents of Transitional Housing are deliberately trying to make the situation for individuals and families worse. I think in many instances service providers were following a funding opportunity to create Transitional Housing and were persuaded by the availability of funds that it must be a good thing to do. I don’t think Transitional Housing providers have malicious intent. I believe they are passionate about helping people. I appreciate and respect the hard work they have put into creating and operating the Transitional Housing, and that devotion is not lost if the organization is willing to look at a different way of doing things.

I encourage service providers with Transitional Housing to look at ways of converting their Transitional Housing into Permanent Supportive Housing, Permanent Affordable Housing or else looking at ways to allow people to transition in place. In all my years as a practitioner I have never seen anything done in Transitional Housing (especially congregate Transitional Housing) that can’t be done just as well, if not better (and certainly for a lot less money) than moving people directly into permanent housing and then wrapping supports around them.

Iain De Jong is the President & CEO of OrgCode Consulting, Inc. and has assisted several transitional housing providers in converting their housing into permanent supportive housing.

When the World Seems Like a Cold Place, it may be Time to Kindle More Fires

This is a very personal blog about my journey to accept my mental illness and to acknowledge how it has helped me to become a much better person, practitioner and teacher.

We all seek meaning in life. We want to do things that enrich us emotionally, intellectually, socially, recreationally and spiritually. Indeed, the world can seem like a cold place when we don’t have this multi-faceted enrichment.

By most measures, I have had a very successful life. I get to work on homeless and housing issues, which is my passion. I set up and provided direction to one of the most successful housing programs in the world — according to the World Habitat Awards. Work I have created has been honored with numerous national and international awards. My business partner John, who is the Founding Partner and COO of OrgCode, is also one of my best friends on the planet. I have been blessed with a terrific family that is very supportive about how I live my life and what I do for a living. I get to tour around and deliver keynote speeches, seminars, training workshops and the like to people who are also trying to make a difference. I get to do meaningful research and quench my insatiable appetite for knowledge by being engaged in academia. Although I am not even 40, yet, that’s another measure of relative achievement that, perhaps, accounts for my sense of urgency.

That is the public presentation of Iain De Jong that many people know. But there is also part of me that I am only coming to embrace more openly. I have a mental illness. Depression.

I live with depression, but it is not who I am. It is part of me. Depression has been with me throughout much of my adult life. I have gone so far as to deny its existence or been frustrated with it or made apologies for behavior that has resulted from it or masked my true mood in some caricature of my true emotional state.

As a child, I completed intelligence tests several times and was deemed to have a genius IQ. One of the aphorisms in life reminds us of the fine line between genius and insanity. I never thought of myself as insane. “Insane” conjures up too many stereotypes that easily triggers my denial. I can personally relate, however, to the odd juxtaposition of genius with compromised mental wellness because I have experienced the joy of being “well” and what I am capable of when I am in that state. As a result of my intelligence, I frequently tried to think my way through my illness. I tried to think myself to “better”. I failed. And then, I left the door open for self-doubt and so I felt that maybe I wasn’t as smart as all the fancy tests said I was. I thought I could be happy through sheer will. That was not possible. But I didn’t give up hope that one day I would self-master an impossible skill of overcoming depression through the power of positive thinking that people who are “well” use so effectively.

I let depression starve me from finding meaning in my life because I didn’t know how to deal with it or respond to its existence. I have worked hard to be what I thought others wanted me to be or expected of me instead of being who I really am. I have spent hours alone staring at the darkness, cursing my mental health, wishing for a different fate. I have cried, though often without tears, and the inwardly focused energy cutting me like a knife. I have faked laughter. I have shown up as aloof or as an uncaring jerk and defended both positions while alienating people even further. I have been a horrible communicator. I most definitely have not always been the best friend, son, brother, partner or father.

I have sometimes wondered what the world would be like without me in it. Oddly, this inner inquiry seemed to occur at times when I was achieving tremendous success in my career or in my personal life…as if somehow the only barometer of success was the dichotomy — to be or not to be. Was I just experiencing luck in my life? Or, was the success actually a result of my skills and contributions? If I was doing such a great job, why did I wonder what the world would be like without me in it – shouldn’t I want to experience even more success?

I have, at times, isolated myself from wonderful people and opportunities. I have denied friendship to many. I have used people to alter my mood rather than enter into relationship. I have gone to great lengths to try and push people away from me. I have thought repeatedly that the world is just a cold, cold place. I have lost count of how many times I have convinced myself that the problem wasn’t with me, it was with every other human being on the planet. How’s that for an ego?

I have been burned badly when I revealed how I felt to some people. One of my bosses was also one of my mentors. At one point when I felt “safe” and in search what I know now was a call for help, I opened up to him and explained how “down” I was feeling — regardless of how confident I appeared on the outside. He told me that this was the sort of thing that I should keep to myself. I may be wrong in my retro-analysis of the situation, but I still link the sudden slowdown in my otherwise rapid career advancement to the revelation of my depression — even though I didn’t use that word. While I now realize that his cautionary advice to me was wrong, I know that his opinion is unfortunately far too consistent with the stigma that still surrounds mental illness and it remains a taboo subject in most organizations. It is okay to talk about other “real” illnesses and be supportive but it is not okay to speak openly about a mental illness. To make things worse, it’s a form of discrimination that is rarely challenged.

Some people see mental illness as a tremendous weakness. As someone who works in a helping profession, it has taken me a long time to appreciate an empathetic relationship. Part of my strength as a practitioner is my experience as a person.

It took me years to finally get the help I needed though I am not — nor ever will be — cured. Part of my journey personally and professionally is to appreciate that if I want to be part of the solution, I need to recognize that I have a direct relationship with the problem. If I think the world is a cold place, then I need to do something about it and I now know that I need to kindle more fires. I need to share my experience. I need to open myself up to the right relationships at the right times with the right people.

About two and a half years ago, life became unbearable for me. It was so uniquely unbearable that I would ask myself several times per day why the heck I still existed — a little too close to Albert Camus. My previous feelings of darkness were more like dusk compared to the deeper shades of black that was experiencing. My response was to build a fortress around my emotions and every nerve ending became raw. Even things like teaching at the University or music that had previously brought me so much joy became disinteresting, even annoying. If I spoke at all, it was to use words as weapons. When I was alone — and isolation is what I was seeking — I would often feel this overwhelming urge to breakdown and cry, but the tears (and relief) wouldn’t come. I worked insane hours. I stayed up late and got up very early so I could work and, more importantly, so I could be alone.

I was lost.

When you are lost, options are few. You can stay lost or you can try to get un-lost. Being “found” or “rescued” through external intervention was not going to work for me, especially when I convinced myself that nobody truly cared. Getting un-lost was mine to own. There is nothing heroic about my journey following that moment of awareness, but it does seem magical as I reflect on it — as well as my momentary hesitation about allowing this blog see the light of day!

After a tumultuous year of emotional pendulum swings, life changes and frustration with how I was presenting myself to the world outside, I eventually ended up on medication — something that I had previously resisted. For the first time, I actually took the time to learn about various medications and their pros and cons. I had a competent and caring physician who worked with me so I would be factually informed about my choices. The decision to go on medication was mine. I wasn’t forced to do it — not even subtly by the people in my life who truly love me.

In less than one month, the dark cloud that had hovered over me for decades began to lift. I feel real again. I can meaningfully connect with people on an emotional level. To be clear, I don’t feel “cured” or “fixed”. I feel as though I knocked down or eliminated a bunch of symptoms. I have no illusions about my current emotional state because the pills will not make my depression disappear completely. These pills have helped me to be in remission and recovery, but that is not synonymous with cure.

In the not so distant past, my time alone was a recipe for disaster. I’m no longer against spending time alone. I try my best to meditate daily and to stay grounded with who I am as a person. I take strength from this quiet time away from what can be a relentless barrage of emails, phone calls, meetings, Tweets, status updates and the like. Alone time can be warm time when it has meaning. Idle time is different and, for me, it becomes lonely time. Like so many clients I have encountered, lonely time seems to bring with it no shortage of temptations to engage in behavior that is actually destructive, self-serving or self-loathing. I am not unhappy when I am alone, but I am unhappy when I am lonely. I now personally understand what clients were expressing to me in the past and that has helped me to grow professionally.

I still think the world can be cold. Which is another reason why I kindle more fires. I do this for people with and without mental illness; with or without a similar life journey as mine; in my personal and professional life. And I am trying to get better and better and better at it.

One way that I think we can kindle more fires is to encourage people to love themselves for who they are. In one of the most important relationships of my life, I learned a very valuable lesson that I’d like to share with you – this person chose to love me not in spite of my faults, but because of them. I will never be a perfect person. Seeking perfection almost killed me. It has taken me more than two decades to realize that self-improvement and imperfections can co-exist. Chances are you will never be perfect, either. It is not trite to say that you can only be the best you that you can be — it is absolutely true.

So, when we look at others in our lives such as coworkers, clients, colleagues and loved ones, I ask you to work on accepting them for who they are while supporting them in their natural quest to grow, change and be better people. Be supportive, not judgmental. Be aware that we are the supporting cast in the play of other people’s lives. Resist the urge to upstage the star of the show!

Another way that we can kindle more fires is to create an environment where others can feel safe to receive feedback for growth, awareness and reflection. I have a shadow that nods when I nod. I have a mirror to see a smile when I smile. I don’t need others in my life to perform those functions for me. When I love and accept myself, I am open to more feedback – even criticism (gulp) – from others. I listen better. I understand more. I accept. I am not defensive. I am more willing to make mistakes and learn from them. I am more willing to forgive others for their mistakes and forgive myself, as well. Both of these dimensions of forgiveness are a gift and inextricably intertwined.

We can kindle more fires by accepting the imperfection in ourselves and others. A mentor once shared with me these wise words, “A mistake is simply another way of doing things.” The way I look at it, every part of life is some form of experiment – and I have come to respect that ongoing experimentation will make me a better person. Some experiments result in new understanding and ways of doing things. Other experiments fail but they inform. No one can ever make me feel inferior without my consent. Therefore, I will own my mistakes and failed experiments and not feel that I am less worthy as a person — I am busy living.

I also appreciate that any feedback I receive about my mistakes has to come from trusted people who have entered into relationship with me. They are offering their thoughts to help me grow because they truly care about me. I still have no patience for people who I don’t trust but who have immediate suggestions for MY self-improvement. I can tell you that being in the spotlight — whether that be the media or at the center of community consultations — has been crippling at times. Negative comments were harder to swallow than they should have been. Outright lies, distortions or misrepresentations of me or my work would keep me awake for days. A misquote would have me wondering aloud why I was doing what I was doing for a living.

More fires will be kindled if we move on from hateful talk, thoughts and actions. Hatred leaves ugly scars, but love — honest enduring compassion — leaves beautiful scars. I cannot change the past. Therefore, I must embrace the hope for a better future that is building within me. I will accept the scars that love leaves behind; even ones that I have inflicted from loving my imperfect self. I cannot immerse myself in a culture that believes in an “eye for an eye”. A world that has gone blind seems like a hateful outcome. I am ready to see and feel the world around me — and be grateful.

Fires are kindled when people have the chance to engage in meaningful daily activities. We cannot, nor should we, pigeon-hole people into certain types of activities over others because we think we know what is best for them. We need to encourage people to find those things to do in their day that stokes their passion. I am thankful for the patience people showed with me until I found the things to do in my life again that brought my life meaning (including this blog that I now realize needs to be posted).

We kindle more fires when we speak truth to power. Over the past few months I have started to speak much more openly about my depression. When I provide training on Housing First or Rapid Re-Housing or how to prioritize services there is always a component on recovery and mental illness. I have begun to self-identify publicly. I do this not only because I think it results in better outcomes for homeless or previously homeless persons, but because I think we need to have the courage to share our personal journey and take mental illness out of the shadows and into the light where we can deal with it intelligently and compassionately. I have started to reveal my illness with my graduate students, and I have been struck by their acceptance and the depth of their inquiries. We need to increase understanding…awareness…acceptance…. and that will result in opportunities for love and compassion.

What has happened to me of late is a release of the shame that I have experienced for a very long time. But, I also know that I have created a safe space where others have felt okay to talk about their depression, too. After one training session I received an email that said, “When you talked about your depression, I finally felt there was someone else who knew what it was like for me.” After a keynote address, a woman come up to me and share how my words helped her embrace her own mental illness rather than be ashamed by it. Two of my graduate students have sought help for the first time in their lives. And there have been many, many more positive examples of the good things that are happening when I bring my mental illness out of the shadows and into the light.

I am a person with a mental illness. I have arrived at a place in my life where I’m okay with that declaration. I am thankful for who I am today. Tomorrow, I may change and I trust that the change will be for the better. Some days, I am impatient with the pace of change, but that is for me to deal with as I mature and gain wisdom.

I am not, nor will I ever be, my mental illness. It is part of who I am but it is not who I am. The surprising paradox is that my mental illness has even become a source of strength for me. I know how to express empathy honestly. I know how to educate people about mental illness more fluently. With time, I may even come to embrace it as a gift. I don’t know what that looks like so, for now, I am grateful that I can articulate my experience and leverage my experience to make me a better person, practitioner and teacher.

Iain De Jong is an award-winning practitioner in housing and human services, lecturer, keynote speaker, researcher and the President & CEO of OrgCode Consulting, Inc.

Distinguishing Between Enabling and Supportive Relationships

My thanks for the blog request on this specific topic.

I’d be hard pressed to think of a housing support worker/case manager that deliberately tries to make the life of any client worse. People go into this type of work because they tend to want to help others. But I think we need to take time to reflect on when helping becomes hurting – even when it is unintentional…when our actions aren’t actually helpful at all. Understanding the differences between enabling our clients and supporting our clients is an important part of self-reflection as a practitioner and is an essential distinction to be made in the type of help we are providing to people.

I look at support as the art and act of encouraging a person to achieve goals. It is the function of working with the clients we have the privilege of assisting, not working for them. We want the individual to deliberate before making decisions, have information to make informed choices, and to experience and understand the consequences of their actions. In a supportive relationship, we want our clients to accept full responsibility for their life – to increase their self-awareness and self-management to the point where they can reframe and rebuild their life. Through supportive relationships we are respectfully presenting opportunities – at times challenging opportunities – for positive life changes while increasing opportunities for growth, learning and awareness.

I look at enabling as the act of encouraging or failing to prevent a person from engaging in unhealthy or self-destructive behavior. It can be deliberate or through omission. In this situation, support staff tend to do things for their clients instead of with their clients. The worker is more likely to try and shield their client from decision-making or painful experiences. They are more likely to make excuses for ongoing behavior. They are less likely to focus on motivating change, and instead can become experts at reinforcing the status quo. In an enabling relationship, the “help” provided by the worker is hurting more than it is helping.

One of the ways to examine our work as practitioners is to ask ourselves about the motivation for why we are providing assistance in a particular way for a particular person. If our motivation is to “meet people where they are at” and then increase learning, inspire change, teach different approaches/behavior, allow people to gain greater independence, empower people to make mistakes that they can learn from – then we are supporting them. If our motivation is to shield people from consequences or pain, because we feel sorry for them, to keep them engaged with us because we fear that they will never do well without us, cover-up deficits, to do things for people that they can and should do for themselves – then we are enabling them.

It isn’t a matter of being nice or being mean – which is an argument I have heard before. I think friendly professionalism is warranted in supportive relationships. It doesn’t make us less compassionate. I’ve also met self-interested, defensive and dramatic guilt-using enablers.

Workers that know how to support their clients are more likely going to see goal attainment in the individualized service plan and report a sense of gratitude and fulfillment in their work because they experience changes with the people they are working with. Workers that tend to have more enabling relationships are more likely going to talk about being “stuck” in getting clients to move forward and are more likely going to be unhappy in their work – even feeling a sense of resentment or false sense of control over their clients at times. Enablers, however, can also feel “wanted” by their clients, which again creates a false sense of importance in the client’s life.

Through supportive relationships we should see incremental – and at times iterative – decreased acuity in components of an individual’s life through our support. In an enabling relationship we will likely see fewer improvements in overall acuity across the individual’s life. In a supportive relationship we should see strong evidence of a recovery-orientation – reinforcing hope and a future-orientation in a person’s life. In an enabling relationship we are more likely to see living in the moment or the past.

Remember that our goal in providing supports to people once housed is to help them achieve greater independence. We want them to integrate as much as possible into the broader community. Should they need ongoing supports for things like parenting, mental wellness, physical ailments, addictions, etc. we want them to get connected to other professionals in the community that can meet these needs long-term. We are brokers and advocates, not healers or fixers. So, if you are helping your client build a bridge to greater self-sufficiency then you are being supportive; enabling is an open-ended commitment to co-dependence (whether that is conscious or sub-conscious).

Some specific things to think about in your work that may be helpful:

• Ensure prospective clients are making an informed decision to enter into a program with your supports and that they understand the nature of the supports that you are offering;

• Present housing options for clients to choose from, and avoid the notion of housing placements or that we know best where people should live;

• When a client wants to see a dentist, doctor, psychiatrist, etc, make the appointment with them, not for them – and work towards them doing it on their own in the future;

• Motivate change by presenting scenarios for them to consider relative to the goals in their case plan – focus on change;

• Be clear that your role is not indefinite and that you want to assist the person with integrating with other community opportunities and resources;

• Teach and model skills with an eye towards self-sufficiency in the future;

• Ask yourself what your motivation is for suggesting particular courses of action for your clients to consider;

• Debrief mistakes and consequences with an eye to realizing the impact of what has occurred while maintaining a future perspective…that lessons can be learned.

I encourage you to think about your practice. Self-assess whether your interactions with clients are supportive instead of enabling. Resolve to make service improvements to be as supportive as possible. Doing so will be better for the client and yourself.

Iain De Jong is the President and CEO of OrgCode Consulting. As a practitioner, he has had to confront his own enabling behaviors to become a more effective, supportive practitioner. Through self-awareness, he has assisted hundreds of housing support practitioners in becoming more supportive and less enabling in their work.