Wellness and Recovery in Housing Support – Part 2 of 4
I have a very personal connection to wellness and recovery as it relates to mental illness. If you haven’t read my older blog on living with depression, you can read it here. Or if you want to watch my video blog on mental illness and stereotypes that emerged in the wake of Sandy Hook, you can watch that here.
Because I have a personal connection to wellness and recovery, I suppose it should come as no surprise that it is one of my favorite areas to provide training to housing case managers, and to help homeless serving agencies truly understand and embrace. This is a four-part blog that examines wellness and recovery in the process of supporting people in housing, and working to prevent homelessness from happening again to that person/family.
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In Part Two of this blog series on Wellness and Recovery, I want to focus on what exactly it is that people are trying to recover. There are twelve areas that need to be considered, each of which is outlined below:
Roles – we all have different roles that we play in our lives…spouse, parent, employee, sibling, friend, worshipper, mentor, teammate, etc. Many people that experience compromised mental wellness have roles re-defined in ways than how they may like them. For example, they may remain a parent, but the roles of parenting may have been taken over by a spouse or grandparent during a patch of being unwell. For some, being dislodged from employment for periods of time has distanced them from the role of being an employee and turned their role into recipient of benefits. Whatever the case, in Recovery, people are supported in reclaiming and redefining their roles in a way that makes sense for their journey towards wellness, appreciating that their illness alone does not make them incapable of performing roles that they want to in their family or society at large.
Decision-making – fundamentally there are various aspects to recovering decision-making. One aspect relates to Rights (discussed in greater detail below) where the ability to make informed decisions for oneself can be suspended during times when an individual may be considered a harm to themselves or others. Another aspect is a direct result of changing roles that can come with the experience of mental illness. I have met more than one person who, when they say things like “Go ask your mother” to their children is really reflecting where they are at in recovery and not wanting to upset the apple cart in their family. In recovery, people should be supported in making decisions again in all areas of their life – from how they engage with their mental health care team to how they choose to spend their money (and everything in between). At the core of the recovery process as it relates to decision-making is having enough information to make decisions, and the supports necessary to realize that mistakes will still occur from making decisions. A mistake is just another way of doing things. It is neither right nor wrong. Each mistake can be learned from to make future decisions better. A gradual, supported process of decision-making increases confidence in the process, while also reducing the likelihood of risks when making the decisions.
Happiness – I believe it is a rather fair statement that even people with a diagnosis other than depression are usually pretty down about the state of their mental health when they have insight. Recovering happiness is first and foremost about reflecting on the things that a person can do each every day that bring them comfort and joy, to things they can do occasionally that make them feel well. A whole range of activities will be self-determined to assist in the process of making one feel closer to happiness. In this instance, I would urge people to consider happiness to be those things that bring about contentment and inner peace in addition to outward joy or euphoria. In the recovery process, some people will also come to analyze those things in their life that are artificial happiness (perhaps using substances or hanging around with certain people that actually has deleterious consequences) and true happiness.
Rights – with instances of severe and persistent mental illness, when a person is remarkably unwell and unable to care for her/himself and may be a legitimate danger to self or others, our society has allowed for intervention against one’s will. We can debate the merits of this and the various circumstances in which it may be justified at another time. But I think you will agree that one’s rights – rights generally shared by all others under the same constitution or laws of the land – are suspended during the time of the episode. Other than criminal behavior, mental illness is one of the only other instances in most modern Western societies where people can be involuntarily detained against their will. They can also have their personal rights suspended as it relates to deciding whether or not to take medication. Restraints and medication are frequently used when a person is having a particularly serious episode and are involuntarily taken to hospital. Because so many people that have experienced mental illness (especially Axis I disorders) have also experienced a suspension of their rights at some point in their life, exercising rights and “owning” one’s rights to personhood can be very important to recovery.
Stability – many people that experienced compromised mental wellness experience instances of instability in their life. Consider being dislodged from education or employment can result in financial instability. Or consider circumstances that result in unstable living arrangements with family or even homelessness. Or consider those instances where family and friends distance themselves from a loved one because the relationship has become unstable as a result of the illness.
There are many dimensions to stability, and stability may be relative for people that have had lots of instability in her/his life. As such, stability may be best understood holistically in this context, and the state of stability should be self-defined.
Responsibilities – for a lot of people that have lived with a mental illness, they have become dislodged from several responsibilities, either intentionally (for example, a court has placed someone else in charge of their finances) or unintentionally (for example, a wife takes over responsibilities for the routine of children in the family as a way of compensating for times when the husband was unwell). It may be possible to argue that both intentional and unintentional suspension of responsibilities may have been prudent at some periods of time. However, in the recovery process it is important for the individual that has experienced compromised wellness to gain more responsibility back in his/her life. Being responsible to others increases community connectivity. Being responsible for decisions that impact life personally (for example, money) reinforces wellness.
Some may be of the opinion that a responsible person takes medication, and an irresponsible person does not. I would urge caution in reducing medication to such a seemingly binary construct. Given how complex psychotropic medications are in their impact on people, side-effects, stigma, cost, ability to store properly and safely, etc., the choice to take or not take medications may not be only related to notions of responsibility.
Well-being – “recovery” is not synonymous with “cure”. A focus on well-being is an intentional journey towards being healthier. With this perspective, an individual working on recovery has the ability to focus on an inclusive understanding of what it means to be well…emotional wellness; physical wellness; financial wellness; social wellness; intellectual wellness; spiritual wellness; recreational wellness; etc. In recovery, an individual can start to make decisions, choose activities, and relate to other people based upon those things that make them feel the most well, as opposed to being engaged based solely on what is prescribed to them or what others have recommended they must do.
Self-esteem – one of the serious tolls of experiencing compromised mental wellness is an erosion of self-esteem. This is especially true of those that have had a longer-term hospital stay as a result of their illness, and/or, have seen their relationships change dramatically as a result of the behavior that coincides with some illnesses. The stigma of mental illness is a heat-seeking missile that rocks identity and personal confidence. Through recovery, as one gains greater understanding and acceptance of oneself in the context of others, self-esteem can again grow and a firm foundation of self-esteem can be (re)created. Consider, for example, how having an apartment after a long-period of homelessness while unwell, can help bolster self-esteem. So to can social connections where the individual can be themselves. Or consider, for example, how re-entering the workforce after a period away from it when dealing with one’s mental illness, increases self-esteem.
Identity – the journey of recovery allows people that have experienced compromised mental wellness to see her/himself other than the label of her/his diagnosis. They can begin to identify again as a person of talents, interests, skills, knowledge, etc. They can begin to identify again as a family member, employee, friend, etc. Living with a mental illness is likely to be part of their ongoing identity, but it does not fully define all that they are as a person. It is simply part of who they are – and some individuals in recovery even start to see this identification as a strength, using it to assist and relate to others also on the pathway to recovery.
Potential – the experience and/or diagnosis of a mental illness can be an albatross. It can feel like a massive anchor holding back the possibility of realizing one’s ambitions or dreams. People that have a mental illness can lead a successful life and reach one’s goals. Recovery supports a personal goal-setting process where each person can identify what actions and resources they feel are necessary to allow them to reach their fullest potential. Mental illness need not be a brick wall to be confronted when actively pursuing a bright future.
Sense of purpose – because of things like stigma, disconnect from friends and family, lost employment opportunities, suspension of rights, lack of decision-making opportunities, etc., a person that has experienced compromised mental wellness can feel that their life has no sense of purpose. Many people with a mental illness merely “go through the motions” each day – alive but not really living. The recovery process can help people achieve and feel a sense of purpose in his/her life again.
Capabilities – as a whole, the recovery process supports people in achieving a range of capabilities that may have been lost, dislodged or suspended in their life as a result of the experience of the mental illness. People in recovery come to learn that they are capable of enjoying a better quality of life. They are capable of being empowered to make informed decisions on their care, support and future. They are capable of achieving self-awareness and engaging in self-directed (or at least self-informed) management of their life. People are capable of experiencing an appositive sense of belonging in community.
Wellness and Recovery in Housing Support – Part 1 of 4
I have a very personal connection to wellness and recovery as it relates to mental illness. If you haven’t read my older blog on living with depression, you can read it here. Or if you want to watch my video blog on mental illness and stereotypes that emerged in the wake of Sandy Hook, you can watch that here.
Because I have a personal connection to wellness and recovery, I suppose it should come as no surprise that it is one of my favorite areas to provide training to housing case managers, and to help homeless serving agencies truly understand and embrace. This is a four-part blog that examines wellness and recovery in the process of supporting people in housing, and working to prevent homelessness from happening again to that person/family.
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There’s a story – I don’t know if it is true – about a guru in Eastern medicine visiting a Western teaching hospital. The guru is asked the difference between “illness” and “wellness”. Calmly, he goes to the chalkboard and writes the words “illness” and “wellness”. He goes on to say, “There is an ‘I’ in ‘illness’, but a ‘We’ in ‘wellness’.”
Recovery is a very personal journey. It is a process. While elements of it have individual activities to promote awareness and confidence, there is a fair amount of inter-connectivity to others as recovery takes hold. I take comfort in connecting Recovery to the notion of Wellness…which allows me to distance conversations about a diagnosed mental illness from labels and pathology, and instead focus on a more holistic understanding of what it means to be well.
Truth is, Recovery is still a pretty new concept only starting to take root in the 1980s. It emerges in the delivery of services to people experiencing mental illness when there is a groundswell to re-examine what the intended and preferred outcomes of assistance with the mental illness should be. Let’s remember that medicine and treatment is evolving. Knowledge increases. New drugs are invented. New types of therapy are put into practice. Most of these activities, driven by a (well-intentioned?) medical model saw stability of symptoms as the preferred outcome for treatment. Recovery suggests that persons with a mental illness can achieve more than just stability. To that end, I embrace the definition put forward by Anthony articulating what Recovery is all about:
“…a deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills, and/or roles. It is a way of living a satisfying, hopeful, and contributing life even with limitations caused by illness. Recovery involves the development of new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness.”
Orienting our support practices to embrace Recovery requires us to both re-think who delivers support to previously homeless individuals in their housing, as well as to consider and challenge some of the more dominant myths related to mental illness.
It is an unfortunate reality that in service delivery to homeless and formerly homeless individuals too often it is those people with the least amount of training and experience in mental wellness that are working directly with people with the most compromised mental wellness. While well intentioned, they can do more harm than good; make people sicker instead of better. Medications and a psychiatrist are not the answer to everything. We need to invest in better training on Wellness and Recovery to homeless and housing service providers.
As for myths, like any illness, there are some misinformed and biased opinions related to mental illnesses. Some of the most dominant myths that I have come across:
Once sick, always sick when it comes to mental illness
All people with schizophrenia are violent
Mental illness isn’t an illness like diabetes or heart disease. It is “crazy”.
Emotional problems are a normal part of life, and people who claim to have depression just need to suck it up like everyone else.
Medications always make things better.
All mental illnesses are the same.
When support services feed into these myths, people experiencing mental illness are further disadvantaged in the road to Recovery. Fundamental to Recovery, the support provider needs to appreciate that everyone’s experience of Recovery will be different. There are no magical steps to follow. Growth and awareness cannot be forced. And we cannot confuse Recovery with “cure”.
At the core of Recovery, the support worker and the person being supported have to embrace the notion of hope. It can very well be that the support worker needs to be the champion of hope until such time as the person being supported can embrace it on his/her own. Hope is what makes Recovery possible. It is the belief that tomorrow can be better than today; next week better than this week; next month better than this month; and so on. It isn’t carte blanche unreasonable blue-skying in dreamland. Hope in Recovery is anchored in practices that promote and demonstrate improved wellness. It is the passionate commitment to the notion of hope that holds all the other pieces of Recovery together.
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Success is Not an Accident
When the movement started towards communities developing 10 Year Plans to End Homelessness, I was skeptical. Not because I didn’t think having Plans was a good idea. They harnessed a lot of great community energy. They started a national conversation in a way that had been absent. They focused attention on the issue of chronic homelessness in a profoundly new way. My skepticism came from the fact that most Plans, generally, did not talk about how the staff on the frontline and the programs within agencies would be trained to change in order to be successful at helping people get access to housing and maintaining housing. The Plans had lots of talk about housing first, permanent supportive housing and the like, but they didn’t hone in on what I thought at the time – and have had confirmed over the past several years – that there was no investment of time or resources to help teach people to actually do the thing expected from the Plan.
If you tell a plumber that they are becoming an electrician overnight don’t be surprised if the house burns down.
Now I find myself in a number of communities working on coordinated access and common assessment to improve intake processes and connecting the right person/family to the right intervention at the right time. I really love this work. I think it is the right thing to do for individuals/families seeking service, to improve efficiencies in the delivery of services, and to move towards a collection of service providers functioning as a system of service delivery. Through this experience I have run into the situation more than a handful of times now where it is evident that service providers have never been taught the skills in order to appropriately serve the population they are supposed to be serving – or that they say they serve. The important goals of reducing the length of time people experience homelessness and reducing recidivism become dreams instead of realities if there is an absence of training to improve the skill base to allow this to happen.
I know that money is tight. However, professional development is not a luxury. It is a must if you want to reach your intended results. Otherwise – and I apologize if this sounds harsh – you are throwing good money after bad. You are doing the same things as before and expecting different results. Changes in your results of working towards ending homelessness may have more to do with luck than actual disciplined, sequenced and strategic changes in practice.
It seems just about every community that I travel to has one or more organization that wants to tell me they are the only ones that work with the “hardest to serve”. With the introduction of common assessment tools and program evaluations I have had the chance to look a little deeper into that proclamation. Time and again – with a handful of exceptions – I find that the people that organization is serving is actually no more acute than those served by other organizations. What becomes clear, though, is that the ones making the proclamation of working with the hardest to serve often have very little training or a professional development plan. No wonder the work seems harder.
Ask a person to make a chocolate soufflé without the proper ingredients, equipment or instructions and you get brown mush.
From time to time I actually find communities that have invested some of its scarce resources into training and professional development. I applaud that. But then I wish they had been more thoughtful about what training and which trainers. For example, some communities have invested in Motivational Interview training, but the trainer has only worked in controlled, therapeutic environments, rarely if ever with homeless people, and even more seldom chronically homeless people. I have encountered some other communities that have invested in case management training, but the trainers had never delivered a housing-support based case management program like Housing First (yes, the capital H and capital F type of Housing First) or Rapid Re-Housing. Or the trainers have loads of theory, but not enough practice oriented that has pragmatic application, so frontline workers say things like “It was interesting but I don’t know how to use it”. Or the community brought in an Assertive Community Treatment program guru, but there is no ACT program or the local ACT program(s) is not focused on serving homeless persons.
With all the increased talk and use of data over the past decade, it would seem that there has been disconnect in expectations and monitoring of programs with one of the essential elements of Performance Management 101 – the need to coach and train for success. Depending on the size of the Continuum of Care, I would argue that a good rule of thumb is 5-10% of the funding available in the year be made available for training. If people in the community don’t want to use the dollars for that purpose, they should use their fundraising efforts for the cause of professional development. While a one or two day training event can be a good kick-off, I encourage communities to have a complete professional development agenda for the entire year.
While a professional development agenda has to be based upon an analysis of local needs and strengths, these are the 10 subjects that most often we end up recommending, and who most benefits from attending:
Core competencies and service orientation of Housing First and Rapid Re-Housing (frontline, supervisors, Executive Directors, local policy makers);
The 5 Essential and Sequential Steps to housing stability for adults that have experienced chronic homelessness (frontline workers and supervisors);
Housing-based case management (frontline workers and supervisors);
Effective leadership and supervision to effectively end homelessness (supervisors, Executive Directors);
Wellness and recovery (frontline workers);
Assertive engagement in a persistent and friendly manner (frontline workers);
Understanding assessment and how to use it to inform housing supports (frontline workers, supervisors – sometimes policy staff too);
Driving performance improvements through data (supervisors, Executive Directors, policy makers);
What it means to think and act like a system (Executive Directors, policy makers);
Proactive crisis planning and risk minimization for effective service delivery (frontline workers, supervisors).
Five Sure Signs that the Leadership in Ending Homelessness has Gone Awry
I’ve been thinking a lot about leadership in the pursuit of ending homelessness lately.
Part of it stems from helping a few communities update their 10 Year Plans to End Homelessness. In some instances, this has been a pure joy – an inspiration to me and my team. In other instances, it has been a train wreck – a reminder that at times local leaders go out of their way to prevent success rather than encourage it.
Part of it stems from working with a handful of communities to get coordinated access and common assessment systems into place. In some instances leaders have sown the seeds for this to happen for years. In other instances, the experience has demonstrated that a lack of leadership reinforces a service approach quite distant from proven practice.
Part of it stems from rolling out our new Team Leader Boot Camp. In some instances, I have experienced “leaderfull” communities, brimming with pride and a shared commitment to invest in leaders that can help programs succeed. In other instances, I have seen people declared the leader of a program because they were the least of all potential evils, or wouldn’t rock the boat, or because of tenure, not talent.
Part of it stems from engaging with elected officials across the entire continuum of ideology. In some instances I have experienced leaders wanting to learn and engage in dialogue about practice and ideas. In other instances I have experienced leaders more interested in their narrow worldview and sound of their own voice that I can only (desperately; bewilderedly) wonder if what they say reflects the populace that put them in office.
So, I have been thinking about the common attributes when leadership isn’t working the way one like want it to when it comes to ending homelessness. Here are the five sure signs that I have come up with based upon what I have seen the most.
1. Excuses Trump Solutions
The royalty of naysayers, these folks use all of their air time in meetings or in media to talk about why things do not or cannot work rather than engaging in constructive conversation about how to solve issues. Finger pointing is common too, which is even more divisive. I’d have to say a certain amount of defensiveness is also the norm, as if generating ideas to address the excuses is somehow a personal insult to their leadership.
2. Delusions of Grandeur
Too often I have found these folks to be remarkably well trained and polished in messaging without the complimentary investment in substance. Perhaps you have also heard over-the-top overtures of how confident a leader is in her/his own ideas or plan or goals even when the idea, plan or goal doesn’t pass the smell test. It never seems to propel a community forward (or end well) when the grandiose concepts put forth defy objective reasoning. I find a smidgen of ego-tripping happens with these delusions too where the leader heaps praise upon themselves for the idea, plan or goal without acknowledging all the others involved in generating the idea, plan or goal. A cult of personality ensues.
3. Bullying Into Submission
The bully is prone to use anger and aggression to get their way, masking their own insecurities, or as an explicit strategy to challenge feelings of being threatened or scared. Might is not right. Every person in a community may not get behind the ideas of a leader (without followers, though, there is no leader) but using position-power (“I’m the Boss, so do what I say”) to force people to perform in a certain way without providing a transparent rationale, reasoned discussion, and evidence is a sign of weakness, not strength.
4. Controlling
The person hell-bent on controlling everything through themselves – every decision big and small; every press release or public announcement; every staffing decision; etc. would seem to simply have a passion for micro-managing. But, I have found many of these otherwise fine individuals have a huge fear of failure and cannot accept the mistakes of others, even if those mistakes are essential for growth. The controlling person also pushes other potential leaders that they work with out of the spotlight, as the potential leaders see no future state where they too can make decisions. At the same time, they may wonder why others around them are incompetent, why there aren’t enough good leaders to work with or choose from. They don’t realize that their controlling behavior makes them blind to the human resource assets around them.
5. President of the Local Chapter of Workaholics
These folks measure everyone else’s efforts and commitment against the pattern of their own behavior, and their behavior if you really dissect it, is being busy most waking hours, most days – but actually accomplishing little. Booking “routine” meetings with these folks is like handling the logistics of landing a fighter jet on an aircraft. They let people feel like they are in the inner circle when they extend the invitation to lunch or a meeting to others and use it as a display of power. How busy someone is cannot be misunderstood as being effective. Leadership is not measured by the number of hours worked in a day. People only have so much bandwidth to work with, and extending it to pursuits beyond the most important work of ending homelessness is a waste.
Consider these action items to get the ball rolling towards remedying shortcomings in leadership:
Peer to Peer Chat
When leaders have others that they would perceive as equals, the conversation about how to change leadership tactics can be more persuasive than people that report to the leader, which the leader may be more dismissive of or misinterpret as something other than genuine concerns about successful leadership
Mentorship
The best leaders often have access to mentors throughout their careers that can provide an important, non-threatening touchdown point. A variety of mentors across different professional disciplines and years of experience can be very enlightening.
Coaching
Sometimes confused with mentorship, this is about working in a secure, confidential manner with another professional to hone leadership skills, and create a personalized plan to build upon strengths and address deficits in leadership capabilities. It can happen completely behind the scenes, and these days can also happen remotely, drawing upon some of the best coaching minds in communities hundreds of miles away.
Training
Leader-specific training is a worthwhile investment for all leaders regardless of their years of experience or skill set. Who doesn’t want another tool to use for their work leading others? Training also creates a networking opportunity to tap into other leaders and their experience. Sometimes the experience of training is also about sharing wisdom and experience with others.
Access to Information
Providing a good written (short) briefing on the most salient evidence and facts for a leader to become aware of in their work to end homelessness or strategies in leadership (or whatever the relevant topic) may expose them to ideas in a way that no conversation is capable of doing.
I’ll Take that as a Compliment Because I am Okay with That
A buddy of mine on the west coast was recently talking to the office of an elected official about a speaking engagement I had there in late 2012. The response in an email, “The [community] reaction was, well….mixed. But I think he is on to something big.”
Now, you might be thinking wouldn’t a unanimous positive reaction to your speaking engagements be better?
Perhaps, but that is not the world I live in. It is not the world that any change catalyst lives in. I hope to bring people along to the reality that ending homelessness is better than maintaining it. I try to break down barriers to serving those that are very vulnerable and marginalized. I try to put common service delivery systems upside down in the hopes that a paradigm shift can be realized. I speak truth to power. I use evidence to back up my positions.
This is not easy work. It is ongoing work. It is iterative work. Many days I can relate to Sisyphus rolling a rock uphill. At times it is very lonely work, even when I lead a very talented team and have the privilege of knowing some excellent service providers.
Am I bold and provocative in doing so? Sometimes. But I warn people that I am about to do so. Now whether they heed my warning, I cannot say. And truth is, when some people hear things they never wanted to hear they shut their ears. I know that between the bold statements I make, statistics I throw around, and the jokes that I tell, that I get people’s attention.
Recently, in an interview for a project on the east coast (now a client) something similar came up when they were considering hiring OrgCode. I am paraphrasing, but the overall gist was, “How can you undertake detailed work to improve homeless services in communities when what you say can be upsetting to folks to hear?”
Allow me to quote my longtime professional colleague Becky Kanis of the 100k Homes Campaign who, I think, sums this up beautifully:
“We are resolute in our belief that complex social problems demand a sometimes frightening degree of honesty: difficult facts must be faced head on and traditional assumptions must be subjected to scrutiny and possible reinvention.”
Ditto. Though I admit Becky said it more eloquently than I might.
Some people are upset that in my public appearances I go out of my way to state homelessness should be ended rather than managed. When I point out the ways in which – even without consciously doing so – their service approach focuses more on managing homeless than ending it, some service providers can react sensitively. I am not insulting their compassion. I am not dissing their desire to serve others. So, when these people are upset, I am okay with that.
Some people are bothered in my written reports that I critique how their homeless service delivery approach can be better, even though countless of volunteers have given hundreds of hours of their time and efforts and non-profits have been doing the work for decades. It is a respectful critique. It is a call to do things better. It doesn’t discount the fact that people tried hard; but trying hard is not the same as performing well. So, when some people are bothered, I am okay with that.
Some people get their knickers in a knot when I talk about how sobriety is not a precondition for being successfully housed or when mental health treatment is not a precondition for being successfully housed. It can collide with their worldview or personal values. It can also be at odds with an anecdote that they wish to share about a specific client or even themselves. Overall data trumps anecdotes in how I see the world. So, when some people get their knickers in a knot, I am okay with that.
Some people get frustrated when I challenge how a criminal background check is a barrier to shelter and housing access. It can be the opposite of how they have thought about corrective punishment through incarceration and the courts, while I have thought about justice and time served. They state that the safety of shelter workers and volunteers is at risk, while I promote risk assessment & minimization and a desire to not have homeless encampments filled with people whose barrier to service was a criminal background. So, when some people get frustrated, I am okay with that.
Some people get vexed when I lay out the case for turning transitional housing into Permanent Supportive Housing, Transition-in-Place, or Interim Housing. I respect they have worked hard to develop the Transitional Housing. I have no doubt many believe it works really well in their hearts, even though the data suggests differently when considered on a national scale. I appreciate that they thought they were doing the right thing. So, when some people get vexed, I am okay with that.
And I could go on. Frankly, I don’t always understand “some people”. But I do understand that the facts of the matter as it relates to working towards ending homelessness can be different than what people think or the traditions that have reinforced that thinking. A fact is a fact, and it may be inconvenient, but facts are the punch in the gut that can require us to look at things different. I am okay with being the lens through which they may see things different. The reaction may be mixed, but I – like Becky Kanis and others that work so hard to change the way that homeless services are oriented and operate – understand that this change is something big. Work on ending homelessness is the most important work I will ever do.
Can’t We Have Both? Short-term and Long-term Shelters
Can your community have short-term and long-term shelters? Sure. Should you? Absolutely not.
Unless you have no desire to ever end homelessness. If that is the case – if you want homelessness to continue so that all shelter employees will have a job for life – try to make all of your shelters as long-term as possible. Heck – make them people’s homes and just call them shelters. Let people put up posters and personal knick-knacks around their bed. Give your long-term stayers special jobs like sweeping the floors or helping in the kitchen. Ensure that you have as much programming in your shelter as possible.
I do not hate shelters. In fact, I think shelters are quite important. But as I outlined in a recent friendly video rant, I want shelters to perform their intended function – short-term, infrequent stays. They are intended for housing emergencies. A focus on helping people through rapid re-housing or housing first is NOT anti-shelter. It just means that shelters are places that people can get out of homelessness and into housing as fast as possible; not places where people are trapped or expected to stay long term.
I know a lot of shelter providers were well intentioned as their program models evolved. Some of the things I have seen a lot of in my travels (and I figure I have been in over 200 homeless shelters):
Employment programs in shelters. The thinking is that people can get the employment skills they need towards self-sufficiency. There are a couple of problems with this. One, long-term employment access and stability is unlikely to follow, according to available data. Two, it keeps people in shelter for a longer period of time. This is a rather expensive way to provide an employment program. Get people out of the shelter and into housing, and connect them to employment assistance as they are moving into their housing.
Treatment/sober living supports in shelter. The thinking is that helping people achieve sobriety will put them on a pathway of ongoing success when they are in housing. There are a few problems with this. One, sobriety is not a precondition for housing success. Most people with addiction to alcohol or other substances will never experience homelessness. People can be housed just fine and still use. Two, a lot of the shelter operators with this sort of programming call what they do a “homeless shelter” but they are really operating as an un-licensed and un-regulated treatment facility. Three, many (though certainly not all) of the people I have met that operate these sorts of programs in shelters have zero training in addiction treatment. Sobriety should never be a condition of shelter access. Perhaps behavior, but never sobriety. If sobriety was a condition for having a roof over your head, I suspect many of you reading this blog would have to turn over your keys and become homeless every weekend (unless you are one of those people who enjoy a glass of wine with dinner each day).
Socio-recreational programs offered through shelters that require a person to be homeless in order to participate. The thinking is that you can help people establish social relationships and networks that will help them when they are housed. The problem is that if we want to reinforce social relationships and networks we should do it within the broader community, not ghettoize people into only hanging out with other lower-income, homeless shelter dwellers.
Life skills training. Sigh. This is probably one of my biggest beefs. First of all, I have not met many people who want to raise their hand and say “My life skills suck. Please, let me be part of your highly structured, condescending, deficit based approach to putting me in a room with all of my peers so we can demonstrate our incompetence to each other.” Okay, that may be paraphrasing and a tad harsh. You want people to know how to cook, clean, do laundry, create and follow a budget, grocery shop, etc? Great. Do it within their natural settings of where they live – in their home! Make life skills training one on one, catered to specific strengths and in a place where people can best practice their skills.
Those are the biggies. There are others too. But I will leave it at that.
So how do you make shelters work well for ending homelessness?
Divert as many people as possible from the shelter system. Make sure people have no other natural supports they can rely on that are safe and appropriate before admitting someone to shelter.
Have coordinated access and a common intake for all shelters in your community. This increases the likelihood of getting the right person/family to the right shelter. Clear shelter standards help in this regard too in order to get everyone on the same page.
Triage housing assistance resources to those with the deepest needs that have been in the shelter longest. Yup, these are probably some of the same people you or others have declared that helping them get into housing would be “setting them up for failure” or that they were not “housing ready”. Right. Maybe the true failure is the shelter provider that hasn’t found the way to get them out of shelter and into housing. Oh, and I suspect they were never asked if they were “homeless ready”. The key is to provide the right supports in housing.
Most people will end their own homelessness within a short period of time and are never homeless again. For every person that comes into shelter for the first time in their life, give them about 7-10 days to try and figure things out on their own before you go about offering supports. And when you do start to offer supports, focus on progressive engagement – the least amount of service to get them out of shelter and into stable housing. No point drowning people in an ocean wave of support when a turkey baster of support is all that is needed.
Make shelters as open and accessible as possible, while supporting emotional and physical safety. If someone is going to be denied shelter entry it should be only in extreme cases, for a short period of time, and with some sort of resolution process. Denying someone access only because they drink or have a previous criminal offence (which may even be decades ago) is absolutely ludicrous. And where there is perceived adverse behavior, that requires risk assessment and modified engagement strategies. It doesn’t mean people should be left outside. (Yes, I can hear the sort of dude I heard a couple of weeks ago arguing with me that people will never learn natural consequences in life unless they learn to alter their actions to conform with what shelters expect from them. All wrong; the human mind does not work that way, even though your own personal values may want the change in others to occur that way.)
Ensure shelters are open during the day, BUT only offer supports that help people get out of the shelter. If a shelter is only open at night, people who stay there will likely spend their day going from place to place just trying to survive rather than actually being able to take care of their housing needs. During the day, shelters should be filled with housing locators and housing case managers helping everyone who has been there longer than 10 days to locate housing and figure out the supports that are needed. Do NOT put any socio-recreational programming or any other events like that in the shelter during the day. Do not let people just hang around and watch TV all day. Be friendly and persistent, using assertive engagement as necessary, to break through and help people realize the importance of being supported and housed.
Shelters are invaluable. Let’s promote their invaluable contributions by having them do the right things to end homelessness. I frequently say shelters are like fire stations – you never want there to be a fire, but you sure are glad they are close by when a fire starts. Can you imagine if the fire department refused to put out your fire because you were a drinker or smoker? Or refused to put out the fire because you didn’t take your medication? Or refused to put out the fire because in 1991 you started an 8 year sentence in a federal prison? Or determined that your entire house and all of your belongings burn to the ground just to teach you a lesson and allow you to truly start all over again? No. I didn’t think you could imagine that. Now I hope you will never be able to imagine shelters as something other than a place where emergency needs are met.