True Currency in a Bankrupt World: A Discussion of Approaches to Substance Use
“The only true currency in this bankrupt world is what you share with someone else when you’re uncool.” – Lester Bangs (Spoken by Phillip Seymour Hoffman in the movie Almost Famous)
Let’s talk about something un-cool to talk about in most circles – substance dependency. So much has been talked about the death of Phillip Seymour Hoffman. Insights like this one from Russell Brand talked of how the death was inevitable in how drug laws are created and enforced. This one from the Washington Post suggests the death points to a broader opioid epidemic. Counter point to this mourn-ography (as Brand puts it) look at the sensationalism and mockery of Rob Ford, known in Late Night circles as “Toronto’s Crack Smoking Mayor”.
In the former (Hoffman) people see tragedy; in the later (Ford) people see buffoonery. A respected actor with a rather large body of work is a loss; the mayor of North America’s fourth largest city using drugs is spectacle.
As I have blogged about previously, required abstinence is not the way to go. There is not a strong relationship between sobriety and housing retention. It has been suggested, however, that somehow it means I encourage or promote drug use. I don’t. I believe the evidence that security of housing is helpful for assisting people in reducing or stopping their substance use. And, I believe in a four-pronged approach to helping programs and communities address the matter of drugs more holistically:
Education
Enforcement
Harm Reduction
Treatment
On the matter of education, I think we need to broaden awareness of what drugs are prevalent in which communities. We need to, from a young age, increase awareness of substances and their impacts without a simplistic “Just say no” approach that glosses over the pervasive and entrenched position that drugs have in our society. I would also urge people to become more educated on the broad range of evidence that supports different approaches to addressing substance use in communities.
For example, take a look at the research findings from InSite – the Safe Injection Site in Vancouver. There will always be a place for enforcement when it comes to drugs, but I think as a society we need to ask ourselves about the best approach to doing so. I really like this piece by Erik Luna where he quite rightly outlines that mandatory minimums do not meet the generally accepted criteria of law – meeting neither the goals of punishment nor consequentialist goals of deterrence.
So where is the place for enforcement? When organized crime is attached to the drug trade, that is an obvious one to me. When minors are impacted, that is argument for another. When any individual is exploited by the drug trade, including sexual exploitation, I believe that is another reason for enforcement. Punishing the substance user? That is in essence punishing someone for having a health condition.
If we take criminality of the drug discussion out of the equation (which I appreciate is difficult because of how interwoven the drug trade is to often harmful and dangerous criminal behavior), we can look at substances from a health perspective. And when we embrace that perspective we can more clearly see the opportunities for harm reduction and treatment. There is a place for both. It is not either/or.
First, let’s consider harm reduction. While harm reduction is interpreted and considered from many different perspectives, I would urge people to consider it from a person-centered point of view within a broader societal context. (Person focusing outward, not society focusing inward.) Harm reduction aims to decrease adverse health, economics and social consequences of substance use without requiring abstinence or cessation of any sort. Harm reduction is achieved through action and policy. Harm reduction considers the broader needs and impacts of substance use on society when supporting the individual. Through harm reduction, we should expect to see fewer interactions with emergency health services and police as a result of drug offences. We should expect to see fewer upset communities and neighbors as a result of behaviors that stem from substance use. We should see improved health and less destructive behaviors on the personal level. It is absolutely incorrect to think that harm reduction embraces use at all costs. It is a myth to think that all harm reduction efforts are a guise to legalize all substances in all forms. It is also incorrect to think that harm reduction enables use, as the evidence demonstrates that the likes of wet housing debunks the enabling hypothesis when you look at rates and types of substance use, and further evidence shows that people are more likely to decrease or stop substance use once they have security of housing. I believe that housing in and of itself is often a form of harm reduction.
Now let’s consider treatment. When treatment is mandatory in order to use a service or access housing, then housing or service becomes the reward of treatment. The problem with this, as I have discussed in other blogs – and as you can research yourself in the evidence – is that rates of treatment success are low. It isn’t that we shouldn’t encourage people to seek treatment and support people that do – we can and we should – but we should never require treatment in order to access housing or services. When treatment is considered we must also do so patiently and from an informed perspective. Treatment is not one size fits all – a treatment that worked for one person is not guaranteed to work for another. The scope and style of treatment should be matched to a person’s experience and personality. Treatment should make sense relative to a person’s housing situation and her/his social network. Treatment comes with a range of emotions – from guilt of needing it to elation of how it helps curb substance use. When treatment doesn’t work out there can also be a range of emotions. And we also need to have informed discussions about treatment with people that may want it or benefit from it, rather than jumping on a treatment bandwagon just because the person is upset with their substance use or is trying to placate someone else by going to treatment.
Substance dependency may be un-cool to talk about. But it is a conversation we need to have if we are truly going to offer a range of approaches to properly confront a complex social issue. And as un-cool as it is to talk about, if we don’t talk about substances when we talk about housing for people with complex and co-occurring issues, there will be a large number of people remaining homeless for no reason other than they didn’t fit a pervasive view of substance use and what should be done about it, rather than considering a range of approaches.
Any Approach to Ending Homelessness Needs Shelters to be Awesome
Ending homelessness is not anti-shelter. In fact, in many instances ending homelessness starts with shelter. Let me put this in a system context.
First of all, your community (or your organization if you are a small shelter in a smaller or more rural setting) needs to start by keeping as many people out of shelter as possible when it is safe and appropriate to do so. Great shelter services start with seeing diversion as a service – not a denial of service.
Next you need to understand who the people are that are seeking shelter. They’ll fit into one of three groups: people using shelter for the first time in his/her life; people with a history of episodic use; people that rely on shelters on almost a daily basis (perhaps when they are not in hospital or jail). Regardless of the group, the emphasis on getting out of shelter and into housing should be the same. But, the strategies to achieve that goal will be different. For example, most first time users of a shelter will get out with a very minimal amount of service or no services at all, whereas chronic users may need more in-depth supports to effectively get out of shelter and into housing. Right size your approach based upon need, not one-size fits all.
Look carefully at the programming offered within the shelter. The intent of shelter is not to heal or fix people – it is to provide shelter. Remarkably imperfect people are great at maintaining housing. This includes more complex issues like substance dependency and compromised mental wellness. Does the shelter offer any programming that is unintentionally prolonging anyone’s homelessness or incentivizing their homelessness? If so, rethink those programs. Some common examples include employment programs for people that are homeless, matched savings programs for people that are homeless, and education programs (like getting your GED through a shelter program). Is there a way you can offer these same supports once people get housed? That way you don’t lose your knowledge of how to deliver helpful programs, but you aren’t incentivizing homelessness.
Examine whether the shelter has an infrastructure that is promoting housing solutions. Do people have access to a telephone, computer and landlord listings? Is there a place where a landlord can leave a message that doesn’t “out” the person as being a shelter resident? Are there easily understood directions to the nearest benefits office? Is there access to a bus pass so that a person can get around the city to look at places? In family shelters, is there a service that can mind small children while mom/dad go look for housing without schlepping kids around with them? Are there staff available to answer the most common questions about housing? Are there staff resources (either shelter staff or an external service provider) that can work with people that have more intensive needs in navigating housing access and supports that may be of benefit?
Then look at the range of shelter services in your community (where there is more than one shelter). Is there a coordinated approach to figuring out how to get into shelters and ensure the person gets to the most appropriate shelter based upon his/her presenting issues? Are there any barriers in place of specific shelter providers or across the broad spectrum of shelter providers that impedes someone from getting into shelter? (Examples from my travels – requirements for ID; criminal reference check at the local police station first; documented proof of residency in the community prior to seeking shelter.)
I also encourage the shelter system to have standards of service that transcend more than one shelter provider. This way, from the shelter users perspective, there are certain transparent elements they can expect from any shelter provider. (In other words, they don’t just get lucky and get a “good” shelter provider through coordinated intake.) One of the elements that I urge shelter providers to reach consensus on, for example, are reasons for barring/service restrictions and length of time. I find it baffling that in the same community telling a shelter staff in Shelter A to F*ck off can get someone barred for two weeks, but punching a shelter staff in Shelter B in the face gets someone barred for three days.
But perhaps the most important things shelters can do to help end homelessness is maintain a housing focus in their work. When people are admitted to the shelter remind and encourage them to work on housing. When people are going through the orientation process, remind and encourage them to work on housing. When people are rising in the morning, remind and encourage them to work on housing. Yes, shelters can and should deal with crises and all of the symptoms of system failures that resulted in someone needing shelter in the first place; but if there isn’t a housing focus we will never be able to build enough shelters to keep up with demand.
Over time if your community has a strong focus on ending homelessness the number of shelter beds will be right-sized. But there will never be a day when shelters are not needed. There will always be some people experiencing housing instability. It is foolish to think otherwise. To me it’s like the local fire station – I never want there to be a fire in my home, but I sure am glad the firefighters are close by and ready to help me when there is. I never want people to need shelters, but I sure am glad really well-intentioned, professional people are there to provide shelter when it is absolutely necessary. I just don’t want anyone to confuse a shelter with a home.
Things I Am Learning to Say
The title makes it sound like I am trying my hand at a new language. I am not. The things I am learning to say are all in English. More accurately, some of the things I am learning to say I am really learning to say more frequently, more honestly, with more conviction, with more thoughtfulness.
“I was wrong.”
Still tastes like vinegar each time I say it, but I have come to appreciate the value of it. I used to think admitting I was wrong was a sign of weakness and vulnerability. Turns out it helps build trust. I thought people would lose respect for me. Turns out admitting wrongness can help gain people’s respect.
“Can you help me?”
I thought asking for help would be seen as a sign of weakness. I thought working 16-18 hour days would be better than asking for help. Turns out asking for help makes us vulnerable in the right ways, helps gain people’s trust, and people overwhelmingly respond positively when help is requested of them.
“Awesome.”
Okay, so this is a word I use a lot. And I mean it when I tell people to be awesome or embrace their awesomeness. So what do I need to learn to say with this word? That it doesn’t lose its meaning if I say is sincerely to people.
“I appreciate you.”
I say thanks for people’s contributions to work quite regularly, but I am learning to say that I appreciate the person that did the work. (And not sound creepy when saying it.) I honestly do appreciate people even though I am not really a people person. I need to learn to take time out to say it.
“Sorry.”
We all have things we need to apologize for. (Heck, if you are Canadian you are pre-conditioned to apologize all the time.) Here’s the thing – I am learning to say “sorry” without couching it in a disclaimer or excuse like “But I was really tired when I said…” or “But I am sure you’ve had situations where you’ve…”
“You are welcome.”
I don’t accept thanks well, which means saying, “you are welcome” has not come easy. But if people appreciate me, my work or contributions I need to vocalize my recognition of that. I need to get better at acknowledging people’s appreciation.
Nada. Zip. Zilch. Nothing.
One of the best things I am learning to say is, in fact, saying nothing at all. Learning to listen is actually teaching me lots about learning how to say things I really mean. And it is hard for me to truly be reflective and in the moment to calm what would be my own contributions to the conversation to just say nothing at all.
Police, Judges and Homeless People
Two stories in the news caught my eye over the past little while: this one where a Montreal police officer was filmed threatening to tie a homeless man to a pole in the freezing cold; and this one where a judge in Prince Edward Island put a homeless man in jail for the night because there was not enough space in the hospital where she felt he would be better served. Sure, they both came from Canada, but they are likely very relevant to what is happening in your community.
On the one hand, we see shortcomings in law enforcement in engaging effectively and humanely with homeless persons. Unfortunately, it paints many in police forces in a similar light, which is unfair and untrue. In my travels I have been fortunate to see the likes of the Grand Junction, Colorado police be very proactive in working with homeless people; hands-on street outreach by the likes of Deputy Steven Donaldson in the Hillsborough County Sheriff’s Office (Tampa) who achieves amazing things in helping homeless folks access housing and resources to stay housed; police working well with street outreach like the DOAP Team at Alpha House in Calgary. I’d like to think that officers like the one in Montreal are the exception, not the norm. But maybe that is wishful thinking. The horror stories about police officers I have heard in my travels would fill a book.
On the other hand, we see the justice system trying to address what, in the instance in PEI, is a shortcoming in the health care system. It would seem the judge had the wellbeing of the man at heart in reaching her conclusion of having the man put in jail when there was no space in the hospital. But we can’t lose sight of the fact that the man’s freedom was suspended in this instance, as a result of an intervention of the court. Nor can we ignore that if the person would be best served by a health intervention, that is most often going to be preferable to the justice intervention.
The bigger question, perhaps, is what is the role of police and judges in the lives of homeless people? And secondly, whether police and judges have the training they need to work effectively with homeless people? (This parks the question of what training homeless service providers, police and judges need to work well with each other…a blog for another day.)
There are community policing efforts where cops know many – if not most – of the street involved people in their beat. Many a time there is a cordial exchange. There are many instances of police also helping ensure the safety of homeless persons on the street. But it seems to me we can do a better job of integrating police into the solution of encouraging and working with people that are street involved to access housing.
There are diversion courts and even programs where outreach workers hang around courtrooms waiting for homeless persons (most often being held on remand) to be released so that they can provide assistance. Seems to me this is a large investment to remedy a situation where a more cost effective solution may be available if there was better information exchange between the courts and homeless serving agencies, and a change in policy that prevented, say, people being released from courts at 4pm on a Friday afternoon of a long weekend.
The role of police and judges should never be to target homeless people because of their homelessness. Involvement in criminal activity makes anyone fair game for policing efforts. But being without a home, or being economically poor, should never be a criminal offence. Police “crackdowns” on specific neighborhoods to “move people along” doesn’t solve anything. It is highly ineffective and very expensive.
As a society, it would seem we have misplaced investment in government assisted housing with investment in prisons and jails. In some places, the creation of more cells is the only housing development (albeit, in the “big house”) that has happened. Incarcerating people exacerbates homelessness. It doesn’t solve it. And it too is remarkably expensive. Many of the same people want lower taxes also want to be tough on crime. Want to reduce crime? House people.
Given the level of interaction that police and judges have with homeless persons, especially chronically homeless people with higher acuity, they should be trained on what homelessness is and the most effective approaches and interventions to end it. Instead, I see an absence of this in my travels, where police and judges are using their best guesses and judgment rather than data and evidence. This is a solvable problem. With small investment, police and judges can learn considerably more about homelessness and its associated issues, thereby encouraging better and more cost effective solutions.
Trying
“Failure was never nearly as important as the fact that we tried That in the war against frailty and limitation We supplied the determination it takes to make ideas and goals the parents of possibility” (Shane Koyczan – Remember How We Forgot)
Making a difference comes from action. Imperfect attempts trump perfect inaction. Social change has never come about from dreaming. It comes from daring. It comes from trying.
Trying is an attempt at attainment. It sets its sights on achievement. It appreciates that skill and knowledge is gleaned while in motion, not while at rest.
Trying is not blind. It is born from thoughtful reflection, planning and research. It stems from a problem identified and reasoning that improvement can be made to rectify the situation.
Trying does not accept the status quo as adequate. In the fight to conquer injustice; in the rally to challenge gaps in practice; in the pursuit of excellence in knowledge – trying claims the space of risk-taking, without the benefit of experience in many instances.
Trying is not reckless. It charts a pathway from the present to a desired future. It moves from over-reaching, vague platitudes to a knowledge base that is prudently anchored in the best available data and evidence. It merges this with strengths, acknowledges limitations, and sets goals that are, on the one hand, obvious, and on the other hand, stretching into the unknown just far enough so as to bend current reality.
Trying is not a fad. It is not the flavour du jour capturing attention for a fleeting moment and abandoned without full effort or evaluation.
Trying is dedicated transformation, with the full muscle and brainpower to ensure steadfast fixity of purpose in achieving the end goal. Really trying overcomes obstacles and barriers rather than coming up with excuses for inaction, resistance or failure.
Trying is the currency of true commitment. One is only a poser if they make claims to want something but only create plans; if they are ever waiting for the solution to appear from elsewhere. To be committed to making a difference means that one must try to make a difference…not just hope it will happen.
Trying is the covenant between those that have the means to make a difference and those that will most benefit from a change being made. It is our duty – nay our privilege – to have the chance to try.
6 Things I Learned in Australia
From December 16-21, 2013 I spent time with Micah Projects in Brisbane, Australia. It was a fabulous opportunity to share the SPDAT with another community, as well as informally take in homelessness services first hand in another part of the world.
Here are six things I took away from that trip:
1. Mobile Government Benefit Workers Is Possible
I have encountered several communities in North America that have worked hard to get streamlined access to government benefit offices to get income supports. I have seen income support staff attend weekly case conferences and offer helpful commentary.
And now I have seen what I thought was only a dream actually happen.
Centrelink is an agency of the Department of Human Services. They actually have staff with laptops that go out to locations where homeless people are (in this instance a food program where there was also outreach) and have the ability to do applications, amend benefits, make notes and approve income supports. Imagine a person in your community in charge of public benefits sitting on a ledge in a park with laptop perched on her knees with a homeless person sitting beside her, and her having the ability to pull up his file, amend information, and approve a payment to him to be picked up the same afternoon. This all was happening before my eyes before 7am.
Skull blown.
2. Homelessness is Homelessness and the Cure is the Same
No matter where I go in Canada or the United States I am able to see more similarities in homelessness and effective program responses and policies than I see differences. Sure, it requires “translation” sometimes to a local context, but the instruments are boldly the same and the evidence that supports certain interventions over another is transferable.
Having now gone to a different hemisphere on the other side of the planet it is obvious to me that homelessness is homelessness (at least in developed countries) and the cure (that is housing, by the way) is the same.
3. Outdoor Feeding is More Structured
Vans that feed people in public spaces – whether that be faith groups or organized outreach teams or service clubs or whatever – has been a hot button issue in many communities I have been in throughout the United States and Canada. I really appreciate what has occurred in Brisbane, and think this may be transferable to other locations. The local government has sanctioned certain locations on certain days of the weeks as the places where food distribution can occur. This also means that other services (housing workers, income support workers, nurses, etc.) can co-locate at the same time and offer a more comprehensive array of services to homeless people coming to get food.
While I remain convinced that food sustainability is better than charitable feeding, and that having people eat indoors can be more humane than having large groups amass outdoors for these types of feedings, the designation of specific locations and specific times is a terrific idea.
4. Scarcity of Affordable and Supportive Housing Is an Underlying Issue in Other Parts of the Developed World Too
Like many large urban centers, Brisbane is experiencing shortages of housing that is affordable to a broad range of its population, and specifically a shortage of housing that is affordable to persons that are homeless and may benefit from additional supports.
I was very impressed with Brisbane Common Ground, and feel the community would like benefit from more of this housing model – as, I understood, would most other communities across Australia.
In discussions with many brilliant people in Australia I also had one of me feelings confirmed – that the thought of expecting government of any level to see the necessity to invest in a suitable number of social or supportive housing units is from a bygone era. We are in a position where some government investment has to be more balanced with additional voucher and rent supplement programs. If we don’t get into this pragmatic mindset, I fear a lot of additional energy will be invested in advocacy efforts that will fall on deaf ears of government leaders.
5. Juggernaut Organizations can Drive Change
If you have never heard of Micah Projects, Inc., I encourage you to check them out.
There are a few non-governmental organizations in my career that I have found can change the nature of the conversation about homelessness and housing, are determined to innovate and balance that desire for innovation with evidence, and be reflective on how to get better and better and better. It was a pleasure to meet another one in Micah Projects. They have a wide range of programs with an underlying commitment across all of the program areas to be awesome at their work – while at the same time participating in state and national discussions and work groups.
6. We Need Better Opportunities to Link of Practitioners Internationally
I have always thought when of the great joys of my job is that I get to cross-pollinate ideas…I meet someone in Place X that is doing something amazing and when I am in Place Y can connect the two of them because Place X has the cure for what Place Y is experiencing. I hope this opportunity never ceases for me.
All the same, I wish there was a cost-effective, accessible way that organizations across countries could learn from each other’s practices in very tangible ways. I am not talking about a research consortium…that exists and is de-linked from a lot of the day-to-day experience of frontline staff. What I would love to figure out is how we can create international communities of practice across organizations that are committed to ending homelessness.
Now the question is just to figure out how. Anybody know a billionaire who would be willing to bring together practitioners in a common place in the world to have a 3-5 day in-depth sharing experience?