Fear is Expensive

I am sometimes shocked at the amount of money we spend on fear. Take the income assistance system. I was staring at the Ministry of Housing and Social Development building the other day (that’s our complicated name for “welfare building” here in BC), and I suddenly realized that this 5 story building containing hundreds and hundreds of well-educated professionals had a singular purpose:



Was it to assess people, or emotionally support people? No, though I suppose some referrals were being made inside.



Was it perhaps to financially assist people? You would think so, but really, the cheque printing machine handles this role quite nicely. One could argue that issuing of cheques by workers is providing assistance, but when you realize that assistance is processed and issued in flow-chart fashion, the role of “issuer” vanishes.



How about training? Lifeskills for clients? Child care advocacy? Parenting courses? Nope… all those are contracted out to non-profit agencies – poorly funded non-profit agencies.



Well, what about providing a human face to assistance? Someone to talk to, someone to make sense of the red tape? Some clients do better when they can relate to a social worker in person, right?



But no, this building was not serving this purpose, I realized. Individual workers for clients had long since disappeared with government downsizing in the 90’s. Increasingly, clients are sent to websites to register, and cheques are sent direct deposit. The information age has taken its toll on the social worker/client relationship. I suppose eventually, you’ll just add the “social assistance app” to your Facebook page and your landlord and grocer will automatically get added as friends and paid by the government.



This entire building was full of mistrust. Almost everybody in it was checking a story, photocopying ID and proof of employment documents, processing forms that proved or disproved a residency, or some other inane fear-based tail chasing. The really unlucky workers were busy gathering evidence of fraud and preparing to destroy the lives of the really bad clients with criminal charges.



Think about how much cheaper it would be if clients were given the benefit of the doubt. All MHSD employees would be supplied a keyboard. The client would come in and say “I need $600.” The worker would type it in, and the cheque would spit out.



Of course, life can’t be THAT simple, can it? People would rip them off, wouldn’t they? Drug users would take out thousands of dollars every few minutes to supply their habit (unless street drugs were decriminalized and prescribed by your doctor… but I digress). You naturally can’t trust that most people will only ask for what they need, can you? Nah, it’s better to be on the safe side, and regulate things. Ditto on the tax system for the more “respectable” working class—they need to be checked up on too. After all, we need to employ all those poor saps who have $30,000 student loans with civil servant positions in Revenue Canada . And hey, you can wear jeans on Friday, so don’t complain about how education should be free, ok?



Wow, that actually feels better when I write it down. I am sometimes surprised at how far left my rantings will take me. I am almost suggesting some sort of anarcho-non-welfare-ism here… simply crazy. Anyhow, I should undo some of what I’ve said, because MHSD is not evil, nor are the people who work there. In fact, I have seen some great improvements lately. Outreach workers are starting to apply more flexibility to social assistance, to factor in addictions and mental health issues. Individual workers are again being assigned to clients who are struggling, and some of these people are truly helpful and concerned about their work. I have even had the pleasure of being shadowed by an MHSD policy developer who took a keen interest in how policy was affecting things on the ground—call him “Welfare Buddha” if you like—super nice guy. There is no question that there are other people out there are thinking the same thing as me: downsize the regulation, upsize the human connection.



Fear is not worth the money spent on it, that’s for sure. Fear is worth, perhaps 17 and a half cents. Mistrust is equally worthless. I’m not saying that we can tear down these huge institutions tomorrow, but we can at least see how damaging they are to the ones we are trying to “help.”

Looks like the BC Liberals are trying to create a new law which will allow police to force homeless people into shelters during bad weather events:

http://www.canada.com/news/Homeless+forced+street/2020166/story.html

It's obvious that this law is in response to a death that happened last year, when a mentally ill woman died from lighting a fire in a makeshift shelter.

It's tragic, the things that happen to people on the street. When someone needlessly dies, one can't help but wonder if there is another way. Certainly those of us who work with the homeless at times wish we could force people into better situations. I sometimes joke with my addicted clients that I'm going to have them randomly kidnapped and taken to a treatment center in the boonies if they don't smarten up. Often, they laugh back "Go ahead, do it!" and part of me knows that they half-mean it.

The reality is, we can't solve these issues with legislation because the problems of addiction, homelessness, and mental illness (and the mixture thereof) are impossibly complicated. I will say it again as I have said many times in this blog: systematic solutions are likely to systematically oppress this population, or at least a large chunk of them. Some people have warned that homeless people will now be hiding during extreme weather so they won't be "arrested" and taken to a shelter. Because they will be hiding, more of them will die of exposure, which defeats and confounds the original intent of the law.

Logistically, this law is a nightmare. Cops will be trying to be social workers, and social workers will be trying to be cops, and the trust between shelter workers and homeless will be strained, if not destroyed. It is also a very pricey option. Want to save money? Try giving a $5 gift certificate to each homeless person who comes into shelters on a cold night-- it's a lot cheaper than using two police officers, a very expensive police car, and other community resources like the ambulance you are gonna need when George takes a swing at the cop who is arresting him for nothing.

Want to save lives and help people who seem lost? Build relationships with them, and address the real issue. Give people universal access to therapy, not seroquel, and you will see the death rate drop. Fund outreach workers, and organizations who care, and you will see the turnaround. Don't throw a desperate law at the situation, it will only add to the problem. Here is a list of better things to spend money on:

- New residential addiction treatment centers with spaces for concurrent clients

- More Shelter Beds

- More outreach workers in the province

- Targeted supportive housing for a range of issues (i.e. supportive housing arrangements for people with personality disorders)

- Funded therapy for people who have been sexually, mentally, and physically abused (Psychological therapy, not volunteer-based "emotional support")

- More school counsellors

- Training for people who currently work with homeless (Such as Motivational Interviewing skills, etc)

The list goes on. This proposed law is well-intentioned, but it lacks on-the-ground understanding, and the money could be better spent dealing with the real issues behind homelessness. In any case, police already have the option to detain someone who is self-harming, they simply do not enforce it in every case because of scare resources. I guess the positive outcome of this latest news is that it will remind people of the impact of extreme weather on the homeless.

Using the Medical Model

Homeless people report being treated badly at hospitals all the time, almost as frequently as they report being treated badly by police. I've heard stories that blow my mind, where a near-death addict is being told they "made their own bed" by an emergency room nurse, or where a clearly suicidal person is discharged because they are "disruptive." It appears that the homeless population doesn't fit so well into the medical model of care, yet doctors, nurses, hospital clerks, ambulance attendants and other health care professionals are forced into social work roles.

I'm going to carelessly throw out some generalizations about the medical model: It is hierarchical, systematic, logical, and as such it requires compliance. We've all watched the TV medical dramas where a doctor or nurse is threatened by a "chief of staff" for not following the chain of command to the letter. I think we romanticize the military mentality in health care, envisioning tough-as-nails doctors rigorously sacrificing self and coworkers to uphold the scientific method for the better good of all patients. We try to create a system of experts, where every hospital has a "Dr House," who lovingly bestows genius on his ignorant, lying patients.

Here in BC we have health "authorities," who decide what services will be provided, in which way, and how the public relations will be handled. This is not an elected system, it is a mild form of dictatorship that exists within our democracy (interesting thought, that...). There is a "chief" who decides the fate of us all, and numerous, powerful committees who set health policy. They decide who will get case mangement ("Schizophrenics and Bipolars only, please"). They establish admission criteria ("must not have an addiction, and must be compliant with medication"). They decide which non-profit organizations will get operational funding, and then they hand-pick the clients that the non-profits will be allowed to work with. Health authorities do this all with an iron fist, stating that because the issues are "life and death," we should all get in line and do as we are told. The threat is always that lives will be lost unless the medically-trained personnel are given a blank cheque and general omnipotence.

I could go on and on about this stuff, but I should get to my point: Homeless people don't give a rats-ass what your medical credentials are. A lot of street people catch a whiff of authority, and go straight for the jugular vein, because many have been abused by authority figures. Does it really make sense to have "compliance" as an admission criteria for a population that is generally defined by (and draws its strength from) non-compliance? Homeless people fight because that's how they have survived until now. Do you expect them to abandon this inner-strength because your "team" needs order?

And that's merely a quick criticism of the medical hierarchy. Let's consider the systematic components of our health care structure. We live in a world of triage flowcharts and prioritized waitlists based on expected human behavior. If this then that, unless A does not equal B, in which case implement C. Of course, if policy makers could spend some time at the homeless shelters or drop-in centres, they would quickly meet people who do NOT fit any category. Here we find the brain-injured crack addict with a personality disorder who just slashed her neck open-- you won't find a place on the flowchart for that! Here we find the overdose victim who refuses medical treatment (hey, lets look on the flowchart...hmmm... patient refuses treatment, therefore medical personnel remove services...sound ok?). I won't even begin to tell you some of the ridiculous catch 22 situations that my clients have been stuck in, because it may single out certain health care services or staff. I will simply say that the current health care approach is lacking flexibility and understanding.

I do want to say at this point that most health care staff are awesome, as are most policy makers. People do not get into health care because they hate people. Yet somehow, we have missed the mark. The medical model is an ineffective way to address the social issues of homelessness, addiction, and mental health. I appreciate the intent and the hard work of health care staff, but I like the bulk of care to come from the community, via properly funded non-profit organizations.

My Story 6: Miller Adventures

I would like to say that my time with my Dad was some wonderful change in my life, a departure from the chaos and suffering of my mother’s family. I started off being elated that I could have Honeycomb cereal for breakfast-- that food was readily available. I envisioned a bonding time with my father, and for the first few weeks it was. We went swimming, and I distinctly remember him throwing me around in the pool to my delight. It seems everytime I go to a public swimming pool I see at least one dad picking up his kids and throwing them as far as possible. For those first few weeks, I was one of those kids, and he bestowed attention and material goods with no conditions or limits.

At some point, perhaps a month into my stay, he gave up. I was one of those kids who did not know when to stop—I was starving for a sense of belonging, and he may have gotten exhausted with my boundless energy. Perhaps he had some internal triggers that kicked in, or his unhappy marriage was dragging him down… whatever the reason, he just stopped playing with me. Now I am aware that perceptions of past events can be contorted with time and emotions, so I have carefully counted the amount times the guy took me out to play. I was with him from 1982 to 1984, and he took me swimming a few times in the first few weeks of my stay, and I think we played basketball once, though I’m not sure if that was my step brother. There was a day trip up Mount Hays in Prince Rupert (though that was with my step mother as well). It’s downright weird how little he interacted with me one-on-one. It also took me a long time to realize how much he neglected me. I always thought we had a pretty good relationship, but I suddenly realized in this crazy group therapy session that he completely abandoned me twice—once when I was born, and again in Prince Rupert.

Whatever. The rejection and alienation accumulated in me, and I became lost in escapist behaviour. I used to hang out at video arcades until they closed at 11pm. I was always coming home late, and my Dad would be furious with me. He was also pretty lost in his drinking at this point. His father had recently passed away, he had divorced his wife, moved to London Ontario, and he was living with his mother again—not the happiest of campers. One day he kicked me out for showing up late yet again. I was hanging out with a new friend, playing video games at his house. I called my dad to check in, and he told me not to come home. I was shocked that he would kick me out at 14, but I pulled it together and went to stay with my aunt Sharon (from my mother’s side). As luck would have it, she lived in the same city. Sharon had a son 3 years older than me, and a daughter 4 years older. She also lived with a nasty biker dude that I secretly hated. Living with them got me back in touch with my mom’s culture, since they would sit around the kitchen table and get wasted, just like old times…

Conflict to Complexity

In non-violent communication training, we are taught to look at the underlying need in a conflict. Sometimes, people need respect, or to be heard. Sometimes they have a tangible need (food, money, etc). Other times they just want to be left alone. The main point of clear communication is to seek the basic need, and address it if possible.

Of course, if you have ever watched a verbal conflict unfold, you would rarely see two humans listening to each others' innermost needs and doing what they can to accommodate. You are way more likely to see two or more people swirling around unnecessary details, pointing blame and demanding terms. Often, this leads to a "compromise," where a system is developed to replicate justice.

For example: two roomates clash over the dishes not being done. They yell at each other for a while, roomate "A" feeling like he is being taken for granted (he does most of the cleaning), and roomate "B" feeling pushed into a corner (she does not want to do the dishes 3 times per day). After some time, they come up with a "chore check list" for everybody in the house (including roomate "C" and roomate "D," who were not even part of the discussion). Lets say for the sake of argument that they never address the underlying needs expressed in the orginal conflict; Roomate "A" still feels unheard and disrespected, because he wanted some gratitude for the vacuuming he has been doing for months, etc.

This house now has a set of chore rules for no apparent reason. The underlying need has not been fully addressed, and the issue is likely to come up again. Perhaps another set of rules will be developed, or the rules will be modified. More conflict leads to more complexity...

Despite this being a fictional conflict, I believe that this sort of stuff happens in real life all the time. So many laws and policies and rules that are based on neglected needs that never got addressed anyway. How many intake procedures, admission criteria, and eviction policies are based on silly little conflicts that never got resolved? Is it really fair to subject the most vulnerable homeless people to endless red tape because so and so at the intake desk didn't feel like her job was important enough?

If you work with the homeless, take a close look at your policies-- are they all necessary? Remember that these folks are having a hard enough time trying to stay alive... they don't need the extra burden of complexity. We need resources that are instantaneous, light on conditions, and for gods' sake, simple to access.

Specific Help

I am still working to get people off the street, and I have been recently blessed with a position that allows me to help more directly. For the last year, I have been a type of outreach worker/case manager for homeless and addicted people. I have taken people to detox, supervised visits with clients' children, taken people to the gym to work out, visited landlords, assisted with applications, and whatever else. It's a very effective method because my help can be custom-tailored to each client. Every person I work with has different specific needs, and the systematic approach will not work very well for those who are "slipping through the cracks." Only when you take a client to fill out a rental application do you realize that the person is illiterate, or terrified of elevators, or something else. There is no quick and easy fix to homelessness, because each homeless person is a complex riddle that can only be unravelled through patient trustbuilding and loads of one-on-one time.

There are still some general themes and similar problems that many street people share, such as a history of trauma, or addiction. How each person copes or does not cope with these issues, however, can only be discovered through understanding the whole person on an individual level.

I am happier in this job than I have ever been, despite the difficulty. I am impressed that society is finally starting to understand the human component to addressing homelessness. This is not a problem that can be medicated away, or ignored. We are starting to learn that simply connecting with those who are lost is a solution in itself.

Now if we could just get funding for trauma counselling... hmmm....

Dipping his Toes...

Apparently, a young fellow by the name of Steve Wood spent a week living on the streets of Philadelphia, to get a greater understanding of street life for an upcoming article he is writing for his school paper. After spending a week, Steve said he became disappointed with the homeless, because they have a "sense of entitlement," and they have expectations for the City to take care of them.

I suppose it is good that he is trying to understand. It is good that anybody is trying to get a grasp of the reality of street life. I suppose I can overlook his ignorance when he says he "lost patience" with the street folks, who in his opinion "make their own bed."

Of course Mr Wood feels that they make their own reality. He certainly makes his own reality, choosing to dip in and out of homelessness on a whim. Unfortunately, he is not factoring in the sheer amount of abuse that homeless people experience, most of them from a very early age.

Steve, let me tell you what happens when you get physically, mentally, or sexually abused from a young age. Because you are so small when it first happens, you learn to cope with abuse from a powerless position. You come to understand on an instinctual level that when people hurt you, you can't do anything about it. By the time you reach adulthood, you're left with a screwed up sense of what "choice" means, and a bitter view on the topic of justice. Because you've been lied to over and over again, you cannot trust others, and thus you cannot trust yourself. You fear becoming an abuser, so you begin a slow form of suicide to prevent yourself from harming others.

That's just one tiny piece of the puzzle. Now let me add another piece. Imagine yourself lying at the bottom of a cliff after having fallen. You are in such excruciating pain that you dare not move. A fellow comes along and says "I'm a first responder, I'm going to get you some help!" The guy takes off running. Several hours later, you are still waiting, unable to move. Another person comes along, gives you a drink of water, and says "Help is coming soon!" That person leaves. Several hours pass. It is getting dark. Tell me you wouldn't have some anticipation of help at this point. What on earth could be taking them so long? Don't they understand how much pain you're in?

Steve, people get dissapointed when Cities, Governments, Churches, or other "helpers" don't live up to their expectations-- it's human nature. Apparently, even the homeless don't live up to some people's expectations. I suppose you wanted them all to be weeping in gratitude over the bowl of soup they received at the soup kitchen, but reality has betrayed you. A lot of homeless have been in crisis for years and years, and they are sick of governments declaring new programs and strategies for assistance only to be left out in the cold.

Yet, I will forgive your resentment. I know from experience that street life makes you cranky. You were resentful towards people who were enjoying their coffees... that's pretty irrational. Those coffee drinkers did nothing to you, why would you be resentful, unless you were simply suffering, and needed a place to project that frustration? You may have also dumped some of your frustration on the homeless. Hopefully, once you have a nice warm shower and sit down at the computer, you will be in a clear enough head to see that these people have been through enough, and probably don't need another negative opinion.

Hey Hey, Ho Ho, blah-blah-blah has got to go!

Perhaps we are too intellectually overwhelmed with poverty and homelessness. It’s the only explanation I have left to offer when I consider the disparity between need and funding for homeless services. I don’t believe in maliciousness, and I think I’ve said that before. Even the tighty-righties that would like to enlist all street people in the military or develop some new form of slavery really have the best, if not foolish, intentions in mind. More liberal (if that word hasn’t been wrecked already) counterparts still espouse the same classic strategies and values: research, protest, research, lobby, research, suck-up-to-the-media, blah blah.

What these two political groups seem to have in common these days is a lack of action. Let me give you an example. In a recent budget for British Columbia, $27 million was earmarked to “help keep 300 emergency shelter beds open all year-round.” A fund of $38 million was also included to finance supportive housing projects, including 600 shelter beds, transitional housing and permanent housing. Sounds nice doesn’t it? 27 million… 38 million… except for the fact that in Victoria BC alone, we may have well over 1000 homeless people, and only few hundred shelter beds to assist them. This budget money would be enough to partially address the issue in Victoria, but the figures given are to cover the entire province!

So what’s going on? A 2004 report by the CBC finds:
“The combined service and shelter costs of the homeless people ranged from $30,000 to $40,000 on average per person for one year (including the cost of staying in a homeless shelter). In contrast, the combined costs of service and housing for housed individuals ranged from $22,000 to $28,000 per person per year, assuming they stayed in supportive housing.”
(http://www.cbc.ca/fifth/main_nowayhome_cost.html)

It seems really simple when you look at these figures. Build enough supportive housing, and save millions of dollars. It would work for the fiscally-prudent (ha ha) conservatives, and it would work for the image-conscious liberals. Considering the fact that we’ve had this information for the last 4 years, one has to ask: what are the funders waiting for? Homelessness is a big media issue right now, so shouldn’t the politicians be lining up for photo-ops with token homeless people, and cutting ribbons to open massive supportive housing projects?
I guess it gets down to intellectual debate, because we have all seen or experienced the ghettoization of large housing projects built decades ago, and nobody wants to create another Regent Park. http://www.thestar.com/Unassigned/article/177861 Not being an engineer, I’m guessing that people sit around tables and try to come up with housing designs that everyone will agree on with little success. Who knows? I imagine that administrative delays are eating up 30% of the time allotted to solutions development, and insurance companies and legal firms are bogging things down. Every now and then, some new academic research comes along and undermines or contradicts the previous research (as researchers are taught to do).
It makes me think that the general public needs a still firmer resolve on the matter. Not that I want to see another police-escorted and carefully organized rally event (hey hey, ho ho, blah-blah-blah has got to go!), but perhaps we need a bit of inspiration…

Staff Consistancy

When you work with people in crisis, they ask for everything at once, and get upset in the blink of an eye if you don't provide it. These days in Victoria, it's hard not to upset at least a few street folks a day, because the place I work at (the needle exchange) has limited resources. Sometime we have food, and sometimes we don't. Sometimes we have blankets, and sometimes we don't.

And people don't believe you when you say that there is nothing to eat because no donations came in today. They think that you have some secret stash of food in the back office that you are not sharing because you are too lazy to go and get it. Alas, the negative effect of lazy or otherwise incompetent workers in this field. I have worked beside people who will lie to homeless people to avoid having to go into the back room to pull out a warm jacket, or will lie simply because they don't know how to say no.

There are also many workers who don't know how to get resources, or are overwhelmed--who simply cannot process all the requests. I have tried to be the person who goes "the extra mile" with clients, and I haven't always lived up to my own standards.

I won't be too hard on other workers here, because we all have our moments of weakness, but it sure is frustrating to deal with people who have been lied to and don't trust you simply because you're on the opposite side of the counter. It would be nice if all social workers were equal in their approach; if we could somehow "clone" the perfect social worker.

There is the other side as well: there are workers who will do so much for the clients that all other workers seem to pale in comparison. This is the person who gives cash or rides to people, who has more access to resources, and gives them freely, sometimes breaking the rules to do so. I have found myself being this person at times, but I have learned through experience that this behaviour creates a good cop/bad cop scenario, and so I have moderated my approach to be more in line with the general ideas of the team.

The answer to all of this inconsistancy is of course effective communication (hmmm... it seems that the answer for a lot of things is communication). I have worked in about 10 different agencies that deal with homelessness and addiction, and I notice that the more successful ones (i.e. the ones that see the best client relationships) are the agencies that communicate often, and communicate effectively.

Antimisinformationism

What is happening out there on the street? Do those of us who sit on various commitees and work in social agencies actually know what is happening out there with the homeless and addicted? I have sat in focus groups where one person said something, and that one statement somehow became an accepted fact at the committee level. One guy at a focus group says "We are tired of people talking to us," and the report for the focus group says "They are tired of people talking to them." The committee then makes a motion to "talk to people less," and the misinformation continues. The newspaper then reports that the committee says people should be talked to less, and the local politicians, wanting to have an "ear to the ground" then use the misinformation to create "non-talking" policies. And this says nothing about the contorting of the message that happens as it gets passed through different people. I'm convinced that very few people in this country have an idea of what is happening in the sub cultures that surround them.

Yet we, in our ignorance, are still forced to take actions on a regular basis. Such is life: we never know what the future may hold, but we are forced to act as though we do. To combat this difficult situation, our society has come to rely on the scientific method to give us a "reasonable" view of reality. If enough academic reports point in a certain direction, we can make enough assumptions to proceed. For the homeless, we apply social science, a smattering of sociology, social work, psychology, cultural geography, anthropology and economics. Ethical guidelines are developed, and legions of volunteers and academics rush out to get the scoop on street life.

Science has a difficult time with humans, however. For example, how do you prove what percentage of homeless people suffer from some form of mental illness? You could try and get a sample population and survey them, but the crisis situation that most are currently in will cause certain traits which may appear to be mental illness. Furthermore, how do you get this sample? Do you invite homeless people to volunteer (which will only gather certain types of people) or do you force people to participate (and if so, how?).

Perhaps the whole idea of "studying the homeless" should be discarded in favour of a more humane approach. I suggest we give what is needed while gathering what information we can in the process. For example, a reasonable homeless count can be done by tallying all of the people who use social helping agencies in a given area (so long as the list of agencies is very wide ranging and complete). Accurate records of client situations can be recorded by staff of foodbanks, soup kitchens, and emergency shelters. There is currently no national database or method for doing this, but I think it is time to initiate one. And when I say a national information database, I don't mean that we should bombard the homeless with technical questions, I simply mean we can ask them a few open-ended questions occasionally, and the staff person asking can interpret and record the results anonymously. For example, most people who come into emergency shelters tell their story to the staff member who does their intake. The staff can, after finishing the intake, visit an online database and fill out a basic form.
This data would accumulate, and eventually would give a somewhat accurate picture of what is happening.

Nevertheless, any attempt to get a glimpse into a sub-culture will produce a limited result, and we should keep this in mind. For this reason any study or data collection carried out with homeless people be done in conjunction with the handing out of tangible resources like food, shelter, etc. We cannot ensure an accurate reflection of reality, but at least we can make sure our time, and the time of clients, is not completely wasted.