We at Street Health are often contacted by members of the media for our opinions on important issues that affect our clients. As part of our mandate to assist in educating others about the impact that severe poverty has on our clients’ quality of life, we see this as an opportunity to clear up misconceptions, stereotypes, and prejudices that have the potential to make an already difficult situation even worse.
Recently, Liam Casey, a reporter with the Toronto Star, asked us to identify a “gap” in the Mental Health and Addiction system, relate how that gap impacts clients, and suggest an effective solution. Mary Kay MacVicar, Harm Reduction Co-ordinator at Street Health, [scroll down for Mary Kay’s article] is often frustrated by the numerous roadblocks to providing effective, compassionate care for our clients. Her considered response to Liam’s request points out that those who are living the experience of homelessness, addiction, or mental health concerns are often neglected (or rejected) by mainstream healthcare until they’ve reached a crisis, and that involving them as equal partners in their own healing is an essential, though often missing, component in the effort to provide dynamic, holistic solutions.
In theory, systems ought to work.
The human interactions that should be part of this larger whole often break apart. It is easy to despair when witnessing “gaps” in the system forming underneath a client. Why does this occur? Is it the result of choices and judgements made by service providers?
“Good” patients get good treatment. Some folks who struggle with complex health and social issues such as homelessness, mental health concerns and substance use or dependency are often not “good patients”. They may be transient, leading chaotic lives. They may come to the attention of health and social service providers only when in crisis as it can be extremely difficult to access mainstream services.
It isn’t uncommon, after repeated attempts with non-effective treatments, that people find symptom relief in the form of other drugs. Crack, opiates, gambling, alcohol, misused prescription medications -whatever it may be, they themselves know they are uncomfortable and alter their state to find what peace they can. Many professionals still refuse to see individuals who are actively using.
When I met Milton I was immediately drawn to his soft spoken manner. He was articulate, sensitive and seemed to care deeply for others. Milton lived an isolated life; he struggled with a chronic and serious mental health concern, poverty and the risks associated with a dependency on an illicit drug. Milton had just started attending a drop-in based in the community that serves individuals who use substances and he learned to recognize that the experience of substance use ranges from: none to some to problematic to dependent. He had come to understand that substance use is part of a continuum that needs to be addressed at any point in its evolution and that the individuals themselves are the experts of their experience. At this drop-in, wrap around services are provided that engage marginalised people in health care and support services. Peers are critical to the success of such an approach.
A peer worker is a person who has lived or is living the experiences of the key population you are trying to engage. A peer worker will typically offer a sense of belonging, acceptance, support, education, encouragement and understanding that builds community. Working with peers who are active in substance use can be useful in dispelling myths. It demands that other service providers see the person differently, recognise the peer’s skills and knowledge thereby creating an opportunity to relate differently with the population as a whole. It adds authenticity to the process. It is a testament to the power of connection.
Contrary to common opinion that folks who use substances are hopeless, we often witness the gains and successes when they are met with kindness, understanding and effective and comprehensive services.
Milton started coming to the drop-in regularly, he saw nurses, a housing worker and began talking with support staff. After completing a peer training, he began working in his community providing street outreach services and other mentoring activities. Over time his self concept began to change, he took control of his substance use, his health, and his housing. Today we rarely see Milton because he is busy with educational and social pursuits. He does stop by from time to time, lighting up his community with smiles, well wishes and hope.