Mental Health Hero nomination

A department within this state (I forget which one) runs a little contest each year for the Mental Health Champion in which the case worker writes about a client with a mental illness, their recovery, and the ways in which they inspire other people. There is a recognition ceremony
in the capital for them, and a little prize as well. Most importantly, they get recognized for how special they are to have not given up, to have continued working. There is a woman I've written about before on this blog, Shalle, who I nominated this year. I haven't yet heard if she's won, but I wanted to share what the nomination essay.

Shalle is a mental health champion for both the recovery in her own life and the effect her spirit has on others. Even without bipolar disorder, the forces that threatened Shalle’s successful life chances were great. Raised by a single addicted mother, she began abusing crack herself when she was 13, and for almost 20 years, perpetuated the family pattern of drug abuse and prostitution. In 2008, this combination left her pregnant with her second daughter. She felt compelled, for the first time, to seek a new way of life, foreign to her, in which her coming child would be spared the drama and trauma of her own childhood. She had no example to follow, but began to take tentative first steps towards adulthood.

She again quit using drugs, for the final time, the most important time, and moved into a homeless shelter. She began to access and utilize services available to a pregnant woman and prepare for her coming daughter. She tenaciously adhered to the medication requirements through the uncomfortable give and take of different combinations, and she faithfully attended 12-step meetings. Most importantly, in the face of loneliness and rejection, she began to seek out a different social support system, one that did not glorify the street life.

Upon her daughter’s birth, some well-meaning family members, unaware of Shalle’s budding transformation, involved child protective services for fear of possible mistreatment. There was little chance of this, however, as her motivation to succeed was renewed every time she saw her baby. With the help of local agencies, she secured an apartment, took parenting classes and maintained the many DFS requirements necessary to keep her child. She did such a good job that, at the end of September, DFS decided that she no longer needed their supervision.

During this time, she began to work small jobs, particularly around the mental health center she attends daily. They gave her a small job of doing other clients’ laundry in exchange for a small stipend, a position reserved for someone mature and trustworthy. During this time, she has grown in self-confidence and self-respect, and she treats every person she helps with dignity and care. She continues to fearlessly face her own emotions, insecurities, fears, and ghosts of the past that continually threaten her sobriety. Finally, she is also reaching out to her elder daughter, who followed in her own footsteps of life on the street.

She faithfully and bravely works to reach her goals of sanity and self-discovery. Even in the face of disappointments, she perseveres. She is a model for others of a successful transition from a drug abusing mentally ill woman wrapped up in prostitution, to an independent sober parent. The changes that Shalle is continuing to make in her life and the way she bravely shares them with others makes her the local mental health champion. People look up to her as proof that the sober life can be achieved. She has done it with perseverance, humility, dignity and class.

I knew I wrote him!

Kent is a man who has been around my center for many many years. His attempts for sobriety have been sporadic, and even now, is not total, however, he has stopped smoking crack and, though still drinking, doing it less. A simple man, its sometimes difficult to talk to him, and I have frequently mistaken this as a reticence to talk to me, but over time, I think I understand him a little better, and our relationship has solidified into one of humor. He's quiet and self-conscious about his missing teeth, which prevents him from smiling broadly, so it usually takes him a little while before he feels comfortable saying something.
My agency organizes Christmas giveaway for our clients who usually fill out an anonymous form with shoe and clothing sizes for themselves and their children, as well as special toy requests. For our department's guys, since they don't have any place to store gifts, we ask for gift cards, and each counselor gives them to their clients. We also ask them to write a thank you note for the donor. I caught Kent on his way through my office to give him his. I said, "Santa came and left a gift for you." He said, "Did he? I knew I wrote him!"
This was such a quick response and one so witty that it still calls up a chuckle and was a good beginning to the holiday weekend.

Meeting Maurice

Maurice has come into our agency for several months, if not years. Homeless for many years and extremely delusional, he can be loud and frightening. As part of his protective street persona, he rarely smiles, is loud, and often talks to the voices he hears so it frequently doesn't make sense.

For a long time, we've just been working with him so that he'll become used to a routine, coming into our program every day, remaining calm, remaining around people all day, the fundamental kinds of social intercouse that can be extremely difficult for one so delusional and accustomed to censure. He became willing to complete an intake with us - something that had before now been too threatening. I was assigned as his direct worker - someone he would connect with on a regular basis, someone with whom he would, eventually, utilize a treatment plan.

The first morning he had his route sheet - the slip of paper someone needs to enter the program every morning - he was taken aback when we asked for it. He did not react abraisively, as I was afraid he would, but I could tell that he was starting to feel overwhelmed, which can easily elicit an expected response. Having a hunch that he perhaps didn't fully understand, I approached him later in the morning and asked if he had a minute to talk. "No," he said, his face expressionless. After a moment, the mask cracked as I saw the corners of his mouth turn up. "I've got years." he finished, streching out the vowel sound. It took m a second to piece together his joke, but he was smiling wider than I'd ever seen before. We sat down together, my mind racing with what I would say and also marveling at how proud he seemed of himself, what this might mean for him.

I took out a route sheet and explained it to him: the purpose of it and our expectations surrounding it. This hadn't before been explained to him, and I could tell he didn't understand at first, but he paid close attention to the things I was saying and eventually got it. On these sheets are spaces left for people to attend certain programs we offer, but I wasn't going to ask that of Maurice just yet. He pointed to the spaces anyway and asked if he needed to attent them. I told him that, eventually, I would ask it of him. For several minutes, he stared off straight ahead of him, he face arranged in a scowl I so often see on him. Suddenly he said, "Different music." At first, I was unsure whether he was talking to me or to something else only he heard. Then I realized that he was referring to the classical or ambient CDs that people play sometimes. By that point, he was smiling, and I realized that, while he was serious, he was also playing with me. I asked him what music he would pick, and again, he started in the distance. "Soul," he finally answered with a large smile. I laughed with him for a little bit, and then we went on with our mornings.

Insignificant, this interaction could be, perhaps for someone historically more functioning. For Maurice, however, this is evidence of playfulness and good humor that I've never seen before, that he may have never been able to reveal before. This interaction also revealed to me how little I know him, how little I know of him, but that's the fun part.

Beautiful hope

Last Thursday was a day that I was glad I keep this blog to remember happy and good things about the job. Because that evening, I was not feeling a bit of it, neither happy nor good. I had just returned from a trip to the police station with a client, Maria, who was raped several weeks ago. A report was filed that night, and a week later, as the rapist was lurking around her, she called them again, added to the report and a warrant was issued for his arrest. As it happens, this rapist was my client about a year ago, so I knew his name and information, but was kept by HIPPA laws from providing it to the authorities. Instead, I merely stood by her and prompted her to provide useful details she omitted.

Over the weekend, the guy was found and brought into the police station. When they tried to find Maria, however, they were unsuccessful, because she's homeless and wanders. Since they couldn't find her, they let him go. Last week, she and I went to the police station to learn what her options were, but we didn't hear any possibilities. In fact, it sounded like it was just dropped. Just closed. Like it was nothing, nothing at all.

I found myself doing what social workers shouldn't do - take something like this personally. I kept thinking, "This could be me. But for the grace of God, this could be me." It got to the point that I couldn't think about any way to help my client, because any time I thought about it, I felt helpless and weak, and I was so frustrated. I felt further disempowered because I couldn't help her in her case, even though I knew the information she needed.

The turning point came when I read responses to my frustrated post on Facebook. As a social worker, I have a number of social worker friends, and they are connected with resources that I can't think of in the moment. Furthermore, they could offer support, even over a digital medium, and their words were encouraging. The following morning, armed with resource names and contact information, I began making calls to sexual assault and legal advocates, and was immediately lifted up. They were extremely helpful and uber informative, and I was quickly armed with several options for empowering and assisting Maria.

But it didn't end there. Later that morning, I met with another woman I've been working with for about a year. She'd recently left a long-term relationship she was no longer happy with, but this day, she disclosed how controlling and abusive he's been to her, something she'd not before let on to me, I think out of embarassment. He's slapped her several times, and he threw a brick into her father's window, almost hitting her. As she was sharing this with me, I could see the shame that had been wrapping around her for so long, finally being a little bit released because she could share it with someone. Because of the the research I had done for Maria, I immediately provide her with phone numbers, talk to her about different options and -most importantly - reassure her that she was not to blame.

I almost have chills when I think about how all of this came together. As dreadful as these circumstance are, I can't help but, when I think about them, marvel how the seemingly unrelated events harmonized. Through the discouraging day of bottomless frustration, an evening of tears, then loving support and suggestions, a morning of furious searching and information-gathering, and then - right when it was needed - hope. Beautiful hope.

Peace be with you, S.

While I try, in this blog, to focus on the positive things that I see in my clients, I feel moved to share a somewhat negative thing that happened last week. One of our clients, S, killed himself. This was his third attempt. I don't know how; one of my co-workers found him when she went to take his medication to him.

While this, in itself, is tragic and devastating (there were many tears flowing around the office that day), out of respect for S, I would like to talk a little bit about him, remembering him.

S first came into my day program after months of outreach from the mobile team establishing a rapport with him on the street. He came to us extremely delusional with symptoms untreated before he came into my center. For the first several weeks, he wouldn't communicate with any people but the mobile outreach team. He actively conversed, however, with the voices in his head, in all volumes. He frightened a number of the clients, and even offended one or two of them when he imagine himself to be God, as he did pretty regularly. Most of the clients, however, could see that he was not well, and they treated him gently. It was really sweet to see them, as tough as they tried to pretend they were, treat someone who was hurting with a kind of quiet care and respect.

When S became extremely loud, one of the workers would go to him, point out his volume, and ask him to lower his voice. When I first began doing this, as soon as I approached him, he would avert his eyes. He would lower his voice, but only for a minute. The longer I knew him, however, the more comfortable he became, and he began to look me in the eye and smile. After a little longer, he began to hold small conversations with me.

He became of client of our Assertive Community Treatment team, which houses chronically homeless and severaly ill clients and then follows them every day or so, making sure they take their meds and go to the doctor. S had only been with them a few months, and then this happened. My agency has a number of burial plots for clients who do not have family so they can be buried with dignity, and S will receive one of those.

When I think about his passing, I'm a little sad, of course, because his was such a simple and sweet spirit. But it was also tortured, and I like to think of him now completely and finally at peace.

Reverend Bobo and Bubblegum

Today I saw one of the more colorful characters I’ve known from my day program. He’s working with our intensive community treatment team, which is the only way the wonder of his current stability is possible – he’s been housed through my agency for over a year. He takes medication regularly, he bathes regularly, and when one asks him a question, he answers in a way that makes sense. This is a far cry from the years he spent on the "hobo trail." He was rarely clean and a hopeless hoarder, saving papers and food, empty cups and trinkets in an old backpack. The only clothes he owned were those on his back - and he had several outfits on his back.

His very name is truly unique. I won't give the actual name here to protect his identity (in the small chance that you'd know him) but it's akin to Empee. As a testament to his then untreated mental illness, however, some days he wanted to be called Earl, and sometimes he wanted to be called Reverend Bobo. Unfortunately, one couldn't tell who he was on which day, and he got very angry when we called him incorrectly.

Not only did he adjust his own name, but also other people's names. He frequently called people Bubblegum, particularly when he was frustrated. "I put that there for a reason, bubblegum.." He had trouble with my name for awhile, and so he just called me Gracie. I don’t know how he got Gracie or why, but I was sad when he stopped. Whether this was due to his personality or mental illness, I don't know.

One thing that I do believe is a testament to his mental illness is that when one asked him a question about how he was or the status of his meetings, he would answer a different question. Very frequently, the answer was to remind us that Darth Vader was his father. Sometimes, though, the answer was an angry outburst, and no amount of soothing voices or corrected names could fix it - he was excused for the day.

The first time that he revealed to me how sweet and gentle person he is was when one of our staff members was leaving. This made him very nervous and anxious, but he really didn't have the words to communicate how he was feeling. Instead, like a frightened child staying near their parents, he hung close to different staff members throughout the day. My turn was during lunch. He hovered around me, almost wringing his hands, and frequently reminded me that she was leaving. Though he was sad, his reaction was touching. He was handling it the best way he knew how.

I remember the day that President Obama was inaugurated – my center has a big screen TV and we let people stay after lunch to watch it. The whole center was darkened, and all of the clients were arranged in a half circle around the TV to watch. Despite the unusually large number of people in the room, they were hushed to hear the television commentator announce the different parts of the ceremony. When they announced a performance by Yoyo Ma, Empee’s voice piped up from the quiet darkness to announce, “Yoyo Ma’s my cousin!”

While I miss Reverend Bobo and Bubblegum, it was nice to be able to hug him hello today and to really be with Empee.

Epilogue: When I was working on a project in my practicum, I was working with prominent members of the faith community, and did, in fact, meet a Reverend Bobo. I spoke with other people about Empee, and they suggested that he knew Reverend Bobo, who is extremely involved in his community. And all this time, I thought it was a delusion...

Another Outsider

One of the occupational hazards of working with the homeless is that I see them no matter where I am. Because, as I like to remind my friends, "The hobo shuffle is the same in every country." My latest international visit took the form of my first cruise in the Caribbean. Before I left, a friend of mine advised me to "take about 20 minutes to feel bad about the opulance and then get over it and have a good time, because its a lot of fun."

As the trip went on, I better understood what she meant. Not only could I pick out the many homeless people on each island, and furthermore, I don't know that I saw a single American face at work on the ship, though I did see plenty of Eastern Europeans and East Asians. On shore, the port area was extremely built up, pandering to the expectations of the "Northern" tourists, but the wealth disparity once one passed the inner circle was immense. I realized how insightful my friend's advice during the many moments of discomfort I felt. It raised a number of questions for me, the most important being: how does my life as a privileged American contribute to this disparity?

This ties into another significant aspect of my future a requirement for my Master's program in Social Work. I will need to do a practicum, or internship, however, and trying to select the site is a challenge. I know that I would like to work in poverty, homelessness, and economic equality, and in order to do this effectively, I've thought that I needed to get outside of my "first world" bubble and see poverty from an outside perspective. Something this past trip showed me, however, is that I will never be able to excape this bubble. There are a number of privileged categories that apply to me: white, educated, Christian, English-speaking, heterosexual. They always will. Even if I go live in community with the underprivileged, I will still be an outsider.

So instead of becoming like them, as though I'm from that community, perhaps there is another or a better way I can use my gifts, even though I'm an outsider.

Getting back up

I was present to another miracle today and I was so excited I wanted to share it with you. There was an alcoholic client I had several months ago that cared about a little more than most. I don't know what it is about some people, some of them just sit a little closer to my heart than others. Several months ago, he completely fell off the grid - he lost his job, lost his apartment, and lost contact with everyone he knew. Several clients and the mobile outreach team talked about seeing him once in awhile either passed out in the street or on a bench. He is a good and honest man and a hard worker, and his disappearance bothered staff and clients alike.

He re-appeared on Tuesday, slumped against my building. He had asked for me, and when I went outside to talk to him, he grasped my hand tightly. His face was swollen, his eye was blackened, and his eyelashes, eyebrows, and moustache were all singed from clumsy cigarette-lighting attempts. He was about ready to break, and heartbreakingly wanted to come back to the program, come back to acceptance. I rubbed his back and told him that he had a place with us. I was able to get him up to our facility for lunch. When he started to get sick and we started talking to him about going to the hospital to detox, however, he blanched. "Have you ever been in the hospital?" he asked my co-worker. She said, "What you need is outside of our scope of care - you need medical help." He wasn't open to any offerings of help. "I'll do this myself, get my own scope of care." He stumbled out of the center with promises to return, sober, the next day. The next day, however, he was nowhere to be found, and I was afraid it would be another two months before I saw him again, if I did.

This morning, another client came for me and told me he was outside. I went to him, his face was still puffy, his pupils still tiny black dots, tears already forming in his eyes, his self-loathing written plainly all over his figure, and I took his hand. He had whiskey and soda with him this time, and while he couldn't stay on property with that, I didn't want to send him away. I again brought up the idea of a hospital and pointed out to him that when he tried to sober up on his own, he couldn't. "You can do this again, but right now you need help, and the hospital is the place you go for that." He started talking about what happens when he goes to a hospital, and I said, "I've been in a hospital for four months; I know what it's like. I also know that's where I got better, and that's what you need." He softly agreed to be taken, and I scampered off to find the worker who could take him before he changed his mind. The worker was gone, however, and I had to stay, and suddenly I was faced with a dilemma. I felt terrible sending him away, away from help he needed, away from his willingness to go to the hospital, but he couldn't be around with that alcohol. I told him as much, and sugggested he come back in 30 minutes, lunchtime, for a ride. He said he wanted to do that, but he didn't move. Thinking he wanted to stay, I said, "Or, you can give me that bottle and let me take care of it, and come upstairs with me right now." "No ma'am," he answered firmly, "I'll take care of it." I helped him up, and he shuffled off in his too-big pants and socks (no shoes on), arms full of bottles and a sweater. "I'm going to throw this away," I could hear him tell people as he scooted past them, "I'm going to the hospital." It was ironically cute and laughable and saddening all at once. I was wracked with uncertainty in my decision - did I do the right thing? Would he come back? Did he think I blew him off?

He didn't come back for lunch, but folks told me he was around. About an hour and a half after lunch, he came to the door of my center, arms clear of belongings, shoes on his feet, and said, "I threw that bottle away. I'm ready to go to the hospital."


I could have cried for the many feelings I still have to think about it: relief, love, respect, humility. It's just another thing to love about the job.

What it means to be a lady

There's a lady, Shelle, that I have that I've known for a few years. I've seen her when she was "out there," the colloquial term that clients give to being in their active addiction. When I first knew her, she was still actively using and prostituting and had attitude to spare - she would lash out at someone before taking their help. This last time has been different and she's been more earnest about her recovery, and more successful. She hasn't used in over a year, after 20+ years on the street.
After several months of working together, she informed me that she watches me and my other women co-workers. She said, "I don't know what it means to be a lady, but I want to be. I want to learn how to be a lady. I watch all of you, the way you walk or carry yourselves, to see how you do it." She brings that idea up frequently in our one-on-ones as she and I talk about her efforts.
She has an 18 year old daughter who saw her while she was using and has begun to emulate those actions. She is living with a man 20 years her senior, and Shelle has seen her on the streets. She knows what her daughter is doing. For a short time, her daughter was living with her. Shelle remained firm in boundaries she was setting for her home, boundaries that any lady would set, and boundaries that were completely new to her daughter. Shelle did not know how long her daughter would stay, and she was trying to instill them into her daughter in the time that she had. At one point, after her daughter hadn't showered for several days and Shelle said, "It's time for you to take a bath. Ladies bathe themselves, and you're a lady. I know I didn't set that example for you when you were younger, and I was wrong for that, so I'm telling you now these things that I'm learning. You are a lady."
Her daughter left shortly after that interaction, again living with that older man, again living "out there." Shelle is distraught with concern about the best way to help and guilt about past errors. Despite this, however, or perhaps in anticipation of the day that her daughter comes back to her, she consistently strives to set an example of "ladyness," while simultaneously learning what it means to be a lady. The changes have been remarkable, and it's a blessing to be with her as she learns these new things. It's also profound to see her put faith in the hope that, though she can't see the effects of her choices now, little changes she makes will reap great rewards. This faith, I think, is one of the cornerstones of the definition of a lady.

Black Boots

I was at work one weekend when a former client dropped in. Nida (not her real name) was a chronically homeless addict with two sons in prison, and her time with my program was the first time that she was truly serious about her recovery. She has an incredibly humble spirit, works extremely hard, and its precious to be with her as she discovers this world sober. It's much the way I imagine a parent would feel to watch their children make discoveries.

She and I were catching up on her job and her upcoming move from transitional housing into her own apartment when a yellow-shirted woman approached me for a pair of shoes from the downstairs clothing room. It was a Saturday, and I don't have access to that room on Saturdays. I told Yellow-Shirt as much, and she lamented that she needed them for work that evening. After several minutes of silence, Nida pointed out, "You know, you could get pair of black shoes at Wal-Mart*...it'll only take one bus ticket to get there." A few seconds of silence streched between us as Nida studied Yellow-Shirt's face. "You don't have it, do you?" Yellow-Shirt shook her head. "I can see how bad you want this; I can see it on your face," Nida said, knowing from years on the homeless street. "If I give you $10, will you take it to the store and get shoes?" Yellow-Shirt said yes, and silence fell as Nida weighed the decision. To take the heat off her, I said, "Let me check the back room," referring to a small closet on our floor with toiletry items and socks and underwear.

I knew there weren't any shoes back there, and if there were, they wouldn't be black, but I was absolutely blown away by the "Pay it Forward" gesture that Nida was making. I know she was thinking about people who had helped her when she was struggling, and she may have been making an amend for those she hadn't helped when she was using drugs. I opened the door to the closet and turned on the light. Chills covered me as I spotted one pair of shoes on the low shelf - black boots. I flipped them over to see the size, and they were just right.

Another good thing about the job: miracles happen everyday, and sometimes I get to be present to them.

Epilogue - I still don't know Yellow-Shirt's name, but the shoes are very comfortable and exactly right for the job. She enjoys it and is doing well in it, and she is interviewing for a second job in a few days.

*In no way is this an endorsement of Wal-Mart. I'm just sayin'.

Miss Sarah, why me?

One of the religious communities in town offers weekends of reflection and rejuvenation for homeless people in recovery or with mental illness. The folks that go on this weekend are typically chronically homeless and usually forgotten, or when they're considered, it's with distain. During one of these weekend, there are different activities set up to encourage them to think and reflect on the current state of their lives and what they want, as well as have an opportunity to grow spiritually. Every single person to have gone to this event returns with positive feedback and having gotten something from it, if only to feel unconditional love for the first time in their lives.

Several weeks ago, I told one of my clients, Dinky (name has been changed), about the weekend, and because we trust each other, he signed up. As the time has approached, however, he's become more and more anxious about going. Last week, he said he was mostly just confused but by this afternoon, he was truly upset. He couldn't sleep this week and he had a headache. He said, "Miss Sarah, I know this is a good weekend and you recommended me and all, but what if I do something wrong? I've never done anything like this before." He thought for several seconds, and then sat back in his chair. "I just don't know why you recommended me for this. Why me?"

My heart absolutely broke. Dinky is one of the most thoughtful, considerate and honest clients I have. He works hard to know the right thing to do and does his best to do it, even when he doesn't want to, even though he's living on the street. I told him all of this, and as I went on, his body lifted incrementally. By the time I finished, he said, "Really? I'm all of those things?" I assured him he was and that I had faith in his ability. He nodded, a big smile on his face, and said, "Okay."

One of the most special things about my job is that I get to love people. My hope is that the love I show to them, they show to other people.