Interactive plenary 3D - The alternatives
Allan Strong
Activist, The Wellness Network
Ontario, Canada
It’s been a wonderful conference and I would like to thank AGIDD-SMQ for the opportunity to be here. It’s been extremely well rendered and I certainly enjoyed networking and having the opportunity to share experiences with so many individuals. And so, I’d like to, first of all, I think we sure all give a round of applause to the organizers for such a wonderful job.
My task this morning is to talk about alternatives and I work for a survivor run initiative in the area of Kitchener in Ontario. We cover a region in the province and I won’t go in too much detail about the region, because it wouldn’t mean that much to you. But what we really try to emphasize is wellness. People think about wellness and I think of new age type of things, such as getting in touch with your inner child, doing all sort of transformative stuff, transgressing the past lives, doing some interesting things like that. I’m not here to put that down. When I think of wellness, I think of a broad range of things. I would like to put a question to you : as survivors, when we talked about wellness, often times, what is it that people talk to us about ? Exactly. Medication !
Medication often times becomes the only thing that people talk to us when it comes to our own wellness. Medication, medication, medication… And yet there are more things to wellness and being healthy and well than medication. Let me put to you, for an example, that theoretically you may have a nice medication that works well for you, but if you live in a substandard rat-infested apartment where you’re paying the majority of your income for your rent, you do not have meaningful daytime activity or employment, you do not have any friends that you can call on, you don’t have any social connections, you don’t have any leisure connections, emotionally, you don’t feel that well, spiritually, you feel unconnected, despite the fact you may have a good medication, if you believe in medication, you’re still going to feel like crap. Wellness is more than just medication.
Wellness is good, decent, affordable, safe housing. Wellness is meaning that you have meaningful daytime activity or meaningful employment. Wellness means that you will have meaningful social relationship and you don’t feel isolated. Wellness means that you have activities that bring joy and pleasure to your life. Wellness means that you feel connected spiritually and you feel connected to what you call the sacred in the day to day life. To me, that’s what wellness is about. And these are the type of things that we need to be fighting for.
So, when we talk about wellness and we talk about alternatives to wellness, we need to keep in focus the broad determinants of what health are. For those of us who don’t… for those people who don’t have a psychiatric diagnosis or a label, these things are taken for granted. Why should it be any difference for us ? What makes us different ? Than the average person, than the so called “normal” ? There was a workshop yesterday and a colleague of mine said “normal is a setting on a dryer”. When you dry your clothes. What is normal ?
But these are the type of things that we need to keep frantic and centre in our work, not only with the political advocacy and fighting for policy. Essentially, we need to keep reminding people that what we all need is a job, a home, and a friend. Those are things that are important to all people. Notwithstanding a label and notwithstanding a diagnosis. Jobs, homes, friends. Safe, caring and supportive communities. Those are the things that we need to be fighting for. Those are alternatives. When we talk about alternatives, let’s talk about alternatives that enrich our lives, empower our lives and give us hope… there’s nothing worse than losing hope.
In my work in the Wellness Network, what we try to do – it’s a very small organization, there’s only two full time staff and four part-time staff – what we attempt to do is community education and community outrage to promote these ideas and to promote policy makers and the general public to consider these ideas and to make them part of the main stream.
The other thing that we really try to fight is prejudice about mental health. I don’t like using the word “statement” any more. Because statement means it’s something to do with me. Let’s call it what it is : prejudice. Let’s put where it belongs, out there. It’s the people out there who don’t understand us, they’re prejudice. It’s not our problem, it’s their problem. And we need to educate and change those attitudes.
So, in closing, I’d like to say that if we can put forth the challenges, when we’ve been questioning, when we have a wonderful symposium here, we’ve come together, there’s been 400 of us here. The energy has been fantastic, but let’s go back to our communities and let’s not lose what we’ve had here. To paraphrase… one wonders if a small group of committed individuals can make any change and often time it is only a small group of committed individuals sure make change.
Plénière interactive 3E - Les alternatives
Sam Tsemberis
Pathways to housing
New York, États-Unis
Premièrement, c’est un honneur d’être ici et d’avoir été invité à titre de conférencier pour le groupe ici présent. J’ai déjà habité Montréal. Je suis assis à côté de Judi Chamberlin, qui fut l’une de mes premières inspirations. Mon histoire n’est pas une histoire personnelle, parce que j’ai travaillé dans le système de santé mentale. J’ai reçu une formation de psychologue à New York. Et, maintenant, je crois être un psychologue en convalescence à cause de ce que j’ai appris dans mon initiation éducationnelle. Je crois que mes plus grands enseignants furent les gens avec qui j’ai travaillé dans les hôpitaux, dans les cliniques ainsi que dans les programmes de foyers où je travaille présentement. Je tiens à vous décrire ces programmes de foyers que j’ai démarrés il y a près de dix ans à New York.
Si vous vous rappelez les années 80, le début de l’itinérance était un problème social terrible. Je travaillais pour la ville de New York, faisant le tour des rues dans une camionnette avec un psychiatre, une infirmière et un travailleur social, en faisant du service le long des trottoirs et interviewant les gens de la rue qui semblaient le plus à risque. Et les gens qui semblaient les plus susceptibles étaient ceux qui avaient un passé psychiatrique et quelque condition médicale et ce, spécialement durant les mois d’hiver à cause des risques de mourir de froid. Il y a eu plusieurs statistiques au cours des années précédentes. Vous savez, le maire Giuliani est très efficace, il met tout le monde en prison, alors nous avons moins de gens dans la rue, mais nous avons un autre problème.
Mais, durant cette période, j’ai parlé avec beaucoup de gens aux prises avec des problèmes psychiatriques. La seule chose que je pouvais faire pour eux était ce traitement d’urgence de les faire monter à bord de ma camionnette et de les mener à une clinique. Nous pensions que c’était la meilleure chose à faire. Nous pouvions rencontrer entre trente à cinquante personnes par jour, mais nous ne pouvions n’en aider peut-être qu’une seule qui répondait aux critères de traitements d’urgence.
Nous avons laissé toutes les autres personnes avec des besoins énormes dans la rue, parce que nous cherchions les personnes avec des maladies mentales, itinérantes et dépendantes aux drogues à cause que nous étions des cliniciens. Nous considérions premièrement les besoins cliniques. En fait, le système américain en entier s’appelle « la continuité des soins ». Ce qu’ils ont établi est une série d’étapes pour que les gens itinérants puissent se trouver un foyer. Vous devez monter plusieurs marches dangereuses. Par exemple, vous devez immédiatement vous engager dans un traitement psychiatrique si vous avez un diagnostic qui mentionne quelque incapacité psychiatrique. Vous devez maintenir une période de sobriété, participer à toutes sortes de traitements de groupes, restriction de recevoir des visiteurs... Ensuite, vous déménagez dans un endroit comprenant un service clinique secondaire. On y gardait là de douze à cinquante autres personnes pour environ un an ou deux. De là, une fois que vous avez démontré des aptitudes à vous comporter de façon « appropriée », on vous autorise à déménager dans une structure plus indépendante avec moins de soutien. Dans l’esprit de certaines personnes, ça faisait un certain sens. Mais ça n’avait aucun sens pour quelqu’un qui était itinérant, qui avait une incapacité psychiatrique ou bien qui était dépendant de quelque narcotique. Les gens aux prises avec ce problème ont une perception totalement différente de la marche à suivre.
La première chose que quelqu’un de la rue vous dira est qu’il a un problème domiciliaire. Ils veulent immédiatement un endroit sécuritaire pour eux; non pas de vivre avec d’autres, ne pas devoir prendre de médicaments, ne pas devoir cesser de boire ou de prendre quoi que ce soit ou n’importe laquelle de ces restrictions. Premièrement, ils veulent juste un endroit pour se sentir sains et saufs, en sécurité.
Nous avons entendu ce message haut et clair. Nous tentons de persuader les pourvoyeurs de logements de la ville d’accepter les gens, de prendre une chance. Ultimement, mes collègues et moi en sommes venus à créer le Pathways to Housing Program, (programme Voies au Logement), organisme qui travaille dans ce sens.
Ce que je tiens à ce que vous reteniez de ma présentation est cette image que vous avez peut-être des personnes itinérantes sur la rue avec leurs sacs autour d’eux ainsi que plusieurs épaisseurs de vêtements. Sachez qu’il y a une façon de retirer immédiatement ces personnes de la rue et de les mettre dans un appartement qui soit le leur sans qu’ils aient à participer à un traitement psychiatrique ou autres ou bien de démontrer leur sobriété. C’est ce que Pathways to Housing fait. Nous avons été en opération avec grand succès depuis dix ans maintenant.
Qui est le plus prêt à avoir son logement qu’un itinérant ? Les gens vivent dans des appartements indépendants dans la communauté. Ils ne vivent pas en congrégation. Nous louons des appartements dans d’autres édifices dans le voisinage. Pas plus de 5% des unités sont louées par des gens de notre programme, parce que nous ne voulons pas saturer aucun édifice. Nous tenons à ce que ce soit intégré le plus possible. Et les gens non seulement peuvent sortir de la vie compliquée de l’itinérance, qui est de ne pas savoir où trouver une boîte postale, l’horaire des soupes populaires; où pouvez-vous trouver un banc ou une couverture dans un édifice pour dormir et coordonner tout ça pendant que vous êtes symptomatique et dépressif ? Déménager dans un appartement qui est le vôtre n’est pas difficile. C’est une tâche assez facile après avoir été itinérant. Et les gens s’ajustent immédiatement et tiennent à leur appartement.
Nous avons un programme de soutien clinique, qui est également mené par le client lui-même, dans ce sens que les personnes choisissent si elles veulent que quelqu’un de l’équipe participe au traitement ou à plusieurs autres programmes. Nous avons une classe de photographie et de réhabilitation vocationnelle et également quelqu’un qui aide pour les emplois, curriculum vitae et soutien éducationnel. Vous pouvez déterminer lequel des services de l’équipe que vous voulez en premier, dans l’ordre que vous les voulez.
Cette idée d’hébergement directement de la rue, cette idée que vous puissiez choisir le service qui vous convient en est le corps principal. Et je crois que c’est à l’origine de mes nouvelles connaissances. Je pense que le système devrait respecter le choix des gens. Je pense que là où le système de santé mentale s’est fourvoyé, et vous le savez plus que moi, c’est qu’il prétend savoir mieux que le client ce qui est bon pour lui. Je crois que c’est le problème fondamental de tout ça.
Ce que j’espère que nous puissions démontrer avec ce programme d’habitation est le fait que lorsque vous êtes à l’écoute des gens et que vous leur donnez le premier choix, vous pouvez mener le meilleur programme d’habitation de la ville de New York, parce que vous écoutez ce que les gens demandent. Merci, je vous remercie de votre appui et de votre attention.
Interactive plenary 3E - The alternatives
Sam Tsemberis
Pathways to housing
New York, USA
It’s an honour to be here and to have been invited to present with this group. Historically, I’ve lived in Montreal and also I’m sitting next to Judi Chamberlin, who was one of my first inspirations. And my story is not a personal story, because I have been working in the mental health system. So, I was trained, originally, as a psychologist in New York City and now I think I’m a psychologist in recovery, because I’ve learned a great deal about all the things that went wrong in my initial education. I think that the greatest teachers have been the people that I’ve worked with in the hospitals and clinics and the housing programs where I work. I want to describe to you this housing program that I started about ten years ago now in New York City.
If you remember in the 80’s, the beginning of homelessness was a terrible social problem. I was working for the city of New York, driving around the streets in a van with a psychiatrist, a nurse and a social worker, making service sidewalks, house calls and interviewing people who were on the street who appeared to be most at risk. People who were most at risk were people who had a psychiatric disability or some medical condition and, specially during the winter months, they were at risk of perhaps freezing to death and they were numerous stats during the earlier years. Now, mayor Giuliani is very efficient, he’s putting everybody in jail so… we have fewer people on the streets, but we have another problem.
But during that time, I was talking to a lot of people with… the only possible help I could offer them was this emergency treatment, bring them to a clinic in our van. We thought “This is the best we could do.” And we would see maybe thirty or fifty people a day and we could help maybe one that met the criteria for requiring emergency treatment.
We left all those other people on the street with enormous needs and I think because we were looking at the person who had mental illness, substance abuse addiction and homelessness, but because we were clinicians, we were considering the clinical needs first. In fact, the entire system in the United States is called “the continued care” and what they have set up is series of steps for people who are homeless to get housing, you have to jump. Many difficult steps. For example, you have to immediately engage in psychiatric treatment if you’re diagnosed having a psychiatric disability. You have to maintain a period of sobriety, you have to participate in all kinds of group treatment, mandated care, restrictions on your visitors and so on. And then you move to a setting with twelve to fifty other people, clinical services on the side for about a year or two, and then once you’ve sort of demonstrated your ability to behave appropriately, you’re given the opportunity to move to a more independent setting with less support. And in some person’s mind, this made a certain amount of sense. But it does not make sense to anybody who has been homeless or anybody who has had a psychiatric disability or a substance abuse addiction. People with these problems see the system completely differently than the way that is set up.
The first thing somebody on the street will tell you is that they have a problem with the housing. They want to be immediately in a safe and secure place of their own, not living with other people, not required to take medication, not required to stop drinking or using… or any of these other restrictions, they just want a place to feel safe and secure, first.
We heard that message loud and clear. We try to persuade housing providers in the city to accept people, to take a chance, and ultimately, we ended up creating, my colleagues and I, this Pathways to Housing Program, which does exactly that. What I want you to remember from my presentation is this image that you may have of a person who’s homeless on the street with their bags around them and the layers of clothing. There is a way to take this person immediately from the street into an apartment of their own, without requiring them to participate in psychiatric treatment or any other kind of treatment or have a period demonstrating sobriety. That’s what Pathways to Housing does. We’ve been doing this for ten years now with great success.
You know there was this belief that you have to get housing ready. Who is more housing ready then people who are homeless ? People are housed in independent apartments in the community. We rent apartments from other buildings in the neighbourhood, no more than 5% of the units are rented by people in the program, because we don’t want to saturate any building. We want to have it as integrated as possible. People not only can move from the complicated life of homelessness, which is knowing where is the mailbox, the schedule for the soup kitchens, where you get a safe little bench or crevasse in a building to sleep and to coordinate all that while you’re symptomatic and depressed. And, people thinking… that is a difficult life ! Moving into an apartment of your own is not difficult. It is quite a simple task after having been homeless and people adjust to it immediately and people hold on to the apartments.
We have a support program, a clinical support program, that is also a client-driven that way in a sense that the person chooses what they want to see any of the team to participate in treatment or to participate in any of the other programs. We have a photography class and vocational rehabilitation and a person that helps with jobs, with resumes, with education and so on. It doesn’t have to be in that sequence : first, you take medication, then, you go to the job program. You could determine which service you want from the team in the order that you want it.
So, this idea of housing directly from the street, this idea of you choosing the service is really the core principal of that and I think that this is where the new learning for me has been – and I think that’s where the provider system needs to go – is honouring what people choose. I think where the mental health system has been completely wrong, and you know better than I do, is that they assume to know better than the client what is good for them. And I think that was the fundamental problem in that.
What I hope we’re demonstrating with this housing program is that when you listen to people and you give them their choice first, you’re able to run the most successful housing program in the city of New York, because you’re listening to what people want. Thank you.
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