Tired

Well I haven’t posted for a few days now.
I have been coming home from work tired.
We have had some very stressful incidents over the past week or so.
Attempting to deal with such issues and keep everyone else safe and well at the same time takes it out of you.

To keep the bureaucratic arm of our organisation happy, we have at work what are called “critical incident” forms.
These forms are to record instances where there was either some form of illness, harm or the risk of harm in the workplace. In theory they are to help us as a team and our OH&S staff at head office to improve workplace safety.

As you know I work in an industry (services to homeless people) where there are probably more than the fair share of incidents. So on average, as a manager, I probably fill in about one of these a month. Since Tuesday last week, I have filled out no less than six of these forms, and strictly it should have been seven.

Here is my list of misadventures and close shaves for the week.

A fight where one client (I’ll call him Hacker, he is actually known by a nickname) attacks another. The victim turns on the attacker and begins to beat him up. Greg and I intervene and manage to talk them down. Result Hacker and the other guy banned from our premises for three months.

A psychotic episode affecting one of our female clients. One of our staff (I’ll call her Jane) is threatened. Result Woman escorted off premises, psych crisis team called (they don’t arrive until after she has left the area, surprise, surprise.)

A psychotic episode (probably drug induced) affects one of our male clients. He threatens a guest psychologist (I’ll call her S). Greg and I intervene. We get S into a safe room. Greg and I continue to try to talk him down. The guy continues to escalate. I instruct Greg to dial 000 (our equivalent of 911 or 999) The Police take fifteen minutes to arrive (their station is maybe 100 metres away). By then the guy has calmed somewhat. The police elect to not arrest him but just move him on.
S has been a psychologist in the city for over ten years. Yet this is the first time anything like this has happened to her. Greg and I spend a long time trying to reassure her. We then walk her to her car (our shift was over by then). I then spend a long time on the phone to her boss trying to ensure she gets a proper debrief.

Hacker (see point 1 above) turns up after a couple of days. He waltzes in as if nothing has happened. I remind him of his ban. He becomes verbally abusive and threatening. Greg hovers nearby in case thing go wrong, but in the end Hacker listens to me and leaves.

Two of our guys argue. Neither wants to back down. It looks like another fight is in the offing. Greg and I intervene. Between us we manage to talk them down. Both are asked to leave for the day, neither is banned.

Finally, yesterday at breakfast one of our volunteers (I’ll call him Larry) suddenly complains of Chest and abdominal pain. Larry is a guy in his mid sixties and his health is not good. I dial 000 for an ambulance and stay with him until they arrive. Larry is taken away by paramedics.
We have to reassure the guys that Larry will be OK (while being worried for him ourselves).
Fortunately Larry was not too bad as it turned out. He spent the day in hospital while tests were run. The diagnosis – kidney stones.

So as you can see I have had a busy week. These sorts of incidents cause a lot of stress for all involved.
No wonder I am tired.

Now to finish on a positive note or two.

Veiled in Shadows is proceeding, albeit a little slowly at the moment. I am almost ready to upload my files to the printer.
However, I have found a few last minute formatting errors so I am checking the whole thing once more.
I have also just received a National Library of Australia Cataloguing-in-Publication entry.
This thing is getting closer and closer.

Finally my youngest’s school has asked if I can be at an open day to meet with prospective parents to answer questions about how we as parents (and our daughter) find the school.
I am only too happy to help out. Lu came to the school last year (in what we call year 10). This is the first school that has come close to meeting her needs and the first school she has ever been happy in. They are clearly doing things better than any school she has ever been to before.

Hmm. I think I have enough for another whole post there.

Enough for now.
I’ll finish with a piccie of some of the high country north of Melbourne. Unlike the Upper Yarra Valley which has featured a lot on my blog this piccie taken a couple of weeks ago shows much more typical Aussie summer colours.

Fred

Well I have had such a strong response to my last post about Fred. And spent so much time crafting responses to each of the thoughtful comments I received that I have decided to "cheat" a bit and make my responses to your comments my next post.


Lisa said...

I pulled up this comment box and then just had to sit here for a moment to absorb your post. First off, I want to applaud you for your efforts to help a portion of the population that is so often neglected. I think the story of Fred points out so many problems we have in our society. Not the least of which is an inability to truly recognize the needs of the mentally ill. If we were willing to pay better wages to the people that care for these individuals, perhaps people like the one that Greg contacted would not be what we got stuck with. So sad.

Hi Lisa,
It is so hard to comprehend, hard to absorb. Thank you for your recognition of the work we do, it is cheering to be recognised.
We do indeed have many problems in our societies and we let so many people down very badly. I think wages and conditions are part of the problem, but sometimes there are simply the wrong people staffing some of these teams. Some people who are in these jobs should go and work sorting paperclips or something, anything other than stuff it up for other people.


Christy Pinheiro, EA ABA said...

I usually lurk but I had to post, too. What a sad story this is. The mentally ill get treated like garbage everywhere-- they are difficult to understand, expensive to treat, and easily forgotten. Thank you for sticking your neck out to help this poor man. Mother Theresa said, "Every day I see Jesus in all his distressing disguises."

I'm not too religious but that quote has always stuck with me. You are doing the work of Mother Theresa. It's hard, joyful, difficult and rewarding work.

Hi Christy,
Thanks for coming out of the shadows (you wicked lurker you). Fred’s story is a real tragedy. The really sad thing is that it is not uncommon for people in his position to be deserted by the system.
Thank you for your kind words. I don’t see myself as a mother Theresa figure, I’m far too worldly for that, but thanks for the sentiment anyway.
You are absolutely right in your last sentence. This work is so hard I wouldn’t do it except for the absolute buzz I get when I can help someone like Fred long enough to make a difference in their life. Day to day the reward is when someone who is as low as you can get says "thanks you make a difference for me".

Amanda said...

O wow. That is so heartbreaking. Sometimes I am amazed at the ineptness of some people in their line of work. And I applaud you and your co-workers efforts. I hope Fred is ok and somehow someway gets the help he needs.

And I love your Echidnas photo. It is realy adorable.

Hi Amanda,
Heartbreaking is right. Staff in these organisations can become very jaded, but it is also a management issue. If staff were properly trained and supported they would be more likely to care about their jobs and the impact their decisions have on other people.
Aren’t Echidnas just adorable. I have met them so many times in the bush and they just make me smile every time.

Wendy R said...

Al - Like everyone here I was moved and distressed by your post in equal proportions. And angry.
Thank you for sharing it with us. You show such generosity of spirit to Fred, and to your co workers. You need to take care of yourself too, to be there again for them and for other people like Fred, who I am sure, will come along.

You restored the balance with your photo of the Echidnas. Ironic that you say 'they don't seem to have an aggressive bone in their bodies', given the content of your early post.

Congratulations on your steady head in these things.

wx

Dear Wendy,
Thanks for your sentiments, I really appreciate them.
I get very angry at times as well. I have been working in the community sector in mental health and related services for many years now. My experience is that, with most people, a small amount of regular support is enough to help them keep things ticking over for themselves.
For a few, like Fred, it is significant support applied in a holistic way for moths or years that is needed. Then if (or more likely when) their condition improves support can be scaled back, but the key is someone like Fred should never be cut adrift. It is too easy for the Freds of this world to become isolated.
But this is an ideal. The reality in a welfare and health system provided by Economic Rationalist policy makers the real cost of neglecting people is never considered and that is what makes me angry. (I’ve just realised you might not know the term economic rationalism, it is an Oz term for something like Thatcherism)
Thank you for you concern for my wellbeing. I have a very simple philosophy when it comes to this sort of thing and that is: “You can’t help anyone else, if you don’t look after yourself first.”
I always push this line with my teams in this type of work. Burnout rates are terrible in any form of welfare work. What makes the difference is cultivating a team ethic that is about supporting one another. But also ensuring individuals (including me) have strategies in place to deal with such stresses. By the way my writing is one of those strategies.
I very deliberately chose to pick up echidnas again exactly because of their lack of aggression (and they are damn cute). I have seen many in the bush and handled quite a number (probably unfair but I just can’t help myself). They are quite small (around cat sized) but immensely powerful, they can break into termite mounds that I couldn’t open without a well swung pick. Yet their defence strategy is absolutely passive, they make no effort to turn those claws on an idiot like me who won’t leave them alone.

Kathleen Jones said...

I felt really sad, Al - these things shouldn't happen, but they do here too. We have this fictional thing called 'care in the community', which means that people are simply tossed out into the street without any support or back up and they have to commit a crime to be absorbed back into the system again. I'm full of admiration for what you (and your team) do. And I hope things turn out better for Fred.
kathleen

Dear Kathleen,
It is so saddening that we let the Freds of this world down so badly. We have similar strategies to “care in the community” in Oz. There are some programs that are funded well and do wonderful work supporting people. I’ve even worked for a couple in the past. But the reality is the vast majority of people do not get anything like the support they need and what support is provided is so often insubstantial and short term.
Unfortunately your assessment about crime is true. Sometimes the results of the justice system becoming involved are positive and people end up with meaningful support. Unfortunately it sometimes becomes a situation where rather than receiving treatment and support people are incarcerated. I don’t know about the stats in the UK but the reality is a huge proportion of people in jails in Oz have a mental illness. That they are there is an indictment of our mental health system.


Thank You all for your wonderful responses. I am humbled by your understanding.

As to Fred unfortunately he is still on the street.
We have not seen him again, but he is still around the city.
He has been to another community service over the weekend. That service were aware of what had happened because some of our other fellows also go there. The police were called. However, presumably because Fred is very frightened and agitated, he left before they arrived.
We can only hope that somehow Fred gets the support he needs.

Next: From Spring Back to Winter

Trials and Tribulations.

Well I have not posted for several days now. Unfortunately, the past few days have been very hectic and very stressful at work.

As you may know, my day job is running a charitable service that supports people who are homeless.
There are three main thrusts to our service: the first is to look after people’s physical needs; the second is community we run a drop in centre where people can simply relax and interact with staff, volunteers and each other; the third plank of our service is what we call information and referral, we offer advice, and support people in accessing other services they need to improve their lot.

Most of our service users are people who are simply down on their luck (not that there is anything simple about homelessness). But a proportion of people who we work with have significant drug and alcohol problems and/or mental health issues.

This story revolves around one young man (I’ll call him Fred to protect his identity) who has been accessing our service recently. He is clearly unwell with some form of mental illness. Most of all he is very frightened and isolated from other people.

So our tack has been to approach Fred very gently and very slowly to try to build trust. One of my team in particular (who in the tradition of protecting the innocent I will call Greg) had invested a large amount of time and effort in building a relationship. Fred was beginning to engage with not only Greg but also other staff and service users.

Finally on Wednesday he plucked up the courage to ask Greg to help him find assistance to deal with his mental health. We are trained in supporting people living with mental illness. But we are not a clinical service and what we are supposed to do in a situation like this is help people access the appropriate agency.

So Greg got on the phone to a staffer on a mental health team. Greg outlined what he saw as Fred’s problems and explained that in his opinion he needs clinical support, and could we arrange for an assessment. The person on the other end of the phone accessed Fred’s file and said to Greg that he had been discharged from their service in 2005 because at that point he was travelling relatively well.

From there it all went down hill. The mental health staffer asked to talk to Fred. Rather than doing what she should have done (which is ask non threatening questions to set him at ease and enable him to explain his current situation) she very bluntly reflected Greg’s concerns back to him and asked directly if he thought he was in a delusional state.

Now I don’t know how most of you would feel if asked by a total stranger over the phone if you are crazy. I suspect that most people would not like it, and would become defensive. Not surprisingly, Fred reacted in exactly that way. He said almost instantly that he was fine and didn’t need support.

The staffer then said to Greg that in her opinion Fred was not in need of clinical support and terminated the conversation. Fred left immediately, obviously very distressed and angry.

He came back on Thursday armed with a knife.

Fred came into our centre and confronted Greg. He was very upset, very angry and accusing Greg of calling him crazy. An absolute nightmare scenario for a community worker.

Due to where he was confronted Greg had no means of retreat. But he is a brilliant worker and reacted exactly as he should. Speaking calmly, trying to deflect the anger and calm Fred down.
I was to one side and had to juggle several things at once: making sure the police were called without provoking Fred any more; being near in case the worse happened and the threat became a physical attack; and trying to keep other clients calm, safe and also with some from attacking to protect “their” worker.
Fortunately Greg’s calm reaction enabled Fred to settle down. He put away the weapon and left.

The Police arrived in force two minutes later. Although they hunted around the area they did not find Fred.

This leaves a very bitter taste in my mouth. My staff and service users have been placed at direct risk (and me as well). Greg seems ok (he is very experienced and has a long history of dealing with difficult situations). But I know all too well that he needs to be supported (and just as importantly needs to FEEL supported) following this incident. This goes for my other staff and for service users (and myself).

Worst of all for me is Fred is still on the street. He is clearly a risk to himself and other people. The police are still looking for him, but the frightening reality is every year people like Fred get shot as police attempt to apprehend them.

Fred now has no one to turn to. This frightened lonely young man is at real risk because a service cut him adrift without follow-up years ago. Then to compound it all when he finally asked for help, someone who should be trained, who should be professional, couldn’t be bothered to take the time to do her job properly.


Now to cheer me up, a unique Aussie.
Back in August I posted this piccie and asked if anyone knew what it was.
A couple of people replied correctly that it was an Echidna. I meant to come back to this but got distracted along the way.
Despite their spiny looks Echidnas are not at all related to either porcupines or hedgehogs. They are monotremes, egg-laying mammals. Their closest living relatives are that other egg-layer the platypus. These photos are of two animals I spotted in the bush last autumn. They are very sweet, very gentle creatures and amazingly curious. When they get frightened they use their massive claws (which you can see in the above photo) to dig into the ground leaving only their spiny back exposed. If the ground is too rocky they roll into a ball. They don't seem to have an aggressive bone in their bodies. They have no teeth but use long sticky tongues to lick up ants or their favourite food termites. They use these claws to tear open rock hard termite nests, but they never seem to use them aggressively or defensively.