March 2010

1. I had another great day on my field placement! Yay!
2. The joy of my “Duck Dream” stuck with me for much of the day.
3. Meatballs!
4. Laughter.
5. My husband gives awesome hugs.

Early this morning, about 30-ish minutes before the alarm went off, Coffee left the bedroom. The sound of the door jolted me out of a dream that I was having and I was really, really mad. REALLY MAD.

It was an awesome dream.

In it, I was in a pet store of some sort and I was holding an enormous duck – he looked like a male mallard, mostly, but was just HUGE. I was ‘petting’ the duck and talking to an employee about him, apparently because I was seriously considering purchasing myself a new pet duck.

The feathers in the dream were really vivid. If you’ve ever held a bird, especially larger one, you’ll know that they’re a strange combination of soft and scratchy and straw-like and wirey and.. weird. They were exactly like that in the dream, and I was marveling over the brilliant colours (blue, green, brown-speckled) of each feather.

As I was petting the duck, he was wiggling his little bum-feathers with glee. This is my favourite thing about fowl, by the way. Those little wiggly tail-feathers. I love seeing them at the Rockton Fair every year – never, ever fails to make me laugh.

Anyway. As he was wiggling his tail feathers and enjoying my petting, it suddenly occured to me that I didn’t want to take home a duck if there was any chance of making baby ducks. The sales clerk (I think) assured me that the duck “has been neutered”. At the word neutered, the duck started wiggling those tail feathers even faster. The clerk said, “Oh, he knows that word!”

And then Coffee woke me up.

I was SO MAD about it that when I tried to go back to sleep I couldn’t. Instead, I got up to pee. And when I returned to bed and Coffee attempted to snuggle up to me, I all-but snarled at him to get away from me.

Later, the alarm went off and we got up. I was recounting the dream to Coffee as we stood in the kitchen and I kept laughing – the entire dream was SO enjoyable and happy and good.

But seriously.. How DARE he take away my duck petting??

I’ve noted that i struggle with using “consumer” in terms of describing the individuals who are seen, in any capacity, within the agency at which I am placed. That’s the word that the agency has chosen to use for a variety of reasons.

Some agencies (and individuals) prefer to use client, customer, patient, friend, partner, service user, survivor, person with a mental illness.. seriously, the list of possible names is REALLY long.

And every single one of the names is offensive to someone.

Hell, we used to refer to people as “lunatics” if they had a mental illness.

I am starting to see the many ways in which language can oppress and how hard it is to combat that. Words have a lot of weight behind them. Everything is fraught with meaning – hidden and open – and interpretation. There are implications about power balances, control, “who’s in charge”. Then there are implications about passivity, decision-making, and, yep, self-determination.

This article talks about some of the labels pertaining to psychiatric care (i.e., medical) and, notes in the conclusion that “The study results indicate lack of universality in preferences for terms for users of mental health services and suggest the need for dialogue about preferred terms between service providers and recipients.” (from the abstract section)

This article from the UK talks about some of the terms as they pertain to non-medical mental health clients. It’s not bad at explaining all of it.

There are a lot of journal articles out there that talk about names – but they’re all academic and behind pay-walls. The gist is that people in the field want to be as unoffensive and as realistic as possible. And no one is sure how to do that appropriately.

My preferrence is “client”, as I’ve noted, because it’s what I used when I worked for psychotherapists. I used “patient” when working with the psychiatrist because it was a medical thing.

I struggle with saying “consumer” and that’s part of why I’m working hard to write it. But it’s really interesting to look at each word and ponder the ways in which it can be negatively perceived (including “client”) and how it can be positive.

No hugs today!

Walking is, as a general rule, a very highly promoted activity within the world of mental health. It’s adaptable to nearly every fitness level, it gets you out of the house, it gives you fresh air, etc. The agency has many semi-formalized Walking Groups that consumers are encouraged to join, both indoor and outdoor.

In addition, one of the options that workers seem to regularly give their consumers is to do a “walk and talk” instead of just sitting on the sofa chatting. It’s the same in the group home – the workers often head outside with a consumer to chat as they explore the neighbourhood.

What I’m saying here is that I’ve been doing a lot of walking lately. And, given how awesome the weather is lately, I have absolutely NO complaints.

In my situation, the walking and talking serves another purpose: it allows me to listen in on conversations without being much of a presence.

It can be hard for people – anybody, not just consumers – to open up about things when there’s a stranger present. Add in some embarrassing things that need to be addressed, or a general shyness, or a touch of paranoia and it’s all multiplied.

In some cases, the consumers have weekly (or more frequent) meetings but many see their workers for check-ins once or twice a month. My presence cannot interfere with that.

So, before bringing me along, the worker first asks the consumer if it’s okay for me to be present. They explain that I am a student and what I’m studying and that it would be very helpful for me to meet consumers but absolutely not necessary.

When we arrive, I am introduced. I shake hands if they’re offered, or simply add a, “Nice to meet you, [name], and thank you for letting me come today.”

Then I sit back unless I’m addressed.

(And, as I’ve noted before, when I leave the consumer’s place I always thank them for letting me visit and tell them that it was nice to meet them.)

This morning I went on a walk with a worker and a consumer. The consumer was discussing some symptoms of mental illness that have recently been increasing due to a change in medications. It was fascinating.

I listened to the concerns and the issues, carefully, as we walked around the consumer’s neighbourhood in the gorgeous sunshine. I was one step behind the whole way and was able to hear everything said – but the client was not expected to address me directly.

Try sitting in a room with two people having a conversation that you want to listen to but not influence it in any way. It’s nearly impossible to keep a neutral face, nor is it necessarily appropriate, but at the same time it’s important because, in that hour, the consumer needs to address various things without needing to tell someone [me] the entire backstory. Eeek! I spend a lot of time making what I hope are sympathetic, warm, friendly faces even when I’m completely confused and have no idea what the hell is being discussed. I do generally make polite conversation about the weather, or school, or seasons or, y’know, whatever, if it comes up.

After that meeting, the worker and I drove to the apartment of another consumer. We were met at the door and informed that we would not be having that meeting in the apartment and that the client wanted to go to Tim Hortons. So, we did. We sat outside, in the sunshine, and talked about all the various things that needed to be discussed. The consumer was very cool about me being there, talked directly to me a few times, and we laughed together a bit. There was a lot that I didn’t understand, though, like when they’d talk about various people (by name) and not indicate their relationship (mother? father? sister? partner? employer? neighbour?) so that made it a touch surreal.

I’ve been getting to know a few mental illnesses a bit better (for lack of a more appropriate way to describe it) in terms of the diagnosis and textbook description vs how it actually impacts people. I’m learning about medications and how they help some, and not others, and how the medications cause new problems altogether. Much of it is stuff I’ve read before, either when I was in university for psychology, on my own reading terms, from friends’, etc. It’s just very interesting to meet people who are there to specifically address things pertaining to their mental illness.

I guess what I mean is that it’s one thing to know someone has schizophrenia (for example) and to occasionally hear small tidbits about it from them. In general, if someone you know has a mental illness, you either hear about it only when they’re in crisis or in passing (“Oh yeah, I’ve been depressed at times..”)

It’s another thing to meet someone in the grocery store, say, and suspect that they have a particular illness but not be particularly concerned because they are, after all, a stranger. You look warily at them, possibly wonder if they’re dangerous, and then move along.

It’s another thing altogether to have the purpose and focus of your meeting and discussion be about mental illness – and how it impacts on absolutely everything else. To hear how schizophrenia led to loss of relationships, dropping out of school, trials of medications (that worked, or didn’t, or are/aren’t working right now), how “the voices” sound, the delusions, how friendships ended, how hard it is to get out of bed, how depressing the basement apartment is, how they’d like to be an artist/writer/shoesmith again, and how they worry about taking tylenol in case it interacts with their medications.

To hear how they’d like to achieve certain goals but can’t because they can’t stay awake for more than an hour when medicated and can’t focus on anything at all when they’re unmedicated. To hear how one makes the choice between hearing voices constantly telling them to kill someone and suffering all manner of uncomfortable and unpleasant, never-ending, physical ailments due to meds.

That’s seriously just the very tip of the iceberg of things I’ve been hearing and seeing. And so I try to remain as inconspicuous as possible because I am constantly mindful of how I’d feel if it were me.

After hours, later in the day, I attended a team meeting for one of the group homes and heard some long-term planning and some details on how each consumer is doing. I loved the teamwork aspect – how each person was able to give feedback, how each person had a different relationship with the consumers, and how each person felt things should go in the future. It was awesome. Very positive, very consumer-focused.

I am starting to recognize that I enjoy the one-on-one support meetings far more than the groups. I like the relationships that consumers have with workers when they’re alone far more than I like the group atmosphere where there are many interpersonal things going on.

Tomorrow morning I have my first one-hour supervision meeting where I can talk about my concerns, questions, ideas, etc. Honestly, I have no idea what to ask or say. Go figure. I feel like I’m just now starting to get a handle on things but still don’t know enough to know what I don‘t know – which means I can’t even ask reasonable questions. Perhaps I’ll just say that.

Note: This post isn’t about the agency where I’m placed – it’s a generic overview of self-determination and my interpretation of it. I’ve used some hypothetical examples, but they’re not applicable to my particular agency directly!

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The agency at which I’m placed, like many others, believes very strongly in “client/consumer self-determination”. Truthfully, it’s a very popular way to run agencies in the post-1990′s, and it’s also a very strong component of individual counseling lately, too.

The gist of it is that the client makes the decisions.

It doesn’t mean, of couse, that the client can do whatever the hell they want whenever they want by shouting, “SELF DETERMINATION, MAAAAN!” It means that they are given information about their options and choices and are free to make the decision. Generally there are guidelines or specific requirements provided, too, when it comes to agency involvement.

Ideally, the second part of self-determination, within any agency (or therapist, or..) is that they then assist the client in the entire process within the professional context.

For example, if a client goes to an agency (not the one I’m at, specifically, but any agency) and requests help, the agency staff would find out first whether they were the right agency to assist. If so, they’d find out from the client exactly what their needs were – counseling, a place to live, whatever. From there, they’d provide education on the topic (“the types of housing we’re able to help with are X Y and Z. The costs would be X. You will need to be non-smoking to live in X place. You would have to abide by these rules of you choose Y or Z place. I can help you with the paperwork, if you like!”)

In terms of individual counseling, it would be along the lines of helping the client figure out what they want to work on and then helping them figure out HOW to work on that. So, a client who comes in with a relationship problem might be asked which part of the relationship is the most problematic and helped to brainstorm some solutions. The counselor would then basically support them through all of it.

(I am WAY oversimplifying this, but hopefully you’re getting the gist of it.)

I’m a HUGE fan of the whole self-determination thing. I love the idea of letting people make their own decisions! I love that I’m expected to leave my own feelings out of it and simply support a client with information, choices, options.. yeah!

In one of my classes, recently, I was part of a group that presented information about Planned Parenthood. I’m a huge fan of PP, so that was a nice thing, but it was where the concept of self-determination REALLY hit home as being an awesome thing.

The biggest misconception that people have about PP is that it’s “pro-abortion” or that the only service they provide through the agency is abortions. I know differently, and knew before the presentation, but I wanted to address it in the presentation.

The basis of Planned Parenthood IS self-determination. You can go there with a certain set of personal beliefs and receive information based on that! You can go in, pregnant, and state that you want information about adoption: they provide it. You can walk in and say that you want information about barrier contraception because you don’t want to use oral contraception: they provide it! And you can walk in and say that you want an abortion and get information about it, too!

It’s beautiful. No one is trying to convince you to do something other than what you want – they’re just telling you all the options, factually, and you go with whatever you feel is right.

In terms of mental health, there are many laws that have changed in recent years pertaining to client’s rights. I am not (yet) educated enough on those laws to speak much to them, but a lot of it is directed toward giving the power back to the client and not the professionals.

To give an example, I’ll give a vague idea of how the group homes I’ve been visiting work. A consumer who wishes to live in one is given a lot of information about what to expect – as much info as possible. They are given written information about their rights as a client of the agency and a resident of the home. One of the rights, for example, is to be consulted on any and all issues pertaining to their care. To have privacy in their rooms.

They are also given information about their responsibilities while living there. This generally includes conduct (no illicit drugs or alcohol on the premises, no fighting, etc) and expectations (X number of chores done per day, cook one meal per week for the residents, etc.) They are made aware that choosing to break these rules will result in consequences – and that can include not being able to live in the home.

On top of that, each consumer has their own plan – goals and responsibilities they’ve chosen for themselves. The goals can be anything (hypothetically) from a personal task like showering daily to getting a full-time job. The staff and consumer work on the plan together and the staff finds ways to support the client (using the examples above, the staff could remind the consumer every day at 10am to shower, or could help them fill in applications for employment).

Okay, so now you’re thinking, “Well, what if the client stops taking their meds and doesn’t help out and WHAT THEN?”

Then they’re reminded of their agreement to behave in certain ways. And if they don’t do so, they are stating that they don’t want to be a resident there anymore.

Now, keep in mind that there’s a huge support team behind most of the residents. There are nurses and psychiatrists and support workers and community support workers and agency employees who work on specific tasks. There are friends, families, neighbours and family doctors, clergy..

So, if someone stops taking their meds (and they are absolutely allowed to choose to stop taking meds – there is no law saying you MUST take meds just because you have any illness) and starts acting out, the various staff members would help sort things out as much as possible. Figuring out what’s going on, helping the client make some decisions, etc.

They’re treated as adults. Adults with rights. Adults who get to make their own decisions.

I really don’t think it should be THAT amazing. I mean, to me it’s a basic human right – no one should be making your decisions FOR you.

(The trick is that I then take self-determination to the next step and get into my feelings about illicit drugs, right-to-die issues, etc. And that latter one is a post STILL in the works…)

Today I spent the entire day working at a crisis and respite home within the agency. It’s a short-term stay facility for people who are.. well, in crisis or in need of respite. Go figure.

Anyway. The clients who are there stay for a brief period – less than 2 weeks, generally – and come for any number of (mental health-related) reasons. The referrals come from all over the place, including self-referrals. It’s generally meant to help people transition but there are other reasons, too.

For example, one client might come from a stay in the hospital and require a short-term stay to help sort out some longer-term housing or just want some non-medical, non-hospital support before returning home. Another might come because of a problem with a roommate or family member and need some support working through things. Another might have recently changed medications and need a quiet place to spend some time adjusting. Etc..etc..etc..

While there, today, I had a chance to see pretty much every part of the process from intake to departure. I was able to ask a million questions about everything, too, which is awesome. And, as always, I ran into graduates from my program. This agency is chock full of them!

My friend Paula had, on finding out the name of the agency I was with, asked if I had met a particular friend of hers. I hadn’t but was keeping my ears open for a mention of her – and today we worked together! (Of great amusement is that this friend of Paula’s is SO much like Kelly!) I managed to get quite a few hugs while working with her – at least 4 – including one when I was leaving. LOVE IT.

While I was there, I sat in on some planning meetings, helped make lunch (and ate it, too!), sorted donations (to be washed and further sorted), read through files to get an idea of how the staff support clients, talked to a few of the consumers (about general things, I mean, not in the sense of counseling or interviewing them), and got to sit in on a shift-change meeting.

The shift-change meeting was quite interesting. The outgoing staff basically briefed the incoming staff on the day’s happenings – from who arrived, to who departed, and everything in between. There was discussion of intake phone calls, problematic consumers (in the sense of what staff needed to keep their eyes on), and various other administrative details about phone calls to make/return, or paperwork to do,

I really, really, REALLY enjoyed working there for the day. Granted, I wasn’t really working so much as observing, but I quite liked the atmosphere and how things are done. I’d like to go back on another day to check it out, if I could.

And, again, I was encouraged to apply to work as relief staff – which sometimes means working at this particular home. I’m seriously considering it!

All told, a very good day.

But man, I’m tired!

1. Today I worked at a Crisis/Respite group home. It was awesome. I love love love love LOVED it.
2. Watching Maymo rocking out, while reading a book, to some Beatles music. I’m not sure he’s aware that his entire body is moving..but he’s totally keeping time!
3. Sunshiiiiine!
4. Warm naan.
5. My beloved husband.

1. I spent my morning, before school, tidying and cleaning and organizing. It was nice. I realize that’s weird.
2. Today I went to school, not field placement, and man, THAT is a walk in the park. Show up, sit down, shut up and you’re MONEY!
3. Laughing almost hysterically in the parking lot after school, talking to a friend about assorted things.
4. Fresh air and sunshine!
5. Tonight we’re having daal and naan for dinner. Nom.