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Archive for February, 2009

One of the individuals, Karen, who is on my case load had been impossible for me to engage with as I had never had the chance to meet her.  I had heard a lot about her from various agencies, all expressing a great deal of concern for her well being as she leads an extremely chaotic life and isn’t receiving any support from any other services due to her problematic behaviour.  She is a rough sleeper, an alcoholic and a chronic street drinker, she also has mental health problems and was hospitalised nearly 100 times in 2008 for various issues including self harm and deliberate overdose. She has some serious, possibly life threatening, physical health problems.  She has been arrested hundreds of times too and is known to be extremely abusive and aggressive. 

 

 I found out Karen was in court so decided to turn up and introduce myself.  When I arrived I saw someone being escorted from the court who was very abusive and distressed, from what I knew I realised this was Karen.  I introduced myself and although she was still extremely agitated I tried to engage with her.  When we were outside the court she was surrounded by a group of people who seemed to be taking advantage of her financially and who were also being quite verbally intimidating towards her.  I stood and had a cigarette with her and she was very hesitant about talking to me and was extremely guarded, she didn’t understand why I would want to talk to her if I didn’t have an agenda.  Karen was quite distressed and kept saying that the people she was with were taking her money and she couldn’t cope like this, I tried, gently, to get a little bit more information from her but all she would say was that they were taking her money and her alcohol and she couldn’t stop them.  She also kept saying that she had been really ill, she wouldn’t really go into detail but just kept repeating that she had been ill.  During this time she was getting very distracted by the group of people milling around outside the court so I suggested that we maybe go for a coffee and a chat, she looked very suspicious but said ok. 

 

We walked into town and as soon as we were on our own she really seemed to open up, she told me about her kids which were taken into care, about her cat, that she had had since she was young, that died because her ex-partner neglected it when she was sectioned.  Although she was very distressed and emotional when recalling this, Karen was actually quite articulate and said that she understands how people perceive her but that she’s not a bad person, despite what people think.  She mentioned that she wants to see her kids but that she’s ashamed of her appearance and the ways she acts when she drinks so she tried to stay away because it’s not fair on them.  On the walk into town she made sure that she stopped and gave every Big Issue vendor £1 and she even had a bit of banter with some Community Support Officers.  She said that I had got her on a good day, she hadn’t been drinking that much but that some days she could “feel her head going” and that she was really struggling to cope at the moment, I asked her if she would like me to accompany her to the doctors and it turned out that, because she struggles to engage with services including her GP, she had been without any medication for nearly 8 weeks.  The medication she was without was for her mental health conditions and it was essential that she took it regularly.  I called her GP’s surgery and explained the situation to them, after some persuasion they agreed to fax a prescription to a chemist in the town centre. I went with Karen to the chemist and waited with her while she got her medication.  During this time we were having a bit of a laugh together but she still didn’t understand that I didn’t have an agenda, she couldn’t get her head round the fact that I just wanted to see if there was anything I could help her with. 

 

By the time I left her, Karen had asked me to make sure I was there next time she was in court and also to accompany her to an appointment she had with ADS (Addiction Dependency Solutions).  I received a phone call the following day from ADS saying that Karen had gone in to the office and told them that she now had a support worker that would be coming to her appointments with her.  I have had a look for her on outreach a couple of times since then but there has been no sign of her, I’ve received a couple of calls from other agencies over the past few days stating their growing concern for her.  I’ll go to her next court date and see if she turns up, hopefully I can start to offer her some support because she is clearly extremely vulnerable, not just due to her health and mental health problems but she is also at risk of financial and emotional exploitation.  Karen’s self esteem is obviously very low, she really thinks very little of herself which is reflected in her destructive behaviour and frequent bouts of self harm.  Despite her challenging behaviour, Karen is someone who has a lot of potential and I’m really looking forward to working with her.

Fiona, Support Worker

 

The purpose of our work is to find the best way forward for each individual.  Fiona had recognised that Karen’s case was far more complicated than any one issue that she faces.  As someone who is so used to being restricted from services and told what to do Fiona saw the value in offering Karen some humanity.  This will build the foundation for further work.  The fact that Karen’s medication issue was resolved in this first meeting is a real bonus.

 

The key to our work is to not get too hung up on individual issues or our assessment of the ones that should be dealt with first.  We have to allow the people we work with to have some say in their care.  In this case Karen’s health and mental health issues are a real concern, as well as her rough-sleeping.  But Karen’s main worry is that she is being intimidated and having her money and her alcohol taken from her.  If Fiona did not listen to these concerns and remain supportive about them then it is very likely that Karen would refuse to engage with her.

 

 

 

 

 

 

 

 

 

 

 

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One of our service users has just been evicted from the hostel he was staying in. The main reason for this is that he is too ‘high risk’. This is because of his many suicide attempts – deliberate or accidental he’s not really sure himself. This man is problematic; his alcohol use means he is quite disruptive and abusive which can have very negative effects on other residents of the hostel.

Last night he took a large amount of alcohol and an ambulance had to be called. His behaviour also meant that the police had to be called to get him in the ambulance. He also had a psychiatric assessment the result of which was that he has no mental health issues; the assessor puts his unusual and problematic behaviour down to his alcohol use (he has had many of these assessments but each is carried out in isolation never referring to information gathered in earlier assessments or taking account of volume of assessments that have been conducted). The trouble is that even if the alcohol is causing his issues of mental functioning he still has them. The major challenge is that he is receiving no formal support with these issues.

His Simon worker is with him now and they are trying to secure some emergency accommodation. If he manages to get some it might well be in a bed & breakfast. Is it right that this man who clearly has some massive support needs that could well be a danger to himself and potentially others is to be put in a completely unsupported environment?

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The guy mentioned in the earlier post ‘the daily challenge’ soon after the post was uploaded went to prison.  We have not had the opportunity to visit him yet and start working on a plan for what happens when he is released.  For confidentiality purposes we can’t really say too much about this, but he’s not likely to be in prison for very long.

It’s not definite but there is a real sense that his offending behaviour was made far worse by his desperate situation.  I mentioned in the last post that we, as an organisation, are compassionate – but simple economics seem to suggest that it is better for society to support someone into housing and offer the opportunity for positive change than to have to pay for several months of imprisonment after which the same cycle will repeat…

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