By Mickey Skidmore, AMHSW, ACSW, MACSW
One of the phrases I frequently hear in my role at Liverpool Hospital is something to the effect of: “what supports do they have?” This question is often a focus of the housing and tenancy specialists with the Department of Housing (DOH). I confess, I find this “turn of phrase” to be unsettling. Rather than saying “how can we help this person?” or “what can be done about their problem?” or “what services or programs are available?” the preferred Australian vernacular seems to be “what supports do they have?”
I’ll acknowledge from the outset that I have yet to reach any final views on this subject. However, I would like to suggest and advocate for an open and genuine unpacking or discussion about what this actually means.
So if someone is struggling with drug and alcohol issues, the implication seems to be that “supports” would mean someone who prevents them from illicit drug use. (I phrase it this way, as individuals routinely decline the D&A resource, services or “supports” offered and recommended to them).
If someone could not or would not tend to the basic cleaning of their property, “supports” would mean someone who cleans the house when the tenant does not.
If someone struggled with paying their bills, “supports” would mean someone who either pays the bills on their behalf, or assist them in doing so.
If someone were not the most hygienic individual, “support” would mean assistance in toileting and/or bathing.
If someone struggled with disorganisation and lacked resources, “support” might mean transporting them to doctor’s appointments and other follow-up care.
Not that this is an exhaustive list, but you get the point.
So for me, this raises a rhetorical question … if an individual requires an entourage of “supports” in order to be successful in a tenancy with DOH, is this really functional independent living in the community? If they require this level of support in the community, are they realistically capable of responsibly sustaining a tenancy with DOH?
The other aspect I struggle with is an (unintended) implication suggesting that all individuals who suffer from mental illness are not capable of independent living unless they have an entourage of “supports”.
I understand the intentions of these questions originate from from a good place. However, I frequently find myself cringing whenever I hear this turn of phrase. When I reflect on why I feel this way, the conclusion I reach for myself is that approaching things from this perspective seems superficial.
It highlights a juxtaposition that leads to a “chicken or the egg” dynamic, in that it is difficult to arrange for “supports” in the community if they have no place to go (address). Yet, DOH is reluctant to allocate accommodation unless such “supports” have been arranged. It also suggests a bind for DOH in that, there is increasing pressure for them to allocate properties to individuals who according to their own policy definitions are seemingly unable to responsibly sustain a tenancy with them or anyone else. Yet, if they adhere to this policy they still have a significant dilemma with increasing numbers of people (in these circumstances) who are or will be homeless. It also creates an eventual critical impasse which will lead to the hospital being unable to discharge people from the hospital — unless they are discharged to the streets.
Recently I experienced this in a different context. A young mother of 4 self-presented to the ED with her two youngest children, distressed, confused and clearly intoxicated/impaired. A historical review of her circumstances would reveal that her husband was involved with drugs; provided drugs to her; and had a warrant out for his arrest. The ED Social Workers did an amazing job of addressing the immediate child protection concerns and made arrangements for all her children to be cared for during her hospitalisation.
It was suggested to me by the treatment team that I meet with her to see what “family supports” I could offer her. So, in this case what does that mean? Baby-sitting? Parenting classes? Marital counselling? Family Therapy? It was as if I was being asked to provide some magical resource that was going to “tic a box” and thereby address this circumstance. As if there was a specific, tangible government-funded resource that the health service could offer to bring this family dysfunction back into a healthy equilibrium. Never mind that the most obvious and pressing resource that seemed to be indicated was that she needed services and/or treatment to assist her in dealing with her illicit drug use. This in my mind was the issue that placed her and her family at the greatest risk. Yet this notion of “supports” was advanced yet again as what I see as a superficial solution to a vastly complex circumstance.
The more I hear these suggestions, the more convinced I am that the notion of offering “supports” in the public health system is often tantamount to actually “doing something for someone or on behalf of someone” (or having the appearance of doing something) rather than teaching them and/or empowering them to develop the ability to do it themselves. Too often in my view, the overarching approach in large public health services (albeit unintentionally perhaps) foster’s increased dependency on the service rather than emphasising the strengths of an individual’s potential and encouragement for their own recovery.
Beyond the surface of the vernacular utilised in these examples is a deeper conversation about issues of therapeutic responsibility (both by the professionals involved and the patients themselves) and recognition of a patient’s self-determination. It has consistently been my experience throughout my career, that if I’m working harder than the client at making change, then the outcome is far from therapeutic. Client’s have to be willing to come to the party and work with us. Because at the end of the day, we can recommend and offer any number of “supports” that may be beneficial to them. However, if they chose to decline, then their trajectory is often predictable and will likely result with varying degrees of ongoing difficulties and hardship.