More than half of Quebec’s homeless people reported having a mental health problem during the last count. Without an address, disorganized, stigmatized and often living with substance abuse problems, they still face many obstacles when trying to get help. Faced with this sad observation, psychologists and psychiatrists decided to break down the barriers by offering care directly in shelters. And it works. First text in a series of three.
A smell of toast and coffee partly camouflages those of little feet and bleach. In the basement of the church which houses the Maison Benoît Labre shelter, in the Saint-Henri district, a handful of homeless people are eating lunch or staring at the TV, staring blankly. Beneath their tough-guy exteriors, many carry great emotional distress that has been repressed and drowned in consumption for years. Some want to end it. Others develop chronic anxiety at the thought of returning to an apartment.
Although they need help, they will probably never talk about their problems on a psychologist’s too-clean couch in an office with pastel walls. On the other hand, there is a chance that they will cross the basement of the church to speak with Mylène or Pierre, two psychologists from Médecins du monde who have set up their office in the former scout premises at the very back of the building. refuge.
“These are extremely suffering people,” notes Mylène Demarbre, one of the instigators of the mental health program for people in a situation of disaffiliation with the Médecins du monde organization.
Here, the therapies are adapted according to the clientele. The framework is flexible and flexible: patients can miss an appointment, arrive late, be in a daze, shout their anger if they want. The goal is to remove as many barriers as possible to allow them to express themselves. “We offer a space to speak to help them tame what they carry inside of them,” summarizes psychologist Pierre Létourneau.
Over time, this weight, which many have carried since childhood, has ended up crushing more than one. This is often what led them into drug use or the street, often both at the same time. And this is what we need to work on if we want to help them get their lives back in hand and get back on solid footing, psychologists believe.
“We are doing in-depth work,” explains Mylène Demarbre. We are in support: how to help them make in-depth changes in relation to their difficulties, to get to the source, so that at a given moment, it stops repeating itself. »
We are engaged in in-depth work. We are in support: how to help them make in-depth changes in relation to their difficulties, to get to the source, so that at a given moment, it stops repeating itself.
This is done at their own pace, depending on their needs and where they are in their journey. But opening up, when you are “disaffiliated”, is often difficult, notes Pierre Létourneau. “I have a patient who came for three weeks in a row at the beginning to tell me: ‘I don’t want to see you, I don’t like your face.’ He came to see me to tell me that! But he persisted. When I came back from vacation this summer, he said to me, “I was bored.” But he is so relationally damaged that he missed the next three meetings. »
Beyond basic needs
When the mental health program for disaffiliated people was created in 2015, it was a first in Quebec. It remains, even today, the only service of its kind in Quebec. But it is currently only offered in two shelters. “It’s still quite rare and it’s still considered truly innovative to say: we’re going to offer psychologists to the disaffiliated population,” notes Mylène Demarbre with astonishment.
“When we talk about homelessness, we focus a lot on basic needs: we will provide meals, we will provide beds, apartments. All of this is very productive and necessary, she assures. But we think less often about the subjective part: what does it feel like for me to be on the street? What consequences does this cause me? What did it do to me to be placed almost my entire life? What traces remain of this? »
This way of hiding the psychological aspect of itinerant people testifies to certain prejudices which persist in society, believes the psychologist. Or, at the very least, a certain incomprehension of the complexity of the problems they are experiencing. “Disaffiliated people have a psyche and a life story. Then, this life story is really intertwined with their current situation and the reasons why it is so difficult to get out of it. »
These life stories are often heartbreaking, marked by abandonment and betrayal. The journey of disaffiliated people is full of obstacles over which they stumble, before getting back up again and again. Some leave prison – “itinerant factories” according to Pierre Létourneau – or lose, with the death of a loved one, their last anchor to reality. Others are unable to find their bearings following a difficult migratory journey. Some can no longer work after suffering physical injuries. For many, consumption was a crutch to help them manage their stress and inner anxieties, before making them lose control altogether.
Alone between four walls
Right now, organizations are placing a lot of emphasis on placing homeless people in transitional or subsidized housing. But many experience great distress at the idea of finding themselves “alone with their problems within four walls” and psychologists must work hard to help them get to grips with this. Many fear “extreme solitude”, because the only network left to them is that of the street and consumption. Others are not ready, for all kinds of reasons.
“A guy told me one day: ‘They’re after me so I can rent a room. Do you have any idea what will happen to me? I’m going to crash between four walls. Everything I carry inside me will come up. I was sexually assaulted, my parents abandoned me. All this will come back to light. I also like staying in the street, it keeps me busy.” »
There is no question of the psychologists at Médecins du monde abandoning their patients once they have found accommodation. On the contrary, their help is more necessary than ever, because the transition is often difficult: they can sleep on the floor in unfurnished accommodation for months before really starting to “live in” their home. “I have two who dream of returning to the street,” says Pierre Létourneau. We look at this together to see what it means. Not to stop them from doing that, but to support them. Because sometimes, when you have low self-esteem, you can tend to sabotage yourself too. »
For Mylène Demarbre, it is time to see mental health as an integral component of social reintegration. “When I think of the gentleman who has been living in an empty home for months, I ask myself: what is our goal? If our goal is for him to be housed and no longer in public space, then yes, statistically, he is housed and we could say that we got him out of homelessness. But if he is not well, if he is not functioning, if he always wants to leave and if he is locked up all alone in his depression, then it is already a step to have accommodation, but for me, the work is far from over. »