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. Second text in a series of three.
They talk in the middle of the street, break down the walls of shelters in search of microphones, hear voices or are convinced that the speakers are filming them without their knowledge to broadcast their image on the Web. In the itinerant population, psychoses are commonplace. To help him, a team of psychiatrists offers him treatments in specialized wings, in certain accommodation locations.
It’s surprisingly quiet on the third floor of the Patricia Mackenzie Pavilion. The walls of this corner of the women’s shelter are white, bare. Flowers have been painted on the sliding doors that give access to the rooms. We feel a desire to offer a calming environment, far from the tumult.
Around ten homeless women are housed in this psychiatric wing managed by the PRISM program team (homelessness and mental health reaffiliation project) affiliated with the CIUSSS du Centre-Sud-de-l’Île-de-Montréal. A psychiatrist, a nurse and a social worker take care of them on site. They are diagnosed and medicated for their psychotic problems.
Once the person emerges from their psychosis and we have the real person in front of us, each time, we are so amazed. We say to ourselves: it was really worth tolerating this hostility, because this is where we are.
It’s not easy every day. There are crises. Negotiations with staff to keep a resident who has just destroyed the furniture or sent a worker away. But all these efforts are largely rewarded, says social worker Nathalie Ménard. “Once the person emerges from their psychosis and we have the real person in front of us, each time, we are so amazed. We say to ourselves: “It was really worth tolerating this hostility, because this is where we are.” »
“Mental health is not sexy”
The team will also redo their identity cards, which are often expired or lost in the street, update their social assistance file, do their taxes and find them accommodation. It is this last psychosocial aspect which generally serves as bait.
“It is certain that mental health is not sexy, continues Nathalie Ménard. And the person is not in the hospital, so I’m not going to approach this head-on. I’m going to go there with his needs: we’re going to offer to help him get off the street, to have some income. And then, we’re going to talk to her about the fact that we have a large team that can help her, because what she’s experiencing is weakening her mental health. »
Psychiatrist Olivier Farmer, who works on the men’s side at the Old Brewery Mission, uses the same technique: “What we are selling is not treatment, it is a way out of homelessness. Medication is presented to them as a way of helping them to calm them down and make them available once they emerge from homelessness. And in the majority of cases, they will say yes. »
The PRISM team must also learn to deal with the great distrust of the homeless towards medical teams. Being on site, meeting customers every day and guiding them plays a crucial role in rebuilding the bond of trust, believes the Dr Farmer.
“Very often, the resistance is linked to terrible experiences that they have had, to being brought by the police against their will into a crowded emergency room, in another neighborhood, with a lot of stimulation, with people a little angry at them. see there, being tied up, poked in the buttocks because they are lacking in consumption and they are losing their cool. They have had this kind of experience. »
A first step on a long road
When PRISM saw the light of day, in 2013, we were in an “absolute void of services”, explains the Dr Farmer. “The first idea came from the feeling of powerlessness regarding homeless customers. ” ” When [les membres de cette clientèle] arrived at the emergency room, they were often very upset and sick, we tried to do business, but when they had time off, they were lost in nature. It was really an acknowledgment of failure,” he says.
And the psychiatrist noted the same “observation of helplessness” on the shelter side. “They were trying to provide services to people who had quite severe mental state disturbances. They sent them to the hospital, but they came back the same lunchtime or the next day, and in the end, that didn’t solve anything. »
Ten years later, the problem of “revolving doors” between shelters and emergencies, as well as the compartmentalization of the homelessness, addiction and mental health sectors, is still present. But the situation tends to improve.
“It’s not easy to access mental health care,” laments Leïla Benaissa, care and health services advisor at La rue des femmes. I called the ambulance the other day because I had a wife in psychosis. By the time that [les ambulanciers] arrived, she had calmed down and they didn’t want to take her. I had to induce another small seizure to get them to take her, but they brought her back after a few hours, with no treatment or anything. I was shocked. »
The director of Chez Doris, Marina Boulos-Winton, would also like to get help for the women experiencing psychosis who attend her establishment. But the PRISM teams are still few in number for the moment. That of the CIUSSS du Centre-Sud-de-l’Île-de-Montréal, installed in the men’s and women’s pavilions of the Old Brewery Mission, sees approximately 120 patients per year. The Jewish General Hospital of Montreal has also developed a program on the same model.
The question of housing
The Dr Farmer also sees that the need is there, but he cannot expand the program to other organizations due to the lack of available housing to relocate patients to at the end of their treatment. He notes with sadness that patients are housed “in increasingly shabby places”, barely more comfortable than shelters. “This is now the big Achilles heel. »
At the Patricia Mackenzie Pavilion, Nathalie Ménard also sees her exit options diminish. “Before, I had lots of cards in my deck, but now I only have one or two, and they’re not aces! » she sighs.
“What happens is that I have people who are stable, who could go back to an apartment, but they stay in my beds, which means that I am stuck and I cannot take on new cases. »
Some success
For her part, Debby Jean-François has only good words for the PRISM team. Two years ago, she was at the Patricia Mackenzie Pavilion, struggling with borderline personality disorder. Today, she has found “peace of mind” in her small home in Hochelaga, even if she still finds it difficult to take her medication every evening. “You have to believe that there are always good people, you just have to go to the right resources,” she confides from her small, overloaded kitchen.
Victoria Hector is also grateful. She lived on the street for 15 years, and when Nathalie Ménard met her, she had been hospitalized in a psychiatric ward for nine months. Today, she lives in a transitional apartment a few steps from the Patricia Mackenzie Pavilion. The social worker is visibly proud of the progress her patient has made, and she is full of praise for her: “For me, it’s a great success! »