At the beginning of the year, I started my fieldwork at Fatima Hospital, where I would be spending 10 weeks working with clients in the acute psychiatric ward. This was a locked ward for those who had attempted suicide, felt unsafe about themselves, was brought in by the police after being found high on drugs, etc. The clients typically stayed for about a week as we provided any emergency psychiatric care they might need and figure out where the best place for them to go next was based on their situation.

This was not the first time I had worked with clients struggling with addiction, mental health issues, or both. I had previously spent 40 hours at an inpatient rehab, one of only two that existed in my state for women. My father has had his own struggle with alcohol addiction and is currently about four years sober.

One of the first things I was required to do with new clients every day was to take them into a private room and talk about their home life, their job, and how their mental health status was currently affecting those aspects of their lives. Lisa* was one client who I met about halfway through my time at Fatima. She was like many of my clients there; homeless, uneducated, and addicted to fentanyl, heroin, and cocaine.

During one of the many groups that I ran, she spoke at length about she had already tried to stay sober, but how she failed no matter what. ‘I always start off good, but once I get to about two or three months.’ She shook her head, eyes glued to the floor. ‘The nightmares start to come back.’

In a shaking voice, she described how her stepfather had sexually molested her as she was growing up. That was what led to her starting to do drugs; having no other way to deal with this terrible thing happening in her life, something that she couldn’t tell anyone about at the time. After she was able to get out of her situation, Lisa tried to get help. She had been to the Fatima acute unit several times before, as well as several similar units at other hospitals. Lisa bounced from rehab program to rehab program with no success.

Despite the numerous types of counselling she received and all the different medications she had been on over the years, there was nothing that could be done to stop her from having nightmares about her stepfather anytime she quit. So, of course, she used again.

Lisa’s story was similar to lots of the clients who came through the doors in those 10 weeks. Most of them did drugs because they were struggling (and failing) to cope with tragic things that had happened to them in the past. If they were receiving some sort of therapy, insurance would only cover for about two weeks, despite dozens of studies showing that 3–4 months of rehab was needed at minimum for standard addiction recovery.

There weren’t enough resources for all the clients we had, so we couldn’t discharge them to the places they needed to go. Sometimes we just had to buy them a bus ticket, but them on a bus in the direction of someone they knew and hope that they would be fine as there were no other options.

So, if the clients were lucky enough to get somewhere that would provide them with counselling or support, the clients would only spend a short amount of time there, time that would barely start to cover their problems. Most of these places, such as halfway houses, had extremely strict rules. This meant that is someone like Lisa was struggling with nightmares of her stepfather assaulting her and slipped up by using one day, the halfway house would punish her by kicking her out of the house.

Homelessness now being an extra stressor in her life, Lisa’s nightmares would become worse, causing her to use even more in a desperate attempt to get them to stop. If the halfway house had supported her when she had messed up, there could have been extra support provided to Lisa, making it so that she was less likely to relapse in the future instead of ensuring it.

With our system that is currently based heavily on extrinsic factors (such as housing, food, clothing, etc.) being based on unshakeable intrinsic factors (expecting perfection from people who are struggling as much as it is) we cannot expect these people to be able to get better. Accepting that people will trip on their way to getting better and helping them up when they do is much better than kicking them while they’re down.

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Name changed for privacy reasons

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Image credit: Freepik

Spencer Fantastic is a Direct Support Professional, and student of Occupational Therapy. Spencer studied creative writing and occupational therapy at Rhode Island College.