Death and taxes

Death seems to be the theme of the year so far. Two funerals in just over a week, and my first outing to the Drug and Alcohol Related Deaths group.

The DARD group aims to identify any improvements any agency in the city could make. Sometimes, there really wasn't anything different that we can see would have made a difference. Accidents happen. The interaction between alcohol, drugs (street and prescription) is unpredictable. Sometimes people succeed in their aim of removing themselves from the planet.

But sometimes we have to admit we screwed up. When someone desperate is turned away because their ex works at the service they need....well, surely it's right that the staff member moves somewhere else so the person can actually get somewhere to live rather than stay on the street. And two of us agencies have changed our policies to make that so. It won't now help Nico, sadly.

And sometimes we just totally missed every chance.

One of the four people we discussed, Aga, was only 19. Her parents in Poland, who waved goodbye to her in September to go to uni in our city, had no idea that she'd dropped out, lost her place in halls, and got in with drug and alcohol users. Of course, being from and A8 country, she had no recouse to public funds, so couldn't get benefits or a roof over her head. So to get somewhere to stay she had to take what she could get, and sadly, a lot of the people who won't ask questions are the fluid population of drug users.

There are big questions here for national government, as well as us locally. The government want to end all rough sleeping by 2012. So someone somewhere has to do something about all the people who can't access public funds. Taxpayers rule.

And pity the person who had to tell Aga's parents that she had died, in England, and of a heroin and alcohol overdose.

Tension - target-driven or user-focused?

We have a constant juggling act to perform, balancing the needs of the individual with the needs of our corporate partners. Corporate targets demand that we move people on within 28 days, when there's a vacancy in a hostel we find someone to fill it. But individuals don't fit into neat categories, boxes, and sometimes everyone's got a reason, good in their eyes, for not going into a hostel. They don't want to pay £25 a week for food that they might not eat; they don't like the area; they've got bad history with a current resident; they think it'll be an awful place to live. Sometimes we agree with the person...and sometimes not. We have to identify who is genuine and who is just working the system and actually would be fine in the hostel. So it's not just the corporate targets and what the person wants, it's also trying to winkle out what really would be the best move for that person. We've all seen someone desperate to get their own flat, only to lose it within a few months, and then have arrears and anti social behaviour against their name. So sometimes when we push a person a particular way, we might just be right. And sometimes not. Balancing paternalism, wisdom, insight, the person's wishes and what they believe might just be possible - and what we know is possible. No wonder we sometimes get it wrong.

Anti social behaviour - by whom?

Sitting in the office idly talking, the manager and a member of staff having just left for the day. Suddenly, we hear the manager shouting, so another female member of staff legs it out. She's a rugby player, and very fit.

Wlaking down the hill, the manager and staff member saw two of our female residents being hosed down by a local member of the community. He lives near our building, and is not happy that we are here. He has suffered, like others in the area, antisocial behaviour from our guys, drinking, hanging around, empty cans and dog mess. Ironically, we have all worked hard to get on top of this problem, and it's been much much better for several weeks.

But he saw red when he saw the two women sitting on his doorstep eating, so turned his hose on them, and when they protested - probably not too politely - he went at them with a baseball bat. Allegedly. When the female staff member intervened, he hit her hard on the arm too, and the manager, who managed to wrestle the weapon off him.
There were witnesses, too, including the commissioner of drug and alcohol services, who called the police.

Feelings in our building were running high...several people threatening reprisals. but we squashed that straight away. It certainly wouldn't help. We need only positive things coming out of our building. The manager laid it on the line to the guys today in an emergency residents' meeting. If the asb continues, we could be closed down. It's that serious.

Now everyone's waiting to see how the crimnal justice system deals with the angry man.

...and another one

No wonder the average age at death of street homeless people is 42. Another of our ex residents, a young Polish girl, only 19, is dead. Reportedly, she died of a heroin overdose. Her boyfriend, a white English man, says another of our ex residents forcibly injected her, as she had refused heroin before. She was a big drinker, so his theory is that she was so drunk she didn't know what was happening to her.

Either way, another tragic waste.

Sad news

The police called to say that one of our residents was found dead behind some shops. He was only in his early 50s, so we had to keep his room untouched until after the post mortem, in case of foul play.

It was heart failure, probably not a lot anyone could do. But it makes you wonder, if he'd been in his room, would it still haev happened? Would he have had time to pull the red emergency cord? And coudl we have saved him? But anyway, at least he would have had some dignity.

We asked the commissioners, when the new project was planned, if we could open 24 hours. No was the answer. It's a very temporary project, don't want people to get oo comfortable.

Mmmm. I wonder.

Plus ca change...

Back at work after 2 weeks off. Lots of admin to catch up on, plus our organisation is so fast moving that I was right when I predicted 24-hour opening. It starts on Monday. The residents won't be allowed in their rooms all day, but activities will be on offer for those who want to take advantage of them. We've got football, walks, jobsearch, welfare benefits advice, arts and crafts....and I've offered to set up a weekly in-house newsletter, and show other staff how to do it. With a background in magazines, I've got lots of ideas.

The new manager started while I was off, really positive move. He's got bags of energy and ideas, and the right approach to people management. We're revising all our procedures and systems, and getting the manuals in place, too. As well as dealing with the day-to-day excitement created by 20 people with varying issues – and that's just the staff! Add 35 residents...

The partnership approach that we're all having to embrace has really come up trumps tackling the antisocial behaviour. It's proved an effective way to get moving, with the right senior people there to make things happen. A much-needed second wet unit for dependent drinkers will be opening soon, and the measures we've all put in place have squashed the worst excesses of shouting and bawling outside, litter (cans and dog poo), drinking groups, aggression and intimidation. It was probably just the first few days of fine weather encouraging the guys to sit outside with their mates and drink.

Lots of regulars still with us:
Mr Booze – who insists that other people are breaking into his room to urinate in his waste bin. Personally if I was going to break into anyone's room, it wouldn't be his.
Mr Personal Hygiene Problem – sees a psychiatrist every six months. The mental health services won't tell us anything about us without his consent. He thinks there's nothing wrong with him, so won't sign the consent. Stalemate.
Mr Just-A-Bit-Odd – we had to call the police to section him just before Christmas, as his weird behaviour was putting others at risk. He was taking the fuses out of plugs, and removing fire extinguishers, as well as saying odd things and wandering round without many clothes on. We'd been worried about him for ages, but the mental health services won't take anyone on board unless they are a danger to themselves or others. So – in a very unpleasant way – he was dragged off to a psychiatric ward. Because we can't refer him for assessment, only his GP can do it, our only options are through the police or A&E. So he's been there two months while they assess him. And they just discharged him back to the streets, because he didn't seem to have a diagnosable illness. In other words, he didn't tick their boxes. In their professional opinion, he's just a bit strange. Unquote. So what we've supposed to do with him if his strangeness gets serious again, I don't know. Mad is the only word for it. He's a lovely guy, that's the sadness.
Mr Complainer – he knows how to run hostels, and we're just useless. Any time he's refused what he wants, he complains at great length. I was a bit soft when I get back, and let him have a concession, but told him no more. So then when I refused him the next one, he gets all angry. Now he's going to put in a complaint against me to my chief exec. Again.

All part of the rich tapestry of life.

No room....

Oh, and just a thought...in the 28 days of February, we turned away 55 people, 47 men and 8 women, on 108 occasions.

Even though we now have two and half times the beds that we had before we moved in September.

Because we have severe weather provision, at least most will have had a billet on a chair or sofa at one of the hostels. But what happens when this ends on 31 March? Because I don't think everyone will just go away on 1 April.

It's easily the worst part of the job. We all hate it.

Inspection and mayhem

Had our Supporting People validation visit yesterday. Bit more worried about it than usual, as we've had so many changes recently, and now I have to delegate so much, so I don't feel as sure as I did about the quality of the work done. Not that I'm so wonderful, but at least I know what I do and how I do it.

The staff on duty were a fairly new young member of staff, still in his probationary period, and a relief person. So I guess if they pass muster, we must be doing something right. A peer reviewer – someone who was homeless herself – came to talk to the residents, and find out what they really think of us. It's a process I think was long overdue, and I completely support. Even if it's more likely to show up our flaws. Because it is, really. After all, we don't exist so I can have a job and a salary, welcome though they are, or so that our organisation can have more services...we exist solely for the people whose heads are on the pillows. If we aren't doing it for them, we shouldn't be doing it at all. And if it isn't doing it for them, we need to get off our butts and change so that it is.

We find out in a week or two what the upshot was.

At least the two officers saw what we're dealing with, several residents too inebriated to make much sense. Two of them fell our earlier in the day, one punched the other twice. Two ex-residents also arrived, to collect a couple of bags, and they were trying to help sort the situation out. Our senior took the main culprit off into an interview room, defused things. We then got the other one to go upstairs to his room, with his girlfriend. Both still chuntering, in the way you do when you've had too much sherbet, as they say.

We're very aware of the issue of alcohol, as I said last time. We've now got eight chronic dependent drinkers. Still an eight month wait for treatment. Not higher philosophy to work out that it's a recipe for mayhem. Especially as they can't drink on our premises. Or in the only day centre. Or in the alcohol-free zone which covers all the areas in between us and the day centre where people go for their meals. As they ask me, So where can we go then?

We have put several measures in place. A poster - ! - requested by a partner agency, litter picks at visible times of day. We've requested increased police presence at crucial times, commuter home and work times. And constant vigilance, going out to stop people shouting and bawling and upsetting the neighbours.

Got an advisory group meeting, which includes partner agencies, so now doubt this will be big on the agenda.

I'm on leave now for two weeks. Interesting to see when I get back what's changed. Maybe even 24-hour opening and managed drinking on the premises....

The demon drink
It's 4am, and I've just finished a proposal for us to open the planned alcohol dependent unit – aka wet unit – a year early. Originally there was to be a wet unit when we moved into our new building six months ago, but it's got to go out to tender and be part of the current review of alcohol services, and will now open in April 2010. All very sensible, but...
We're finding a lot of problems managing the serious drinkers, especially as we only have funding to open 19 hours a day. Oddly enough, this – and the fact that we can't cope with drinking on the premises – means that the most problematic people are out on the streets causing and absorbing chaos, which they then bring back indoors. Oh, and the neighbours, local residents and businesses, aren't wildly thrilled either. This is not really a surprise to us, as we've seen the trend for a couple of years, alcohol use increasing. Two-thirds of our residents right now are drinkers of one sort or another (entrenched alcoholic, binge drinker, occasional drinker). It seems to have caught some of the statutory agencies off guard. Maybe they thought we'd find a way to magic a service out of thin air, or that the individuals concerned would just be obliging and not cause problems until the service was in place.
And why the government doesn't just ban strong lager and cider is beyond me. There's an acknowledged problem with alcohol use in this country. Some countries don't seem to sell Skol Stupid or Synthetic Pseudo-Cider that's never seen an apple and is more addictive...why can't we just outlaw them? At least the extra volume of liquid necessary might reduce the overall intoxication levels, or slow down progress to collapse.
When I started working at the night shelter, drug use was a major issue. I've seen it go down, as methadone programmes take away people's need to use crime to fund their habit. Some people then turn to drink, to replace drugs, because their underlying issues haven't been addressed. Some just get into alcohol. I believe that a lot of substance use is caused by abuse in the person's early years, the Baby P's of this world, if they survive, often turn to drugs or alcohol to cope. In much the same way that many workers go home and have a drink or two....and there just isn't enough capacity in the mental health services, or primary care, to fund therapy for everyone who needs it. So a lot of our residents continue as flotsam and jetsam, buffeted by every wave, thrown here and there by each event happening at that moment, not able to control their own lives. Some just have their heads above water, some are not quite sinking but not quite swimming either. We're just a life-raft, a temporary respite, with the chance to climb painfully out onto dry land, eventually, if you persevere, and wait, and struggle.

Spent the day working out how to reconcile what the residents want and need with what funders require, and what the city needs strategically. Luckily I've always enjoyed this sort of creativity.

I do passionately believe that stratgic planners should stay in touch with the front line. I feel I couldn't do the strategic part of my job if I didn't listen to and work with our residents regularly.

Sad that I am, I quite like immuring myself in the monitoring and admin. Figures, unlike people, don't answer back. Don't introduce new problems. Stay where they are put. Do what they're told. Sometimes I just need that, the calm instead of the chaos.

Inflammatory people but no fire

Sunday 8 March 2009

Called in to the hostel last night halfway through watching Queen Victoria's Men, fire alarm going off. Again. This time an unnamed resident has pressed the red box – which I still think of as a break glass box, even though now there is no glass (and anyway it wasn't glass but perspex). Before I even set foot in the building one of the residents is wanting to shout at me. Tell him the fire alarm is a priority and go up to the top floor. Try to remember how to reset the box. I was shown but can't remember, so I have to work it out. Fiddle about unprofitably for what seems like ages, send one of the two senior who are expectantly watching my fumbles, to look for more info in one of the four big fat manuals on the building manager's desk. No joy, so I ring the emergency number. We can't have the main doors wide open all night, which they will be if we can't reset the alarm, which won't reset while the red box thinks there's a fire. They promise to ring back within 35 minutes. Maybe they aim for half an hour but give themselves the extra five minutes so we'll be pleased that they've been quicker? Then straight after I work out how to reset the box, sod's law.

On the way back downstairs, stop a panel beeping because someone's gone out of the fire exit and set off another different alarm system. Fire alarm still shows a trigger, so despatch a member of staff to check the bedrooms, looks like someone's been smoking in their room, which they shouldn't do. Turns out it was a candle under the detector. Confiscate the candle.

Then back into reception, reset the fire alarm, satisfying to see the main doors close. Don't get me started on the doors...

Then turn to the Ranting Resident, and attempt, foolishly, to reason with him and explain. First line of defence here is to listen until people run out of steam, but RR doesn't stop at one Rant, he's got several that segue into one another seamlessly. First, he is irate that he doesn't have to sign in any more,and wrongly, thinks that the staff now won't know whether he is on the premises or not, and that he'll fry in his bed if there's a fire. Try to explain that the Government Man who came to visit wants residents to feel secure, and thinks that signing in every day makes people think they only have the bed for one night. In practice it makes no difference, only now staff write IN, or NIGHT OUT, next to the person's name. We struggle to keep up with the constant in and out anyway, so if there was a fire, all we'd do is look on the board to see which keys are hanging up, indicating that the resident is out. Also explain to RR that all the doors in the building – which is brand new – are 30-minute fire doors, and that provided he can't see the fire, he'll be safe for half an hour. And the fire station is only 10 minutes away. RR then changes tack, starts shouting, It's been more than half an hour and the fire engine isn't here. I point out that we didn't actually call them, we followed our procedure and checked first to see if there is a fire. RR immediately inflamed by this, and accuses us of playing fast and loose with his safety, and insists he's going straight to our head office in the morning. On Sunday....hmmm.... Vainly try to explain that we now have the same system as all the other hostels, but he still isn't pacified, so I just refuse to go round the loop again. Suspect his alcohol intake has affected his ability to listen and understand.

Back into the office, check the night staff are happy. Report for fire log. Off home again, but RR is now trying to stoke up another resident. Luckily, she's a bit more with it and can understand what I'm saying, and ignores him.

Not often being on call means physically going in, but the odd time that it does can be entertaining.