nursingforsocialjustice

Lately I have felt really disappointed when listening to CBC radio. It seems like much of what is offered in popular media is driven by the election, or fear that society is going to hell in a handbasket, or public opinion that is not always the best informed; the rhetoric, the words, the emotions, are from a place of concern (I believe) but not always (seldom?)from a place of evidence and research. I get it, we feel strongly about certain things, certain social issues that probe and prod at the the bottom of our hearts, calling us to action, we feel the collective pain in everyday interactions with other human beings, we see it in the economic disparity of the city we live in, the world we live in, but, I think that our emotions, our personal values and beliefs, though valuable and valid, sometimes this really clouds our collective judgement. And I think we really have to take a step back sometimes and remind ourselves that our experience is n=1 , it is ours, and it is real, it is important but it is not everyone’s experience, it does not represent everyone’s experience and it can cloud our judgement. In our pursuit of ethical practice in health care, it can sometimes steer us away from pursuit of that delicate balance of justice, autonomy, non-maleficence, and beneficence. Good is happening right now, at the same time as the bad. I think sometimes we forget this.

I live in the Lower Mainland, BC. There is a lot of rhetoric out there about the overdose crisis that is happening and the need for more treatment beds and recovery houses and so on and so forth. The reality is that there are many people out there with big hearts that want to help but unfortunately, I think that even if suddenly a flood of money was available to open more treatment facilities and programs for people living with substance use and addictions issues the amount of people that are properly trained to best work with people living with complex mental health and substance use and addictions issues is much smaller, the people with the leadership skills to spearhead and develop such programs in a thoughtful way that ensures some success and sustainability is less and the glaring risks (I think) litter a road that we have been down before.

I think that the first step (the real first step, the baby step) is actually having better communication between all the different care providers, all the different services that are being provided in the Vancouver area. We are working in silos here, inpatient versus outpatient, acute versus rehab, community versus inpatient, health care versus housing, not-for profit versus not-for profit. There are lots of services out there already, I have been working in health care for almost 10 years, the majority of them in the Lower Mainland, and I do not know about most of them. I think that the first step involves us, the organizations, the people that are trying to do the good, the people with the big hearts and the passion to help, to get together more often (or for the first time ever?) to get to know each other, and the services that are being provided, to understand what each has to offer and how we can work together better. And (I’m just spitballing here) I think this needs to happen through something like an open house (that probably happens annually or semi-annually) where all the providers are in a room together to make connections with each other. I am not just talking about the leadership of these teams, I am talking about the direct care staff.

In my (almost 10) years working in health care I have seen, personally witnessed (and personally been the perpetrator of) the lack of communication that seems to happen between different providers, on the same team, on different teams, between different organizations. I find more and more I reminisce about how actually pretty great it was when I was working in Calgary because there were more opportunities to have cross-service education and open houses. I think this is missing in Vancouver. I think that we are all trying to do good, we all want to do good, but we are all working in individual silos.

It seems sometimes, that even without the complication of multiple organizations we do not always know what the people in the program right next door are doing, and how that service fits with ours. I think that sometimes we do not even have a really clear idea of what we are supposed to be doing, but somehow we are supposed to be doing it, leaving us not only confused and unfulfilled with our jobs (Atefi, Abdullah, Wong, & Mazlom, 2014), but morally distressed (Severinsson, & Hummelvoll, 2001). I do not think this is just some organic things that magically emerges when everyone is trying the hardest that they can because if no one has a clear idea of where the ship is going and what their role is in terms of making the ship function then the journey is going to be seemingly endless, as resources are depleted and eventually everyone on board will perish. Epic fail.

We have to be willing to see outside of the box, and see a bigger picture than day to day tasks. I think this takes effort on the part of direct care workers, because this has to be deliberate, this will involve actually going into the office and introducing oneself and letting them know about your role and the program you work in and what the program has to offer and maintaining a relationship. I think it probably takes 10 times (maybe 100 times) as much effort and resources and planning and pain to stop the inertia of that ball when it has been rolling down the hill, picking up speed. But I think it’s responsibility to take that hit to change the direction. And this will take repeated contact, effortful relationship forming, introductions and re-introduction, because there are lots of people who work in programs that are run 24/7 and sometimes lots of turnover of staff.

I think that Step 2 is actually community building. Not just the community of people that are accessing and using services, the community of care providers, the community of organizations. We are a community, and I think we have to start viewing ourselves as being part of a health care, a social service community. Narcan kits, addiction treatment “beds” (is it a weird thing when we use language that take the human being out of the picture?), acute inpatient psych treatment, those may all be temporary solutions that are more reactive. I think that making everyone feel valued is important. My brainwave idea of the day: I think that we can get ahead of this by creating more recreational sports teams where cost is not a barrier, teams open to kids, teens and also adults. I think that community kitchens, communal spaces in buildings that are built where recreation therapists, peer support workers, volunteers etc. are there to help build community is important. I think that people need to feel valued and like someone will notice if they are missing, and get invited to people’s parties and events. I think some focus should be spent on building self-esteem.

I do not think that it is helpful (it’s actually probably harmful) to make assumptions about other services and programs and the people that are working in them. It is helpful or harmful to approach other service providers as the enemy without talking to them first and trying to understand why it does not initially seem that we may see eye to eye? I think that it is dangerous to hold one service as better simply because of personal values and beliefs, not really with any regard or attention to actual outcomes of the service. I think we really need to explore in a tangible, measurable way, is the service good? One step down the line also involves figuring out what meaningful outcome measures are, and understanding that outcome measures can be fluid, because the goals may change as time change and the context of the world changes.

I have an idea for a study. It is longitudinal, following everyone that is identified as having a mental health and substance use issue throughout time to see where the ebbs and flows are in terms of their recovery…what we now conceptualize, what we understand to be recovery.

Peace,

Michelle D.