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Lighthouse program provides mental health support

Complex Needs18

A room in Complex Needs

It’s been over three years since the Complex Needs Wing at The Lighthouse opened its doors to clients with mental health issues. The program has just added eight beds to the recently renovated Dubé Tower as part of the six month pilot project with the Health Region. New rooms are a welcome addition to those who need a safe place to stay in the city.

Mental illness is often an underlying cause of chronic homelessness, as many are faced with, “difficulty of various kinds in keeping their housing. Some end up getting kicked out of their accommodations due to their illness or addiction, or their needs are in excess of what their approved care home can provide,” says Dennis Bueckert, Director of Client Services.

The one year program is meant for individuals with a significant mental health issue and, “there can also be an addictions component to it in some cases. About two thirds of the folks up there have a combination of the two,” says Bueckert.

The unit is intended to be a transitional program to get people on the path to greater independence and long term housing. It operates with support from Saskatoon Health Region’s Mental Health and Addictions Services. Case Manager Kemi Bashorun explains, “The aim of the program is to help with the health, stability and independence of individual clients who are suffering from mental illness and addictions.”

Kemi 2

Case Manager Kemi Bashorun

The process of admission begins with a referral from someone working with the potential client, such as their psychiatrist, community health nurse or social worker. Once the client’s needs are assessed and found appropriate for the program, an interview is organized between the client, their care worker, a Health Region representative and a member of the Lighthouse staff.

Bashorun emphasizes that they only accept people who are serious about committing to the program. “We don’t want someone who has been forced into the program. Don’t forget we give them autonomy to make choices and decisions. So they have to be able to say ‘Ok, I think that program will be suitable for me,” says Bashorun.

Successful clients are invited to move into their own private room in the Complex Needs Wing. Each room has its own bed, dresser and bathroom with a shower. Some people bring their own TVs or other furniture, and many go a long way in decorating their room. Meals are provided in the dining hall, and clients are encouraged to socialize with other residents.

A requirement of the service is taking part in daily activities. The Lighthouse offers various programs such as Games Night, People Skills and Recovery Group for those struggling with addictions. Clients may choose to be involved in programs at other organizations, “some of them, they go to Clothing Depot to volunteer, it’s so they have something to engage in,” says Bashorun.

Complex Needs 13

The Complex Needs office

The Complex Needs office is on the first floor of the Dubé Supported Living Tower. It’s a small room with a horse stall door so staff can supervise clients taking their medication and interact with them throughout the day. Part of the treatment plan is for staff to be able to monitor their medication compliance. They make sure clients are taking their medication as prescribed and observe the effects. If staff see a deterioration in their mental state, they will liaise with their nurse or psychiatrist to alter the dosage or type of medication.

Clients are also encouraged to meet with a case manager regularly and discuss their progress. It gives them an opportunity to propose other forms of treatment, discuss resources or suggest adjustments to their medication that may be needed. According to Bashorun, the aim is to, “help stabilize them and help to promote independence. So what we’re trying to avoid is for them to relapse and have to go back to the hospital.”

A vital component to the program is establishing a relationship based on trust. Lighthouse staff engage with clients on a daily basis, “so they’ll know that we’re here to listen, we know where they’re coming from and empathize with them,” says Bashorun.

Jamie Johnson has been living in The Complex Needs Wing since last winter. She’s ten months clean of all substances and credits The Lighthouse with her sobriety. “They’re treating me really well,” says Johnson, “they look after my meds. I’m schizo affective and bi-polar, so I’m on medication for my mind and I’m on methadone for treating my drug habit.”

All rooms have a private bathroom with a shower

All rooms have a private bathroom with a shower

Once a client has completed nine months of the program, their case manager begins to prepare them to transition back into the community. They collaborate with their care worker to find them appropriate housing. Some clients move in with roommates or go to group homes, but many don’t want to leave.

“They really like it here, this is their home. They’re very stable and the option of leaving at the end of twelve months is difficult for them,” says Bashorun, “So we’re not really pushing them, but at the same time it’s like a baby step.” In those cases, staff work to place clients in the Supported Living Suites at The Lighthouse. Those rooms offer more independence without taking them away from their environment.

The Complex Needs Wing recently expanded from nine to seventeen rooms. Occupancy rates are high, running between 80-95%. Two case managers and four staff provide support for these clients.

Support Worker Adriana Krebsz is finishing her last shift in The Complex Needs Wing before moving to her new house and a job with the Health Region. “I was really happy here. When I was hired I planned to stay long, but we found a house we liked in Wynyard,” says Krebsz. Originally from Romania, Krebsz is a social worker and nurse with experience working with the elderly. “I’ll miss you,” says Bashorun, giving her a big hug.

Krebsz and Bashorun

Adriana and Kemi

Bashorun also moved to Canada with her family, and has been working at The Lighthouse for the past year and a half. Born in the UK, she grew up in Nigeria but returned to England for university. She worked as a dual diagnostic nurse in several different environments. “I’ve worked in in-patient psychiatry, and as an emergency nurse. I’ve worked in rehab centers, community drug and alcohol settings, and my last work was in prison corrections in London,” says Bashorun.

“The thing about The Lighthouse is this is a family kind of setting. So it’s not a tense environment, even though your work is so tense,” Bashorun says, “Even if you go out, the impression that you get from the community is, ‘Oh Lighthouse! How do you cope?’ Sometimes I just laugh and say, ‘You know what? We have people here that really need help and it’s somebody’s job to be there for them.”

Case Manager and Care Aide team up to help clients

Over the last two months, Case Manager Touni Vardeh-Esakian has helped to house over twenty clients from The Lighthouse emergency shelter. He goes about it the old fashioned way: looking for ads on Kijiji, calling landlords and helping clients fill out application forms.

The biggest challenge in finding housing is convincing landlords to give his clients a chance. “Homeless has a different meaning to lots of people who’ve never been homeless before,” says Vardeh-Esakian, “I try to explain to them that they’re just normal people who’ve had something go wrong in their lives, they’re here temporarily and we’re trying to get them back into the community.”

Touni & Sheila 4

Sheila & Touni in the Lighthouse dining room

Vardeh-Esakian also helps clients navigate Social Services, look for jobs, replace lost IDs, and attend court hearings. “I’m there for support,” he says, “Also, I’m there just to talk, because people have a lot of stress in their life, and sometimes they just want to sit down and let it all out.”

Sheila Poorman was recently hired as a full time Care Aide, a new position created as part of the six month pilot project. She started at The Lighthouse as a custodian, but once she met the residents, they opened up to her and she quickly realized that she wanted to work in client care.

“I come from a background of addictions, so I know what the clients are going through and I have an understanding of their situation,” says Poorman, who moved to the Stabilization Unit and started to build relationships with her clients. Working in Stabilization reminded her of her mother, and how her addiction eventually took her life.

As a Care Aide, she now helps residents with activities, such as reminding them of doctor’s appointments, helping them with laundry and changing one client’s medical socks every day.

Since the pilot project launched, Poorman and Vardeh-Esakian have teamed up to help each other. “We support each other if one of us needs help, if one can’t handle it. We’re always there for each other, it’s like a marriage,” jokes Vardeh-Esakian. The duo have set out to help residents manage their rooms and promote healthy lifestyles. As Poorman explains, “a problem with most of the clients is that they’re hoarders, and it causes health issues for themselves and any other tenants.”

People hoard, “because they’re missing something in their life and they’re trying to compensate for it,” says Poorman, “So if it’s something they lost, like a family member, you know that’s something that was meaningful to them. So they take all these little possessions that they find and they keep them and they don’t want to lose them.”

It’s slow and patient work for Poorman and Vardeh-Esakian as they try to help one client at a time. Poorman admits, “Even for us it’s very difficult to get their permission and have them feel comfortable for us to go in. We need to have a really close relationship to touch their clothes or go in their personal belongings. We can’t just go in and start throwing stuff out, they have to trust us.”

Touni & Sheila 2Once they get into a room, they’ll go through their possessions one by one, asking what can be thrown away and what can stay. The work consists of, “mainly going through their clothing, making sure they have dressers to put them in, a laundry hamper, and a garbage can. We try to get them in a routine of doing their laundry and setting a time of when they would clean their room,” explains Poorman.

Since this is a new service being offered, it takes some time for residents to get used to the idea of someone to help clean their room. Sometimes Poorman will help clients move from one apartment to another, and get rid of unwanted things in the process.

“I had one client who, after we went in and helped him, he put it upon himself to say, ‘I want to get rid of more stuff,’ says Poorman, “And that’s the point where we want to see the clients, to take the initiative to say, ‘Ok, I want to get rid of stuff’ on their own. At least they have the mindset of ‘I’m doing this’, instead of us doing it to them.”

Vardeh-Esakian is going to school as well as working at The Lighthouse. He’s set to graduate with his Bachelor of Social Work next year and plans to stay on as a Case Manager. “You do get attached to these clients because you work with them every day,” he says, “You see them breakfast, lunch and supper. You see them cry, you see them intoxicated, you see them on their worst days and on their happiest days.”

Both Poorman and Vardeh-Esakian are parents, and their children demonstrate the same care and compassion to clients as they do. “I bring my kids here to volunteer. They come to the main kitchen and they love it. My eldest daughter, she comes here and she really likes it,” says Vardeh-Esakian.

Poorman and her two daughters used to cruise 20th St. and offer rides to people before The Lighthouse Mobile Outreach program launched. “My daughter would say, ‘Mom, let’s go see if they’re ok.’ So we would, and some of them needed a ride,” recalls Poorman, “And that was when in my heart I felt I needed to help these people a little bit more, and not just by giving them a ride.”

“I think they feel safe when they see the Lighthouse van, when they see us around, because they know that we’re there for them,” explains Poorman. “We understand them,” adds Vardeh-Esakian. Poorman nods in agreement, “We’ll treat them with respect,” she says, “And it’s a good lesson for my daughters to understand that homelessness isn’t an ugly thing.”

A Shelter from the Storm

It’s noon on a Tuesday and the Stabilization Unit is quiet. The dimly lit room is situated with beds on the right, and a long desk for employees near the double doors at the front. A half wall divides the beds from the lounge to the left. Two men are sleeping in beds farthest away from the doors and another is eating at a table in the lounge, watching Netflix on a TV in the corner. Staff members speak in slightly hushed voices and the dim lighting gives a sleepy, relaxed atmosphere to the shadowy green room.

Stabilization 1

This is where people who are intoxicated can come to sleep, eat and sober up. The rules are strict: no drugs or alcohol allowed on the premises, meals are served only during specific times, and clients must keep their personal belongings in a bin and collect them when they leave, even if it’s just for a smoke break.

The phone rings and Whitney Rines answers; It’s the Front Desk with another intoxicated client. Rines explains that afternoons are usually slow in the unit because most clients are out and about during the day. The busy hours are from 4pm to midnight, and the beds fill up quickly.

Staff members work hard to make this a safe environment. “You have to understand that people are drinking or using,” says Rines, “you know things that they say they don’t mean, or things that they do they don’t mean. So I think it’s quite a tolerant environment, but violence is not accepted at all.” Clients are supervised at all times and are escorted in and out of the building by a staff member.

Whitney Rines

Rines has been working at The Lighthouse for the past four years and has been with the Stabilization Unit from its inception two and a half years ago. Since opening in February, 2013, the unit has drastically reduced the number of people held in police custody for intoxication, and helped take the pressure off of emergency rooms.

Last month, the Stabilization Unit housed 724 people and used 930 beds, which averages out to 24 people every day. The bed usage is higher because many clients come to the unit twice a day. The staff estimates they have 80 to 100 regular clients they see on a weekly basis, most of them men of First Nations descent. “A lot of them do stay nightly, a lot of them come twice a day or more and eat every meal here,” says Rines.

Tommy LaPlante sits at the table in the lounge and chats quietly with two men who are eating lunch and watching a movie on Netflix. They seem at ease with him and it becomes clear that he’s there to help them get sober. “Have you ever been to a meeting?” he asks one man casually.

LaPlante is the Case Manager in the Stabilization Unit and it’s his job to help connect clients with services like addictions counselling or applying for housing. “We’re not just a warehouse for people. We are a place where people can come in and change and access supports. And a lot of people don’t realize that there are supports out there,” says LaPlante, who has held this position for the past two months.

On a daily basis, LaPlante will sit down with five to seven people and discuss their addictions. He says that, “a lot of times people are at this pre-contemplation stage where they’re not even thinking about their problem, so if I can be there and just listen and talk and wait for those moments of clarity where they’re tired of being tired and they’re tired of not having a home, then I can really start to help them.”

At the desk, Michelle Belanger is keeping busy organizing files. A big part of her job is also cleaning the showers and washrooms, changing bedding and doing laundry. When new clients come into the Stabilization Unit, Belanger will sit with them and fill out a long intake form, asking questions about alcohol consumption, drug use and other health concerns. She gives the client a pair of sweat pants and t-shirt to wear and washes their clothing while they sleep.Michelle 1

Belanger says she had to grow a thick skin when she first started at The Lighthouse, “I quickly realized not to take anything too personally here. There were times when I’d start crying, but I learned to let it all roll off my back. They don’t mean what they say when they’re intoxicated.” Belanger now has an easy rapport with the clients, who form strong relationships with staff.

As one client gets ready to leave, he jovially bids Belanger and Rines goodbye, “Thank you for lunch ladies, make sure these boys behave. If not you can always duct tape them to the chairs,” he picks up some green tape from the desk. “That’s painter’s tape,” laughs Rines.

Clients are offered meals at specific times and are served cereal or toast for breakfast and sandwiches for supper. The hot lunch today is a burrito with chicken noodle soup and a juice box. There is a toaster, microwave, electric tea kettle and water cooler behind the desk, and clients are offered toast after three hours to help settle their stomach.

As the afternoon wears on, two more men come in to the unit. They lay on beds side by side, and one falls asleep right away. The other is quite visibly intoxicated, and can’t get comfortable. He sits up on the edge of his bed, holds his head in his hands and swears loudly. “He’s grumpy today,” observes Rines.

Finally he decides to get up and go outside for a smoke. Rines immediately gets his backpack for him to take but he refuses, saying, “I’m not taking my backpack outside just to have a smoke. Are you stupid?” As he gets more agitated, Rines continues to calmly explain that it’s the rule. They don’t want clients to forget their belongings and have to throw it out. She ends up carrying the backpack herself as she escorts him outside.

When she gets back she explains, “He couldn’t tell it was me! He said he couldn’t see me in the dim light and didn’t realize it was me. When we got outside he broke down and started crying. He’s just having a bad day.”

The compassion and support of the staff is evident. Their understanding comes from a personal place as some staff members have struggled with addictions and homelessness themselves.

Rines is a nursing student who goes to school full time while working two part time jobs. She worked in Complex Needs, Client Programming and Mobile Outreach before coming to the Stabilization Unit. Rines explains that she feels comfortable here because she grew up in a similar environment. She has two years of school left before she completes her degree, then hopes to find work as a nurse.

Belanger is a single mother of two who has been working at The Lighthouse for eight months. The best part of her job is seeing clients decide to go into treatment to get the help they need. She recently received a thank you note from one person who left for rehab, but Belanger says, “I don’t need any gifts or thank yous, seeing them get better is the only gift I need.” She hopes to make a career in this field and has recently applied to go back to school to become an Addictions Counsellor at SIIT.

LaPlante recently finished the same program and received his Diploma in Addictions Counselling last month. Six years ago he was living at the Salvation Army, struggling with his own addictions. Now he helps some of the people he used to live with. “Years ago when my life was a wreck, I used to drink down by the river with some of these guys. I was in and out of jail and I met a lot of these guys there and a lot of people still remember me from that,” recalls LaPlante, “A lot of them are very happy for me. Especially once I graduated, I got big sweaty hugs from them because they were Michelle and Whitneyproud of me.”

He now uses his experience with homelessness to motivate his clients, “I’ve heard it many times now, ‘Well if you did it, I can do it,’ and that’s just it. And I tell them, ‘Yes!’ I get to tell them now that five years ago I went into treatment. I went to a year-long treatment center and I made all these steps to improve myself.”

Renovations are underway to improve the Stabilization Unit. The plan is to expand the current unit from 20 to 37 beds. The new space on the ground floor of the Wellness and Education Centre will have an entrance at the back of the building, separate from the Front Desk. This will allow clients to discreetly come and go as necessary, without a staff escort. There will also be an intake room where LaPlante can chat with clients privately.

“I tell them they can do it now. I say, ‘What if I told you in five years you can be working at the job that you want to work at, have an education and be at the same place in life that I am?” says Laplante, “It’s a powerful tool, a lot of them do like that.” The new Stabilization Unit is set to open this fall.

Lighthouse Nurses on Front Lines of Health Care

When Jeannie Coe steps into her office at The Lighthouse, she has no idea what the day will bring her. As a nurse practitioner employed through Saskatoon Health Region, she has to be ready for anything. Coe and her colleague Donna McKnight, a registered psychiatric nurse, are on the front lines of primary health care at The Lighthouse.

Coe and McKnight run a drop-in clinic for anyone staying or living at The Lighthouse, helping people on a first come, first served basis, “people can show up or call or leave a note and say I have a medical concern or a health concern or I have a need and I need to see you,” says Coe.

Jeannie in her office at The Lighthouse

Jeannie in her office at The Lighthouse.

She emphasizes that this is not a doctor’s office, clients don’t need to make an appointment and they don’t need to have a family physician. Both nurses are experienced and knowledgeable, and as a NP Coe can, “diagnose and treat common medical disorders, including ordering diagnostic tests, x-rays, lab work, ultrasounds and prescribe medication.”

Clients are welcome to come see McKnight or Coe for anything from an episodic illness, such as a cold or the flu, to a serious chronic illness. “We do have a lot of people living with Hep C, HIV and chronic diseases like diabetes, obesity, hypertension, high cholesterol, COPD, depression and anxiety,” describes Coe, “but we also have some more complicated people with cystic fibrosis, schizophrenia, bi-polar disease and pre-natal clients who are homeless, living in poverty often with infectious diseases as well.”

For more complicated presentations, Coe helps connect her patients to a specialist or family physician, ensuring they receive the care they need. “We highlight that the Westside Clinic is a great support to us. There are eight family doctors and a nurse practitioner that work out of there and we get a lot of people attached to that clinic.”

Before coming to The Lighthouse, Coe was a nurse practitioner in Northern Saskatchewan, “I worked with an excellent team in La Ronge that gave me invaluable experience about providing holistic care to people.” The Lighthouse has adopted the holistic care practice, meaning both nurses seek to treat not only their patient’s body, but also provide culturally appropriate emotional, mental and spiritual care.

Donna McKnight and Jeannie Coe

Donna McKnight and Jeannie Coe

“One thing we try to do here is be very opportunistic,” says Coe, “so it’s not like you come in and we can only deal with one thing, as you hear can happen in other places. So when they’re here and they’re engaged we do as much for them as we can.”

Sometimes the best service Coe can provide is lending an ear, “Lots of times it’s just listening with compassion, that’s what meets their need at the time. We hear often that’s really what they’re after and that’s how they find their way through some of their struggles, if they know that there’s somebody there to listen to them. That’s what makes this such rewarding work.”

Kevin Ohlheiser is a resident of the Affordable Living Suites. He came to The Lighthouse in February and stayed in the Emergency Shelter briefly. When an independent apartment became available, Ohlheiser and a roommate moved in.

“Jeannie has been very helpful, it’s nice to have that support, medical and counselling all here in The Lighthouse,” says Ohlheiser,  “I feel comfortable coming down here, as I told Leanne [the addictions counsellor], I feel like I have four or five counsellors, Jeannie being one of them. Things, they get busy here, and you know sometimes Leanne and I try to get together and we can’t, and I’ll go down and talk to Jeannie or Donna. And she’s taking care of all my medical now.”

Jeannie and Kevin

Jeannie and Kevin

Coe says the biggest barrier to caring for clients at The Lighthouse is treating concurrent addictions, “people struggling to manage their addictions impacts their health and impacts their ability to engage in a plan for their care.”

She sees many relapses in addictions with her patients, due to the nature of having clients at different points in their recovery under one roof, “we’ve got people active in their addiction right next to the people that are just on their first steps out of it,” Coe says the solution is “to find adequate housing in the community. If we relocate them, they can start their journey.”

For Kevin Ohlheiser, living at The Lighthouse is the best thing for him right now, “My goal is recovery, and being able to talk to these people like Jeannie is very helpful and reassuring, knowing that there’s somebody here.” He says his full time job now is getting a grasp on recovery, “It’s been helpful, I feel like I’m in the right place at the right time to really start this process. I’ll take a serious run at it. I’m learning with the help of Jeannie and Leanne.”

 

Clients Benefit from Physiotherapy Program

Physiotherapy is an important sector of the healthcare field, especially as an aid to recovering from an injury or treating physical limitations. Unfortunately, it is difficult to secure funding in this area for underprivileged members of our community. After recognizing a need for physiotherapy at The Lighthouse, Nurse Practitioner Jeannie Coe set out to create a volunteer based program. She contacted the Saskatchewan Physiotherapy Association who put out an email and several members responded. One of them was CBI Health Group who offered to donate their services free of charge.

The program launched in April, and has been seeing positive results over the past two months. A group of five young physiotherapists have been taking turns coming to The Lighthouse every Friday afternoon to meet with clients and assess their health concerns.

Calla Belyk, Lacey Nairn Pederson, Ryan Fehr, Garnette Weber and Shelby Schemenauer

Physiostherapists Calla Belyk, Lacey Nairn Pederson, Ryan Fehr, Garnette Weber and Shelby Schemenauer

Ryan Fehr and Lindsey Tasker are two physios who jumped at the opportunity to work at The Lighthouse. “I was really excited to see different presentations of various conditions that I had never seen before,” says Tasker, “so it’s been exciting for me just as a therapist to gain more experience.”

Fehr says they’ve been seeing “a variety of clients presenting with different neurological and musculoskeletal conditions and injuries, both acute and chronic.” Tasker nods in agreement and adds, “I’ve seen long standing injuries that never got attention, which should have probably seen therapy at some point after the injury. So we’re seeing them months, years later. It’s unfortunate, but at least we can provide care now and get people on the right path.”

When the therapists meet a client, they assess their injury, answer questions and decide on the best method of treatment. Sometimes they give clients stretches or exercises to do every day, and they print out pictures to help them remember. “But there’s also the education component,” Fehr explains, “because a lot of these people have chronic pain or arthritic pain that they don’t understand. One thing as physios that we really try to promote is independence in your own care. We assist where needed, and then give them control to take care of themselves.”

Although they encourage clients to come back for follow up sessions, Tasker says the most challenging part is not knowing if they will see their patients again, “I find I’m definitely spending a lot more time educating them on a bunch of different things, where normally I would spread that out over several visits at the clinic.”

Fehr and Tasker also have the opportunity to train students through this program. Second year physiotherapy students from the U of S have been sitting in on assessments for the past few weeks and say they’ve been learning a lot. “It’s a different population than what we normally get exposed to, which I think is the most valuable part,” says Shelby Schemenauer.

Lighthouse resident Gabriel Montgrand "Mimi" and Lindsey Tasker

Lighthouse resident Gabriel Montgrand “Mimi” and Lindsey Tasker

After seeing the physiotherapist, clients have been speaking with Garnette Weber, who is the Physio Project Manager. She has just started conducting a survey to gather information about the results of the program. Weber plans on using her research to apply for long term funding towards a permanent physiotherapy position at The Lighthouse.

Everyone involved with the program says that a full time physiotherapist is a much needed service at The Lighthouse. “It would be very challenging for a lot of the residents to be able to access physio outside of here,” says Weber, “They’ve really appreciated that it was available here and they can just go in when it fit with them in a place where they’re comfortable.”

With the Education and Wellness Center set to be completed by the end of September, a more frequent physiotherapy program would be welcomed. The center’s gym and exercise area offers the perfect environment for a therapist to conduct fitness classes designed to work on muscle strength, balance and body awareness.

Although the future of the program is up in the air, Fehr and Tasker have learned a lot from this valuable experience. Both therapists agree that the clients are the best part, “The people we’ve met are incredible and they’re very friendly and very appreciative of our care,” says Fehr, “To hear their stories and to give them a chance to tell their stories, it’s been a really good opportunity. And then we can share our experiences and try to change that stigma and the way others think about homeless people in Saskatoon.”