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"Leahy ... shared my philosophy that people who are homeless are still people and deserve to be treated with dignity and respect." —Stu Berger |
THE STATE OF GLOBAL HEALTHHomelessness across the continents: From San Francisco to Dublin by Stu Berger
I am a psychiatric clinical nurse specialist (advanced practice nurse). As part of research I conducted while employed at a hospital in San Francisco, Calif., I evaluated a community care program for mentally ill homeless veterans. I worked as a team leader in a transitional community care (TCC) program. In reaching out to homeless veterans in San Francisco, I embraced a bio-psycho-social-spiritual approach, which proved successful in efforts to establish trust and positive relationships. I spent much time at A Man’s Place, a shelter for homeless people in downtown San Francisco, where I led group therapy two evenings per week. The group was open to everyone who stayed at the shelter, not only veterans. The only one of its kind, the group served as a way for the disenfranchised—those with no voice—to have a voice. The homeless veterans, especially, were able to express their feelings in an environment far away from the auspices of the medical center but right in the midst of where they spent most of their time—on the streets. I was amazed by the stories I heard—accounts of physical and emotional turmoil and torment, scrounging for food on a daily basis, feeling uncared for and ignored, and using alcohol and drugs as means of escape. I was also awed by stories of courage. The self-reflection these men demonstrated after being given a chance to vent their anger and frustration at parents, spouses, children, partners, friends and the Veterans Administration was truly remarkable. Throughout the process, I was able to see through their pain and suffering and see human beings who deserved to be treated with respect and dignity. Because of the need for more housing, I initiated a successful plan to provide 33 rooms at the El Capitan Hotel in the Mission district of the city, to be used exclusively as permanent housing for homeless veterans. In 2004, I presented the results of my research at the 15th International Nursing Research Congress in Dublin, Ireland, sponsored by the Honor Society of Nursing, Sigma Theta Tau International. While in Dublin, I was fortunate to meet Alice Leahy, a wonderful woman and nurse who shared my philosophy that people who are homeless are still people and deserve to be treated with dignity and respect. Leahy turned her vision into the Trust organization, a haven for homeless people of Dublin. She invited me to visit Trust, and I was truly amazed at what I saw. Unlike shelters I have seen in the United States, when one enters the door of Trust, tea and scones await in a nice, comfortable lobby. People, sometimes with pets at their side, sit and drink a cup of tea while waiting their turn to go inside and attend to whatever their need is for that day—washing their feet, taking a shower, changing their clothes, having a dressing changed, or just chatting for a few minutes with friendly staff whom they consider family. In discussing issues related to homelessness, Leahy and I came to the conclusion that issues were much the same in the United States as in Ireland: not enough staff, not enough money, not enough attention paid to the problem. In Ireland, where people who are homeless are labeled as such, or worse, Leahy and Trust use the term “outsider” in all their publicity and educational initiatives. As a result, support has been mobilized, and this agency has become a haven for “outsiders” in need. Even more impressive is to see that nurses are in charge. Unfortunately, I was not able to apply what I learned in Ireland to my work setting in the United States. In February 2005, the program I was working on was terminated. As the only nurse doing outreach to homeless veterans in the San Francisco community, I was outraged by the lack of vision and short-sightedness of the decision. The reasons put forward were all too familiar: not enough “numbers” to justify my salary, inadequate outcome measures, etc. Leahy, in her book With Trust in Place: Writing from the Outside, describes this phenomenon quite well. She writes:
She further states:
In psychiatry, this is described as parallel process. Those working with a certain clientele are seen and treated much the same. I know this from personal experience. I still see veterans who were at the shelter where I worked. They thank me and tell me I made a difference in their lives. I listened to them and built trust. I took some of them out of the shelter, brought them to transitional housing and helped them begin to restore their self-esteem and dignity. It is reassuring to know that some have found their way back and are living independently, clean and sober. I owe Leahy and her colleagues at Trust a debt of gratitude for helping me to restore faith in myself that I had made, and still can make, a difference in the lives of homeless people. RNL Stu Berger, RN, MSN, CS, is now employed as a clinical nurse specialist at a community hospital in Berkeley, Calif. A former member of San Francisco’s Local Homeless Coordinating Board, he is an assistant clinical professor at the University of California, San Francisco School of Nursing. For more information about Trust organization, visit www.trust-ireland.ie. The book With Trust in Place: Writing from the Outside, edited by Director Alice Leahy, can be purchased directly through that site. References: Trust. (2003). (Available from Trust, Bride Road, Dublin 8, Ireland) |
