By Rudi Anna
9/12/2015
BOSTON– On any given night in Boston, well over a hundred bleary-eyed adults stalk the city streets, calling nowhere home.
They have no address, no bathroom, no fridge, no lights, no phone and no medical attention. Almost all will have some type of anxiety disorder. Many will suffer through stinging pangs of substance withdrawal and abate the pain with the low-hanging fruit of toxic self-medication.
It’s a lot to manage. Some might even say being homeless is a full-time job.
After living day-to-day on the streets, the road to recovery and housing seems like a distant dream– something understood but impossible to realize. But perhaps more challenging, is finding the solutions in order to change those destitute realities.
The challenge is working to bring the homeless back into what might be called functioning ‘society’.
Trudie Munroe is at the forefront of that challenge. She is a social worker in a housing-first program at the Pine Street Inn, a Boston homeless advocacy and supports organization. Funded by federal grant money, Munroe works for a special group of case managers with a specialized skill set.
Her team works with the highest-risk population. Cases get referred to her if they’ve been homeless for at least three years, suffer from substance abuse, and have clinically diagnosed disorders, like bi-polar or schizophrenia.
“We get the super crazies,” said Munroe. “We have the kind of people who just got karma-slapped at some point in their lives, whether it was their fault or not. My clients tend to have zero family support, plus they’re drinking or druggin’ on something. If you add to that depression or any kind of mania, then it probably won’t be long before they’re on the streets.”
Munroe has a caseload of almost 18 ‘clients’, the term they give to the newly housed intakes, individuals who have just started the program and signed an apartment sub-lease with Pine Street. Once given the keys to their own abode, typically a modest, one-bedroom apartment, Munroe’s clients have a series of tasks they must do to stay in the program.
Munroe starts new clients off by scheduling a doctor’s appointment for them to see if they qualify for medical entitlement benefits. Next, she might help clients get copies of their social security card, followed by signing up them up for a state ID card.
If a client is entitled to food stamps (most usually are), now he or she can sign up for them. Then comes a phone line, a bank account, and a grocery list. Seriously cognitive restructuring takes place. A new decisional matrix supplants the previous. Old destructive behaviors get replaced by new beneficial ones. Slowly, a life starts to rebuild from the ground up.
But the most important part is the human element.
“They all receive intensive case-management. We have to physically visit them at least two to three times a week,” said Munroe. “But for most of these guys, the hardest part about transitioning from life on the streets to being housed is the loneliness.”
According to Munroe, there’s a social hierarchy on the streets, even for the homeless. “Some are loners, sure, but most have their own cliques. Some guys are known as the popular ones. Some guys are the nerdy ones. Some are brawlers. Some guys just engage by drug dealing. When that whole social structure gets taken away, especially for fragile psyches like this [population], they can get pretty overwhelmed. But that’s why we’re here. That’s why we advocate for them for almost every step.”
Munroe, a card-carrying Alcoholics Anonymous member and briefly homeless person herself at one point, hasn’t had a drink in 22 years. She can share with her clients her own example of recovery and carry with her the empathy and redemption that helps her communicate, even to her most recalcitrant clients, that a light does exist at the end of a dismal tunnel.
“I think this mixture of knowing how bad things can get with an understanding that life can change for the better gives me a kind of behind-the-curtain insight that lets me know where to meet clients at,” said Munroe. This, she thinks, is important, since a lot of the new Pine Street housing-first policy adjustments cater toward ‘harm-reduction’ techniques that require social workers to allow for certain regressive behaviors, like relapsing into drug use, as long as other important goals to maintain housing are being met.
“This whole process is about teaching a baby how to walk again,” said Tony Harris, a social worker from South Boston and member of Munroe’s team, referring to counseling clients on the realities of living in permanent housing for the first time in what could be years. “The baby needs help to do almost everything, and without a little help, the baby can’t function. That sounds rough. I know it, for sure, but that’s what it is. On the flip side, babies can learn, and babies can grow up.”
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