Tag Archives: memorial

The Death of a Service User

When a homeless person dies, not only do friends and family members of that person become affected, but so can front line workers. Richard Lakeman, Mim Fox, and R. Dean Wright and colleagues conducted separate research on how service workers are affected by deaths of people who are homeless. Lakeman tells us that service workers can encounter deaths frequently (2011:928). Wright et al., suggest that service workers may feel self-doubt and might ask questions such as “Did I do enough?” or “Was there something that I could have done differently?” (1999:245). Fox explains how social workers see the deaths and continually feel powerless (2005:196).

I volunteered with two different agencies a while back, doing street outreach for homeless youth. Luckily, I never did experience the death of someone I knew directly, probably because I had only volunteered for a few months. However, I did counsel some youths who had friends pass away on the streets. At this point, I was out of school from Child and Youth Work, so that support system was no longer available. There were people that I volunteered with and the service providers who understood, but many of them were dealing with their own problems. This was a tough time for me personally, as I was finding myself burning out and nowhere to turn for help.

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Maslach et al., define burnout as “…emotional exhaustion, depersonalisation, and reduced personal accomplishment” (1997:192). I know this feeling all too well. You simply feel as though you no longer have the mental capacity to handle day to day situations, let alone help anyone else.  There is a sense that things will never change and you can even start doubting yourself and your abilities.

Research shows that depersonalisation can happen when a service provider loses someone. Even the terminology we use at times is depersonalising. “Service user” and “Client” are ways to distance our professional selves from those we serve. Wright et al., found that “[a] common, although dysfunctional, response among staff to the multiple losses they experience is professional distancing. They may deny any feelings for the deceased and detach from other guests so as not to be ‘affected’ or place themselves in jeopardy of suffering more loss” (1999:244). Lakeman says workers may expect more deaths in the future and that a feeling of uselessness may occur (2011:933).

When front line workers don’t get the services they need after dealing with many deaths in the community they may suffer from intrusive memories or experience anxiety, wondering who will be next (Lakeman 2011:942).

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What can be done?

Few organizations have the capacity or resources to fully attend to the needs of service workers (Wright et al., 1999:247). Lakeman suggests that a positive response to the death of a service user includes the ability to preserve the memory of that person, like a picture on a wall (2011:942).

Some organizations have their own ways of dealing with the loss of people they work with. Lakeman learned that some service providers would do things like “…convening a special group, planting a tree, or having a sing-along…lighting a candle or spending a few moments in quiet reflection at some point during the working day” (2011:937). Wright et al., made a similar finding that staff may hold a moment of silence, or have an annual service to recognize those homeless people who have died throughout the year (1999:241).

candles

 

An organization here in Toronto has a Reflections Memorial Project that helps everyone grieve and remember those who have passed away. The project was inspired by the need for people to process loss and encourage healing through art, expression and memorial.

Firstly, they have an ongoing scrapbook, where photos, artwork and writings are added when someone dies. The book can be looked at by service providers whenever they want to remember. Secondly, they have a wall mounted display which is magnetic.  Small circular buttons are placed on the wall that contain initials, artwork, photos or writings that each represent someone who has passed away. The display is hanging on the wall in a visible space in the organization. Lastly, they hold a Reflections Memorial Event in the fall every year, symbolic of change, transition and reflection. Poems are read, candles are lit and the memory book is available for others to read.

These are just some great suggestions for how other organizations may approach remembering people who have died while homeless.  These rituals are a way for service providers to mark death, which “…serves a therapeutic function in that it helps people to experience emotions and is part of properly framing death. Marking death is undertaken in highly personal and private ways as well as collectively through formal mechanisms such as memorial services and funerals” (Lakeman 2011:936).

Working with socially excluded people is a tough job. It requires resiliency, stamina, support, compassion and coping strategies in order to keep going. Much respect goes out to those who continue to serve others despite the hardships, your efforts are greatly appreciated.

 

References

Fox, M. (2005). To die destitute today: What are the implications for social work?. Australian Social Work, 58(2), 188-198.

Lakeman, R. (2011). How homeless sector workers deal with the death of service users: a grounded theory study. Death studies, 35(10), 925-948.

Maslach, C., Jackson, S. E., & Leiter, M. P. (1997). Maslach burnout inventory. Evaluating stress: A book of resources, 3, 191-218.

Wright, R. D., Wright, S. E., & Jones, A. (1999). Dying homeless but not alone: Social support roles of staff members in homeless shelters. Illness, Crisis & Loss, 7(3), 233-251.

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Commemoration Events And Causes of Death

The Stone and Glass Art Installation launch was beautifully done.  Artist Rebecca Houston had a vision along with the Myseum Intersections project. How can we tell stories that reflect the culture of Toronto while including historical dimensions?

Rebecca chose to highlight the numerous homeless deaths that have occurred over the past few decades. Names, initials, Jane and John Doe’s were projected onto the Church of the Holy Trinity’s front façade. This is where the Toronto Homeless Memorial happens every second Tuesday of the month at noon, to remember those who have passed away.

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To open the night, a few remarks were made by Rebecca, Britt Welter-Nolan, street nurse Cathy Crowe, and Reverend Sherman. Andrew Wesley began smudging and recited a prayer and then the Smoke Trail Singers began drumming to initiate the projection of the names.

Visitors were then encouraged to stand vigil as the names scrolled across the church wall. Otherwise, people could go inside and experience other interactive pieces. There was an audio installation where you could hear stories about people’s lives and the intersections of homelessness, as well as a reading of the names.

Cups were placed on a table next to the list of people who have died and you could write one of the names on the cup in memoriam to that person, which was placed on the carpet to act as a “headstone.”  Art pieces and a reflections board were displayed where people could write down any thoughts about the night or about homeless deaths in general.

 

What are the causes?

I have written previously on how death is widespread within the homeless community. However, I want to bring to light the causes of death.  Before I get into some of the research, I will say right up front:

People who die when they are homeless, die because they were homeless.

You may be thinking, “what do you mean? They die from stabbings, and alcohol and other things!” Well, those “other things” are actually just symptomatic. Other researchers have also suggested that homelessness itself is the main risk factor for death that needs to be addressed (Hibbs et al., 1994:308, Barrow et al., 1999:533, Condon & McDermid, 2014:3). Let’s explore further.

We know that both individual AND structural factors are involved with why people become homeless in the first place (Fazel et al 2015:1). We also know several times over that people who are homeless die younger than the general population (Hibbs et al., 1994:307; Cheung & Hwang 2004:1243; Barrow et al., 1999:529; O’Connell 2005:13). In British Columbia, “[t]he median age of death for a homeless person…is between 40 and 49. The average life expectancy for the general population in British Columbia is 82.65 years” (Condon & McDermid, 2014:4). In Copenhagen “[h]omeless people staying in hostels, particularly young women, are more likely to die early than the general population” (Nordentoft & Wandall-Holm 2003:81).

When homeless people are at almost half the life expectancy as the general population, then we have a major crisis that needs addressing.

For people who are homeless, many die from violence and trauma from being on the streets (Wright et al., 1999:244). “In the USA…younger people die disproportionately from external causes of death (suicide, accidental overdoses, and homicide) and infectious diseases, and there is also a spike in older homeless people” (Fazel et al. 2015:5). Some researchers suggest that “[d]rug overdose has replaced HIV as the emerging epidemic” (Baggett et al., 2013:2). The St.Michael’s Hospital Centre for Research on Inner City Health recently released this quick read guide that highlights health problems and mortality rates. Mental illness is a major factor in homelessness, but I will be writing about that in more detail in a future post.

Numbers, numbers and more numbers

The 2015 Annual Review of Statistics on Deaths of Shelter Residents was recently released. This report provides rough estimates of deaths since 2007 specifically of shelter residents, which does not include many others who choose not to go to shelters. People have suggested that we need a count of the number of people who are homeless at a particular point in time. Researchers say that, “…without sufficient provincial data it is difficult to determine the necessary steps to minimize homeless deaths across the country” (Condon & McDermid, 2014:18). I understand how policy makers like to use evidence based decisions to tackle social issues. As a graduate student, I also understand the need for research and providing evidence in order to strengthen arguments.

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However, in this case, do we really need a count? We know people are dying. The government needs a number? How high must the number be in order for these deaths to be seen as a significant issue? For me, one death would be enough. Apparently there needs to be many, but we don’t know what that number is since the government is not making this a priority, nor are its citizens. A child gets shot, we fight for gun laws. A child is hit by a car, we fight for road laws. A child dies on the streets and apparently we don’t give a shit.

Prevention

Researchers have not only mentioned that homelessness itself is a risk factor for death but also that homeless deaths are largely preventable (Hibbs et al., 1994:304,Condon & McDermid, 2014:3). Hwang et al. maintain that “[a] large part of the premature mortality in people living in shelters, rooming houses, and hotels was potentially avoidable” (2009:6).

For individual circumstances, we need to “… include behavioural health integration into primary medical care, public health initiatives to prevent and reverse drug overdose, and social policy measures to end homelessness” (Baggett et al., 2013:2).  For young people it is suggested that they receive “…psychiatric treatment, detoxification treatment, medical treatment, social advice, and accommodation. The prevention of social exclusion should start early in life” (Nordentoft & Wandall-Holm 2003:81). For older homeless people “the management of chronic diseases, geriatric conditions, frailty, and end-of-life issues is more prominent” (Fazel et al. 2015:5).

prevention

In order to prevent people from dying way earlier then they should, we need a national housing program and social supports that include counseling, better access to health care, decriminalization, employment help and training programs. These must be used together. If you only have housing first programs or only have employment training, then they will fail.

Tackling stigma is another factor in preventing homeless deaths from happening in the first place. Some common stigmas include racism, sexism, AIDS, autism, homophobia, and ageism, among others. Attitudes and beliefs can make the difference between someone being housed or homeless.

The fight will be a tough one and we need more people that can speak out against the crisis of homeless deaths. People are needlessly dying. We need to notice and we need to care. Ending homelessness in our towns is not some esoteric unattainable concept, others have done it. So why don’t we?

 

Featured Image artwork by Jim Houston

 

References

Baggett, T. P., Hwang, S. W., O’Connell, J. J., Porneala, B. C., Stringfellow, E. J., Orav, E. J., Singer, D.E., & Rigotti, N. A. (2013). Mortality among homeless adults in Boston: shifts in causes of death over a 15-year period. JAMA internal medicine, 173(3), 189-195.

Barrow, S. M., Herman, D. B., Cordova, P., & Struening, E. L. (1999). Mortality among homeless shelter residents in New York City. American Journal of Public Health, 89(4), 529-534.

Cheung, A. M., & Hwang, S. W. (2004). Risk of death among homeless women: a cohort study and review of the literature. Canadian Medical Association Journal, 170(8), 1243-1247.

Condon, S., & McDermid, J., (2014). Dying on the Streets: Homeless Deaths in British Columbia. Street Corner Media Foundation. https://d3n8a8pro7vhmx.cloudfront.net/megaphone/pages/7/attachments/original/1415231881/Dying_on_the_Streets_Homeless_Deaths_in_British_Columbia.pdf?1415231881, accessed Mar.10, 2016.

Fazel, S., Geddes, J. R., & Kushel, M. (2014). The health of homeless people in high-income countries: descriptive epidemiology, health consequences, and clinical and policy recommendations. The Lancet, 384(9953), 1529-1540.

Hibbs, J. R., Benner, L., Klugman, L., Spencer, R., Macchia, I., Mellinger, A. K., & Fife, D. (1994). Mortality in a cohort of homeless adults in Philadelphia. New England Journal of Medicine, 331(5), 304-309.

Nordentoft, M., & Wandall-Holm, N. (2003). 10 year follow up study of mortality among users of hostels for homeless people in Copenhagen. Bmj, 327(7406), 81.

O’Connell, J. J. (2005). Premature mortality in homeless populations: A review of the literature. Nashville, TN: National Health Care for the Homeless Council, 1-16.

Wright, R. D., Wright, S. E., & Jones, A. (1999). Dying homeless but not alone: Social support roles of staff members in homeless shelters. Illness, Crisis & Loss, 7(3), 233-251.

Stone and Glass: We Are All Transient

Myseum is a non-profit organization that celebrates diversity and helps the community to further understand it’s culture and urban spaces. The collective is launching its first annual festival of exhibits exploring different perspectives on the city’s natural, cultural, and historical diversity.The festival runs March.6th-31st.

On March.9th from 6:30-9:30pm at The Church of the Holy Trinity and Trinity Square, the event launch will be taking place that includes an art installation, live music, drumming, historical church tour, food and activism.

The event is a collaboration between The Church of the Holy Trinity, The Toronto Homeless Memorial Network and community artist Rebecca Houston. The premise for the installation is that most people aren’t aware of how many people die homeless and without support. The names of those who have passed away will be projected onto the front face of the church in order for people to take notice.

This is an excerpt from the flyer:

“We all pass briefly through the world, but we are not all treated the same. In Toronto alone nearly 800 people have died on the streets and in temporary shelters since 1985. Many die without a name, listed only as Jane or John Doe. Come for an evening light and sound installation honouring them and calling for change in their memory”

memorialflyer

 

The following is a list of what she is looking for if you are interested in volunteering:
Volunteers to arrive early, (5pm) help set up sound, tables, chairs, food (5-10 people)
Crowd greeting and handing out programs- “Ambassadors” (10-15 people) (from 5:45-7pm)
Help serving food (5 people) (from 6-8:30pm)
Clean up (10-15 people) (9-10pm)

If you are interested in volunteering, please contact Rebecca Houston:rebeccajanehouston[at]gmail.com

Here is the official website.
Twitter: Stone and Glass @homelessevent

Toronto Homeless Memorial

Another month…more names.

I try to make it out to the memorial service when I can. The ceremony is not long and it’s a great way to show support and remember those homeless people who have passed away. The service is also a reminder that this shouldn’t be happening in the first place, people should not be dying because of homelessness.

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People come together to read poetry (focusing on what is a priority to the homeless community for that month) and hear music that speaks to the systemic problems that contribute to poverty. Michael Shapcott gives us a run down of the political climate and of course there is a reading of the names, tribute speakers and a moment of silence.

Community members also take the opportunity to announce any initiatives, projects or protests during the service.

If you are in the Toronto area, feel free to stop by and remember. The memorial happens every second Tuesday of the month at noon.

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