For the first two days of this week, I’ve been involved in a series of meetings and site visits. Many ideas are percolating in my mind as topics that deserve further exploration before I commence to write. However, today I want to focus on three more aspects I have noticed about this remarkable system:
- A cat
- A team that functions like a family
- A commitment to not give up.
Let’s start with the cat.
Speaking personally, I love my cat. I look forward to coming home each night to see Gustavo and to hold him on my lap. He calms me down after a long day. I have a friend, formerly homeless in Hollywood, who now lives in a board & care home in Pico Rivera. When I come to see him, we have a ritual that involves lunch at Sizzler and ice cream at Baskin Robbins, but in the middle we go to PetSmart and we look at every cage that has an animal (including parakeets, gerbils and rats). But my friend wishes he could have a dog or a cat to love – and I wish that for him also!
So imagine my excitement today as I toured a group apartment attached to the Dipartimento di Salute Mentale in Trieste, where five women live. We arrived just as they were sitting down to lunch prepared by their care-giver (one of three, involved in 24-hour care). There, on the sofa, next to their dining table, was a beautifully large and content cat, the resident king of the house.
Can someone send me a reasonable, defensible explanation why the licensing officials, who oversee board & care homes in California, would consider the presence of a pet to be an infraction? Could someone please send me information about the rationale as to why a pet (or pets) in a group living scenario are not considered therapeutic?
Next, the team that functions as a family. What I have noticed now, having visited two Community Mental Health Centers (Domio and Barcola) is the synergy that exists amongst the team members who work collaboratively to serve the people they are accountable to in their catchment area. Every day, at 1:30 p.m., all team members come together for a meeting to discuss/problem-solve/strategize over how to assist the people living in their temporary beds, and other users in their system. This team includes the psychiatrists, psychologists, nurses, social workers, student volunteers and others. Here is what I notice. There is not a formal agenda and no one is keeping notes. Names are brought up and everyone weighs in. A plan results and there is concurrence, and they move onto the next person.
Here’s an example. On Monday, I was driven to Barcola by a young psychiatrist, Dr. Chiara Luchetta who works there with three other psychiatrists. I was briefed regarding a young man, Matteo, who has been known to their center since he was 18. He is currently 24. His illness has been particularly taxing on his family and he has had his ups and downs, but most recently a down, perhaps precipitated by stopping his medication and returning to a marijuana habit, that resulted in him taking a baseball bat and demolishing some furniture in the family home. At this point, they are not willing to take him back. He is staying at Barcola until the team can find a new living option for him. So much of this young man’s story resonated with situations I have observed in Hollywood; it seemed to me he’d be homeless in Hollywood, if he did not live in a place like Trieste where the staff of the DSM care deeply about outcomes.
In the spirit of a family gathering, at Barcola, yesterday, there was a happy celebration for a nurse, Mario, who had 30 years of service with the DSM. It was his last day on the job. I was delighted to be an observer of the love expressed for this man, not only by colleagues, but by users of their system who came by to partake of the festivities. Afterward, the staff sat down for their 1:30 meeting (which by now was 2:30 p.m. because of the retirement party) and the first item on their agenda was Matteo.
Now, again, my Italian is limited, but what I noticed was a shared responsibility for his well-being. Many weighed in with observations about his behavior (and the improvement since he arrived at the Center) and his family situation and options for the future. I had seen Matteo participate in the celebration for Mario – and noticed his tattoos and piercings, but he seemed sweet and gentle.
Later, as I observed to Chiara the attention paid to Matteo’s situation, and the complications associated with needing to find him another place to live since his family was clearly exasperated, I said, “it’s amazing to me that you don’t give up on him.” She replied, “we don’t give up. This is what we do.”
Not giving up comes from a place of feeling accountable. What I am observing about the division of labor in the community mental health center system in Trieste is this: if someone in their catchment area is in crisis, is suffering, is experiencing challenges, the job of the Center is to assist. Giving up is not an option.