Caitlin Burritt  00:00 

Thank you for listening to the Unsilencing Stories Podcast. We are in the midst of a public health crisis. More than 32,000 people in Canada have died from fatal opioid overdoses since 2016 according to Health Canada. Previously, this podcast featured interviews with bereaved people in smaller towns and communities in BC and Alberta who have lost loved ones to fatal overdose. In this phase, we're sharing interviews with seven harm reduction workers, also known as peers, in different parts of BC.     

Caitlin Burritt  00:27 

The BC Centre for Disease Control Harm Reduction Services defines harm reduction as support services and strategies that aim to keep people safe and minimise death, disease and injury from high risk behaviour. Peers face a lot of challenges. This has been documented by many researchers including Zahra Mamdani and colleagues in BC. In their 2021 paper they outline significant challenges peers face including financial struggles, difficulty finding housing and stressors at work. We wanted to explore these themes with peers and find out more about their experiences and share this information with the public. So we conducted multiple remote interviews with harm reduction workers and invited them to talk about the stressors they face. 

Caitlin Burritt  01:06 

Please note this podcast contains information about substance use, overdose death, grief, trauma and stressors that peers face and this may be distressing to listen to. The podcast is part of a research project led by Aaron Goodman, PhD, faculty member at Kwantlen Polytechnic University in Surrey, BC, and conducted under the auspices of a grant known as the Chancellor's Chair Award. I'm Caitlin Burritt, a researcher with the project. A number of researchers including Giorgia Ricciardi and Chloe Burritt, who happens to be my sister, and a number of students have played key roles in the study and you'll hear many of their voices in this podcast. 

Caitlin Burritt  01:40 

In this episode, you'll hear Lily talk to Lucas Akai and Esther Cheung about the extreme barriers faced in her community regarding supportive, safe and affordable housing. Lily discusses the stigmatising effects of the lack of affordability, as well as the difficulty of navigating government systems for housing support. Lily also describes her experience working in a safe supply programme and how she effectively supports individuals experiencing extreme stressors in their lives. 

Lucas Akai  02:04 

All right, perfect. So we'll kind of, I guess we'll just dive straight into the questions. I don't know if you still have the paper with you? Today, we're gonna go over kind of like the inability to access and/or refer individuals to resources.  

Lily  02:16 

Okay. 

Lucas Akai  02:17 

So first question is, do you experience challenges when it comes to referring individuals you work with to resources in the community?  

Lily  02:25 

Um, well, housing is a huge one, for sure. There's, it's just like, it can be really a hopeless battle trying to get people into permanent housing. Like I've been talking about having these little wins with that one shelter in town. Which is like, the better of the shelter styles where they don't have to leave every night like in a normal shelter people stay at night, and then they're out again, and you like kind of reapply the next day. That's not really any more stabilising, right? But um, this type of emergency shelter we have here,  you, when you're and you get a spot you're in until you either miss three nights in a row, or there's an act of violence or stealing or whatever the heck, smoking inside, things that would cause you to get a temporary bar.  

Lily  03:13 

So we've been having a lot of luck, I just found out I got our little 22 year old guy in to there today. So he's not on the street anymore. So these are like some really big wins that we, you don't normally see that many of but because I used to work at this place, and I kind of know how it goes. I was like, you know what, like, if you're just persistent, keep getting people's names on the list. Eventually, it just works. But it also takes the client getting there on time. So today, we learned there was going to be a male spot given. Yeah um, so I called the kid about it, I was like, we got a really good chance today but you gotta get there by five at the latest and that can be hard for our folks too, so. Like, you know, like getting somewhere on time when a) you don't have like a phone or a watch and you're impaired on um, drugs that make you slow down and fall asleep a lot of the time, right like, that's why they, they tend to need help and support with getting to appointments and stuff, so.  

Lily  04:12 

This little kiddo was able, I just found out, was able to get himself there on time and he's now housed for as long as he's able to maintain it. So that's been a really nice win because getting people into the more like, what we call like supportive housing, where they're actually paying rent for like low barrier housing, for people on income assistance, like $375 a month, that kind of stuff, but they're pretty rough buildings, right? And it's like a waitlist and applying with BC housing is just an absolute nightmare from everyone I hear and you're on waitlist for years and that's like a really hard battle to see a lot of the time because, you realise how important housing is. Like I know it for myself when I didn't have housing, how stabilising it was to have it again and we see the improvement in our folks, even in a matter of like days.  

Lily  05:01 

Like somebody that was just on the street for years, I got them into this shelter. A couple days later, they're back at the clinic and like they're literally like, their cheeks have gone from being sunken to like, they've got like some meat on their face again, they're looking rested and clean, and they've changed their clothes. And they're eating three meals a day now. And it's just like, even though that's like the bare minimum level of like housing support we can give them, it so much better than what they're dealing with on the street and so much more, even in the winter now, right? So really happy to be getting some wins there but it's still not like the overarching solution. But it's better than where they were at, that's for sure.  

Lily  05:41 

And I don't deal a lot with the referrals section other than I guess I've been getting people in the shelters. But we have another crew of folks that work with us called, they call, call them system navigators. And their sole job is helping people with applications for housing, say getting their ID, because if you don't have ID, that's a barrier to getting other things. So their whole job is just learning how to work within those systems. And helping people make appointments, get to them on time transfer, transporting them, advocating for them, helping filling out these complicated paperwork forms. And just like being that extra support to help get people the things they need to get them back on their feet, because that's a whole other side of it. So I don't deal with that don't deal with as much of that directly but my coworker that is in the systems navigator role is dealing with that a lot, so. 

Lily  06:38 

 I mean, it's a similar thing with things like if people are like, "oh, I want to go to detox," like, "alright, well, we'll get your name on the list," but like, we're looking at two months down the road, probably. So how is that helpful for people that want help now that may be in a place of readiness to get that help, have to wait and continue to struggle, maybe even die waiting? Or then often when the time comes around well, maybe they didn't, you know, like people's thoughts and positions change on their readiness and willingness to do that. So say two months down the line, they call and say "hey, your bed's ready next week for detox." And they're like, "Oh, God, I don't want to go now. But I wanted to go two months ago."  

Lily  07:18 

So that's really challenging and also that there's no like, after care after that, like detox here is one week in hospital and then you're pretty much like off on your own, out into the street. Like it just the, the chance of relapse and, and then also if their tolerance is screwed up, the chance of overdose deaths after that is substantially increased, when they go from a week in detox, doing really well, completely coming off this stuff, just to be let out into the world with possibly no home, nowhere to go. So now they're on the street immediately back into using, most likely, like how could you not? And then probably going to overdose because their tolerance is screwed. There. I don't know of many places that have like, like treatment centres that are paid for, like average treatment centre, I think costs like $10,000 a month or something like that, like it's crazy, right?  

Lily  08:10 

Like, unless you have extended health benefits, which most of our folks wouldn't, or families that would pay for that. Like, nobody has an opportunity to go to this except more middle class working folk or rich people. So I think there's a big stigmatised barrier there between what people in poverty and the addicted street folk can gain access for help, versus just people that can pay for it or, you know, I mean, there is still definitely like those kind of closet, opiate users of the real world, which I think those people are also at a great risk of overdose because there's the difference between like, like, our folks are generally using with each other.  

Lily  08:58 

Or in supervised consumption sites, right? They come and use those services. Say somebody's like a businessman that has a closet opiate addiction, he's probably using at home alone, maybe hiding it, like, if he overdoses like, no one's there to help, right? Because the main thing that's important with the overdose crisis and using, is never use alone because if you are and you OD, there's no one to get help. If you're with someone and you go down, they can call for help. If you're in a supervised consumption site, there's staff there with oxygen tanks ready to go that have done this a 1000 times. But if you're like a middle class person using at home like, secretly or somewhere like not, they don't come down to these services. I think that's a lot scarier. So got a little strayed from the topic there but all useful information. 

Lucas Akai  09:44 

Absolutely. Absolutely. You had mentioned that there is a level of persistence that you have to have when you're referring individuals to housing resources. So knowing, like, the level of persistence required, how do you feel in regards to the overall system that that level of persistence is necessary? 

Lily  10:02 

There's just not enough openings and options. And I mean, maybe it's different in different cities? But I mean, even for myself to find housing was insane. Like, I don't know how it is in Ontario, for example, like, do they have more housing? I mean, I think Toronto is pretty expensive, too. But is it everywhere in Canada, where we're, there's just not enough places to live that are affordable? Or is this a BC thing? I'm not, I'm not sure. But here, it just seems like there's just not enough. And that honestly, like, there was so much less before COVID happened too, the only reason a lot of these places opened up like, the government started buying like, derelict motels and buildings like that to transform into supportive housing and single room occupancy hotels, was because of the pandemic. Because they didn't want all these people floating around on the street mingling with each other and spreading COVID, they started bringing people indoors and individual spaces, so they had more places to quarantine in a way, right? 

Lily  11:01 

 Like, literally, that was a huge game changer in people getting off the street was COVID. But it took COVID to make that happen. Like they had teams of people going out and like going out into encampments, and like getting people's information, and then starting to buy out more motels, and fill them with people. And now we kind of like have what we have. And we still need more, right? But and I mean, there are still more coming but there's still too many people sleeping outside in the winter, like this. Everybody needs a home. And I think we all deserve that as human beings. And even if you're struggling, there should still be ways to do this, like, 

Lucas Akai  11:36 

absolutely. And so you mentioned when referring people to detox sites, sometimes the waitlist can last multiple months. 

Lily  11:44 

Mhmm. 

Lucas Akai  11:44 

And on occasions, individuals that initially you know, two months prior had wanted to sign up no longer want to attend. After those two months. How do you how do you respond in those scenarios? Or how do you feel in those scenarios have you tried to set that up or successfully set that up? 

Lily  12:00 

Well, I mean, we're not here to force people, right? Like all we can do is be supportive and understand that it's hard, it's also, even if say they want to, it's like getting your foot in that door. I mean, I've gone once, it was probably the hardest foot I've ever had to get in a door. And as soon as I got in that door, I had a massive panic attack where I like literally had to be given like multiple Valiums, like I couldn't even breathe. Like I've never had a panic attack to that degree. I didn't see it coming. I had no idea what was happening. I completely froze, couldn't move my hands or my legs. I was like, like, literally frozen and it just hit me because...  

Lily  12:36 

And I think a lot of that you don't, you like think about it. But that's a real feeling, right? I had no idea, I didn't even know until I came out of the panic attack, what had happened and they explained. I was like "I'm having really hard even like moving my fingers." Like I have anxiety but like I've never had anything like that. And they explained to me, it's because it's, a panic attack that severe, literally all the blood goes to your core, like the fight or flight, fight or flight response, where the, all your extremities, all your blood rushes to your core in an act to protect and survive, right? Comes to the vital organs. And that's literally why you lose the ability to move. So I was like, "wow, that's really extreme." 

Lily  13:17 

 Yeah, like, I don't blame our folks that are like, even if it comes up, "okay, your beds coming up tomorrow, gotta be there by 11." Like, it's just this thing that's coming in the future that's like, scary and like, you know, you want it and you know you need the help. But you also know, it's gonna be hard and suck and gonna,  you're giving up a lot. You're like, you're losing a lot to gain stuff. But it's like, it's not as easy as you'd like it to be. So a lot of people get cold feet right before and just dodge, so. And really all we can do for folks in that is just be supportive of where they're at, you know, be supportive, encouraging, but like, never punitive. Like, we just have client-centred approach to support people where they're at, understand the emotions, just do what we can for people do what we can to support, just listen nonjudgmentally. And you know what, maybe it's not the time? Well you know what? When they're ready for it again, we'll try again, that's all we can do, so.  

Lily  14:14 

It's not our life, it's their life. And it's their choice. So, you know, maybe some people will never go. Like I saw that in housing, it was really hard to see how many people would never get out of this lifestyle. That was really depressing after a while. Whereas where I work now, I've mentioned we really see a lot of the positive change and hope and the good we bring and like even someone today was like, "hey, I want to talk to the doctor about getting on like Methadone or Kadian and he's like, as he's injecting su-fentanyl. He's like, he's like I just can't keep doing this to my arms. I need to do something oral, you know, like we see that change, right? So yeah, we just, you just have to keep showing up for people and loving them where they're at and listening and being there until they come to a place where they feel it for themselves, which, you know, it is really hard when you're on the street and struggling and just trying to survive like, is your priority then getting better? No, you're just trying to escape all of this nightmare. 

Lucas Akai  15:11 

Um, and so you mentioned though, that with detox sites, there is an anxiety, an intimidation factor, maybe. Have you ever as, as an employee, with the current organisation that you work with had to 

Lily  15:23 

mhmm 

Lucas Akai  15:23 

 help clients 

Lily  15:25 

yep 

Lucas Akai  15:25 

who have had maybe anxiety or 

Lily  15:27 

yeah 

Lucas Akai  15:28 

like an intimidation walking in? Is that something that comes up for when they attempt to access resources that you provide?  

Lily  15:36 

Um no, but like, it was also running for two years before I started there. But so most people are coming there every day or a couple times a week. It's a very familiar community, we all know each other, everybody knows each other. I don't know how it was at the start. But I also know that people feel, for the most part, people don't take it for granted, because they know there's a long list of people that would want to be a part of this programme that we can't take, because we're at capacity helping these folks.  

Lily  16:05 

So some people are like, really respectful of that, right? Like, and they'll tell each other like, "Hey, man, like don't smoke that right outside," like "we can't have that public perception," like, you know, like, "follow the rules, like we want to stay open, like I want to be able to get my meds" like, they keep each other accountable, because it's important to them, that they can be here and have this privilege that not everybody else can have. So. 

Lucas Akai  16:27 

And so actually, you just mentioned of course, the long, the long kind of waitlist, is that a daily struggle or the inability to provide you know, spots for individuals not currently participating, or? 

Lily  16:40 

Absolutely. It's like a question, we just flounder over, you know, like, the every, [a] couple times a week someone will call and be like, hey, "like, how do I get on the programme? Are you accepting people to the waitlist," and we're like, "No, we're full." Like, we don't have the capacity to have more. We need more like this, that, because it is helping people like you know, like, we've proven what we've done, we've continued our funding, pretty sure, I didn't get like the green light, but. We just need more of this more people to be able to access it, so it sucks that we can't help everyone and I don't always know where to direct everyone, like there are other meds you can get through pharmacies, but certain doctors won't prescribe. We've had a couple of good calls lately, though, from doctors nd that's been really cool.  

Lily  17:27 

Two doctors in the last like two weeks have called and been like, "hey, I want to learn more about Fentora, the Fentora programme, the oral, oral med," they're like, "I want to start being able to use this in my practice. And can you guys tell me a bit more about it?" So I'll hand them off to a nurse. And that's really cool to see more doctors seeing what we do, because that's also, that's a big factor in it as well, like, it's partially government funding, but it's like, like, we have, I think five or six doctors on our team that vouch for this and have proven to the College of Physicians like, why it's a good thing and sharing with comrades.  

Lily  18:01 

So like when other doctors phone to gain information about that, and curiosity, genuinely that they believe in it, and they want to start doing it as well. That's frickin' amazing, right? Like, that's a good sign. So it's been cool to field some of those calls, like, having our nurses step aside and talk to a doctor on the phone for like half an hour from Vancouver  "that's like, I want to learn more," like "how can I get this set up at my clinic?" 

Lucas Akai  18:23 

And so you, you briefly mentioned that when you do receive calls from individuals hoping to access [the] safer programme, when you have like the full capacity waitlist, that you mentioned, there was some resources that you could possibly refer them to. Do you maybe want to expand on that, that aspect and what maybe more specifics as to what you do in those situations? 

Lily  18:45 

I wish I knew more, like really all we can do is like, certain doctors like, they can't get the meds that we give. And they can't get all the meds they want. But there's some meds they can get, like, they can get Methadone, they can get Kadian, and they can get Suboxone, prescribed from most doctors but um, other doctors that work with the street population can give those meds. But a lot of people want like oxy prescriptions and things like that, because that's one of the main ones that actually works and relieves it. But a lot of doctors have different perceptions, like, "oh they're just getting high or they could sell them" or whatever, right like Oxycodon's [a] pretty hot commodity on the street, so. But our doctors do prescribe it.  

Lily  19:27 

So there's some, some, more things you can get with us that you can't get from other places. So, so they can kind of get the general stuff that everybody else can get, but they can't get su-fentanyl,  Fentora, or well, I've heard the fentanyl patch programme is becoming more accepted um, these days as well. I've just learned about more places being able to offer the patch. So that's cool, because that's just a slow release of fentanyl, right. As long as people are like returning them when they're, like, to get another one you have to give back the ones you've had to show that you didn't like sell them or something. So that's cool that they are expanding on that in terms of the provincial government, I guess, at different places. Like,  you have to already have been a opiate addict obviously. But like, I think that's a great idea. It just helps again, give that stability to life where it's just a slow feed, right? 

Lily  20:18 

 Like, you're not even necessarily getting high off it. It's just preventing you from going into the horrible dope sickness. And when people don't get dope sick, what does that prevent, crime theft, sex work, hustling, stealing, like just all this, bottling, all the things that they have to do in a day to struggle, just to make that money just to get un-dope sick? Here, let me take that edge off. Okay. Now, what can you focus on in a day, "oh, well, maybe I want to do this and that? Maybe I can focus on my housing now?" Like, it just gives people the breath of air to think about something else in life, take care of themselves, feed themselves. 

Lily  20:51 

 You just see the stability, it takes away the fight or flight response, and just adds a bit of ease to this horrid struggle. Absolute evil struggle, that is oppiate addiction as I wouldn't wish [it] upon anyone. I'm grateful every freaking day, I swear to God that I have not ever touched opiates, you couldn't pay me a million dollars to ever touch one. I'd break my neck and be like, "I don't want to know," because I'm already susceptible to addiction and I've seen what these people go through and where it's hard, where you see people's judgments too of like, "oh, they could just get off if they want, why don't they just get a job?" It's like, do you think people are having fun? Like, no, they've, in whatever way, they became addicted, whether it was from being born into this life, born into [a] life of poverty with parents that were addicted.  

Lily  21:35 

I've met a lot of people that were totally functioning normal human beings that fell off a ladder at work and broke their necks and then now they're, were prescribed Percocets or oxys or Dilaudid. Now they became addicted through the doctors and now they're screwed and they've screwed up their whole life because they've got a pharmaceutical dependence that has put them to the street. That's a factor. So there's a lot of reasons people get involved in this, but I really don't believe it's fully a choice. And I don't, I think if people could wave a magic wand and take it away, they absolutely would. You know?  

Lily  22:09 

I remember even talking to clients, I work once when I was like, "oh, man, like, I knew this guy. Like, I didn't know him very well. I've just started like, noticed, like saw him on the street," for example. And "my god, he told me, he's just started smoking fentanyl for the first time" and I'm like, "You idiot, you know, like, why would you ever start?" And that's exactly what the clients at my work. So they're like, "what? Don't ever start, Like, who? No." Nobody wants this hell, nobody wants this hell, you know? So, sucks. Not an easy life. So I think, and you know, and their lives haven't been easy to get to that point, either. So I think they deserve more, more kindness and compassion than a lot of the world gives them  

Lucas Akai  22:49 

Speaking, maybe speaking more to the clients that you see on a day to day basis? Are there any struggles in terms of assisting these clients and accessing the medications? On a day to day level?  

Lily  23:01 

Um, it, well, sometimes it can depend on behaviours, right? Like, if somebody isn't 

Lily  23:09 

um whether that means they're just like particularly unwell um, and maybe not as conscious of what they're doing. Because I don't think people intentionally try to be assholes, right? But if you're really depleted and unwell or been up for 11 days, like how we hear some people, like, doesn't really lead to good things. They're hearing voices now, and they're in psychosis and suspicious, just it leads to their behaviours, becoming more hostile and aggressive, and it can lead to them getting temporary bars, like "oh, sorry, you know, you freaked out and threw a glass of juice at me because I asked you to some kind of thing," like, I don't know. Whatever it was, their behaviour's led to them being asked to leave for a day. So now they're without those meds, they're still able to get meds that we can send to a regular pharmacy. Like they could get their Methadone or Kadian sent to another pharmacy so they can still get that but they can't come in and get their injectables changed or oral Fentora, because they need a break from because we do have to keep some peace and order, right? So.  

Lily  24:13 

We don't deal with those things too much. We've worked very hard to, and with the folks too. And it's not just us setting the rules. We work with our folks for what feels good for them, what's safe for them and develop a bit of a list that we've gone over with people one on one and had them sign the agreement. So that we can kind of come back to that if you know, "Hey, man, you've started a fight or were name calling people or screaming or being rude or refusing to leave your booth. You know, you're gonna have to take a break for a day." If it's anything that gets worse in terms of like particular like threats to staff or anything that was like more or risk of violence, they're probably asked to leave until the following Monday where they have to speak to a manager to come back. If it's something like they just blew their lid and need a day off, we'll give them the day break. "Okay, you're done for the day, no more doses today, you can come back tomorrow, start again." Because we're not here to try to punish people long term, a lot of the times people just need to start fresh the next day, had a shitty the time but if it's anything more serious then they need to kind of take a break until the start of the next week, and then actually have a sit down conversation with the coordinators before coming back.  

Lucas Akai  25:25 

And so with that, with the day break, or the week break, do you find that there's a struggle there for you personally, when you have to tell someone, you know, it's time to take a break, knowing that, you know, it might be a day or in some cases a week before they get their meds again? Or is that just part of the process and part of keeping peace? 

Lily  25:45 

I think the folks kind of know too, like, we've got one person that that tends to happen based on her level of where she's at in psychosis. And I think even when it happens, when it gets that bad, we're like, "hey, you need to leave, you need to leave now." Like, we almost don't even need you want to say like you can't come back till tomorrow, but like they know. And like they sometimes need that break, too. Maybe like even just the environment was too stimulating for them as well. Like we do a lot of things to manage. We're not just like expecting, like, we have to take what we give as well. So like, soon as a crisis starts to hit, we're doing things like we dim the lights, we turn the lights down, the music goes down, we make the room feel wider. So any kind of like we've got like a barrier, dividing a wall, we open that up like make, making the space feel not so restricting.  

Lily  26:27 

Like we're doing things, reducing the number of staff in the room. So say we've got four staff and one client having a freakout, two, at least two of those staff need to go to the backroom, just reduce the audience, like [there's] a lot of factors we do to help tone down the stimulate, level of stimulation in the environment. Because we're also, we're working with people that are highly sensorially, really affected. And also people that are on drugs. So maybe like, I mean, if they're on meth, like maybe it's all like, way too much, right? If they're on down, maybe it's this and that, like, are they exhausted? Are they in psychosis and feeling very paranoid and suspicious? Like, what can we do to give the best possible outcome by controlling what we can control? So that's something that we do. 

Lucas Akai  27:15 

And so maybe speaking more on these ways that you address the challenges that you face? Are there any other ways that like, in terms of the other clients that are present, are there any specific protocols in regards to them when there is a possible freak out, as you said, with another client, or that's just having a bad day, or? 

Lily  27:32 

Um, a general rule of thumb is we encourage nobody else to comment, you know, like, it's more like, there's a behavioural thing, which risks other people chiming in, either like, "Oh, my God, just shut up already." Or like, "stop talking to the staff like that," or, like, people will get snarky and make fun. We're like, "Hey, man, like, we just this is a small space, there's nowhere else to go,"  

Lily  27:54 

What we need from everybody else, and kind of the crowd control aspect of it is, please respect that the staff know and they are doing the best they can to work with that person, given we know this person's medical history. We know their needs, we know what we can do best in the situation to deal with this. And you don't necessarily know that stuff, right? Because that's confidential client information. We can't do these things in private necessarily. So what we need for everybody else is just like, hold your comments, hold your snarky things, everybody, please just try [to] like mind your own. And trust that the staff are doing the best they can to deal with it for everybody's well-being the client, them, and yourselves as well. Because it can also be really distressing for some of our folks. Like, when that one girl was popping off all the time in psychosis and doing things, that really bothered everybody else, too.  

Lily  28:46 

They're just like, "oh my God, she just never stops," you know, like, it's very small, little fitting room and like, everybody affects everybody, right? So we're, like, we have everybody's best interests in mind and we're always kind of managing that. So. And people have been really, really good lately, of just being like, because you know, if they become too much, too well, now they're risking a bar because they wouldn't stop chiming in and calling the person names. Okay. It's like, you know, you're just as much a problem now, you're not making it any better. So lately, we've just need people to be like, quiet, pretend it's not happening. Just Just let us deal with this. And, you know, it just resolves better that way. So if we're ever having like, you know, say the person got banned, and they need to come back and talk with us, well, we're gonna have that conversation like outside.  

Lily  29:33 

Like, "Oh, they're coming down the street," okay. Or they're here like, "Oh, hey, I just need to have a chat with you outside before we're able to give you meds again," just for their own privacy and well-being and like, when you reduce that audience, like, if you try to talk to somebody about what happened in front of a room of people, they might oh, get all defensive. And you know, they've got an audience listening. So it's a lot easier to have those conversations one on one in private, like, "Hey, can I give you cigarette? Come outside and let's chat." It's a lot of talking. 

Lucas Akai  30:02 

No, that's, that's the value of this is your experiences.  

Lily  30:02 

mhmm. 

Lucas Akai  30:07 

but just maybe for my next question, just to clarify something  

Lily  30:07 

mhmm 

Lucas Akai  30:08 

before I ask it? So, because I don't believe we've ever spoken to it as like a physical location, I imagine the waiting room is quite small? And then there's like adjoining-- 

Lily  30:18 

it's all one room 

Lucas Akai  30:20 

 Oh, it's all--okay.  

Lily  30:21 

Yeah, all one room.  

Lucas Akai  30:23 

So like when they're receiving their medications, it's in the same room as the waiting room, or? 

Lily  30:31 

I can draw you a picture maybe, for next week or something? 

Lucas Akai  30:31 

 Perfect.  

Lily  30:31 

The entrance with like about four 

Lucas Akai  30:33 

right 

Lily  30:33 

or five chairs in the waiting room, with little coffee table 

Lucas Akai  30:36 

okay 

Lily  30:37 

then we got four booths on this side. 

Lucas Akai  30:37 

sure 

Lily  30:39 

and then there's like a half wall. And right behind that is 

Lucas Akai  30:41 

right  

Lily  30:42 

the nurses' computers in the med room 

Lucas Akai  30:44 

okay 

Lily  30:44 

So the only other room or actually like through the other area is through the hall, there's a little doctor's  

Lucas Akai  30:51 

right 

Lily  31:10 

clinic, which is rarely used, only when the doctors there, and then there's one small little office back here that's like, it's a pretty small place. But in terms of where the clients go, that's it. So everything can be heard, there's not really, like, we have to be careful about that when we're talking about people if we're talking in private, we're using acronyms and not people's names. But in general, and like even like, if you're getting overwhelmed and need to blow off steam, you need to be like, "hey," like tag out my coworker, I need to go in the back and have a breather, not just think I can stand at the back of the room and be like "oh my fucking God, they're being so annoying," you know? Like, no, because everybody can hear you. So. 

Lucas Akai  31:28 

right 

Lily  31:28 

it's just an, it's a small room and it's like, can be echoey. And when there's all these different voices talking like that can even just be triggering for people, like the stimulation right? There's, say eight people in the room and a couple of people are having different conversations. It's like, "oh," with music,  it can be a lot. So yeah, I can draw a little map for next week. 

Lucas Akai  31:48 

That would be perfect for next week.  

Lily  31:50 

Yeah, sure.  

Lucas Akai  31:51 

So maybe kind of building on that, with it being such a small space and the clients all being centred in the same area, do you find that there are challenges in regards to the confidentiality and with each client and with their treatments? 

Lily  32:25 

There can be a little, I mean, we're doing the best we can and we're able to give people options as well. Like, if somebody's getting a fentanyl patch done, and then that means they need it on their back. So they got to pull their shirt up their back or something like we have first offer people a booth spot. A lot of people are, especially guys, are happy to just sit at a booth and do it. But if somebody wants that extra privacy, we can offer them the back doctor's clinic, if they have something private, they want to talk about, we're going to do our best to do it at a booth where we're like, quietly talking just one on one. Or for some people, we know that they're particularly sensitive to their information. So I might be like, "Oh, hey, I've got something I'm wanna chat with you about. Would you like to chat about it here or would you rather come in the back?" So that's, trauma informed cares, always giving people choice as well. So giving them the option, not just assuming or starting into something.  

Lily  32:56 

It's nice to say like, "Hey, are you comfortable doing your patch here, or if you'd rather, we could go in the back?" Some things are kind of just gonna happen out front regardless, like putting pills in your mouth. I don't think we need to go to the back for that, within reason. But we very much do our best to do that. And as staff not talking about behavioural issues or things that happened. If we need to have a quick debrief, then we need to go into the back, be like, "okay, somebody else cover up front, we need to go talk back here," close the door. So we can talk about people in terms of their acronyms instead of using their whole names. Yeah, we definitely do our best to maintain confidentiality. 

Lucas Akai  33:34 

And so with this, like, confined space, let's say where all the clients are in the same area, do you find that it's a positive because it builds community or would a larger space with an independent waiting room and treatments room still be preferred in that type of scenario? 

Lily  33:50 

I think for what we do, we're a good size and that if it got bigger, that could lead to a decrease in safety. Because when you add more people to the mix, there's more reason for people to feel unsafe or more people they need to trust, more people around, I think it gets their guards up more. We have a good functioning community here. I think we're at a good level of staff, to clients, to participants, to this. What we need is more of our sites in different places, not us bigger, more. I think that's what would be best. I think we're good size for what we do, but we just need to duplicate the amount across the city and country. But yeah, bigger in terms of size, I don't think necessarily, it'd be better. Smaller wouldn't be better either. But maybe we could go up to like six booths, ax, but like, it just adds more people and more things. And it's a comfortable level right now, to keep, keep everything in check. 

Lucas Akai  34:47 

And so you actually you mentioned not going like smaller in terms of size. But maybe do you find that you've, you feel the need to have a certain number of, of clients? Or, you know, if there was a smaller amount of clients, do you think that would be better? 

Lily  35:05 

Well, I think we need to like refresh. And I think we are going to soon once we had confirmed the funding was the people that are like on the list of people that can come in daily for meds, and just have, we haven't seen for months, those names need to get refreshed. And they can just be put into an outreach thing or given other meds they can pick up elsewhere. But if they're not accessing that list, and we hear from clients, too, they're like, "when are you going to let new people in? Like, I've got people that have been on this list since to you opened, that want in. People that would be here every day." So sooner than we do, I think we need to be refreshing the list of who's allowed to come and access these meds. Because we have people that are there every day without fail. It's weird if we don't see them, and we're worried. And then there's people that are like, oh, they haven't been here since July, like someone else could have that spot that would benefit from this every day.  

Lucas Akai  35:52 

And so maybe just for reference on that list of like, the daily individuals, maybe just estimate the number of total, even if they haven't shown up in the past little while. 

Lily  36:03 

Well, I think we're up to, we're at 75 right now. But um, some of those people are strictly outreach. We have about 20 on the su- fentanyl list, 10 on the fentora list. And I can't say on the patch programme, because I don't see that [track] as much. But there's like for as many people as we have in, there's also equal number of people in outreach, where we have an outreach nurse and an outreach support worker and systems navigator, going to sites doing wound care, fentanyl patch changes, they're not getting the su-fentanyl and Fentora, but in total clients, I think we're at 75 right now. But on a daily basis, if everybody came in with a list of daily meds, we could maybe get like 30, 25 to 30, which would like a really busy day, oh my God. 

Lily  36:49 

Because you've also got to think that some of those people can come for four doses a day. So if we have 20 people on the su-fentanyl list, but they can each up for doses an hour apart and we have four booths that people can use. That's a lot of like someone's sitting down, nurse checking their chart, getting their meds, giving it to them, giving them the chance to use some people can get it in in like five seconds, other people might take 20 minutes to get their shot to actually get into their body. And then they might fall asleep at their booth and we got to like wake them up and move them along and then clean the booth. Like, you know, that's four booths that I got to filter through all these people and triage their list. So there's only so many people we can cram in into the space on one day and that way, comfortably. 

Lucas Akai  37:32 

And so you mentioned that in terms of like, not necessarily like big crisis, of course, but in terms of like behavioural episodes is, you do have these differing measures that you take to help the other clients that are present. Are there things that you guys have in place outside of like, whenever there's a behavioural incident to just keep everyone calm and carrying on or is?  

Lily  37:55 

Well, yeah, just I mean, keeping it positive, light hearted like, seeing, like, seeing where they're at and what they need. Like sometimes people want to make art with us, sometimes people want to talk, sometimes people want to be left alone to sleep. There's one guy I play these word games on my phone with where like, you know, here's all the scrambled letters, like how many words can you make out of the thing like he just especially if shit's hitting the fan. I'm like, "hey, hey, you, you want to play some, play that word game with me?" and we sit on my phone together and it just takes his mind right off of it, so.  

Lily  38:25 

Other times, some of our folks that are still sleeping on the street just need to come in and have an nap and be like, "Hey, do you want me to not bug you for a couple hours and ask you if you want meds? Do you want to just sleep?" and they're like "yeah." So we just leave them alone because they're sleeping in a chair sitting up, right? It's the best I can do for now. Sometimes they need snack, sometimes they just need a place to warm up, wash their hands, wash their hair in the sink like, we see it all. It's a safe space community, it'ss a community that can come back to that they can trust and know that they're loved and not judged. So  

Lucas Akai  38:58 

And so by the sounds of it, you have a lot of face to face time with each patient  

Lily  39:01 

yeah  

Lucas Akai  39:02 

even just on an individual level between you and the patient.  

Lily  39:05 

Definitely. Definitely. 

Lucas Akai  39:06 

Do you do find that that itself is a challenge and just managing your time and, and the stress related to the job or?  

Lily  39:14 

No, because we're not always interacting like I don't know and some days we have more to give than others. Some days I'm kind of quiet and I don't feel very social. Other times I'm out there having fun and causing some laughs like, you know, we all just kind of go with where people are at in the energy of the room. And some days we have more to give than others. And sometimes things are appropriate. Sometimes they aren't. And yeah, it's just sensing where everybody's at. 

Lucas Akai  39:42 

And so a couple more questions just regarding the way you guys work and the challenges that you face. You mentioned that the atmosphere of the room can oftentimes dictate how everyone is doing, do you find that that's frequently a challenge to where, you know, one incident might, you know, take over the whole day or, and interfere with the overall practice? 

Lily  40:05 

No, it blows over pretty quick. I find it's more like things can get really hectic and busy. And that kind of increases the energy like, today, we were like, at capacity. And I've got like a lineup of people trying to ask me things, and my coworker's on his hour break, so I'm doing all this on my own. And I've got a phone call, I'm on phone, and another call comes in,  "oh, can I put you on hold" and "hold on, I can't answer your question yet" that, we have to really check ourselves and slow down. Because when our energy increases, it risks the clients becoming increased as well. So that's the part of how we have to be trained to work is to always be checking our emotional thermometer, I think they call it. Yeah, and just being aware, like if I am getting too stressed, or a behavioural thing is setting me off, and I can't respond in the same way then I need to tell my coworker, hey, I need to, I need five minutes. So I can come back to where I need to be. It's a lot of self care involved in that and communicating as a team so that it helps the whole. 

Lucas Akai  41:04 

And so is that like that um, the emotional thermometer and all those different aspects of just being able to watch your own progress throughout the day. Is that something that's like trained right at the start? Or is it kind of a learn as you go type of? 

Lily  41:18 

Um, no, that was actually external training I received through, it's called the nonviolent crisis intervention training, and how to de-escalate or de-escalation training? Not not not necessarily everybody has been given that we're having an extra training workshop in in December. I mean, I learned a lot of this because I have a master's in therapy, right? So I learned a lot about therapeutic presence and how to be working in a therapeutic role with someone is You, yourself too, it's not just showing up however you want. There's a lot to say about body language, tone of voice, our response and that, so I have a lot more training and education in that. Also put it into practice for many years. And then there's these more practical courses that are also really helpful. 

Esther Cheung  42:03 

Is that going to be in early December? 

Lily  42:11 

I think it's on like, the sixth and 14th, maybe? I think it's, there's two dates, I think they said sixth and 14, something like that.  

Esther Cheung  42:20 

That's great.  

Lily  42:20 

Kind of like day workshops, and I'll get to do the opening and then like attend one of them and then open for the other, paid course, paid training. I really like that my work incorporates a fair number of workshops and training. We, a couple months ago we did one on sensory stuff. We have somebody with sensory processing disorder come in and even just for how our coworkers work as well, right, like being aware of, I guess, like you know, just the spectrum of people's different sensitivities and how to be aware and mindful and accommodating to clients and coworkers in that. So I really love the amount of training opportunities I get through my work that my other job didn't have as many. 

Esther Cheung  43:02 

Yeah, that might be a good place to wrap up for today. But that's very good to know. Maybe we can focus on that for one of the future, future conversations? 

Caitlin Burritt  43:13 

That brings us to the end of this episode of the Unsilencing Stories Podcast. To listen to more interviews in the series, please go to www.unsilencingstories.com, and if you'd like to share your thoughts on the episode, message us at unsilencingstories@gmail.com. Thank you for listening.