Rosie's Place Fall Newsletter 2016

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FALL 2016 Rosie’s Place Works to Dispel “Bag Lady” Stereotype The Story of a Special Guest Our Executive Director Reflects on Our Community of Acceptance

NEWS

Gearing Up for Election Season The Glass Castle Author Will Speak at Annual Luncheon October 13

Rosie’s Place Provides a Welcoming Environment for Guests Living with Mental Illness

Q&A

MEGHAN PUGACH

MENTAL HEALTH WORKER Clinical psychologist Meghan Pugach joined Rosie’s Place from partner agency Brookline Community Mental Health Center a year ago to boost our mental health support for guests. She brings to the job a deep background in counseling, particularly with underserved populations. For her doctoral dissertation at Boston College, she researched the challenges poor women face when looking to an inadequate mental health care system for help. What she learned motivated her to offer something more to guests at Rosie’s Place. Can you tell us more about what you discovered in your Ph.D. work regarding the challenges women face in getting help? Challenges in accessing and maintaining mental health care include long waitlists, inflexible policies or procedures, and having little choice in your therapist (most often low-income clients are assigned to interns who turnover within the year). From my research I learned that once low-income women are in treatment, three overarching themes are most important to promoting buy-in and continued participation: the therapist’s awareness of the realities of living in poverty; the quality of the therapistclient relationship, built on a view of the client as a person, not a case or a constellation of problems; and an ability of the therapist to offer practical support in addition to emotional support (i.e. realizing that to realistically help someone, linking them to resources to access basic material needs is just as valuable and important as processing their various thoughts and feelings linked to their depression). What are your primary responsibilities here? I try to put out emotional fires by helping a woman in crisis at that moment. I will assess risk for suicide or violence and if necessary, help her access emergency services and sometimes even accompany her to the ER. I am also available to see women for supportive counseling. Often I help link guests to mental health providers if they are not currently receiving care or if the care they are receiving is not meeting their needs. I also help guests with applications for services through agencies such as the Department of Mental Health (DMH) or the Department of Developmental Services (DDS), and can perform clinical assessments to help with the application process. Through DMH a guest can connect with a collaborative team of providers who can offer help with case management, housing, medications and other treatment. Because Rosie’s Place has no government affiliation, we can remove some structural barriers to care and be more open. I can let the guest guide the work; we can be flexible and meet the women “where they are.” How do we counter any stigmatization guests face outside Rosie’s Place? I think the most important thing we can do is to recognize that the women we work with who have mental illness should not be defined by it. It is a part of them, but just that—a part of a whole person whose life is comprised of a range of experiences and strengths (not just difficulties). When I interviewed women for my study, so many commented on the significance of seemingly small gestures of kindness and/or authenticity that affirmed for them that they were seen as a fellow human being. Connecting to someone else who treats you in a mutual, collaborative and humanizing way is what matters most to our women—far more than a degree or a fancy treatment protocol ever could.

At Rosie’s Place, women living with a range of mental health issues have been welcome since the day we first opened our doors, 42 years ago. They are never demonized here but treated with the same acceptance and love shown to each of our guests. We work every day to erase the stereotype of the “bag lady,” replacing it with images of women who reach out for the support they need and bravely work towards a better life. “Given the pervasiveness of trauma in their lives, many of our guests grapple with depression, anxiety, PTSD or psychosis,” says Sandy Mariano, who oversees direct services as Vice President of Internal Programs. “We are mindful of treating all guests with respect and giving latitude to difficult and unintentional behavior.” Fifty years ago severely mentally ill persons were housed in public psychiatric hospitals. Today nearly all of those institutions are closed, but they were not replaced with a coherent care system, leaving thousands to navigate a fragmented network of community services or just give up. “There are not enough services available for our guests,” Sandy adds, “and, unfortunately, MassHealth patients encounter the most hurdles to care.”

Rosie’s Place provides a range of services to assist guests living with mental illness. We work with the Department of Mental Health (DMH) to have a member of their Homeless Outreach Team visit weekly to

Nai’s Story Nai grew up in an affluent family in Egypt that emphasized education for Nai and her sister. In school she mastered English, Spanish and French as well as her native Arabic. She came to Boston on a student visa at age 18, and went on to earn a nursing degree from Boston University and later a master’s degree from Yale. While working as a nurse at Massachusetts General Hospital she met her husband, an American citizen. They soon had a baby girl, Cotti, but Nai was abused by him and rejected as a foreigner by his family. She left him when Cotti was three years old, around 1969. A few years later, Nai and Cotti barely escaped a fire in their Chelsea apartment building. Nai, who received no support from her ex-husband, lost everything. She often said she thought he was responsible for the fire; this may have been when her paranoia began. Then, while walking Cotti to school, Nai watched as her daughter ran into the street and was killed by a motorist. Nai’s sister Fifi flew to Boston, collected Cotti’s body and brought it back to Egypt to be buried in their family’s tomb. Nai wanted to stay for the trial of the man who hit Cotti, a physician. Nai was devastated when he was acquitted.

connect our most critically mentally ill homeless guests with their services and transitional housing. We also have hired our own mental health clinician who provides supportive counseling to guests, advice to staff and other services. (See Q & A on this page.)

Recently, The Boston Globe began a series of articles investigating a crisis in the mental health care system in Massachusetts. While the stories correctly pointed out the myriad ways persons who are mentally ill are not getting the services they need, many mental health activists objected to a focus on the violent behavior of a handful of individuals. With so little attention to this issue, they protested, why sensationalize the lives of the people who need help and understanding?

We are mindful of treating all guests with respect and giving latitude to difficult and unintentional behavior. Sandy Mariano, VP of Internal Programs

Rosie’s Place Advocates meet individually with guests and often work to locate hard-to-find inpatient beds and available clinical services. In addition, our housing stabilization workers refer guests with acute physical and, especially, mental health needs to our Community Health Worker Program. Among many services, such as finding medical and behavioral health providers for guests, program manager Guissela Mariluz helps improve communication at medical appointments. She often finds that women who are severely mentally ill are not treated with understanding and respect by health professionals. Guissela is present to support guests and intervene on their behalf, leading to more positive interactions and better care. “For a long time, I heard from our guests that they were being stigmatized and mistreated,” Guissela says. “I am able to speak up for guests and help them get what they need. And the health results are better when I can encourage our guests to stay connected to their providers. I believe it will make a positive difference.” Rosie’s Place will continue to do what is within our power for guests living with mental illness while pursuing all external avenues for their care. “We can provide clinical services here and referrals,” Sandy says, “but, for many guests, all they want right now is a safe place that is loving and nonjudgmental. And we can do that, too.”

At this point, Nai’s life began to really unravel. Nai never applied for citizenship and eventually, she lost her job, overstayed her work visa and ended up homeless. For decades after, she bounced between having housing and living in shelters or on the street. “Nai revealed her story to me very gradually over the 15 years we knew each other,” says Vice President for Internal Programs Sandy Mariano. “I met her at Rosie’s Place when I worked for the Department of Mental Health (DMH). She was a little wary of me at first but I persisted, stopping to say ‘hi’ or to have a conversation. She slept on our ramp or in the bus stop shelter then in front of Rosie’s Place, with the occasional stay here or at the city’s Woods-Mullen shelter. When I began working as an Advocate at Rosie’s Place, we met regularly. I repeatedly tried to see if we could secure her some benefits, but she refused to provide any real information regarding her identity, making the process impossible.” Over the years, Nai survived two massive heart attacks–one took place while in our shelter and the other was when she was living on the street. She was able to get

housing after the first incident, but lost it because of her hoarding. After the second event, she agreed to go to Parker West, a DMH transitional program. Nai could be challenging to work with because her mental health issues were so prominent and hoarding and argumentative behaviors caused her to jeopardize her housing. But that was balanced by her many wonderful qualities: she was quite smart, interesting, charming and kind. She was appreciative of anything she was given and would knit scarves as “thank yous” with a stitch she said she created. She had a hard shell, but once Rosie’s Place was able to crack it, she felt safe enough to receive help from all of us here. Continued on Page 2

Sandy, Nai and Jane at Logan Airport


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