I remember vividly the day I first met J; she shambled over to me with her blonde hair hanging in her face and asked me for money for the bus. I explained I wasn’t allowed to give money but would check the time of her appointment and buy her a ticket… but when I turned around she was gone. Through snippets of contact and information from other services I learned that she had severe health problems, experienced psychotic episodes and was sleeping in bin shoots. J was without benefits, and despite injecting heroin daily she was not in drug treatment. What struck me most about J was how alone she was – she refused to engage with any support services and was frequently attacked by others on the streets due to her vulnerability. J would beg frequently and although she didn’t walk up and down the street in the red light district, if someone offered her money for sex whilst she was begging she would take it. I can’t imagine being in the situation where I have to choose between sitting out in the cold for hours or having sex with a stranger to earn enough money to survive.
As I slowly got to know J through persistent outreach, I learned that she had experienced all types of abuse since the day she was born. She had experienced further suffering when she had to give up a daughter for adoption as a young mother, and witnessed the brutal death of a close friend. After all this heroin seemed like an appealing way of blocking things out, but of course it caused more problems than it solved.
The pace of change has been so slow it’s only when I sit down and reflect that I realise she has made some small but significant steps forward. In terms of her support once a trusting relationship had been established we agreed to focus on achieving a degree of stability, so I supported her to claim benefits and referred her to supported housing providers – she is now in suitable accommodation. J has reduced her drug use and is more motivated to make changes in this area – she is now in drug treatment. However since the heroin is no longer blocking things out, the fragile state of her mental health has become glaringly apparent so we are supporting her towards accessing more specialist dual-diagnosis services. J is also accessing healthcare and has visited the dentist recently. Sometimes she becomes very upset and her behaviour can seem frightening to others, but there are moments when she seems so vulnerable.
J is simultaneously fragile and extremely strong – I’m not sure I would have survived what she has had to endure. The fact that she is still here, has aspirations for the future and is willing to take risks in order to move forward is a miracle in my eyes. In terms of her goals J wants what a lot of us take for granted – a partner who she can trust, friends she can spend time with and to go to college as she is highly intelligent. My role is to continue to provide emotional support, reassurance and encouragement as well as opportunities to access specialist support. I also utilise techniques from CBT and Motivational Interviewing in order to encourage her to be more reflective about where she is now and where she wants to go. I have heard that government funded services are now being told that instead of being able to support people for 2 years, they have just 4-6 months – I am fortunate to work for an organisation that will be there for as long as it takes for clients to have a more positive future.