CHARITY EUGAIR

Eighth in a series

What defines a crisis? While there’s apt to be more than one right answer, I was taught that a crisis, fundamentally, is a critical situation in which the demands exceed the resources available to meet them. A crisis often feels like “we can’t get there from here.”

In the work of crisis response, we never know what a day will bring. Whether we are working in mental health (as I do), emergency housing, law enforcement, EMT service, emergency medicine or domestic violence, the assignment is wildly different from day to day, but the job description is always the same: “Figure it out, whatever it takes.” 

As a clinician on CSAC’s Emergency Team, working many nights and weekends, I am grateful that most of the time we can pull together, and weave together solutions. As a community, I think we do an honorable job of combining our respective resources and services to bring hard, and even dangerous situations from a crisis status back to a manageable one. 

However, the crisis I run into that seems the hardest one for us to team on is homelessness. More than with most problems, there are a litany of causal factors in homelessness (mental health being just one), and a gravely slim range of solutions. While our community is lucky to be more resourced with shelter than many, homelessness is a crisis steeped in powerlessness. Not just for those experiencing it, but for all involved. 

None of us respond well to powerlessness. It’s one of the hardest things to hold, especially where there is suffering and vulnerability. Especially when we are afraid. For unhoused people in need of care, powerlessness might look like problem behaviors, ill-chosen expressions or even crimes, inspiring conflict among citizens. For those working to respond, powerlessness can manifest within our network of partnerships as blame, criticism and divisiveness. 

When crisis response depends on community partnerships, we cannot afford to let our sense of powerlessness in the work silo our services. 

To be fair, I acknowledge that this isn’t easy. When the limitations of our work (and others’) leave risk on the table, our unchecked powerlessness can breed criticism quickly. Fear and anger have been old friends for all time. I’m not immune to big frustrations and occasionally grumbling about what I wish someone else would do differently.

In mental health we are frequently criticized for not doing what people expect in the face of disruptive, and even risky, mental health presentations. At least once a week, someone is exasperated with me about why we won’t just “put them in the hospital,” referring to someone whose troubling behavior is assumed to be mental health related. Our least-loved tool, the Emergency Exam application, is what we use to involuntarily hospitalize people, a last-resort safety measure when “imminent risk of physical harm” is driven by mental illness. 

Since the use of this tool revokes a person’s constitutional freedom we exhaust numerous alternative crisis interventions first, including Mobil Crisis response, Interlude (a peer-based support program), and Rapid Access, which offers holdover services while people await therapy. People want us to use hospitalization to impose treatment on those who need it and refuse it. However, involuntary hospitalization is not created to support people or help them heal, therapeutically. It’s not designed to motivate them or build trust in the care system. Involuntary hospitalization is an imposition of profound powerlessness upon someone who already feels that way, and it’s meant to keep them, and others, alive. That’s it. 

Each agency or community partner has some version of this — something people desperately demand that they can’t provide. In crisis response, the space between what we want to do and what we’re empowered to do can be a dark one. The powerlessness we feel in that space widens the gap and, if we are not mindful, can undermine our efforts. 

The antidote to this powerlessness is not power. It is not policy, or research or even funding (though more of both would be great). The antidote to powerlessness is curiosity, and this is exceedingly hard. It’s not easy to maintain curiosity under duress. Wonder and fear are not old friends. This, of course, is why we must reach for curiosity proactively. Doing so doesn’t hinge on what we know, rather it requires that we consider what we don’t know yet. 

I’m grateful to see curiosity at work in Addison County. At CSAC, we invited law enforcement leadership to our table in January and have ongoing meetings planned to help us understand each other’s work and collaborate more effectively. Having worked in domestic violence in Rutland County, I’m thrilled to learn about conversations aimed at integrating elements of the Project VISION model here. Project VISION is a Rutland County coalition comprising over 300 partners, who collaborate as guided by a shared ethos that addressing challenges exceeds the capacity of any single entity. Some of the most challenging outcomes of my work in Rutland happened because of Project VISION partnerships. 

Where the crisis of homelessness is concerned, there is no easy answer. I think we’re all a long way from transcending the powerlessness that comes with it. In the meantime, we must work just as hard on working together as we do on living together, strive to maintain curiosity and give each other some grace along the way. It is the best chance we have of getting there from here.

Charity Eugair is E-Team Clinician for the Counseling Service of Addison County, or CSAC.