|Bay Window : Hope on the Street: Q&A with Ken Lim, City of San Francisco Outreach Worker
What are the major issues that the mentally ill homeless on the streets face?
When they are very ill, they often have a hard time realizing that they need treatment. Trust is a big issue. In some cases, I have worked with clients for three or four years before they are willing to come into the clinic for treatment or before they would even talk about their needs. There is a lack of education for many people on the streets. They often think that hearing voices or the other symptoms of mental illness are part of who they are and cannot or should not be treated.
Are there cultural differences that you need to be sensitive to in the field?
Yes, but once these people get to the point where I have contact with them, they are already on the street, so we need to treat them as we would anyone. I look at homelessness itself as a culture. When you see a homeless encampment, they are like a community - looking out for one another. Often, these people cannot trust others outside of their "family" in the encampment. We try to be sensitive to the needs of the entire encampment when we do outreach work there.
Are people in the encampments scared of you?
Sometimes. They are scared of us because we work for the city or the mental health system and think that we just want to take them to the hospital. In fact, the hospital is the last course of action we take when we visit people.
How do you and other outreach workers develop relationships with your clients?
We outreached to Sandra (who is in the film) for five or six years to build the relationship. We started by checking on her and occasionally bringing her some food or items for her basic needs, like a toothbrush. We would try to talk to her, but often she would walk away. These visits were sometimes as short as five minutes. Over time we were able to gain her trust.
In general, there is a lot of relationship building. We try to go at the pace that the client is comfortable with. If they think you are going to put them in the hospital, they will not trust you.
How do you find your clients? Do you go looking for them?
No. Generally, police officers, city workers, merchants, and other people on the street refer most of our clients to us. We will initially try to establish if the person is already in the mental healthcare system and try to get as much background information as we can. Often, we donít have a name of an individual, just a description. We try to locate the person and begin outreach. Generally, we bring some food or clothing to them and just try to build the relationship, unless the person is injured or a threat to themselves or others. Then, we have no choice but to try to treat them.
What have you done to develop your relationship with the people we see in "Hope on the Street"?
City of San Francisco agencies and CalTrans referred Sandra to us because she had been living at the CalTrain station for quite some time. Sandra was being taken care of by people who were getting off the train in San Francisco and giving her clothing and food. We were eventually able to get her into a treatment program and got her taking medication for her mental illness.
I was in contact with a beat cop who called me about Richard. He had been hospitalized several times, but when released, he would always return to the same block. I worked with the police department and San Francisco General Hospital to develop a treatment plan for Richard, so we could keep track of him and make sure he got the proper treatment he needed. Eventually, we were able to contact a family member, his niece. We continued our work and she became involved in the treatment plan for her uncle. The development of the relationship with Richard was over the course of four or five years.
Are the cases we see in "Hope on the Street" typical or are they unusual?
In some ways they are both typical and unusual. Generally, we donít know anything about the client. We were lucky in that we were able to find out more information about Sandra and Richard, which allowed us to get their families involved in their treatment. We always try to establish a relationship and build trust. We always try to help with the client's most pressing needs. That could be housing, money or medication. We can't force the client to do something they don't want to do. For example, we cannot force a client to take medication, but we can work with them on their own terms and help them find housing.
What do you see in the future for Richard, J.J. and Sandra?
In my mind, I always want to see a better place for all of my clients. It's one of the ways that I keep my enthusiasm for my job. Part of the reason I work in outreach is because of people like Sandra and Richard. I hope that one day Sandra will be reunited with her family. And in Richard's case, he is much better off than he was a few years ago. He is taking medication, he is off the streets and is receiving care.
Do you consider these success stories?
I think that if their lifestyles have changed for the positive then it is a success. If I can help them turn the corner and help them change their lives a little, that is part of success. In some ways I have hope that my clients can one-day return to mainstream society and work. For example, look at J.J. He is able to work and has integrated back into mainstream society.
My clients were not born into this situation. They have at one time led normal lives. Richard was in the Armed Forces; Sandra had a family and a job. Their problems developed over time and I hope that one day they can work out their problems and return to society. I see a future for these people. That's what keeps me going in this job.
Speaking of that, how come you become a social worker?
In high school, I did some student work at a day treatment program for the mentally ill. This was my introduction to Social Work. When I went to college I knew that I wanted to work with people. I liked to talk to people, so I majored into Social Work. After college I worked at a youth organization doing counseling and therapy, but wasnít satisfied with the work. I knew I wanted to get my Master's degree, so I went to Graduate school, where I interned at a mental health facility. After graduation I worked within the mental health community and eventually became part of a mental health outreach team, where I was working with the homeless population.
It was very difficult for me in the beginning. For the first three months, I would go home at night and I felt like crying. At the same time, I felt that if I could help one person at a time to turn their life around a little, that would be my reward. That has kept me going for thirteen years in the mental health field.