Case History - Sara
© Faith Ash 2001
For fifteen years I`ve worked with schizophrenics, manic depressives, psychotics, and autistic individuals in government funded group homes for the mentally ill. Throughout that time I've gained an insight into their lives and have had invaluable experience dealing with their bizarre behaviour. Outsiders have often asked me what it's like working with schizophrenics from the viewpoint of thinking that all schizophrenics are the worst case scenario. My answer is usually to ask them, "What do you think it would be like to deal with a member of your family?" However, this is not enough to overcome their preconceived notion that schizophrenics are 'just sick'. They also say things like, "Aren't you scared of them?" to which I reply, "Why would I be afraid of a schizophrenic? They're just the same as you and me, only sick."
Often the schizophrenic's coping mechanisms are at such a low ebb that they require a lot of help just to deal with everyday problems and the strangers (staff and other residents) they have come to live with. This presents a tremendous challenge for the care givers who need more than the usual amount of patience, understanding, kindness, and an ability for quiet problem solving in order to make the resident's lives manageable.
These are the challenges we, as group home care givers, are faced with every day we go in to work. But, in other ways it is like every other job that deals with people; some times it's boring, sometimes challenging, and sometimes heartbreaking. In my work with these unfortunate souls I have experienced, along with them, every range of human emotion a person can have. Learning and experiencing this range of emotions, and seeing the schizophrenic in action, is to see the raw truth of what we humans really are behind our facade. The truly sick person usually cannot hide their true feelings; they express anger, hurt, or passive emotions, even though they may not be conscious of why they are angry, hurt, or wanting to withdraw.
The schizophrenic finds it very difficult to trust anyone. I've found that it usually takes about a year, from the first bit of evidence that they might be wanting to trust, for it to build into something we can work with. I would tell the new workers that came on staff, the ones trying to tell me how a resident was feeling or what they wanted, to come and tell me that same thing after they had worked with them for an entire year. Of course, when the year was done (if the same staff member was still there) it was a different story. Take the case of Sarah, for example. The first time I met her I was at a Christmas party for the residents when this girl came rushing up to tell me how much she loved my nails and nail polish. She was all smiles, very exuberant with hugs and kisses and, in fact, behaved very inappropriately. I did not know her background as I was working at a different group home at that time. Later I changed jobs and ended up in the home in which Sarah lived. I learned she was from East India, spoiled, childlike, and very aggressive. She acted like a twelve year old and seemed to need more than her share of attention. She was so demanding that none of the staff liked and refused to work with her. Slowly I began a rapport with her realizing her need to be treated like a child. She needed to learn respect for others and how not to be inappropriate.
At about this time the status of the facility changed from Adult Mental Health Group Home to Adult Rehabilitation Group Home. Our job description also changed so that we were now care givers and case managers which meant we would be one on one with the residents. Our facility was now going to be a stepping stone for residents to learn how to cope in the outside world and live independently. So we were now called a Rehabilitation Adult Group Home.
At this point, since no one would work with Sarah, I felt compelled to step in. I did not fully realize at that time what I was getting into. She really was spoiled, had no manners, was very aggressive, and did not look after herself properly. In short, she was abominable.
The first thing I did was to set up core plans for her which meant sitting down with her to figure out her goals both long and short term. Long term she wanted to have her own apartment. Short term she needed to learn to budget, cook, clean, and look after personal hygiene so that she could reach her long term goal. I set up charts for her to follow with a reward system of colors (red was her favorite so that was used for jobs completed; blue meant she needed to work a little harder on that part of the program, etc.) that she was delighted to get for doing good or getting coloured stars when she successfully completed a task.
She was spending all her money on cigarettes and since she had a small incentive job (which stores will give to residents with assistance from the government) she made more than most of the other residents. But all her cigarette money would go up in smoke the first week of the month. So, we sat down together to decide how she could change the situation. We made a chart to show how she could smoke just so many cigarettes each day and make them last for longer than a week. Other staff members wanted to doll them out for her but I felt it would not help her learn self control. I told Sara it was up to her whether she wanted to use the chart or not but once her cigarettes were gone there would be no more until next day. It took almost a year but finally she succeeded. We also worked on her budget and she eventually managed to save three hundred dollars for her Christmas fund and emergencies or, if she wanted, something nice for herself. In her cooking program Sara eventually learned to make meals for the entire house and she even cleaned up afterwards. She also learned to keep a regularly timed hygiene schedule and eventually took pride in looking nice. However, these successes only manifested themselves after many a temper tantrum and, at one point, a refusal on my part to continue as her case manager. She begged me to work with her again and gradually began to make changes. Eventually she began to quiet down, learned respect for others and their privacy, stopped asking personal questions of strangers, and began to better care for herself. After working so closely with her for those four years I can happily say she reached her long term goal of living in her own apartment and is doing very well with her family's assistance.