Tag Archives: suicide

The Women of Can’t Catch a Break: January 2017 Update

Life is never boring for the women of Can’t Catch a Break. Over the past months they’ve faced serious health problems; they’ve struggled to care for their children and grandchildren; they’ve suffered at the hands of violent men; and they’ve remained trapped in an institutional circuit that often seems to present more hurdles than actual help. Yet that is not the whole story. Many of the women continue to build and draw upon social networks that provide them with places to stay, help with childcare, emotional support, and medical advice.

See Summer 2016 Update to catch up on the women and to help put the January 2017 update into context!

 

Andrea has not been well. Though trim and fit-looking (she’s an avid fan of exercise tapes), she’s been having trouble breathing and her body has been retaining fluids for almost a year. By December 2016, after a string of hospital stays, she was placed in a nursing home. When we spoke she told me, “I hate to tell you but my heart and lungs are not doing so well, so they brought me here. There’s nothing they can do for me at the other hospital.”

I’ve known Andrea for almost a decade and I still can’t tell whether it’s stoicism, fatalism, optimism and / or complete trust in modern medicine, but she was far more upbeat than I imagine that I would be in her situation. As always, she is comfortable staying in a medical institution — perhaps more comfortable than staying at home. Unable to read (she has had mild cognitive disabilities all her life), she finds navigating daily life on her own to be a challenge. In the hospital or nursing home she is looked after, there are professionals around who can explain things to her, and with her friendly demeanor she can always find a nurse or other staff person to chat with her for a bit. “I’m fine, Susan,” she told me. “I’m holding my own. I can still tell jokes and whatnot.”

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Carly (see “A New Home for Carly“) still has not received her baby back from DCF (child welfare department.) Without the baby, she is no longer eligible for the housing subsidy for her two bedroom apartment. For several months after losing her apartment she was on the streets. As of this writing she is couch surfing with a “friend”. (I put “friend” in quotes because Carly has a long history of being taken advantage of and even robbed and raped by so-called “friends”).

Since the baby was taken away, she has become extremely distressed, tormented by hostile spirits, suspicious of conspiracies to hurt her and to steal her baby, and hospitalized (voluntarily and involuntarily). During one hospitalization, “I was shot full of drugs – of Haldol. That’s why I won’t go back there.”

Through all of this, she remains focused on getting her baby back and attends frequent meetings and appointments with social workers, court-appointed psychologists, lawyers, and doctors. She carries around a large pack with her everywhere she goes. The pack contains “all the papers that prove that the baby is mine and that I took care of her properly. I have her umbilical cord, her footprint from the hospital, and records showing she had her infant check-ups.”

I have spent a great deal of time with Carly and honestly cannot figure out how much of what she does and says has to do with her deeply held belief in the active presence of good and evil spiritual powers in this world; how much may be symptoms of mental illness — even psychosis; and how much may be simple naivete. I can say that from what I’ve seen she took proper care of her baby, but I acknowledge that Carly likely tries to show me that she is stable and competent. I don’t envy the DCF workers, psychiatrists and judges who ultimately will decide whether the child is better off with Carly or in foster care.

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Daisy remains limited in her ability to care for herself, but both of her children have stepped up and are able to help her out. Her son has arranged for a supermarket to deliver food to her at regular intervals. She is not up to cooking (she is allowed to use the kitchen in her rooming house), but can prepare simple breakfasts and frozen meals for her lunch and dinner. She continues to enjoy the program for disabled adults that she attends three days each week, and considers the other people there to be her friends. And, “I do my laundry every single weekend.” She sees her daughter at regular intervals and her son and his wife took her along on a road trip to Ohio to visit her in-laws for Thanksgiving.

She does feel lonely much of the time (on the days she does not go to her program she rarely talks to anyone), and spends more time than she’d like cooped up in her room watching television.

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Francesca (see “The Bitch at the Welfare Office“) is still living in a working-class suburb with her son and younger granddaughter. She is busy raising the child and has landed a part-time job at a local supermarket. She does not earn enough to be independent, and continues to rely on her son and boyfriend (she has been in several serious relationships during the past year) for financial support. Unfortunately, that support comes with strings attached. In the case of her son, the strings are expectations that she take on the lion’s share of child care. In the case of her boyfriend, the strings are a matter of exerting control over her time and activities. But overall she is happy with her current life and posts encouraging comments on Facebook at least once a day.

One of Francesca’s greatest assets is her ability to nurture social ties. Over the years she has maintained a strong relationship with the mother of her older grandchild. That relationship is paying off now as the two women help one another with child care. All in all, Francesca has managed to create a safe, cozy and loving family and home for her granddaughter.

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Ginger (seeThe New Price of Freedom“) is back in touch with me on a regular basis! In the summer and early fall she was living on the streets. When I ran into her she told me she was smoking a lot of crack and staying with her “trans mother” (an older woman who had helped her come out as trans when Ginger was in her teens.) A mutual friend told me that he saw her fish around in the garbage and take out a cup and then sit down on the sidewalk with the cup in front of her to panhandle.

A few weeks later she called me from a “safety” phone that she had been given by an agency that helps homeless people. She had moved in with her Aunt after “a homeless man from the Boston Common hit me in the head.” She had a concussion and spent three days in the hospital. When we got together for coffee she told me that she actually had been beaten up three times by the same homeless man who called her “ugly names” because she is trans. When she went to the police they told her they wouldn’t do anything because they told people to stay out of the Common at night. She also had her ID stolen. When she went to meet with a housing advocate he told her that she needs to get her ID first. For Ginger, this is a pretty overwhelming task, involving visits to various offices and paying fees that she cannot afford to pay.

Throughout late fall and early winter she has stayed off crack, resumed her beloved weekly bingo games, and returned to the excellent doctor who has helped her with anti-depressants and hormones over the years.

In November she moved in with an old boyfriend who lives in a rooming house (SRO) but, “We got into a domestic dispute. He hit me over the head with a lamp.” I asked her if she called the police. She said she couldn’t “because I’m a known trespasser [in his building] and they’d arrest me.” For now, she is staying with his brother and trying to move forward on getting her own housing.

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Isabella (see “Failure by Design: Isabella’s Experiences with Social Services“) continues to grieve for her late husband. Over the past months she’s lived in several different apartments, each of which turned out to be problematic. She has come close to getting a job but in the end things have fallen through. She continues to help out friends and acquaintances who need to get into detox or who need help managing their methadone regimes or other drug-related health problems.

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Joy continues to cycle through psychiatric wards throughout the Commonwealth of Massachusetts. In September I visited her in a locked psychiatric ward where she’d been taken after attempting suicide. She told me that she had overdosed. “I just tried to end it. But someone found me and here I am. I woke up in the hospital with tubes everywhere. They told me I almost died. … I had not used drugs for a long time. I got high that one night to kill myself.” The person who found her called 911, and then stole her phone.

A long chain of miserable events had led her to the point of wanting to end her life. Both of her parents have been unwell and may not be able to care for her daughter for much longer. She did not have a place to live and had been staying with a man who constantly criticized her and told her that she can’t do anything right. And she’d spent the previous month in prison. “A drunk woman started fighting with me [in the street.] I slapped her to get her to let go of my hair, and the police arrested me. I was still on probation from [an old] charge of soliciting a police officer [for sex] so they locked me up. I asked them to take me to a hospital and the police refused. When I saw the judge after a month he said to me, “You’ve been in my courtroom at least twenty times. I see that you have paid all but $260 of your restitution and fees [on old charges]. That’s enough. I’m releasing you on time served and remitting the remaining payments. Your probation is terminated.” Joy plead guilty (she told me she didn’t know why) “and that was that. I was released.” Unfortunately, on that same day a former boyfriend who had beaten her up (badly) was in court on the domestic violence charge. Because she had to come to court for her own hearing she was not able to go and testify at his hearing, and he was released. She asked to be able to go and testify but “I was told that wouldn’t be possible because I had to appear at my own hearing.” After he was released, Joy said, he told people that he would track her down wherever she went. She is terrified of him.

While we chatted at the hospital I noticed that her eyes were puffy and her speech slightly slurred. She said she was given Librium to help detox from alcohol – she had begun drinking over the summer and had become addicted. She’d also been put on Haldol and a few other psychiatric medicines.

Her hospital caseworker joined us and we talked about where Joy would go after the hospital releases (at some point in the next few days.) The caseworker had been tasked with setting up Joy’s outpatient therapy, not with finding her a residential program. Joy made her own call to a rehab program she’d been in previously and was told that they couldn’t take her unless she detoxes there first. “But I’ve already detoxed here! They told me to get high and then come to detox and then I could get into the program.” The caseworker confirmed that this is indeed the case, and told Joy that, “You need to do what you need to do to get into a program.”

We asked the caseworker about getting Joy into a group home under the auspices of the Department of Mental Health (DMH). The caseworker explained that group homes only accept people coming from state mental hospitals and Joy is not sick enough to need to go to the state mental hospital. I pointed out that Joy has repeatedly tried to kill herself. She replied, “Joy is high functioning and does not fit the criteria for a state hospital. What you need to do, Joy, is go to a homeless shelter. They will work with you to help you save money so that you can get an apartment. You need to get a job and then the shelter will reserve a bed for you. You need to go to your outpatient appointments and see the doctor. It’s a lot of work but you have to do it. It’s up to you to do the work.” Incredulous, I pointed out to the caseworker that Joy cannot get a job or an apartment. She has three felony convictions, has been homeless since age 18, and has already been in just about every shelter and program in the state.

We then asked what will happen if no placement is found for her when she is discharged. “You will be given two weeks supply of your medication and we’ll set up an appointment for you with an outpatient psychiatrist.” Joy pointed out that it takes longer than two weeks to get an appointment.

The caseworker was not being mean-spirited. Rather, she was a very young woman with no concept of the realities of life faced by someone like Joy. My sense is that she truly believes that if Joy tries hard she’ll make things work.

By November Joy was in another locked ward in another hospital – her third of the fall. When we spoke on the phone her speech was slurred from the medication they gave her. “They are discharging me today – couldn’t find a program or placement. They’ll pay for a taxi.” She told me that she would be going back to [the emotionally abusive] man she’d been living with when she’d tried to kill herself in September. She knew this wasn’t a good solution, “but I have nowhere else to go.”

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Kahtia (See “Prostitution, Decriminalization and the Problem of Consent“)

Throughout the first part of the fall Kahtia was doing well – volunteering everyday at a soup kitchen and attending multiple AA and NA meetings each week. With pride in her voice, she told me how many people the soup kitchen feeds each day and how much the staff appreciates her dedicated work. Most important, the family court judge told her that if she continues doing what she has been doing she will get her daughters back from DCF custody in a few months.

Her daughters were not doing as well. They had been taken away from their third foster home because the foster mother hit one of them. Now in foster home number four, one of the girls had become very introverted. The new foster mother took them for haircuts, which she is not supposed to do without Kahtia’s permission. “She gave them yuppy hair cuts. I mean, they look cute but it’s not what I would have done.” Kahtia expressed concern that the girls will become accustomed to living in a wealthier household and will resent her when they come back home to her.

Later in the fall Kahtia called to tell me that, “I am going through the worst thing in my life. DCF entered a charge of sexual and physical abuse against my husband [the girls’ father]. They haven’t told me any details and they’ve canceled home visits for the girls.” The story, as best as she can figure it out, is this: Quite a while ago, before she lost the girls, they told her that “Daddy touched me”. She took them to the hospital where they were examined but there were no physical signs of rape and no follow-up inquiry. Several months into their foster care time they said the same thing – that “Daddy touched me” (apparently referring to the same incident.) The girls spoke with their therapists but nothing more was said and nothing else happened. Then, almost a year later, in their third foster home, they mentioned it again. “They sent them to a  trauma specialist – I don’t even know what that is – and now the whole thing is under investigation. I don’t know why they talked about this now. Did something new happen in foster care that triggered them to say this? I don’t know what is going on. I don’t know if my husband really did hit or sexually abuse the girls. I feel guilty for not protecting them. Or if the whole thing is made up by DCF? I don’t know. I’m devastated, Susan, especially, you know, because I was a victim of incest and of rape.” She told me in tears, “All I ever wanted was a family, a husband and my children, a house with a white picket fence and a dog in the back and a cat on the window sill.”

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Melanie‘s doctors seem to have stopped looking into her medical problems and are concentrating solely on her PTSD. She has been placed on Disability (SSDI), which does not please her. But she is allowed to work part-time and has arranged to return to the shelter where she had been working, albeit as a “relief” staff rather than a shift supervisor.

Her big news is that — after several tries — she passed her test for her learner’s permit. She feels that she is able to drive, but because of her learning disabilities she’d “bombed” the written test. This time she was allowed to take the test with pencil and paper (instead of on the computer), and the person who administered the test was nice, which allowed Melanie to relax and focus on filling in the right answers. “I feel that everything is coming together!”

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Tonya (see “Knowledge is Power“) is still living in the same apartment. She is dedicated to raising her son and helping out with her grandchildren. Much of her time and resources are eaten up by  family members who come to her for a place to stay and assistance of various sorts.

Her son is now in school and there is no role for her there as a volunteer. “I need something to do but don’t know what to do.”

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Vanessa, now a grandmother, is staying at a homeless shelter. She has not had stable housing for several years. She looks forward to holidays when she can come stay with her mother for a few days. Other than those visits, she seems to be holding steady — no major disasters but no progress in terms of housing or employment.

 

To read previous updates click on:  Summer 2016  New Years 2016   Summer 2015   Christmas 2014 / 2015    Fall 2014 

 

 

Suicide is Painful, Update

Last week I wrote about my friend Joy, a woman who has dealt with sexual violence, homelessness, substance abuse, humiliation and criminalization since she was in her early teens. A few days earlier she had tried to end her life. Precipitating the suicide was her realization that if she kept using heroin she would not survive. She made the tough decision to go onto methadone, and enrolled in a methadone clinic. Though she told the clinic  about the extent of her heroin use, she was given too low a dose to stave off painful withdrawal symptoms. (Clinics sometimes give doses that are too low to be effective out of fear that patients are trying to trick the staff into giving them more methadone than they really need.) To supplement the methadone she went back to the streets and sex work for the money to buy heroin. The day she tried to kill herself she felt, as she told me later, “What’s the point? I try to do the right thing, go on methadone, and that doesn’t work. There’s nothing left for me.”

Today Joy called me again. She sounded great. She’d had two weeks of a safe bed to sleep in and nutritious meals to eat in the psych ward of a hospital near my house, and the doctors there had gradually raised her methadone dose to a point at which she was no longer dope sick.

“How did you get them to keep you for so long?” I asked, reminding her that last week the hospital had told her that she couldn’t stay there for more than a few days. “They tried to find a place to send me,” Joy explained, “but the social workers couldn’t find anyplace willing to take someone who is on methadone and coming from a psych ward. So they tried to send me to a homeless shelter but I told them that if I went into a shelter I’d be back on the streets and I’d jump off the roof, so they had to keep me because I said I was suicidal. I actually wouldn’t jump off the roof, but sometimes,” Joy added, “you’ve got to finagle a bagel.”

“What now?” I asked. “Well they just gave me my phone back and I’m waiting for the detox [facility] to pick me up.” “What are you detoxing from?” I asked. “You haven’t used drugs. You’ve been in the hospital for the past two weeks.” “Methadone,” she replied. “They decided to send me to detox to get me off methadone because that is the only way I can get a placement in a halfway house or rehab.”

Sounds crazy? Yes, it is. But those are the rules.

Joy has been around this block before, and she doesn’t expect the system to make sense. I, far more naïve than she, repeatedly find myself hoping that this time the doctors, the social workers, the nurses and the caseworkers who advocate for Joy will be able to arrange an appropriate, permanent placement. But even the best medical and social service personnel (and she has been assisted by many wonderful professionals) cannot create a rational plan out of the current hodgepodge of short-term public and private programs.

No Magic Bullet – But Some Sensible Recommendations

There is no magic bullet that will cure Joy. The social conditions — and especially the gender inequality and sexual violence that cause her misery continue to be our reality. But there are steps we can take both at the policy and the programmatic levels that can increase Joy’s odds of survival.

One, we must bring the jumble of programs for people who are struggling with substance abuse into a coherent system in which a given individual can know that she has a therapeutic “home” that she can turn to, a home that knows her history and in which there is at least a fighting chance of developing some level of mutual trust. Joy cannot even remember all of the programs she has been sent to over the years, but when we tried to brainstorm we came up with a list of more than three dozen different facilities and programs — each with its own intake and assessments, each with its own medical protocols, each with its own rules. Right now, I am still fuming over the idiocy of putting Joy on too low a dose of methadone in an outpatient clinic, increasing her dose in an inpatient psych ward, and then sending her to a detox facility to withdraw from methadone so that she can get into a “holding” program while waiting for placement in a rehab program.

Two, we need to change the criteria for participation in mental health programs and in substance abuse programs in order to serve the needs of people like Joy with “dual diagnoses” (mental illness and addiction). The fact is that the majority of people who overuse psychoactive substances are, in one way or another, self-medicating their misery. The ersatz distinction between mental illness and addiction reflects out-dated ideas about what constitutes criminal behavior. It is neither realistic nor helpful.

Three, we need to know when to say “enough” to drug treatment programs. Joy has been through so many programs that, as she once told me, “I could teach the classes myself.” Rather than send Joy to detox and still another program, it would be far more sensible to provide her with secure housing where she will have access to on-going healthcare and emotional support, where she won’t be kicked out for breaking the rules or for “relapsing” (which, I acknowledge, she likely will), and where she will have at least a fair shot at putting down the roots and building the social networks that, in the long run, may be more salutary than methadone.

Over the next few weeks I will post additional recommendations for addressing the suffering experienced by Joy and other women I have come to know in Massachusetts over the past decade.You can read more about my work in Can’t Catch a Break: Gender, Jail, Drugs, and the Limits of Personal Responsibility.

Suicide is Painful

The week that Robin Williams’ suicide hit every media outlet in the country, my friend Joy drove into the woods, shot herself up with enough heroin to kill a horse, and sat on a rock waiting to die. Unlike Williams, Joy survived (though the person who found her and called 911 first stole all of the cash from her wallet). And while I’m not surprised or even hurt that Joy’s intentional overdose has not received the media attention of Williams’ hanging, I do feel the need to acknowledge and share the knowledge of what led her to that rock and what happened after she was “rescued”.

The youngest daughter of a white, middle-class couple, Joy recalls that, “Until I was seven everything was normal – white picket fence, father went to work, mother stayed home with the children. Then everything fell apart.” Her parents divorced, her mother received custody and her mother’s boyfriend molested Joy and her older sister. Joy saw therapists and was given psychiatric medication throughout her childhood. Eventually she was removed from the home and placed into the child welfare system where she lived in various foster homes and juvenile programs. “None of these placements worked. I was an early drug abuser.” When I first met her crack cocaine was her drug of choice; a few years ago a boyfriend introduced her to heroin.

As an adult, Joy has never held a job that pays a living wage, never had secure housing, and never had custody of her daughter (her father is raising her daughter.) She suffers from impaired hearing, diabetes, insomnia, Hepatitis C, chronic hip and shoulder pain, lumps in several lymph nodes, and neuropathy in her feet. Joy’s sole legal income is her monthly SSI check of approximately $740, which she supplements through sex work. For the past twenty years she has moved among drug rehabilitation programs, motel rooms, shelters, jail and psychiatric hospitals. During the years I have known her she has been prescribed the following psychiatric medications: Trileptal, Seroquel, Neurontin, Abilify, Remeron, Buspar, Celexa, Wellbutrin, Neurontin, and Effexor.

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I’d last seen Joy a few months ago right after she was released from jail. She had been held while awaiting trial on a prostitution charge and then let go on “time served.” After losing track of her for a while, a few days ago I heard that she was in the locked psychiatric ward of a local hospital and I went to visit her. Although brightly painted and staffed by cheerful nurses, the ward gave off a “One Flew Over the Cuckoo’s Nest” vibe. Most of the patients were wearing hospital gowns, and since they are not allowed shoes they shuffled back and forth in the corridors in slippers or socks. Some gave off unpleasant odors; many had the blank “zombie” look of heavy psych medication.

Joy was delighted to see me (and delighted with the chocolate and magazines I brought). I asked her how she ended up on the ward. She explained that she’d been drifting around between stints of jail time and realized (not for the first time) that she needed to make a change in her life if she is going to survive and “be there for my daughter”. She made the decision try methadone and see if she could kick her drug use once and for all. The methadone clinic put her on a dose that was too low for the amount of heroin that she had been using, and she became extremely dope sick. “They moved up my dose but it wasn’t enough so I kept using dope together with methadone. I realized it wasn’t working and I already tried everything else – you know Susan I’ve been in so many programs that I could teach them — so I decided to end it all.” The last thing she remembers is feeling the heroin start to work. When she woke up in a hospital close to where she was found, she was told that she very nearly died and that the medical staff worked on her for a significant amount of time to bring her back.

…..

Two days later the hospital released her. She was told that they had tried to place her into the detox facility with which the hospital works, but that facility only takes people on Suboxone (another drug that is used to treat opiate addiction), not methadone. The nurse handed Joy a piece of paper with some phone numbers for her to call to find a detox program for herself, and told her to leave. Joy said to the nurse, “Are you kidding me? I tried to kill myself less than 48 hours ago.” The staff claimed they didn’t know that, but in that case she could stay in the hospital.

The next day they transferred her to the hospital at which I met her. Joy was assigned a doctor whom she liked, but after one day a “fill-in doctor” took that doctor’s place. The fill-in doctor looked at her chart and cut in half the medication for the neuropathy in her feet and stopped her anti-anxiety medication without talking to her or seeing her. A nurse told Joy that she’d try to speak to the doctor on her behalf, but the doctor made it clear that “I am the doctor and you’ll get the medication I give you.”

Joy was not assigned a therapist but was told to meet with a social worker who tried to find a rehabilitation program for her. Joy told the social worker that she had thrived at a facility she had been in a few years ago, but that program only lasted for five months, after which she was sent back to the streets.

Two days later when I called Joy told me that the doctor felt a large lump in her stomach and was sending her for an ultrasound later that day. Also, a lump on her neck had grown and she was being sent for a scan. I told her I’d drop by but I could only come in the morning. Because visiting hours start at 4:00 the nurse would not let me in (although Joy told her that I was the only person visiting her and that my visits help her want to live.)

Later that day Joy and I talked again on the phone. “It’s good you didn’t come, Susan, because they had me packed up and ready to go to a detox program in [another city]. I was literally going out the door when the program called and said they can’t take someone from a psych ward. So I’m just waiting for them to find a holding place for me where I can wait for a halfway house placement.” I asked her about the results of the ultrasound and scan. These tests had not been done nor had the doctor written up orders for them to be done at her next placement.

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The U.S Centers for Disease Control and Prevention (CDC) recently reported substantial increases in suicide rates among middle-aged adults in the United States. Based on National Vital Statistics System mortality data from 1999–2010, CDC researchers found that the suicide rate among American men aged 35–64 had increased 27.3 percent from 1999 to 2010, and among American women aged 35-64 the rate had increased 31.5 percent. A variety of theories have been proposed to explain these increases. Psychologist and author Bruce E. Levine notes that while it is popular to blame chemical imbalances in the brain for suicide, according to the CDC, “Possible contributing factors for the rise in suicide rates among middle-aged adults include the recent economic downturn (historically, suicide rates tend to correlate with business cycles, with higher rates observed during times of economic hardship).

One would assume that our current partiality to theories regarding the biological and chemical bases of mental illness would lead us beyond blaming the individual for his or her pain. But that is not the case – as witnessed by the estimate that nearly two-thirds of people sitting in jails and prisons are mentally ill.

And that is what I find so difficult to swallow.

Within forty-eight hours of Joy’s almost fatal suicide experience she had to fight to stop the hospital from releasing her to the streets where she’d surely be re-arrested for drugs, prostitution or simply loitering. Then she was confined in a locked ward where her visitors were limited and where she was prescribed different medication regimes by two different doctors (one of whom refused to listen to anything she or her nurses had to say). She knows she needs to stay off the streets but she has been told that there is no placement available for someone who is both suicidal and on methadone so the best she can hope for is a temporary “holding” facility until a place can be found in a slightly-less-temporary halfway house from which (as she and I know from her past experiences) she will be kicked-out if she “relapses”. And all of this happened in a very reputable treatment setting, which, Joy told me, is not all that different from jail.

…….

Now, it may be tempting to chalk Joy’s experiences up to bureaucratic run-around or an episode of particularly egregious institutional incompetence. But when the run-arounds and incomeptences are built into the laws, the regulations, the policies and rules and protocols, then they must be understood as manifestations of “the system” rather than as haphazard or idiosyncratic exceptions.

I don’t know if Joy will die from being raped or beaten by a trick, from a bullet one day when she can’t hear the police tell her to stand still, from whatever is causing the mass in her stomach and the lump on her neck, from the chaotic cocktails of prescription medication she receives, or from an unintentional overdose or another try at suicide. I don’t know if she’ll die in prison, a violent and oppressive setting that gives rise to high rates of suicide, or after her next prison release – a time in which suicide rates again rise. I don’t know if she’ll die in a detox facility or a homeless shelter. But each time I say good-bye to her, I have a sick feeling that this may well be for the last time.

You can read more about Joy in Can’t Catch a Break: Gender, Jail, Drugs, and the Limits of Personal Responsibility.