Helping Hands Clinic:
 Fostering Relationship, Reconnection and Recovery

Presented by Dr. Richard Christensen on Thursday, November 12th, 2009

I’m incredibly flattered to have the opportunity to share a few reflections about the Helping Hands Clinic now that it’s reached its 20th anniversary. I haven’t been actively involved during this last decade since my UF work has taken me to Jacksonville, but I have very strong memories of those early years when I was a young resident in Psychiatry. At that time in the early 90’s, believe it or not by looking at me today, I had shoulder length hair which I wore in a pony-tail. And, believe it or not, Rob Averbuch was an impressionable young medical student who DIDN’T have shoulder length hair. What’s more, Randy Stacey still spoke with a Wisconsin accent. And Ross McElroy wasn’t a curmudgeon. Well, come to think of it, Ross has always been a curmudgeon. ….A very psychodnamically-astute curmudgeon, but a curmudgeon nonetheless. Remarkably, twenty years later, these same individuals continue providing psychiatric care at HHC along with Drs. Lou Solomon, Jackie Hobbes, Lew Baxter and others from the UF department of psychiatry. And I know there are persons here tonight who have also provided care and service there for nearly two decades.
So what I share tonight comes out of my years at HH during its first decade, but I hope these thoughts will somehow resonate with each of you who have been involved with this amazing clinic that continues to be driven by an inspiring community of givers and providers.

When I think of my experience at HH’s I think of persons: those who came looking for medical/psychiatric care and those involved in ensuring they received it. And when I think more broadly I keep coming back to three core features that define the work, that brought providers to serve, that drew persons back week after week to a medical home that is so much more than a dispensary of medical services and medications. For me there are three defining features of HH’s that were present when I was there and I know infuse the work today. These core action principles are what I would describe as the 3 R’s: Relationship, Reconnection and Recovery

Relationship

In my view, central to the most meaningful work at HH clinic has been the cultivation of relationships: to offer deep listening and attentive presence while delivering medical care, and the healing process of establishing relationships that begins the repair of wounds and brokenness.
The most recent HUD figures place the number of homeless persons in this country at approximately 700,000 on any given night. Nearly 25 % of those persons suffer a harrowing existence on the streets battling the despair, hallucinations or delusions of their mental illness. As we all know, those living on the street have little or no access to medical care. But what’s more, they have even less opportunity for supportive, meaningful, life-giving relationships.

My very first patient at HHC was Robert. Robert lived in the woods off Archer Road and had set up camp there for years…at least when he wasn’t in jail or involuntarily hospitalized. He didn’t much trust or care for psychiatrists. In fact, he would get downright stirred up when waxing eloquently on the subject. But he came to the clinic and Randy somehow convinced him to talk to me on one of the first nights I was there in the early nineties. At that time HH’s was based at the Salvation Army on University and my “office” at night was the second-hand clothing room by day. I had two chairs and a folding table. Ironically, my “clinical” space was defined by how generous the community had been during the week in shedding their old clothes
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It turns out that Robert had been treated for bipolar disorder at an early age, but hated the medications, the restrictions on his life and the social stigma of being seen as someone who struggled with a mental illness. He refused to go to public psychiatric clinics because “all they want to do is admit me for three days and pump me full of meds. Then they kick me to the streets.” So Robert lived in the woods and, instead of medications, used alcohol and marijuana to control his moods. When I asked, in my best therapeutic manner (remember I was a first year resident back then) how that was working for him he gave me this incredibly sarcastic smile and snarled out, “Terrific, doc. I’m homeless, drunk, angry, and I ain’t got no family and friends.”

What HH’s provided for Robert, and me, was the opportunity for relationship. During those initial encounters every week---and Robert was faithful about coming---we seldom discussed medications, rarely talked about the negative impact of his alcohol use, and most certainly avoided topics of inpatient hospitalization and the development of a formal treatment plan. In that cluttered space at HH’s, we quite simply were allowed to recognize in one another an unconditional regard and the beginning of a human relationship that had great potential for healing. Eventually, Robert did take medications and, over the years, he even reconnected with his family. But none of that would have happened if this solitary figure hadn’t been given the opportunity to cultivate the one thing no medication, nor treatment plan, or hospitalization can provide: a caring relationship with another human being. HH’s made that possible.

Reconnection

My experience of the healing that occurs through human reconnection involves Kathy, a middle-aged woman who was battling the devastating effects of multiple sclerosis after losing her insurance when she could no longer work. She was running the risk of losing her home and losing her marriage. I saw her because she felt as if she was also losing her mind. Kathy was battling a depression that was every bit as merciless and relentless as her MS. Sad always, tearful frequently, hopeless often. Like so many in our country, when she lost her job, she lost her medical care.
Kathy was adrift when she came to HH. She had lost connection to purposeful work, to her previous medical home, and was struggling to maintain a tenuous hold on her marriage. But she was able to receive primary care, and a renewed sense of hope, from the providers like Cynthia who didn’t give a hoot that she was uninsured. I was able to see her every two or three weeks for a depression that slowly began to ease and lighten with brief therapy and antidepressant medication. She had the energy to pursue a We Care referral and found a generous neurologist in the community who agreed to follow her. Her marriage became understandably less troubled and less precarious, providing her a greater sense of stability, hope and support. And, eventually, she was approved for Medicaid that allowed her to receive the medical care needed for her MS. Kathy reconnected to all that was important in her life through the HH community. Being welcomed into the compassionate circle of givers at HH allowed her to reconnect to those essential elements in life she was so understandably fearful of losing to the relentless illness of mind and body.

Recovery

But relationship and reconnection that mark the work at HHC do not stand alone. They should and do lead to recovery. The work at HH is not only life giving but, without question, it is life saving. Not just in a physical, literal sense of that word, but in a much fuller, broader understanding of what it means for a person to lose an “illness identity” and REcover their truest self.

Michael came to HH clinic because his despair drove him there for help. He believed the gifts that defined who he was and what he had hoped to become were slipping away. A talented musician and composer, he had excelled academically and on stage for years. Now, at the brink of embarking upon his career, he suddenly found himself wracked by an unmitigated loss of confidence to complete his graduate work and pursue his dream of musical performance and teaching. Panic and wrenching anxiety robbed him of the confidence needed to complete his graduate work and wildly-frightening panic attacks prevented him from performing in public settings. He was devastated: embarrassed, confused and, for the first time in his life, unsure of who he was and what he was capable of accomplishing.

Michael came to the HH clinic specifically for psychiatric care. He had no idea that he was going to be treated by an incredibly inexperienced psychiatry resident who, most of the time, wasn’t quite sure who of the two persons was more confused. However, he came to the HHC because he didn’t want any of his friends or professional colleagues to know about his deepest fears and loss of direction.

Over time, Michael slowly revealed his worst fears and most frightening insecurities, most of which were connected to what was obviously his “illness” identity. In that welcoming environment, he was able to begin and pursue a treatment process that involved unconditional regard, a tincture of medication, and an opportunity to recover that which most clearly defined his truest self: his passion for teaching and performing. His time at HHC carved out a path toward recovery that allowed him to embrace a view of himself that admitted vulnerability, but evidenced the courage needed to be the person he knew he was.


After two decades I can say with confidence that HHC is still all about relationships, reconnections and remarkable stories of recovery. But not just for the patients who have been welcomed into that healing community, but also for all of us who have had the enormous privilege of serving there. I believe most of us were drawn there for a multitude of reasons, yet we all share a basic “language of care” that was consistently spoken at HHC.
Craig Rennebohm, a pastoral minister based in Seattle, has spent the past decade providing street outreach to homeless persons suffering the effects of mental illness and addictions. He describes this “language of care” as being “greater than the act of speaking. It is a language of sensitivity, patient presence, and gentle approach; a language of mutual respect. It doesn’t depend upon our particular roles or the labels the world gives us. (Rather) Healing words flow from our common humanness, our feel for a person’s life condition, and our compassion for someone else’s suffering.” At HHC this “language” is consistently evidenced in gestures of recognition and respect, words of empathy and compassion, a fundamental and simple vocabulary of acceptance and mercy.

There is a line in the bestselling novel, The Elegance of the Hedgehog, where the adolescent narrator exults because she believes she’s finally discovered at least one certain truth in life. She writes:

For those of us who have shared in the two decades of work at HHC, I believe we can either choose to smile, or weep, or perhaps do both, at this celebration tonight. Because by putting into action a “language of care” we have experienced our own healing through relationship, reconnection and recovery. Randy and Cynthia Stacey, twenty years ago, created a remarkable community of healing and recovery by establishing HH’s. They developed what Henri Nouwen would call a “free and friendly space for the stranger” where those with physical and emotional suffering would be recognized and welcomed unconditionally. I think it’s only fitting that we say to them, during this ritual moment of acknowledgement and recognition, “Thank you” for all that you have done and all that you continue to do. Through your remarkable work, you have become the bearers of hope for the many, many individuals in our community who are at risk of surrendering all of their own.