street roots
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I Am Not A Poet
HEADS, from page 1
of time and need to address each client’s most
pressing health issues. According to Solotaroff,
by Sergio Holffmans
clinicians end up using a “clinical reasoning
more edgy when you’re homeless,” Hill'said. “And
process” to determine what type of screening
you’re closer to violence when you’re on the
A lazy admirer of poetry is what I am.
might be most important for a particular client
streets.”
A loving dreamer,
TBI rarely makes it to the top of the list
who always has a dream to dream and a failure to tell.
But given the high correlation between
homelessness and brain injury, some advocates
I write verses and poems, but I am not a poet.
think it deserves more attention.
ne of TBI’s biggest dangers is that it often
I have the disgrace of not getting advice from my Father,
“We have to find a way to identify brain injury on
goes unrecognized. People with TBI often
don’t connect their symptoms with previous head the streets,” says Pat Murray, the Executive
who says he is a poet
Director of Portland’s Brain Injury Resource
injuries, and many health care providers, mental
Community (BISC). “When we understand that this
health workers, and case managers don’t either.
I do not write because he is a poet,
is a physical injury, we start to look at people
Some brain injury survivors have a hard time
I write because I am a slave to love.
differently. We might need to work with them a
remembering appointments, following instructions
little differently. And there may be ways to help.”
or taking medications. They may have a hard time
I am just a verse,
According to Murray, identifying brain injury
organizing their thoughts, finding the right words,
and the pen, that writes the tears that wait to be cried,
could
lead
to
more
appropriate
treatment,
as
well
or picking up on social cues. As a consequence,
in the hands of the woman that I want, that I love.
as better access to benefits and services.
these clients might be labeled as disinterested, |
rude, or non-compliant.
They will say that I inherited my inspiration, but no!
Or they may be misdiagnosed. Symptoms of TBI
can also look a lot like major mental illness,
ecause the effects of brain injury can be
emotional trauma, or drug and alcohol abuse. And
I created my inspiration with one look -
disabling, some TBI survivors are eligible for
these conditions often co-exist and exacerbate one
my inspiration was created
Social Security disability benefits. For Nick Patton, because I am a slave to love
another. Distinguishing between them can be
it was a turning point in his recovery. But getting
difficult.
and nothing else!
there wasn’t easy.
This was the case for Nick Patton.
“Without help, I would’ve walked away. I had
“They thought I had schizophrenia, even though
given up on it three times already. It would be
the symptoms didn’t start till after the injury. And
hard for a normal person. But they make it so
that was when I was 32.” (Much later than the
hard that a person who really, really needs SSI
typical onset of schizophrenia.)
The Housing Authority of Portland (HAP) is
can’t do it unless they have an advocate.”
His doctors prescribed heavy antipsychotic
preparing
to open the Bud Clark Commons —
Luckily, Nick found one: Central City Concern’s
medications to control his hallucinations, but that
Portland’s new access center that will also provide
BEST program, a project that helps homeless men
left him so sedated he couldn’t function. And it
130 units of permanent supportive housing. For
and women through the long and complicated
didn’t get to the root of the Nick’s problem: small
file
first time in Portland, these units won’t be
disability claims process. The program provides
seizures caused by the brain injury, left completely
offered
on a first-come, first-served basis. Instead,
assistance with every step and pays for the
undiagnosed.
the
Commons
will offer housing to those they
expensive testing that’s often required; According
According to Dr. Wismer, Nick’s case is a prime
consider
the
inost
vulnerable. And that will
to Kascadare Causeya, BEST’S program manager,
example of why it’s important to identify TBI in an
include individuals who experience memory
more than half of BEST’S clients have had a TBI in
individual who is homeless. Treatment for TBI is
attention, organization, social skills and anger
their lifetime.
often different from traditional mental illness,
management, all areas that can be directly affected
“I
couldn’t
think
well
enough,
so
they
helped
me
including differences in medications. Some
by a brain injury.
psychiatric medications have little positive effect on fill out the paperwork,” Nick explains. “They knew
Although the model is controversial, it could
what
doctors
to
send
me
to
and
got
my
medical
an individual with TBI, yet can produce very
offer
vital support for those recovering from brain
records sent from Alaska. I couldn’t remember the
harmful side effects.
.
injury.
It also indicates a growing awareness of
name of the hospital where I had my surgery, so
George Dennison knows more about traumatic
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plays in a person’s ability to care for him- or her
They also stuck with Nick through two denials
him I’m doing a story on TBI and homelessness,
self — especially amid the chaotic, deficient, and
and appeals. According to Mellani Calvin, Nick’s
he says, “Oh good! Because it’s rampant out
often dangerous circumstances of the streets.
advocate at BEST, “the state’s disability reviewers
there!” He goes on to tell me about his own brain
were blaming his mental health disorder on his
injury.
prior drug use. They saw him as just a drug addict
who didn’t really need those (psychiatric) meds.”
ccording to Pat Murray, we still have a lot of
After four-and-a-half years, Nick finally won the
work to do, and it needs to start with
claim.
information. “Awareness has to happen first. And
The
medical
benefits
started
first,
which
gave
"We have to find a way to Identify brain
that
awareness needs to start with those who serve
Nick access to new doctors. And when the
In ju ry on the streets, When we understand
homeless individuals.” She offers Brain Injury
monthly cash benefits kicked in, he was able tp
Support Community as a resource to these
that this Is a physical Injury, we start to look afford the co-pay to see a new doctor - one who
providers. “We want to work together with people
at people differently. We m ight need to work
got to the root of Nick’s hallucinations.
serving the homeless community - to help those
Measurements of electrical activity in his brain
w ith them a little differently. And there may
who have already fallen through the cracks.”
confirmed that Nick was having small seizures - a
be ways to help."
And, she says, the time is right. “We have a real
direct result of his brain injury. Now, finally, an
— RAT M U R R A Y
opportunity right now - brain injury is in the media
anti-seizure
medication
is
helping
to
control
the
E X E C U T IV E D IR E C T O R O F P O R T L A N D 'S
and research is catching up with the reality. We’re
,
B R A IN IN J U R Y R E S O U R C E C O M M U N I T Y
voices and hallucinations. The medication has
just getting a lot smarter about brain injury.”
been a critical piece of Nick’s recovery.
Nick Patton is living proof that with the right
diagnosis, the right support, and a committed
advocate, life can get better, even if it never goes 1
“See this water cooler? This is like brain
rain injury comes in all shapes and sizes and so back to normal.
reserve. If you’re way up here at the top, you’ve
Even 10 years on, Nick still feels the effects of
does recovery. A lot depends on the location
got a full tank. But I had the genetic predisposition
and extent of the damage. Mild TBIs may take just his attack. Although the medications have helped
for bipolar disorder, so that means I start off a little
dramatically, he still hears voices. But now he
a short time to heal completely, while a severe
lower - about here. Then I go for years with it
knows that they’re just voices and that they’re
injury may heal very slowly or cause permanent
undiagnosed, so that brings me down some more.
caused by the injury - he doesn’t have to listen to
damage. In most cases, the underlying idea is the
Then I smash my head into a car windshield. That
them. He can trust people again.
same - to rest the brain as much as possible while
one - that brings me down to here.” George’s -
He also still struggles with some of the signature
it takes time to heal.
hand is about halfway down the tank.
symptoms of brain injury - including memory and
If you suffer a brain injury, you’ll probably be
George wants to be clear. It’s not just the TBI.
concentration. “It’s hard to keep my thoughts
advised to get plenty of sleep, limit sensory
It has all taken a toll. “But TBI, mental illness,
together. I can’t really read anymore - and if I do,
stimulation, and eliminate stressors. You’ll be
substance abuse, PTSD - they all go together like
I can’t remember it five minutes later.”
encouraged to drink plenty of water, eat well, and
peanut butter and jelly.”
He says he’d like to go to school to be a case
avoid anything that might cause another injury - all
Because of its high prevalence, the National
worker, to offer the same kind of support he’s
relatively minor adjustments for most people. But
Healthcare for the Homeless Coalition
gotten from others. But he knows it’s not in the
recommends that homeless individuals be routinely for people without a home, they are virtually
cards. He says it would just be too much; to do the
impossible.
screened for TBI during health appointments and
coursework needed to get the certificate.
“If you’re homeless you’re always living in this
in other service settings. For a comprehensive,
But he’s learned to be happy again and to work
ultra-aware state. There’s no way to relax,”
standardized screen, the coalition recommends a
around his symptoms. He sets his phone to remind
explains Brad Taylor, an outreach worker with
web-based tool called the Brain Injury Screening
him of appointments and tries not to promise that
Questionnaire. Although it only takes four minutes JOIN. In the world of homelessness there is no
he’ll
be somewhere on time. Social security covers
place
to
rest
or
to
get
a
full
night’s
sleep.
And
for the questionnaire to rule out brain injury,
his basic expenses. “I actually like paying my bills
waking time is taxing.
confirming a TBI takes about 20 minutes.
now. It makes me feel normal.”
Which is why Dr. Wismer sees housing as the
This isn’t a standard practice in Portland where
But most importantly, Nick goes fishing. As
first real step in recovery for many who are
busy clinics are filled with patients at risk for a
often
as he can, he goes out with a group of guys
homeless
-
specifically,
permanent
supportive
whole host of health problems.
from AA to hit the best fishing spots in the city
housing with nurses, case managers, and social
“The system isn’t set up to support a really
It’s something he knows by heart - something the
workers. For some brain injury survivors, a new
thoughtful and complete history of complex
brain injury can’t take away from him
permanent supportive housing facility in Portland
individuals,” explains Rachel Solotaroff, Director of
may come close.
Old Town Clinic. Physicians have a limited amount
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