Michael had a job, but struggled with depression. He self-medicated with drugs, which led him to develop a heroin habit. He had lost his job and was living on the street when he had his first overdose. A friend, who also was using heroin, gave him Narcan and managed to call 911, but when EMTs arrived, Michel refused to go to the hospital. He had heard too many horror stories of staff treating people as “druggies” who could not change and would die the next time, or the time after that.
Still, the overdose spooked Michael, and he started to visit Prevention Point. He began to develop a relationship with the case managers, but kept his distance. Trust is a particular issue with homeless people, who make up about 80% of the clients for PP’s services. Besides the stigma of their situation, they are frequent victims of theft, which can include documents and prescriptions as well as whatever possessions they carry with them. Michael said he wanted to change his situation. He did not want to live on the streets doing heroin, but he was not able to change things on his own, and he was not ready to trust someone’s help. He had stayed at a couple of shelters, but did not like being crowded together with so many other people, so many of whom were using drugs.
The stresses of the situation deepened Michael’s depression and he started having suicidal thoughts. One day he felt so desperate that he went on his own to a crisis center. The staff told him that he would have to sit in the waiting room for at least 24 hours so they could verify that his mental distress was not caused by any drugs he was taking. If he left, they warned, he would have to start the waiting time over. The state requires them to follow this protocol in order to receive funding. Michael had not eaten for hours before he arrived. At some point the staff gave him a pack of crackers and an orange juice. After about 10 hours, he left.
Back on the streets, he was using heroin and barely surviving. Michael later told caseworkers that he was no longer getting high from the drug, just using it to avoid going into withdrawal. He overdosed and was brought around with Narcan at least one more time, but was even more vehement about not going to a hospital.
The realization that he would die on the streets hit him, he says, after he found himself mixing heroin one day with water from a puddle in the street. He managed to call PP and ask someone to take him to the hospital. A caseworker took him to the University of Pennsylvania Hospital, knowing that he would be treated better there than at some other hospitals.
After doctors treated him for a blood infection, Michael talked with a recovery specialist working at the hospital. He agreed to enter an intensive outpatient treatment program, which was the easiest to arrange since he had no insurance. Despite the difficulties of participating in a program that required him to be present 5 days a week, he was able to stay with the program for a while, with support from caseworkers.
Eventually, Michael could not keep up with the program schedule. But he had been visiting PP regularly. One of the first things caseworkers had done was to set him up with a P.O. Box there, an essential step in accessing government services, after which they had enrolled him in Medicaid. They learned that he had stopped going to the outpatient program, and when one of them saw him on the street one day, she gave him Narcan for emergency use as a way of letting him know that they knew he was using again.
A short time later, he came to PP and asked for help to get back into treatment. More options were available now that he had Medicaid. However, Michael finally had a stroke of luck. Few residential programs will accept someone with mental health issues, but caseworkers were able to get him accepted into one of them.
Michael finished the 28-day program and has continued to make progress with recovery groups. He is living in a transitional residence and hopes to be able to go through training to be a recovery counselor.