Issues with understanding the differences between resource availability for beds within inpatient services, the appropriateness and the need to remove yourself from complete life issues that you are facing with being able to take yourself out of your normal home / respite services environments may result in the need for emergency housing overnight.
NDIS provides for emergency respite. However this is initiated by the adults caring for the individual rather than the individual who absconds themselves. When faced with distress out in the community and seeking support from those, the concept of someone coming up to an individual with a disability and mental health issues and asking Are you Ok? Do you need anything? can be incredibly distressing if this isn’t done by those in ‘authority’ positions. This may cause the individual to abscond further than their initial plan or direction because of the need to get away from those additional people that they ‘perceive’ as not helping.
Some families have found that using the Family Room within the Emergency Department has provided a safe quiet place for their loved one to calm and organise their thinking before being able to see staff and then return home.
When individuals abscond they may be responding to immediate issues and may not plan what they need to take with them, either in terms of clothing or food or money. High Functioning individuals need additional strategies talked through with them about safety when out in the community after they have absconded if they are at significant risk of doing this again, repeatedly. Whilst some individuals may know all of the transport timetables, things like a bus not stopping to pick them up repeatedly may cause significant distress regardless of the fact that they have an Opal card/ money to pay for the ticket. Not having access to money for food or having specific dietary requirements will further exacerbate their individual distress and distress towards those who help or don’t help them. Individuals may also have insight post absconding into the organisational planning issues that have occurred whilst they were out in the community as safety issues and may blame themselves and therefore be at risk for greater self harm and greater frequency of absconding so that they can ‘learn’ how to manage themselves safely out in the community because there are no other options being provided within their current service programming that support their needs and manage the issues that are causing them to abscond in the first place.
Discussion around which suburbs are safer for travelling during the day and when it gets dark is important if they are having to walk between transport hubs and local hospitals / services. Knowledge of what time different transport routes stop is important for parents to have immediately on hand at home so that they can see what options their loved one has which will help make it easier to predict where they may have gone if they are unable to track them using a phone. Their loved one may not respond to texts or phone calls, or may be more likely to respond to texts because they can control the pace of the conversation and choose to only respond to certain things and not to others. Where this is important for repeat absconders is that whilst they may need the help that only a parent / carer can provide the help that they need when out in the community may be about solving transport travelling issues that they are having, and that might be the only reason that they want to talk to them, to get the help and then they will continue to be out in the community before deciding that they are ready to come home. Talking on the phone may be something that they do not want to do because it puts them at risk of being told to come home / back to the service, however they still need help. Risk management is needed to ascertain when information is provided however the escalation in length of time and distances covered can provide an understanding of what is being achieved when out in the community absconding. It is important to also note that the length of time may not be a result of the initial reason that the individual absconded, it may be because they are then dealing with individual circumstances of people in positions of authority who talk rudely to them at various times as they move around. When multiple people do this over a period of time in one period of absconding this may result in that day extending for a longer period of time which can make it look like it was the individuals regulatory / comprehension difficulties to start with and that was how overwhelmed they were with the initial situation whereas it was not.
For those individuals who need to have a carer with them when they are out the need to have someone ‘protect’ them from a social justice issue can be challenging to deal with and can be hidden in its impact when this is added to the level of constant bullying that can have been experienced and the lack of help that didn’t occur when it was managed and for how long it has gone on for or went on for.
As initial searching options for emergency housing to reduce the risk of longer periods of time being out e.g. days, which may result in hospitalisation etc options may include traditional emergency housing options such as I need a bed tonight (Wesley Mission).
Occupational Therapy Perspective References –
Josephine Beker, Tina DeAngelis, Nitasha Rivera; Life-Skill Development and Its Impact on Perceived Stress and Employment Pursuits: A Study of Young Adults With a History of Homelessness and Trauma. Am J Occup Ther 2020;74(4_Supplement_1):7411515435.
Sharon Gutman, Sara Barnett, Lauren Fischman, Jamie Halpern, Genni Hester, Colleen Kerrisk, Travis McLaughlin, Ezgi Ozel, Haisu Wang; Pilot Effectiveness of a Stress-Management Program for Sheltered Homeless Adults With Mental Illness: A Two-Group Controlled Study. Am J Occup Ther2019;73(4_Supplement_1):7311520431.
Evan Semmelhack, Emily Simpson, Bridget Conniff, Breanna Faber; Young People’s Experiences of Homelessness and Its Influence on Their Daily Routines and Occupational Participation. Am J Occup Ther 2019;73(4_Supplement_1):7311505125.