PROFILE: In Memory
Nikki Bradley, of the London Borough of Tower Hamlets, highlights the tragic life of ‘Jenny’ and the struggle that ended with her death aged 35.
Jenny died of pneumonia in December 2011, she was 35 years old. She had been in hospital for about a week. As usual, my team and I found out through a grapevine of contacts and friends who had helped us keep up with Jenny for the four years that we knew her.
My first memory of Jenny was across a Child Protection Case conference table; a small but feisty figure, struggling against her wish to leave the room and managing to stay the course, and politely thanking her friend who was looking after her 11-year old son. At that stage there were no plans for the fostering arrangement to continue indefinitely, that was before we learned about the extent of Jenny’s drug use and her dependence on alcohol. For most of her child’s life Jenny had used drugs. She later told me how she was introduced to them when she was struggling to care for her baby alone, his father was on a long prison sentence and she was vulnerable enough to fall for the temporary comfort of a hit or a drink. The ‘support’ of her partner’s friends started her on a road to disaster that became progressively worse over the next decade.
My attendance at the conference was so that I could see if I could connect with Jenny and link her in to what my service could offer her. The focus was to test out her motivation and capacity to get some treatment for her drug addiction so that she could regain the care of her son.
Jenny was one of the people that helping agencies call ‘hard to engage’; she was unreliable and often turned up drunk outside of the arranged appointment. We spent months concerned that she would not get through another weekend. As a street sex worker she was often assaulted and abused, sometimes staggering in to our service, injured and dirty. Her needle sites were inflamed and painful and way beyond our expertise. But, she kept coming back and we kept searching for her. Her key worker walked the length of the local market time and time again, calling and recalling to her flat until she found out where Jenny was. The flexibility that is built into the Family Intervention model allowed a response outside of office hours and beyond allotted appointment times. An open door allowed Jenny to reach us when she could.
Once she began to trust us, Jenny allowed us to link her in to the specialist services she needed. Her health began to improve and she kept to a pattern of coming in for a meal and a shower before her contact sessions with her son. For some time we were able to support Jenny and help her to start to regain control – she even started on a detox programme. She had been abused as a child and suffered with postnatal depression, but didn’t have a belief that life could be any different or that others could help her. Instead, substance misuse had become a way of managing her problems.
Part of our work with Jenny was to get her on to a regular income that negated the need for prostitution. Her application over the phone to the benefits agency necessitated her providing an explanation of why she had never claimed benefits. The call took 90 minutes in which Jenny had to acknowledge her dependence on drugs and that she has ‘got by’ by selling herself on the street. Her honesty was rewarded by a tax demand from the Inland Revenue three weeks later and a penalty notice for failing to declare self-employed income. However, backdated housing benefit, removed the immediate threat of eviction for her.
‘The damage that addiction does is so far reaching and long lasting that it is difficult to fully measure its impact, but what is most difficult to measure are the human costs.’
Sadly, years of severe drug use and dirty needles had undermined her liver, she had hepatitis and her stomach was swollen. So much so, that when she became pregnant she didn’t realise until it was far too late for an early termination. The trauma and the guilt of a late procedure devastated Jenny, who believed strongly that abortion was wrong. She had to face the fact that her lifestyle had already damaged her baby’s life chances and she understood without any doubt that she could not care for her baby. She and the baby’s father were devastated, and travelled together to the clinic. This event knocked Jenny hard on her road to recovery, and while we tried to offer her as much support as we could post-intervention, our timescales are limited and once our intervention period was complete we could not continue to give her the full support she needed.
The damage that addiction does is so far reaching and long lasting that it is difficult to fully measure its impact, but what is most difficult to measure are the human costs. The government’s ‘DRUG STRATEGY 2010: Reducing Demand, Restricting Supply, Building Recovery : Supporting People to Live a Drug Free Life’ estimated that there are ‘320,000 heroin and/or crack cocaine users in England’ and that ‘1.6 million people have mild, moderate or severe alcohol dependence’. The strategy also estimated that class A drugs cost UK services £15.2bn (~€18.8bn) per year and that alcohol misuse costs services in England £25-27bn per year. What is much more difficult to measure are the human costs; the mental and physical effects that addiction has on people and their families. The emotional, social and economic losses, traumas and crises that take people to their lowest point are so much harder to recover from once the effects of the substances, that so many turn to, start to take hold.
Jenny was an addict and at times it was as if she had no shame. The degradation of some her experiences are hard to imagine. The pull of the next fix was stronger than anything and her physical dependence on alcohol overwhelmed her. However, Jenny was also one of the most straightforward and transparent people I have ever met. She was warm, witty, genuine and so funny at times that she made the whole place light up with laughter. She didn’t think that she was intelligent, but she was definitely resourceful and clever and she loved her son with every bone in her body, although towards the end of her life she believed that he was better off without her. Despite the challenges that she posed to her friends and neighbours, they were quick to rally round to ensure that she had a decent funeral. She had so much to contribute.
‘The role of my service at this stage is to support him in organising a plaque in memory of his mother so that he has a place to grieve her, and to encourage him into a trusted counselling relationship where he can begin to address the pain of his loss.’
Jenny had the capacity to face up to the most difficult decisions without pretending, and she was the first to point out how much her drug use and his father’s criminal behaviour had affected her son. Jenny pushed the limits in every interaction she had, she confounded me when I was close to giving up on her, she taught me a great deal about human compassion and respect, and about the choices that people have to make about their lives, even if it isn’t your choice and even if you might do it differently.
Jenny’s son moved to the care of his father on his release from prison. His physical needs have been met but the impact of living with emotionally unavailable adults, the insecurity of basic provisions, food and safety, a range of other addicted adults in and out of the house and seeing his parents either incarcerated or abused in the community have taken their toll on his emotional health. The role of my service at this stage is to support him in organising a plaque in memory of his mother so that he has a place to grieve her, and to encourage him into a trusted counselling relationship where he can begin to address the pain of his loss.
On paper, the work with Jenny might look like a failure. Outcomes records will show; no rehabilitation, no abstinence, rent arrears and a raft of anti-social behaviour. There is little space in our outcome-focused work to acknowledge the limited contribution that my service made to Jenny’s life. In the current economic climate there is so much focus on outcomes and payment-by-results and little space to consider the long-term aspect of some of the work and the measurable but softer outcomes that arise from the most complex intervention.
In the midst of the intense stress of Jenny’s life and the many hours of threat and pain that she experienced, there was a window of safety, respect and unconditional regard at our door. We gained far more than she did; I wish I could have said goodbye.
Note: pseudonym used to protect ‘Jenny’s’ family. The rest of the article is factual.
Nikki Bradley
Service Manager, Family Intervention Service and Troubled Families Co-ordinator
London Borough of Tower Hamlets
+44 (20) 7364 4082
