Myriam Ouazzani

Wearing out the frontline

Graphic Myriam Ouazzani

Hayley Carolan,
Local Journalism Initiative

Intervention workers in downtown Montreal are struggling

Disclaimer: The author has volunteered at Face à Face since November 2023.

Today is welfare cheque day and volunteers walk quickly down a narrow, beige corridor, fetching mail for clients waiting in a line that trails out the front door.

Most of those waiting are sociable, chatting with the people behind them and thanking the volunteers. But one client paces back and forth, shaking his head. 

His cheque hasn’t arrived, and he shouts at the woman sitting at the front desk. 

Heads turn towards him, and the volunteers stop handing out mail. He slams his hands onto the desk. The moment is tense, and no one seems to know what to do.  

Then, Akira Buhaina enters the room.

The volunteers seem relieved as she walks out of the back office. She strides quickly to the front desk, hurried but confident. 

She greets the client, asks him to be polite with the volunteers and assures him that she’ll do her best to help him. Leading him into a small counselling room a few feet away, she offers a tired smile to her volunteers, before taking a seat across from him and closing the door. 

Buhaina is the lead intervention worker at Face à Face, a non-profit organization offering mail reception for people without a fixed address and crisis intervention for anyone in need. Workers also help clients find housing, search for apartments on the private market and help them fill out complex applications for social housing.

Since the pandemic, soaring housing costs have resulted in increased homelessness in Quebec. From 2013 to 2022, the number of people experiencing visible homelessness in the province grew from approximately 3,149 people in 2018, to 10,000 in 2022. Nearly half of this population lives in Montreal. 

The growing population of unhoused people has put unprecedented pressure on the city’s frontline services. Over the last two years, five staff members have left Face à Face. Buhaina has stayed on for over three years.

She is the go-to person for every question, and clients specifically request her by name. She says that despite the hectic and at times stressful environment, she loves her job. But sometimes she’s so run off her feet that she doesn’t get a chance to go to the bathroom until the last hour of her shift. 

“It’s hard when someone comes in and they’re getting kicked out of their apartment and they’re basically suicidal,” Buhaina says. 

Clients face various systemic barriers and are often in immediate need of support when they arrive at the centre, making it difficult for staff to take breaks.

“There’s a lot going on at the centre, but we do our best to make time for everyone,”  Buhaina adds.

Recently, she has noticed the job taking a toll on her mental health. Despite trying to manage her stress through hobbies, like playing in her band and taking care of her garden, she sometimes leaves the centre with a tightness in her chest.

“A lot of my stress comes from being very frustrated, either with the government or the fact that there’s not enough housing, and all these systemic issues that are going on right now,” Buhaina says. “It gets me more angry when I think about how desperate people are, how little help they have and how we’re working with a very broken system.” 

In an effort to protect her mental health, she decided to take a two-month leave of absence over the summer. She is unsure if she will return.

Buhaina is not alone. Social service providers across Quebec are burning out at an unprecedented rate. Within the next two years, close to 2,400 social workers in the province are planning to leave their jobs, according to the most recent survey from the Order of Social Workers, Family, and Marriage Therapists of Quebec (OTSTCFQ).

In a press conference, Pierre-Paul Malenfant, the outgoing president of OTSTCFQ, spoke on the results of the survey. He stated that the province is currently seeing a “deep distress among these professionals which the Quebec government must address immediately.”

“This trend worries us greatly, because in the end, if social workers break down and leave the profession, it is the population who will pay the price,” Malenfant said. “Not only could the quality and availability of services be compromised, but the pressure on the shoulders of the remaining healthcare workers will be exacerbated.”

A brief from the Canadian Association of Social Workers says that the emotionally challenging work performed by intervention workers can make it difficult for them to maintain good mental health. After years of supporting struggling clients and extending empathy at every turn, fatigue can set in. 

Sophie Meunier, an organizational psychologist who studies strategies to reduce intervention worker burnout, says that while self-care strategies can help reduce the negative impacts of emotionally intense work, they should not be the only avenue used to address worker well-being. 

She explains that it would be more efficient to change the entire system that perpetuates worker distress than to improve the well-being of one individual at a time.

She adds that in addition to the emotional stress inherent to the job, the lack of resources that intervention workers have to help their clients can make them feel powerless and lead to burnout. Low compensation rates, a lack of extended benefits and ever-changing funding requirements further exacerbate the issue. She says that changing these factors would significantly improve intervention workers’ well-being.  

Last month, the federal and provincial governments pledged $115 million over the next two years to develop housing for people experiencing homelessness in Montreal. The money will go towards 520 new emergency and transitional housing spaces in the city.  

Edward Eberle-Sinatra, another intervention worker at Face à Face, says this is a step in the right direction, but doesn’t think it’ll make the lives of intervention workers or their clients any easier.

“It’s not really going to do much for us,” Eberle-Sinatra says. “The housing will just go to people at the top of the (Office municipal d’habitation de Montréal) list.”

Currently, most new applicants placed on this social housing list must wait several years before being allocated a subsidized apartment, depending on factors including their income and number of children. 

He explains that organizations like Face à Face need more funding to offer quality services to their clients. With it, they could hire more people to spread out their workload and avoid losing the knowledgeable staff they already have. 

However, Buhaina isn’t waiting for the system to change. During her break, she’s planning to take care of herself by reading, journaling and spending time in nature. 

“I’m trying to find center and balance within myself and give myself the care I need, because so much of what I do is about taking care of others,” Buhaina says. “I really advise anyone in this field to take moments to remember who you are.”

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Understanding eating disorders in BIPOC communities

BIPOC individuals with eating disorders are likely to have their condition overlooked. Graphic Myriam Ouazzani

Cole Cooper,
Local Journalism Initiative

Dieticians say people of colour with eating disorders are half as likely to be diagnosed or receive treatment

At one point during her anorexia recovery, Stephanie Ng texted her nutritionist to ask how a specific dim sum fit into her meal plan. Her nutritionist didn’t have an exact answer and told her to eat the dim sum regardless, to lean on the side of abundance to help her recovery.  

“That was like, a nightmare for me to hear because I’m like, ‘I need to know how that fits into  the prescribed meal plan that you’ve made.’” Ng says.

Although BIPOC people develop eating disorders at nearly the same rate as white people, they are half as likely to be diagnosed and significantly less likely to be screened for symptoms. Eating disorders are extremely dangerous psychological and physical afflictions — anorexia nervosa is, after all, the most deadly mental illness — but stigma often prevents BIPOC people from receiving the treatment they urgently need. Those who can access treatment often find it lacks cultural competency.

“Personally, I’ve tried to look for a therapist for myself who is of Asian descent and I could count the number of people I’ve found in Quebec on my hands,” says Jamie Lee, a registered dietitian at the Sööma clinic in Montreal.

“There are a lot of people who come see me. Specifically because I might know their food more,” Lee says.

Sööma is one of Montreal’s two dietary clinics specializing in eating recovery. Lee has been with Sööma since the clininc’s opening four years ago. 

“I was the first one hired. It was just me and my boss,” Lee says. “Now we’re a group of  seven dietitians. So it really grew a lot over the last three, four years.” 

In retrospect, Sööma’s growth is predictable —opening a dietary clinic in 2019 is akin to opening an engineering firm the day before an earthquake. Between March 2020 and December 2022 there were more than double the predicted ER visits for eating disorders, per a 2023 Canadian Medical Association Journal report. In-patient Canadian hospital stays for eating disorders increased by nearly 60 per cent among adolescent girls over the same period, according to the Canadian Institute for Health Information. Those patients needed dietary plans, and to be guided through the refeeding process. 

“A lot of people think directly to a psychologist to help with eating disorders,” Lee says. However, renourishing the brain is often a precursor to genuine psychological progress.  

Eating disorder recovery is often difficult and sometimes life-threatening. According to data from the South Carolina Department of Mental Health, approximately five per cent of patients with anorexia will die within four years of their diagnosis. That rate increases to about ten per cent after ten years and about 20 per cent after 20 years, according to the organization Eating Disorder Hope

Lee compares the recovery process to climbing a mountain, with the dietitian acting as a guide. 

“I can see your mountain, so I know, like, ‘Oh, put your left foot here and put your right there,’”  she says. “We work at the pace that the client works at.” 

Lee and her colleagues repeatedly reinforce that, as emotionally and physically difficult as treatment can be, patients who don’t fit the stereotypical image of an eating disorder are often overlooked. 

Elsa Chu is another dietitian at Sööma. Chu began her career working with athletes and competed  on the winning team at the Canadian Ultimate Frisbee Championships in 2018. 

“BIPOC people in general are a lot less likely to be asked about eating disorder symptoms. The  big stereotype with eating disorders is that we think of a thin white woman,” Chu says. She warns that anyone who doesn’t fit the stereotype has a good chance of being overlooked. 

“BIPOC people with eating disorders are half as likely to be diagnosed or to receive treatment,”  Chu says. 

According to Eating Disorder Hope, 20 per cent of untreated eating disorders result in death. 

This is an issue with a lot at stake. 

For BIPOC people who are able to seek treatment, there is yet another obstacle: the unlikelihood of finding treatment that sees and suits them. 

Ng recalls telling her college therapist that she didn’t know how to say no to her mom when they had disagreements over food. 

“My therapist was like, ‘Just tell her,’ and I was like ‘I can’t.’” Ng says. “It doesn’t work that way, you can’t say that stuff to your mom.” 

Chu also says that eating disorder symptoms can be misdiagnosed and misunderstood based on a patient’s cultural background. 

“So, for example, Hispanics and Asians are more predisposed to diabetes and insulin resistance,” Chu says. “It may not be necessarily right off the bat an eating disorder thing, it might be a predisposition just because of where they’re from.” 

“All the training that we’ve done (for nutrition interventions), it’s based off of studies that were done on white people,” Lee says. 

For example: “In East Asian cultures, dairy and wheat are much less of a thing than they are here, and those tend to be foods we recommend a lot in Eurocentric approaches,” Chu says.

Ng experienced that exact challenge firsthand when she began anorexia treatment as a preteen in Hong Kong. Her recovery was centered around Eurocentric foods, and that lack of cultural sensitivity just made the process harder. 

When Ng was studying in America, she founded the organization Body Banter as a platform for youth to have difficult conversations about body image and mental health. When she returned to Hong  Kong, she realized Body Banter’s efforts were even more necessary there.  

“What happens in public hospitals in Hong Kong is that there is minimal to no psychological  support. Your physical body is seen as the main problem,” Ng describes. “And that’s all that gets  addressed.” 

For those who couldn’t afford professional psychological help, or who weren’t ready for it, Body Banter became a solution.  

Ng says one of Body Banter’s biggest powers is giving people the language to understand their  feelings and talk them through. She describes being unable to explain her emotions to a therapist, 

simply because she didn’t have the words. Her world opened up when psychology classes gave  her the language to make sense of it. She finds youth with more nuanced language to discuss body image allows them to have more informed conversations and to develop more comprehensive understandings of their experiences.  

“Helping our profession become more culturally competent is just having more access to this  information, more awareness,” Chu says. “We can’t fault people for not knowing a culture that is  not their own.”

Having an open-minded approach is what Chu classifies as the key to recovery. “Collaborating and gently modifying through cooperation,” Chu adds.

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