Supporting wellness and recovery beyond hospital walls

May 7, 2024

Kingston resident Kevin Cowan strolls the aisles of his local grocery store with a mental list of the food he needs for the week. He travels from the strawberries to the bananas, to the bread, carrying his basket and finding the best deals. Accompanying him is Providence Care Registered Nurse and Concurrent Disorder Specialist, Kristy Mikolich. Kristy is a nurse with the Assertive Community Treatment (ACT) team, a Providence Care community integration program that provides recovery-oriented treatment, rehabilitation and support services for individuals with serious and persistent mental illness.

“I would probably be homeless. I’d probably be living on the streets with mental illness,” explains Kevin, when asked what life would look like without the care of his ACT team. “I have a place to live, I’m very lucky.”

As a Registered Nurse with 20 years of expertise in mental health and addiction support, Kristy is one of many members of the multidisciplinary team that makes up one of four Kingston-based ACT teams, which also includes other nurses, social workers, occupational therapists and a physician. As a mental health nurse working in the community, Kristy is able to maintain long-standing relationships with her clients helping them with tasks of daily living that you might not connect with nursing, like grocery shopping.

“Working on a community mental health team means we all have to function in a generalist role. So, I do a lot of assistance with activities of daily living such as budgeting, grocery shopping, maybe someone needs help with hygiene prompts, or their Ontario Disability Support Program (ODSP) papers. I help people get to doctor’s appointments and am responsible for medications, monitoring the side effects of medications and the efficacy, as well as administering injections for anybody that’s on a long acting, anti-psychotic [medications]. Most importantly though, I’d say we’re advocating for the people in our care through a nursing lens in every aspect of their life.”

Kevin has been a member of the ACT team for the last 10 years, following an addiction that left him in the hospital near death.

“I used to be a runner and my knees were really hurting me. And so, I started taking just Advil and soon Advil wasn’t strong enough, so my doctor prescribed Tylenol 3 and diazepam, and it just got way out of control, things spiraled for a long time. I went to bed one night and I woke up in the hospital. I don’t even remember the ambulance ride. By then I was on methadone, and no one knew at the hospital, so I went through withdrawal. I wasn’t talking, I couldn’t get out of bed, I thought I was done.”

Kevin is proud to say that since that hospital stay more than 10 years ago, he has been sober thanks to the ongoing care of Providence Care’s ACT team. Since becoming a client, he has developed and grown his ability to communicate his needs and is able to set goals for the future. Kristy says being a witness to the successes of her clients over time fuels her career as a community mental health nurse.

“The rewarding part is just even the smallest of successes, even if it’s somebody is engaging in a harm reduction activity that maybe they didn’t think of before. So, let’s say they were injecting drugs and now they’re consuming them in a safer way for both themselves and those around them. That’s success in my mind. Or being a part of reconnecting someone with something they enjoy, like getting someone street involved back to the library if they enjoyed that in the past. It’s the little, tiny steps over time that we celebrate. Of course, long-term, the goal of our team is to keep our clients out of hospital while maximizing their strengths to reach any goals that they have.”

Kevin has a few exciting short-term goals Kristy and the rest of his team will be working with him to achieve. One is to join a walking group to get socialization and exercise, and the other is to reconnect with his family, whom he hasn’t spoken with in 20 years.

“Everyone is doing their own thing and I just got separated from my mom and my brothers and sisters. I don’t know where they are or how to go about getting in touch, but I know they’re in Kingston. I went through a really tough time, but I’m a lot happier now, more content.”

Kristy, who has a caseload of clients with different needs, works with them individually in wellness, recovery and in goal setting.

“If somebody has a goal to go dog walking at the Humane Society, we’ve helped them with that. We’ve helped people with resumes and to get a part time job in the community. It’s individualized care. We meet people where they are and best support them to keep them out of hospital. On occasion we do have to take a more directive approach, where the safety of self and others is prioritized over autonomy-a decision that is never taken lightly.”

As a nurse who doesn’t work in a typical hospital role, Kristy says it’s important that anyone considering nursing understands nursing careers come in all different shapes and sizes. Working in community mental health is where Kristy’s passion lies, and combining her love for helping people and science is what drew her to nursing and kept her going for 20 years.

“My brain loves the science portion and curiosity is what makes me able to do this job. I’m curious about how people got here and how we can help them. It takes a lot of information gathering and seeking to appreciate the fact that people use substances for a number of reasons; mental illness being one of them, trauma being another. People generally don’t get into situations where they have substance use disorders just because it’s a good time and is continuing to be a good time.”

ACT team Psychiatrist, Dr. Jonathan Fairbairn works closely with Kristy and says her ability to build an excellent rapport with vulnerable and marginalized clients is just one highlight of her outstanding contributions to clinical care.

“Our clients often face systemic barriers to accessing care and social support, and Kristy helps those we serve navigate these issues. She regularly goes above and beyond in terms of her willingness to take on complex and challenging assessments which she completes at an advanced level. She specializes in the area of addiction medicine which greatly contributes to our team and the care of clients with comorbid substance use issues.”

“This population is underserved and undervalued,” says Kristy. “I’ve learned a tremendous amount over the years from the clients I’ve worked with, and I’ve seen kindness that you don’t see in the general population from my folks that are street involved. I’ve seen people put themselves in some horrendous situations to help out someone else because they know what it’s like to sleep rough; or give their last five bucks to the guy that’s panning because he looked like he needed it.”

Continuing to advocate for clients on the ACT team, like Kevin, is what keeps Kristy motivated. She is also the first one to point out and celebrate all the hard work clients put into their own wellness and recovery journey, telling Kevin that while the team was there to support, he was the one that put in the hard work, often doing it with a smile.

Kevin smiles and reminds Kristy smiles are free.

“I always smile and say hi to everybody, because it might make their day and what does it take to smile? It doesn’t take anything, they’re free.”

During National Nursing Week and Mental Health Awareness Week, Providence Care is grateful to community nurses like Kristy who meet clients and families in the places they call home all while going the extra mile (literally and figuratively) to support our most vulnerable citizens. Our nurses are advocates, supporters, collaborators, system navigators, leaders, innovators, stewards, and change agents. Thank you for your unwavering compassion and dedication.

Are you or someone you know looking for support for your mental health, substance use health and addictions? Visit AccessMHA.ca for help.