Good question. I'm a volunteer on a telephone support line at a psych hospital. I've been doing it for 2.5 years. I'd say the vast majority of our callers are what we call "repeat" callers - callers who call the line once and sometimes twice daily. They are all extremely socially isolated and in some cases we may be the only people they talk to all day. On a typical 3 hour Fri. night shift I get between 5-7 calls. Out of those calls, I'd say only 1 person is genuinely trying to make steps to change their life for the better. The rest are simply stuck, going nowhere, and don't even see the possibility of change.

Now I think there's an element of genetics and how you were raised to explain how much resiliance anyone individual has, and your degree of resiliance is going to largely determine how hard you're willing to work on change, what you're willing to try, and how many attempts you're willing to make. I see this all the time with alcoholism, I'm in AA and I go to non-AA treatment groups as well. Yes I've had more than my fair share of relapses, but I keep coming back and starting over, and trying again, whereas other's once they relapse just give up and keep using.

Then I think there are people who are simply beaten down by the system and poverty. Mental health and addiction care is not well integrated and is badly underfunded here. Wait lists are long, and community agencies are overwhelmed. Navigating the system to get help requires intelligence, perseverence, being pushy, knowing your rights, and knowing how to advocate for yourself. None of those are easy when you're sick. And once you're on disability (ODSP here in ON) you're too focused on survival to focus on change. I think the max a single individual on ODSP can get is $968 / month. That's not a lot to live on in a major city - most likely means you're living in a boarding house that's a dump. One of my cousins is a peer support worker with an Assertive Community Treatment team and she's said that the stats are, once an individual has been on ODSP for a year, there is an 80 % likelihood that they will never return to work. So much for helping people move out of poverty.

--splitimage