Feature -- by Mark Sproxton

"You have to appreciate the small steps, even if it's sitting having a coffee with you." Allan Fehr, Alberta Mental Health Board

Above the din of a busy downtown coffee shop, two voices ring out in laughter. The shoulders of the two gentlemen, one wearing a black ball cap, the other a blue nylon windbreaker, heave forward from laughing. Toothy smiles consume their faces.

A few months ago, however, this scene never could have happened. The fellow with the cap wouldn't say much more than "Hi" to the mental health social worker dressed in the windbreaker. "It's long-term planning," explained Allan Fehr, a mental health therapist with the Alberta Mental Health Board who's part of a new program that literally takes treatment to the streets. "It can be two or three years to make progress. You have to appreciate the small steps, even if it's sitting having a coffee with you."

The assertive community treatment program has team members, that also includes psychiatrists and psychiatric nurses to name a few, dealing with clients on their own turf, be it in a coffee shop, a hospital or in front of a corner store. "We're always in the community," Fehr said. "It's mostly work in the inner-city and (with) people who live there. We don't see clients in our office. Our program assists the most severely affected people who are generally very disconnected from support networks and not engaged in life as most people are."

Referred to as the "invisible illness," mental health disorders can be tough to overcome. "People who have been sick for a long time have a routine built up and that can keep them in an unhealthy lifestyle," the University of Calgary graduate explained. "To provide treatment (can be) frustrating because they have no motivation to change." But those periodic frustrations are more welcome than the frustrations Fehr experienced in his previous career.

"I worked in the oil field originally and didn't find it stimulating," he said. "I'm a people person and through life experience felt that (this) would be a rewarding area for me." Moving from the patch to post-secondary, Fehr completed a two-year social work diploma and began working with youth in a residential treatment setting. From there he returned to school to complete his bachelor of social work degree before moving into mental health.

Applying for a job with a vague job description -- due to the newness of the position and program -- Fehr eventually began working with people suffering from schizophrenia. "The ad asked for a community coach and I thought I'd apply. It proved interesting, and I started enjoying it." Over the years, from hands-on experience, or through workshops and lectures, Fehr began to learn more about diagnosing mental illnesses, medications and how they're used, what dosages mean, how they're dispensed and the many different types of treatment. "I was more a generalist when I started. I was taking more of a systems approach. I worked seven years in non-profit and in a general sense, the non-profit (groups) won't have the clinical expertise and would refer to the government for the next stage of development. Now it's quite clinical."

Working shifts on the weekdays, either from 8-4:30 p.m. or 11:30-8 p.m., Fehr must also work four Saturdays every 16 weeks. Regardless of when he's on duty, there's little time to sit around. A typical day could include: going to work to check to his schedule (appointments are scheduled for him), going to a client's house and taking him to a specialist, communicating the results to the client and then following up with phone calls and paperwork; then picking up a client to see the team's psychiatrist and if a change in medication is prescribed, Fehr would deliver it to the nurse who would arrange its filling and then Fehr would pick it up and later consult with the psychiatrist about the change. Taking a client out recreationally, to a driving range for instance, to help him build coping skills, having team meetings back at the office and continuing with one-on-one appointments that could include discussing things such as substance abuse could also be part of a typical day.

"It's a high-demand job," Fehr said. "You need to be accountable for your time in this model." You must also posses a wide array of skills. "You need to be patient in this for sure and I think you need to have minimal need to control. Our clients will move at their pace and you have to be willing to live with that." Some clients, and their issues, may also cause you to reflect on your own situation, he added. "You need to be stable and have worked through a lot of your issues prior to coming in. Good coping skills are important. If you stay in your head, you won't be healthy for long. You need some outlets."

While the work can be straining and requires much energy and long hours, Fehr enjoys the contact with people while helping improve their quality of life and increasing their life-options. "I like the fact I'm in a position to help people who are slipping through the cracks."

Social workers with an interest and experience in psychological and clinical settings may see more of this type of work available in the near future, according to Fehr. "This helps people who aren't connected and for some reason aren't followed up. It's the wave of the future."