Books, internet and naloxone: In-house nurse supports people in crisis at Edmonton library

White Coat Black Art26:30Library on the Frontlines

You wouldn’t expect to find an overdose response and prevention team at a library. But Edmonton’s flagship library is going next level to take care of some of its most vulnerable citizens. They also have a team of social workers and other programs. They're meeting people where they're at, and it's making a difference.

Tabatha Plesuk spends her day responding to mental health crises and opioid poisonings, but the nurse isn't based at a hospital or safe-consumption site.

Instead, she works at the Stanley Milner Library, the only branch in downtown Edmonton, which has seen a rising number of overdoses in recent years. Plesuk, who works with Edmonton Public Libraries (EPL) as part of a pilot program under the city's Downtown Vibrancy Strategy, is equipped with naloxone and works alongside outreach worker Blake Loates.

"We see, like, everyone and anyone," Plesuk, an overdose prevention and response nurse for Boyle Street Community Services, which supports homeless people in Edmonton, told White Coat, Black Art.

"We see youth — we've had like people as young as 14 years of age to somebody ... who's been houseless for 14 years."

While the library isn't designated as a space for people to consume drugs, staff are equipped and trained to respond to overdoses. Plesuk also provides basic health support, like wound care, to people who are facing homelessness.

She began working as a nurse at the library in August 2022. The pilot was developed, in part, to respond to an increase in security incidents and opioid poisonings around the library.

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Tabatha Plesuk is a nurse based at the Stanley Milner Library in Edmonton. She provides health support and clean supplies to vulnerable people in and around the branch.

Libraries are responding more frequently to the needs of a broad population because they're known to be a welcoming space. Branches across the country — including in Halifax and Calgary — have brought in support staff and social workers to supplement their standard offerings of books and movies.

"They've become, especially in core areas, sort of the last place people can go to get warm or to use a washroom or to sleep or to feel safe or to get on the net," said Siobhan Stevenson, a University of Toronto professor who researches the expanding role of public libraries. 

"They've become a real Mecca for that."

Libraries taking on more responsibilities

Plesuk and Loates do two rounds of the library and surrounding area, seeing between 40 and 60 people each day.

Her backpack is filled with medical and safer sex supplies, clean tools for using drugs — like needles and pipes — and importantly, snacks. Many of the items are donated, but Plesuk buys some with her own money keeping it within $100 a month.

EPL first brought in social workers in 2011 as more people sought refuge at the downtown branch. 

Libraries can offer access to support services in a way that may be stigmatized elsewhere, says Sharon Day, EPL's executive director of customer experience.

"We connect our community to the services and those resources and everything that they need to really live a fully functioning, vibrant, exciting life."

But as the library welcomes all clients, Day says it needs to ensure it remains safe for all.

Many overdoses at Stanley Milner Library were occurring in washrooms. The library now employs attendants, and security patrols the main library and parkade, to ensure drugs aren't being used on site.

Since the start of the COVID-19 pandemic, the number of people identifying as homeless in Edmonton has doubled. According to EPL statistics, there were 99 overdoses across the system in 2022, with 70 per cent occurring at the Stanley Milner Library. Meanwhile, the library system reported nearly 3,000 security incidents as of Nov. 12, up from just over 2,600 last year.

"There are lots of things that draw people to a library," said Plesuk. "If you are experiencing precarity of housing or if you use substances in general … the places that you are allowed to go use them are less and less all the time, and so people just end up here."

That shift brings tension, however. Librarians want to serve the public, Stevenson says, but as clientele with more complex needs come into libraries, there are questions about how to best help them.

The message she's heard from many librarians during her research is: "'I didn't go in to be a social worker. If I wanted to be a social worker, that's what I'd have studied.'"

Stevenson says the increase in services provided by libraries is symptomatic of cuts to social services. Libraries are bearing the brunt while funding to their core services isn't increasing, she added. 

"The needs by these populations, people who didn't used to necessarily use the library, it's just skyrocketed, especially since the pandemic," said Stevenson. "Libraries can be an important part of the solution, but they just require funding."

Situation improving 'substantially'

Plesuk acknowledges that the library isn't the "best or most optimal" place for people to get support for substance use, but it offers two things: warmth and internet.

Being able to get online — especially for those without a phone — is essential to access applications required for certain services.

"My dad was houseless for a long time and passed away of an opiate poisoning," Plesuk said. 

"We had long conversations about how much better he did when he had access to a cellphone. Social isolation is really hard for people. It's hard to attend appointments and things like that."

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In addition to various shelters, 11 municipal sites were chosen in November for encampments. Each site will have a designated tent capacity monitored by city staff.

Coupled with Plesuk's on-site support, Day says the situation has improved "substantially," and staff are making fewer emergency calls.

As of Nov. 19, there have been 29 overdoses at the branch, and 56 in the system overall this year.

"It's like a symbiotic relationship," said Day, pointing to the various points that clients can access services. 

"We have people … potentially going to the desk, be able to get support here. We have security, maybe providing them with support through the nurse or maybe somebody from our outreach team."

The pilot project between Boyle Street Community Service and EPL is set to conclude at the end of December. 

In a statement, the City of Edmonton says it's looking at funding to "extend the important services that the overdose prevention and response team provides across our downtown communities," including long-term support from the provincial and federal governments.

Despite the difficult nature of the work, Plesuk says it's gratifying to be able to support the community.

"People are so kind, even though they are experiencing some things that I could never handle," she said.

"And we just get to see community care every day."