Between the Lines of Care

I spend a lot of time thinking about why some care helps people move forward, and why some care seems to quietly hold them in place.

On the surface, it can all look the same: food, clothing, shelter, wound care, a listening ear. But over time, I have learned that it is not the service itself that determines whether it helps. It is the structure around it…the consistency, the expectations, the honesty.

When care loses its shape, it starts to do something else.

In my work, I see people who access multiple services every day: outreach teams, drop-ins, clinics, emergency departments, shelters. Many of these services are staffed by compassionate people who genuinely want to help. The intention is rarely the problem.

The problem is what happens when care is provided without assessment, without follow-through, and without boundaries.

I see clients who are told yes everywhere they go but are not actually getting better. Their wounds are cleaned but never healed. Their overdoses are reversed but never properly assessed. Their stories are listened to but never gently challenged. Over time, the message becomes clear: nothing changes because nothing is expected to change.

There is a quiet belief that people who use substances, who live outside, or who struggle with mental illness cannot tolerate discomfort or accountability. That belief shapes how services respond. It lowers the bar. It avoids difficult conversations. It prioritizes immediate relief over long-term stability.

What often gets missed is that many people I work with are incredibly perceptive. They notice inconsistency immediately. They know when a boundary is real and when it will bend. They know which staff will follow through and which will not. This is not manipulation. It is adaptation.

When boundaries are unclear or inconsistently enforced, clients are left navigating a system that feels chaotic and unfair. One day something is allowed. The next day it is not. One worker provides something another refuses. Over time, frustration builds on all sides.

I have also seen how unstructured care can unintentionally reinforce narratives that keep people stuck. Stories about being broken beyond repair, about systems always failing, about nothing ever working. When those stories are never questioned, they become explanations for why nothing changes.

This does not mean dismissing pain or trauma. It means recognizing that healing requires more than sympathy. It requires honesty. It requires skill. It requires the willingness to sit with someone in discomfort rather than rushing to remove it.

Harm reduction, when done well, is not about removing all risk. It is about reducing harm while still supporting movement toward health. That requires assessment. It requires training. It requires staff who understand physiology, behavior, and the difference between compassion and avoidance.

I have learned that the care that helps the most is often the least dramatic. It looks like showing up consistently. Doing what you say you will do. Saying no when no is the safest answer. Saying yes when yes is appropriate. Holding people to expectations they are capable of meeting.

Care needs shape. Without it, it becomes something else. Something quieter, something that feels kind in the moment but leaves people standing in the same place years later.

This is not a failure of the people receiving care. It is a reflection of how we have designed the systems around them.

If we truly believe people are capable of more, then our systems need to reflect that belief. Structure is not cruelty. Boundaries are not rejection. Done well, they are a form of respect. And respect, more than anything, is what makes care transformative rather than performative.