My rookie year working in the Downtown Eastside

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When a person suffering from a schizophrenic episode starts trashing his room and screaming in rage, one of the best things you can do is knock softly on the door and ask if he would like a glass of water.

That's one of the ways 28-year-old Ryan Semiao has learned to calm troubled residents since he began working full time in March at a rough-and-tumble housing facility in Vancouver's Downtown Eastside. Semiao's new job combines janitorial duties – such as cleaning up drug paraphernalia – with front-line support that may include helping someone find an alternative to drinking Listerine.

With no previous experience in the mental health field, Semiao has made the usual rookie mistakes since he started working at the Stanley Hotel in the dimly lit Blood Alley, a residential hotel run by PHS Community Services Society, the same organization that co-manages Vancouver's supervised injection site. Early on, he buzzed in at least one volatile individual after forgetting to check the building's "barred persons" list.

In the past nine months, Semiao has been first on the scene of numerous drug overdoses, which involves grabbing a "crash kit" to administer Narcan, a medication used to counteract the effects of opioid drugs and restore breathing while paramedics are on the way. Semiao described drug overdose as "the most stressful situation that I've been part of." Nevertheless, he said, "this is where I want to be."

Last year, Semiao left a senior position in the Western Canada office of an international non-profit organization because he was looking for something that was "a bit more hands-on." He heard about a job opening at PHS through his volunteer work with the Vancouver Street Soccer League, which provides camaraderie for people affected by homelessness. Ever since high school, social justice and advocacy work "have been passions of mine," he said.

His new job couldn't be more hands-on. The overwhelming majority of the hotel's 70-plus residents suffer from drug or alcohol addiction in addition to mental illness such as schizophrenia and bipolar disorder. For these individuals, who range in age from their late 20s to early 70s, The Stanley is either a last resort before homelessness or a first shot at housing after many rough nights on the street. The hotel's harm-reduction policy allows residents to shoot up in their rooms and find refuge during psychiatric crises that might otherwise land them in police custody. Semiao's job is to offer practical support, such as connecting residents with medical services, or filling out application forms for picture ID – and helping them stay alive.

So far, no one has died from an overdose on his watch. Semiao took a range of first-aid classes during job training and learned the ropes from experienced colleagues. However, in emergency situations, he said, "you just hope that the reflexes kick in."

Semiao has a degree in political science, and said he hopes to enter part-time studies in social work. Nevertheless, he pointed out that a big part of the job involves "showing empathy and being able to read a situation very well, which I don't think you can necessarily learn from a textbook."

Semiao was raised by a single mother of two, a nurse who worked night shifts throughout his childhood. Visiting his mom at work, he witnessed the feedback loop of his mom's attentive care and patients' appreciative responses. "That definitely had an impact on me," he said.

But Semiao is under no illusion that he can turn every drug user's life around. Even if a resident is motivated to kick a habit, beds at detox facilities are in short supply and sobriety is nearly impossible to keep up when residents return to the drug-addled neighbourhood simply because they have nowhere else to go. Reflecting on the iron grip of addiction, Semiao explained that watching residents he describes as "loving, caring people" pace the building in search of a fix, or spin out of control in the throes of withdrawal, has given him insight into the struggles of a close family member who suffers from alcohol abuse.

He added that dealing with the systemic barriers in the Downtown Eastside that reduce residents' chances of recovery can be extremely frustrating: "If I were to focus on these issues seven days a week, I don't know that I would last too long."

Semiao said it took him a while to figure out how to unplug from the job. From March until a few weeks ago, he was on the graveyard shift, working three 12-hour nights in a row. The constant threat of emergency left him on hyper-alert, wreaking havoc with his sleep.

He took up hot yoga and plays competitive soccer, a physical outlet that allows him to "run around not thinking." But Semiao said his sleep didn't really improve until he discovered a labyrinth in a park near his home. After a three-night shift ending at 8 a.m., he would follow the loops of the labyrinth very slowly, focusing only on what was directly in front him. Walking at a snail's pace for more than half an hour relieved his tension, calming him enough to sleep after a long night.

Even though he recently landed a coveted day shift, Semiao said he's keen to get back to his labyrinth ritual. "It's amazing how much it helped," he said.