Blog 2 – I talked about the Catalyst Harm Reduction approach in my last blog in support of International Overdose Day, and want to expand on some of the differences in how we work to support people and keep them safe.
In considering harm related approaches it is worth keeping in mind the wider determinants of health – considering options to support someone who vapes, is at risk of blood borne viruses through unsafe practice – as well as encouraging people to access needle exchange at Xchange in Woking, Surrey or through local pharmacies.
Maslow’s Hierarchy of Needs is a good example of an approach to working with clients who don’t even meet that baseline of basic needs. How do you motivate someone when their physical needs are not being met; when they are trying to remain safe when rough sleeping, or not knowing where the next meal or drink of water comes from?
It can take a long time to gain trust from people – especially when someone has had the door closed on them many times because of the choices they have made to survive. Often people demonstrate their frustrations through aggression and distrust of why anyone would want to help.
For our staff working with vulnerable people, it is important that boundaries are put in place and that they go at the pace of the person – but also to recognise when they may be being manipulated. Showing humanity to someone whose coping strategy is to wake up and think about getting their next fix, how they will get that fix and putting themselves potentially at risk to get the funds to pay for their next fix, is a big step in the direction of gaining trust.
Expectations from both sides need to remain achievable; enabling someone rough sleeping to have their own home can be an aim but it needs to be grounded in the realisation that this is something that will come over time. It is important not to raise expectations and damage the relationship because some basic needs are not met quickly enough.
Day centres can provide access to food, shelter, medical professionals, laundry facilities and advice and guidance on housing and benefits. Whilst hostels provide great access at night, there is no provision during the day. People must be over18 and eligible for Housing Benefit – a contribution is required, but there is access to breakfast and evening meal, hot and cold drinks, and assistance with securing long-term accommodation. Admission is by direct access only and a client must present themselves in person at the hostel. But bed allocation is on a first come, first served basis.
Only when basic needs are met can you start looking at climbing through the stages in Maslow’s diagram.
While it is well known that even small amounts of alcohol can affect people’s ability to drive safely, driving laws allow a small amount of alcohol in the bloodstream, setting a limit to reduce risks of serious accidents. When a person uses both alcohol and cocaine, the substances form a unique substance known as cocaethylene metabolised in the liver. Cocaethylene, also known as ethylbenzoylecgonine, has some significant effects of its own.
With any substance, waste products and new substances can build up in the system and be harmful. Cocaine and alcohol are toxic and harmful to bodily tissues and metabolised in the liver in order to eliminate them from the body.
Regular use of both can have serious effects – but some, like sudden heart attacks or impulsive behaviours might affect even occasional users.
The i-access team (in partnership with Catalyst) offer needle exchange to people in their own environments via outreach as well as encouraging peer distribution (one individual providing a range of needle paraphernalia to other drug injecting people); this provides increased access to clean works, allows the dissemination of health promotion and prevention messages and engages with more injecting drug users.
The challenges and complexities of working with people to engage them and help address these basic needs, are ones which Catalyst has a long and successful history of delivering.