People who inject drugs are often misunderstood and stigmatised or discriminated against by the broader community.
Consequently, for NSPs to operate in what can be a hostile environment, they have to maintain a kind of social licence by working with community to improve their understanding of NSP work, says Northern Territory Aids and Hepatitis Council peer worker Peter Sidaway.
While some of this work is done through advocacy, training and formal discussion, Pete says it’s often the little things NSP workers can do that have the biggest impact.
“Some people do have the wrong ideas or maybe don’t really understand. It’s very easy to justify what we do and why,” he says.
“Often it’s just a simple conversation, and I just start with a simple premise: ‘Mate, 1.3 cents for a syringe or tens of thousands of dollars for a hepatitis treatment? Which would you, as a tax-payer, prefer?’ Explaining it in simple dollar-and-cents terms, they get it straight away. It just makes sense.”
Mate, 1.3 cents for a syringe or tens of thousands of dollars for a hepatitis treatment? Which would you, as a tax-payer, prefer?
To work with the community, NSPs also need to be part of that community.
It’s vital that NSPs form strong working relationships with various community groups to help them better understand the work NSPs do and also to help NSPs respond to community concerns, says Canberra’s Directions Health Service CEO Bronwyn Hendry.
‘Community’ is a broad and general term, so Bronwyn says it’s important to look at the different groups that make up the community and to meet those groups in different ways.
“We do target particular groups as well as have opportunistic discussions when we get the chance to address misconceptions. That includes government, political, community groups. You do have to spread the message. There’s definitely a need for increased understanding,” says Bronwyn.
“We do a lot of advocacy to counter [misconceptions]. We really try to target stigma and discrimination in our advocacy. There’s a lot that can be done in the community to inform people better and decrease misunderstandings and misconceptions.”
We really try to target stigma and discrimination in our advocacy. There’s a lot that can be done in the community to inform people better and decrease misunderstandings and misconceptions.
Some Directions staff are qualified to train and license other ACT businesses to distribute injecting equipment.
Sometimes discrimination comes from within the organisations they are training, says NSP co-ordinator Mitch Segal, and a core part of their training focuses on improving that.
“When I go around training people within Canberra and licensing people to distribute injecting equipment, we have a very big focus on how important it is to recognise that our clients, for many of them, have been on quite a journey and their sheer resilience has been absolutely astounding,” says Mitch.
“They’ve been through experiences that a lot of us just couldn’t imagine getting through even one or two of, and our clients go through so many of them. Yet each day they get up and keep putting one foot in front of the other, which takes tremendous courage. And so we really push that message with other community organisations, along with other conversations we have with people on a day-to-day basis.
While Directions offers a walk-in NSP service at its Canberra site, it also strives to be as accessible as possible by delivering community outreach programs.
To best direct the outreach work it consults with the clients who form a vital part of the community to find out where it’s most needed, says Directions director of services Stephanie Stephens.
“We do a lot to make our services accessible because we know that different cross-sections of the community have different needs and operate in different locations and experience different barriers,” Stephanie says.
“For many people, transport can be a massive barrier for accessing sterile injecting equipment.
“Our clients have told us where people are going without access to clean equipment or safe disposal and we’ve worked to target those areas to have increased access there.”
Bronwyn says having various health service and other providers co-located within the same premises as NSPs helps create better understanding and relationships.
“Having health services co-located with NSPs can increase understanding and help with some of the de-stigmatisation,” she says.
“A good example of that stigma is when people think that the work we’re doing promotes drug use. There has been no commensurate increase in drug use and increased availability of equipment. The NSP is really a protective mechanism for the community, not just the clients themselves.”
The NSP is really a protective mechanism for the community, not just the clients themselves.
In Sydney’s Kings Cross, the Medically Supervised Injecting Centre (MSIC) has served as that protective mechanism for its community for more than 20 years.
MSIC was established in 2001 after an epidemic of heroin overdose deaths in the Kings Cross area. It was the first centre of its kind in the Southern Hemisphere and was driven not by the government but by local residents and community groups, says MSIC medical director Marianne Jauncey.
“This was always driven from the ground up. It was the local community of Kings Cross who were forced to confront the reality of public drug injecting: people injecting in their back streets and alleyways, high numbers of people overdosing,” Marianne says.
“It was the residents and business themselves who were calling ambulances and responding to overdoses. There was roughly a death every week just in this local area, and they were forced to confront and decide about what their views on drug use were.
“MSIC is a local solution to a local problem, specifically put here to respond absolutely and unequivocally to community needs.”
MSIC is a local solution to a local problem, specifically put here to respond absolutely and unequivocally to community needs.
While it was the local community who petitioned for the centre, not everybody within that community shared these views. Initially, MSIC was met with scepticism and controversy, says Marianne, and the team has worked to counter this by opening its doors to the public.
“You don’t have to agree with us to come on a tour. We would genuinely invite anyone on a tour. We run tours for the police as well as students and people who work at services in the area, new residents, businesses,” she says.
“Senior managers walk them through and allow them to ask any questions they want at a time when the service isn’t in operation. Nothing is off limits. It’s really a case of ‘We’re inviting you in. There’s nothing we have to hide. We want you to understand what we do’.”
These tours work both ways, and consulting with the community informs some of the work and processes of MSIC, says Marianne. MSIC also regularly hosts community meetings which work to build a direct line of contact and strong relationships with other community-based organisations.
“We host meetings on site with representations from local council, police, residents, business. They can bring anything to that meeting that they want to discuss. We have a very functional working relationship with the local police. We meet regularly with them and have that open line of communication with the local council and local [parliamentary] member, too.”
Marianne says it’s a willingness to listen and respond, communication and openness that make MSIC and other NSP programs an integral part of their communities and, ultimately, help them to better serve their clients.
“While I can’t pretend that everybody loves us, I would certainly say that everybody has the opportunity to come and talk to me or come and talk to one of the managers and to raise concerns,” she says.
“I really think there’s something about being prepared to have a conversation and not shying away from a difficult or sensitive or controversial topic – being willing and open and listening to people’s concerns.
“Where we can, we’ll absolutely work with them and see if we can amend and change things to everybody’s benefit. If we’re to do our job well, it’s not just about the patients in front of us but about the whole of the local community.”
– Tom de Souza
A guiding hand
The NSW Guideline to Consumer Participation in NSW alcohol and drug services offers a framework for community consultation.
Key areas of focus include:
• Involving clients, carers and staff from the beginning of planning for consumer participation
• Training clients to advocate for themselves and for their peers
• Building strong working relationships with other community groups and health services.
More information can be found in a PDF on the NSW Government health website.