Harm reduction workers help people that most of us ignore, but OHS practices lacking
By Lawrence Nault
Every day workers and volunteers enter areas of the city and buildings that few but the police will enter. Their only protection is the clipboard, cellphone and paperwork they are carrying. They frequent locations that place them in close proximity to individuals with mental health issues, often on drugs, with contaminated needles, drug paraphernalia and drugs in close proximity. They know that many of the people they are engaging with are carrying concealed weapons or have them easily accessible. The environments they are working in are usually uncontrolled (such as a park or alley or apartment) and they aren’t wearing protective gear. They don’t carry weapons or have a badge and they are often working alone. This is a job that combines elements of what have been rated as some of the most dangerous jobs exposing workers to threats, aggression, violence and health risks on a daily (if not more often) basis. This is the daily reality of many working in the field of harm reduction.
Every day thousands of workers, mostly young women, are working selflessly in the field of harm reduction, helping those in our society that many of us walk past, ignore, avoid and complain about. Harm reduction programs and practices focus on reducing the negative social and economic consequences that may ensue from the use of legal and illegal substances, without requiring a reduction in the substance use. Their work not only exposes them to physical risks but also mental health risks. A 2016 study of workers in the homeless-serving sector in Edmonton by Jeannette Waegemakers Schiff and Annette Lane found that 23 per cent suffer from burnout and 30.6 per cent reported symptoms of post-traumatic stress disorder (PTSD).
The majority of organizations providing harm reduction services are not for profit, charitable organizations, created by people and groups with big hearts and good intentions. They aren’t doing this kind of work for the high pay, personal gain or the public profile, but because they want to make a difference in the lives of others. When organizations and workers are so focused on helping others and keeping clients safe, the combination of good intentions and high risk can be a dangerous. They fail to see the hazards and risk and, as a result, they put their own personal safety at risk. In Social Work Today, Christian Reardon acknowledged how social workers “don’t recognize workplace violence as an issue that affects them.” Studies and published literature on harm reduction programs illustrate the focus on the client. A good example of this is the Best Practice Recommendations for Canadian Harm Reduction Programs: Part 1 and Part 2. More recent reviews of best practices also focus on clients and fail to address the health and safety of workers and volunteers supporting the programs.
To those who have not worked in this field, the level of risk acceptance by workers and organizations seems far beyond anything that would be acceptable in the workplace. To those working in harm reduction, the training, exposure and necessity to accept these risks and hazards in order to provide assistance to those who need it desensitizes them to the level of risk in their work environment. Situations that would be identified as incidents and near misses in the workplace are “normal” for harm reduction workers, and because they are normalized, they are not assessed for opportunities to address repeated hazards and risks. These incidents are documented, but the documentation occurs in client files and medical records because it is the client and their mental health and social welfare issues that resulted in the behaviour that caused the incident. Privacy restrictions prevent this documentation from being seen and reviewed by anyone not specifically needing that information to assess a client and, as a result, the incident and the impacts on the worker are overlooked. This segregation of information results in a disconnect between administrators, supervisors and workers.
The impacts of incidents on workers in this field are not ignored but they tend to be assessed separately from the incidents the clients were involved in. Burnout, stress and PTSD are often considered to be personal issues unrelated to work. This type of system and documentation fails to acknowledge that every time there is an incident involving a client, there is an impact on the workers and volunteers working with that client. With every harm reduction client there are actions and behaviours that are affecting the client and corresponding actions and behaviours for the workers and volunteers supporting that client. There is also an area of overlap between what is happening with the clients and with the workers. It is this area that harm reduction organizations must monitor, evaluate and constantly reassess.
Given the hazards and risks associated with harm-reduction work, one would expect that government occupational health and safety divisions, workers’ compensation boards and similar organizations would be tracking incident statistics in this field. There are statistics for social workers, nurses and all the professions that work within the field of harm reduction. For instance one-third of violent workplace incidents involved a victim working in social assistance or health-care services, but the specifics within the specific field of harm reduction are not readily available. A combination of factors contributes to this lack of statistics including not tracking and reporting incidents, not recognizing incidents, protection of internal organizational information, not recognizing mental health and stress as work related (instead having it managed under benefits plans as sick and stress leave), and not taking the time to understand why there is such a high staff turnover.
Client deaths, overdoses, aggressive actions, drug induced behaviours, adapted responses, violence and weapons use all have a negative impact on workers and volunteers. Sometimes, the impact is physical in the form of contact and exposure to blood-borne pathogens and hazardous substances; other times it’s in the form of stress that has long-term impacts on mental health. The work being done by harm-reduction organizations and workers is invaluable but as long as the leaders of these organizations fail to acknowledge, investigate and respond to incidents from both a client and a worker perspective, the field of harm reduction will continue to have a high worker turnover, high rates of stress related illness and leave and may actually be contributing to the causes they are working so hard to resolve.