Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Substance Abuse Treatment, Prevention, and Policy
Published in: Substance Abuse Treatment, Prevention, and Policy 1/2017

Open Access 01-12-2017 | Research

Harm Reduction and Tensions in Trust and Distrust in a Mental Health Service: A Qualitative Approach

Authors: Rozilaine Redi Lago, Elizabeth Peter, Cláudia Maria Bógus

Published in: Substance Abuse Treatment, Prevention, and Policy | Issue 1/2017

Login to get access

Abstract

Background

People seeking care for substance use (PSCSU) experience deep social and health inequities. Harm reduction can be a moral imperative to approach these persons. The purpose of this study was to explore relationships among users, health care providers, relatives, and society regarding harm reduction in mental health care, using a trust approach rooted in feminist ethics.

Methods

A qualitative study was conducted in a mental health service for PSCSU, and included fifteen participants who were health care providers, users, and their relatives. Individual in-depth and group interviews, participant observation, and a review of patients’ records and service reports were conducted.

Results

Three nested levels of (dis)trust were identified: (dis)trust in the treatment, (dis)trust in the user, and self-(dis)trust of the user, revealing the interconnections among different layers of trust. (Dis)trust at each level can amplify or decrease the potential for a positive therapeutic response in users, their relatives’ support, and how professionals act and build innovations in care. Distrust was more abundant than trust in participants’ reports, revealing the fragility of trust and the focus on abstinence within this setting.

Conclusion

The mismatch between wants and needs of users and the expectations and requirements of a society and mental health care system based on a logic of “fixing” has contributed to distrust and stigma. Therefore, we recommend policies that increase the investment in harm reduction education and practice that target service providers, PSCSU, and society to change the context of distrust identified.
Literature
1.
Cameron A, Abrahams H, Morgan K, Williamson E, Henry L. From pillar to post: homeless women’s experiences of social care. Health Soc Care Community. 2016;24:345–52.CrossRefPubMed
2.
Pauly B. Shifting moral values to enhance access to health care: harm reduction as a context for ethical nursing practice. Int J Drug Policy. 2008;19:195–204.CrossRefPubMed
3.
4.
Keane H. Critiques of harm reduction, morality and the promise of human rights. Int J Drug Policy. 2003;14:227–32.CrossRef
5.
Canadian Nurses Association. Harm reduction and currently illegal drugs: implications for nursing policy, practice, education and research. Discussion Paper. Ottawa: Canadian Nurses Association; 2011.
6.
Stancliff S, Phillips BW, Maghsoudi N, Joseph H. Harm reduction: front line public health. J Addict Dis. 2015;34:206–19.CrossRefPubMed
7.
Wilson DP, Donalda B, Shattocka AJ, Wilson D, Fraser-Hurt N. The cost-effectiveness of harm reduction. Int J Drug Policy. 2015;26:S5–S11.CrossRefPubMed
8.
Bruggmann P, Grebely J. Prevention, treatment and care of hepatitis C virus infection among people who inject drugs. Int J Drug Policy. 2015;26:S22–6.CrossRefPubMed
9.
Carvalho LB, Bosi ML, Freire JC. Dimensão ética do cuidado em saúde mental na rede pública de serviços [Ethical dimension of mental health care within the public health network]. Rev Saude Publica. 2008;42:700–6.CrossRefPubMed
10.
Rhodes T, Prodanović A, Žikić B, Kuneski E, Pavićević T, Karadžić D, Bernays S. Trust, disruption and responsibility in accounts of injecting equipment sharing and hepatitis C risk. Health, Risk & Society. 2008;10(3):221–40.CrossRef
11.
Strike C, Guta A, de Prinse K, Switzer S, Chan CS. Living with addiction: the perspectives of drug using and non-using individuals about sharing space in a hospital setting. Int J Drug Policy. 2014;25:640–49.CrossRefPubMed
12.
13.
14.
Edland-Gryt M, Skatvedt AH. Thresholds in a low-threshold setting: an empirical study of barriers in a centre for people with drug problems and mental health disorders. Int J Drug Policy. 2013;24:257–64.CrossRefPubMed
15.
McLeod C. Trust. Stanford encyclopedia of philosophy. Stanford, CA: Center for the study of language and information, Stanford University; 2006.
16.
17.
McLeod C, Sherwin S. Relational autonomy, self-trust and health care for patients who are oppressed. In: Mackenzie C, Stoljar N, editors. Relational autonomy: feminist perspectives on autonomy, agency and the social self. New York: Oxford University Press; 2000. p. 259–79.
18.
Harris M, Rhodes T, Martin A. Taming systems to create enabling environments for HCV treatment: negotiating trust in the drug and alcohol setting. Soc Sci Med. 2013;83:19–26.CrossRefPubMed
19.
Palamar JJ. A pilot study examining perceived rejection and secrecy in relation to illicit drug use and associated stigma. Drug Alcohol Rev. 2012;31(4):573–9.CrossRefPubMed
20.
Palamar JJ. An examination of beliefs and opinions about drug use in relation to personal stigmatization towards drug users. J Psychoactive Drugs. 2013;45(5):367–73.CrossRefPubMed
21.
Tran BX, Vu PB, Nguyen LH, Latkin SK, Nguyen CT, Phan HTT, Latkin CA. Drug addiction stigma in relation to methadone maintenance treatment by different service delivery models in Vietnam. BMC Public Health. 2016;16:238.CrossRefPubMedPubMedCentral
22.
Carspecken P. Critical ethnography in educational research: A theoretical and practical guide. New York: Routledge; 1996.
23.
Creswell JW. Projeto de pesquisa: métodos qualitativo, quantitativo e misto [Reseach Project: qualitative, quantitative and mixed methods]. 2ath ed. Porto Alegre: Artmed; 2007.
24.
25.
Islam M, Topp L, Conigrave KM, Day CA. Defining a service for people who use drugs as ‘low-threshold’: what should be the criteria? Int J Drug Policy. 2013;24:220–22.CrossRef
26.
Marini M, Schnornberger TM, Brandalise GB, Bergozza M, Heldt E. Quality of life determinants in patients of a psychosocial care center for alcohol and other drug users. Issues Ment Health Nurs. 2013;34:524–30.CrossRefPubMed
27.
Gallassi AD, Nakano EY, Wagner GA, Rodrigues MN, Silva MO, Fischer B. Characteristics of clients using a community-based drug treatment service (‘CAPS-AD’) in Brazil: an exploratory study. Int J Drug Policy. 2016. doi:10.​1016/​j.​drugpo.​2016.​01.​020.PubMed
28.
Ribeiro DB, Schneider JF, Terra MG, Soccol KLS, Camillo LA, Plein FAZ. Reasons for attempting suicide among men who use alcohol and other drugs. Rev Gaúcha Enferm. 2016;37(1):e54896.CrossRefPubMed
29.
Mohammed S, Peter E, Gastaldo D, Howell D. Rethinking Case Study Methodology in Poststructural Research. Can J Nurs Res. 2015;47(1):97–114.
30.
Emerson R. Working with ‘key incidents’. In: Seale C, Gobo G, Gubrium JF, Silverman D, editors. Qualitative research practice. Thousand Oaks: Sage; 2007. p. 427–42.
31.
Kincheloe JL, McLaren P. Rethinking critical theory and qualitative research. In: Denzin NK, Lincoln Y, editors. Qualitative research. Thousand Oaks: Sage; 2005. p. 303–41.
32.
Melia KM. Recognizing quality in qualitative research. In: Bourgeault I, DeVries R, Dingwall R, editors. Handbook of qualitative research. Los Angeles: Sage; 2010. p. 559–74.
33.
Whetten K, Leserman J, Whetten R, Ostermann J, Thielman N, Swartz M, Stangl D. Exploring Lack of Trust in Care Providers and the Government as a Barrier to Health Service Use. Ame J Public Health. 2006;96(4):716–21.CrossRef
34.
Jauffret-Roustide M, Cohen J, Poisot-Martin I, Spire B, Gossop M, Carrieri MP, the MANIF 2000 Study Group. Distributive sharing among HIV–HCV co-infected injecting drug users: the preventive role of trust in one’s physician. AIDS Care. 2012;24(2):232–8.PubMed
35.
Peterson J, Mitchell SG, Hong Y, Agar M, Latkin C. Getting clean and harm reduction: adversarial or complementary issues for injection drug users. Cad Saúde Pública. 2006;22:733–40.CrossRefPubMed
36.
Garcia MLT, Leal FX, Abreu CC. A política antidrogas brasileira: velhos dilemas [Brazil’s anti-drugs policies: old dilemmas]. Psicologia & Sociedade, Porto Alegre. 2008;20:267–76.CrossRef
37.
Ronzani TM, Higgins-Biddle J, Furtado EF. Stigmatization of alcohol and other drug users by primary care providers in Southeast Brazil. Soc Sci Med. 2009;69:1080–84.CrossRefPubMed
38.
Bastos FI. Structural violence in the context of drug policy and initiatives aiming to reduce drug-related harm in contemporary Brazil: A review. Subst Use Misuse. 2012;47:1603–10.CrossRefPubMed
39.
Ostertag, S., Wright, B., Broadhead, R. S., Altice, F. Trust and other characteristics associated with health care utilization by injection drug users. J of Drug Issues. 2006;36:953–974.
40.
Treloar C, Rance J, on behalf of the ETHOS Study Group. How to build trustworthy hepatitis C services in an opioid treatment clinic? A qualitative study of clients and health workers in a co-located setting. Int J Drug Policy. 2014;25:865–70.CrossRefPubMed
41.
Treloar C, Rance J, Yates K, Mao L. Trust and people who inject drugs: The perspectives of clients and staff of Needle Syringe Programs. Int J Drug Policy. 2016;27:138–45.CrossRefPubMed
42.
Borg M, Kristiansen K. Recovery-oriented professionals: Helping relationships in mental health services. J Ment Health. 2004;13:493–505.CrossRef
43.
Andrews D, Kramera R, Klumper L, Barrington C. A qualitative exploration of individuals’ motivators for seeking substance user treatment. Subst Use Misuse. 2012;47:1224–33.CrossRefPubMed
44.
Kothari G, Hardy G, Rowse G. The therapeutic relationship between therapists and substance-using clients: a qualitative exploration. J Subst Use. 2010;15:257–71.CrossRef
45.
Lee HS, Zerai A. “Everyone deserves services no matter what”: defining success in harm-reduction-based substance user treatment. Subst Use Misuse. 2010;45:2411–27.CrossRefPubMed
46.
Moore D, Fraser S. Putting at risk what we know: reflecting on the drug-using subject in harm reduction and its political implications. Soc Sci Med. 2006;62:3035–47.CrossRefPubMed
47.
Morgan K, Lee J, Sebar B. Community health workers: a bridge to healthcare for people who inject drugs. Int J Drug Policy. 2015;26:380–87.CrossRefPubMed
48.
Islam M, Topp L, Day CA, Dawson A, Conigrave KM. The accessibility, acceptability, health impact and cost implications of primary healthcare outlets that target injecting drug users: a narrative synthesis of literature. Int J Drug Policy. 2012;23:94–102.CrossRefPubMed
49.
Ventevogel P. Integration of mental health into primary healthcare in low-income countries: avoiding medicalization. Int Rev Psychiatr. 2014;26:669–79.CrossRef
Metadata
Title
Harm Reduction and Tensions in Trust and Distrust in a Mental Health Service: A Qualitative Approach
Authors
Rozilaine Redi Lago
Elizabeth Peter
Cláudia Maria Bógus
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Substance Abuse Treatment, Prevention, and Policy / Issue 1/2017
Electronic ISSN: 1747-597X
DOI
https://doi.org/10.1186/s13011-017-0098-1

Other articles of this Issue 1/2017

Substance Abuse Treatment, Prevention, and Policy 1/2017 Go to the issue

Research

A mixed methods study of HIV-related services in buprenorphine treatment

Review

Is there room for resilience? A scoping review and critique of substance use literature and its utilization of the concept of resilience

Research

Korean national athletes’ knowledge, practices, and attitudes of doping: a cross-sectional study

Research

The impact of subsidized low aromatic fuel (LAF) on petrol (gasoline) sniffing in remote Australian indigenous communities

Research

Intensive Case Management for Addiction to promote engagement with care of people with severe mental and substance use disorders: an observational study

Research

Systemic and individual factors in the buprenorphine treatment-seeking process: a qualitative study