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Daily Update
– DAY THREE – Wednesday 22 April 2009
T
his morning’s session
The good, the bad and the ugly,
part of
the ‘user’s choice’ series, looks at employing drug users in harm
reduction from a number of angles – even running the
organisation themselves. ‘That raises the question of not having to hide
things and play the game – allowing people to talk honestly and openly
about their drug taking,’ says INPUD board consultant Mat Southwell
Southwell has extensive experience of running drug services in
London. ‘This was before I came out publicly as a drug user,’ he
says. ‘We had a team where more than half of the staff were drug
users, either in treatment or not – there were problems, but there
were real opportunities that came out of that as well.’
This was back in the ‘90s– has the situation changed since
then? ‘A very good indication is that all the drug using drug
workers were sacked after I left,’ he says. ‘The big challenge in
services is that people who are caught using drugs are basically
told “have a clean reference and leave without making any noise”.
So the problems never get challenged. It’s about saying “we have
employed drug users very successfully in drug services”. We were
doing pioneering harm reduction work, but it wasn’t sustainable
because it was driven by individual managers and when they left
everyone else went back to their fearful position.’
Does he have any sense of optimism that things might change
for the better? ‘The UK is particularly problematic, because we
have this NTA-driven model that at best says “if you’re in treatment
or an ex-user you can be involved, but if you’re still using you
can’t”. It’s completely tokenistic. We’re told to shut up and accept
it, but we did for ten years employ drug users and had an award
winning team. I’m not trying to say there were no problems, but the
benefits outweighed the problems.’
Among those benefits are valuable experience and insight, he
stresses. ‘That’s not to say that experiential expertise is better than
professional expertise – we had both. You also get a trust with the local
using community – it immediately gives you a way in, especially with
hard to reach communities – and you get the ability to intervene in the
local scene. For instance, when crack broke you could see those trends
coming because people are out there taking part in those trends. You
get much better intelligence from the ground much more quickly.’
A key issue for agencies is about being brave enough to do the
Employing drug users
in harm reduction
can give agencies
unprecedented access
to hard to reach
communities. But
only if it’s done right
work, he says. ‘One of the success stories of the HIV era was the way
that drug users brokered relationships between new developments
and practice, but it’s hard to see that tradition continuing. It’s also
about using your peer expertise and your privileged access to pursue
a community development approach. Just employing drug users
doesn’t automatically get you those things.’
Indeed he believes that the main downsides to employing drug
users stem from the way it’s done, rather than the process itself. ‘I
don’t think there are negatives per se, but there are huge negatives
if you do it badly,’ he says. ‘When I came into the field back in the
late ‘80s I saw people appointed as outreach workers on
methadone and stuck out there with no training to do one of the
most complex jobs in the drugs field. And drug users are often put
into that role – one of the most challenging and demanding – at
half the salary rates of other professionals.’
Agencies that employ drug users in a tokenistic way will find
those workers cease to be a broker between the organisation and
the drug using community, he says. ‘They can be patsies, put up
as “our nice reformed drug user” – organisations will just appoint
their favourite drug user and say “we’ve done it.’ The problem is it
alienates that drug user from the community and makes people feel
even more marginalised. If you give people participation without
power it actually increases their sense of powerlessness.’
Employers also need to be realistic with people, he stresses.
‘The biggest problems come with not offering training, proper
supervision or a safe environment where they can talk about the
inevitable risks and challenges posed by going back into the using
community and working in it,’ he says
Rushing into the process without thinking about the implications
can carry huge risks, he warns. ‘The danger is that it can sabotage
the whole process. Back in the 1980s, because of these few cases
that were very poorly managed, even though there were good
intentions, the idea of employing drug users in outreach in that period
was discredited. There’s a policy impact if you don’t do this right.’
The good, the bad and the ugly
is at 11.00. The next
‘users choice’ session is
Drug user organising in Asia
at
16.00, which offers delegates a chance to hear about
emerging drug user activism.
WINNING HEARTS AND MINDS