There are these two fish swimming along... This is not a post about the lack of clean water for people who inject drugs and how they end up using puddles, toilet water, or saliva as their water for injections. It's about stigma.
It’s only an impression but, when I have been locumming, I sometimes got the impression that some institutions had a slightly condescending approach to clients - and that individuals who did not adopt similar attitudes were frowned on.
I’ve just been put on daily pick up after years on weekly . Even when I was clean for several years and started using “ daily “ again and went back I was put onto weekly pick up , now fair enough I’ve used a “ little “ on top , which is once or twice a week and go two three weeks without using .
The hard fact is my key worker is on leave and I’ve been handed over to someone who doesn’t regard me as important and therefore said nothing to the doctor when putting me up 5mls to 35mls when in weeks I’ll be in detox ( which shows my character) plus the surroundings I’m in which is a hostel for the homeless ( even when on the streets I was clean too ) yet still they won’t hear my argument nor listen to the fact this is prejudiced against me and also stigmatising adding an already heavy load onto an unbearable load as is and so I put down the phone before I swore and or shouted . Though I imagine I’m still the bad guy and they just don’t get it as they’re doing the government a favor by keeping the pressure on us at all times or in my case - when they can get away with it and I find it humiliating.
So called health care workers need to be hired on perspective of personal experience with a built in experience of the system and not of a nepotistic approach or simply on academic merit who follow orders from government just to keep a job instead of standing up for those who truly are suffering at the bottom because it’s almost as if the healthcare side of things is set up for service users to fail and said workers are helping in keeping us down .
Thanks Mark. I have to admit I do worry a lot about changes to supervision and pick ups for the kind of reasons you mention. It's often done for safety reasons but it is really hard to weigh up the evidence of benefit/harm - and the harms, as you describe, are often keenly felt by individuals like you. I'd like to see much better evidence around this to help make decisions.
I also take your point about healthcare workers and it highlights the critical importance of that relationship. Often, though, keyworkers don't necessarily have a lot of control over some aspects of care and it's handed down to them. As a doctor I can often choose to make decisions, based on the evidence, that don't necessarily fit perfectly with "orders from government". However, I know that I'm in a strong position to defend those decisions - that's often not a luxury that keyworkers will have at all which makes it difficult to get beyond guidelines written for the many and not the individual.
It’s only an impression but, when I have been locumming, I sometimes got the impression that some institutions had a slightly condescending approach to clients - and that individuals who did not adopt similar attitudes were frowned on.
Cultural attitudes within organisations are so critical. Water conditions will vary! And, of course, it takes an outsider to spot the differences as those swimming around in it just don't notice. I've never locumed in substance misuse settings but I have in GP - it was always fascinating to step into a new practice and pick up the vibe.
Stigma of folks with Substance Use Disorders. It is like a form of racism. Extremely harmful and unhelpful. Multifactorial. Multidirectional. Conscious and unconscious. But, like racism, it must be challenged at every opportunity. Education is important. And we need to start with the healthcare professions. And we also need to help our clients 'unlearn their self stigmatisation' that society has caused.
Yes, I agree. I’d be more wary about people who are being stigmatised having to ‘unlearn’ it and I’m not familiar with social science research into this area (one to look at) - I do think it needs careful framing to avoid any suggestion it is caused by them. As you say, it’s put on them by society and the stigmatisation is so deep, so ingrained, that people don’t see it and there is a self loathing (usually for other reasons as well of course) that feeds off that.
Stigma can even extend to healthcare workers who are sympathetic to clients!
Interesting point , how do you find this to be the case , Peter ?
It’s only an impression but, when I have been locumming, I sometimes got the impression that some institutions had a slightly condescending approach to clients - and that individuals who did not adopt similar attitudes were frowned on.
I’ve just been put on daily pick up after years on weekly . Even when I was clean for several years and started using “ daily “ again and went back I was put onto weekly pick up , now fair enough I’ve used a “ little “ on top , which is once or twice a week and go two three weeks without using .
The hard fact is my key worker is on leave and I’ve been handed over to someone who doesn’t regard me as important and therefore said nothing to the doctor when putting me up 5mls to 35mls when in weeks I’ll be in detox ( which shows my character) plus the surroundings I’m in which is a hostel for the homeless ( even when on the streets I was clean too ) yet still they won’t hear my argument nor listen to the fact this is prejudiced against me and also stigmatising adding an already heavy load onto an unbearable load as is and so I put down the phone before I swore and or shouted . Though I imagine I’m still the bad guy and they just don’t get it as they’re doing the government a favor by keeping the pressure on us at all times or in my case - when they can get away with it and I find it humiliating.
So called health care workers need to be hired on perspective of personal experience with a built in experience of the system and not of a nepotistic approach or simply on academic merit who follow orders from government just to keep a job instead of standing up for those who truly are suffering at the bottom because it’s almost as if the healthcare side of things is set up for service users to fail and said workers are helping in keeping us down .
Thanks Mark. I have to admit I do worry a lot about changes to supervision and pick ups for the kind of reasons you mention. It's often done for safety reasons but it is really hard to weigh up the evidence of benefit/harm - and the harms, as you describe, are often keenly felt by individuals like you. I'd like to see much better evidence around this to help make decisions.
I also take your point about healthcare workers and it highlights the critical importance of that relationship. Often, though, keyworkers don't necessarily have a lot of control over some aspects of care and it's handed down to them. As a doctor I can often choose to make decisions, based on the evidence, that don't necessarily fit perfectly with "orders from government". However, I know that I'm in a strong position to defend those decisions - that's often not a luxury that keyworkers will have at all which makes it difficult to get beyond guidelines written for the many and not the individual.
It’s only an impression but, when I have been locumming, I sometimes got the impression that some institutions had a slightly condescending approach to clients - and that individuals who did not adopt similar attitudes were frowned on.
Cultural attitudes within organisations are so critical. Water conditions will vary! And, of course, it takes an outsider to spot the differences as those swimming around in it just don't notice. I've never locumed in substance misuse settings but I have in GP - it was always fascinating to step into a new practice and pick up the vibe.
Stigma of folks with Substance Use Disorders. It is like a form of racism. Extremely harmful and unhelpful. Multifactorial. Multidirectional. Conscious and unconscious. But, like racism, it must be challenged at every opportunity. Education is important. And we need to start with the healthcare professions. And we also need to help our clients 'unlearn their self stigmatisation' that society has caused.
Yes, I agree. I’d be more wary about people who are being stigmatised having to ‘unlearn’ it and I’m not familiar with social science research into this area (one to look at) - I do think it needs careful framing to avoid any suggestion it is caused by them. As you say, it’s put on them by society and the stigmatisation is so deep, so ingrained, that people don’t see it and there is a self loathing (usually for other reasons as well of course) that feeds off that.