Thursday, January 28, 2016

Key Challenges in Providing Services to People Who Use Drugs: The Perspectives of People Working in Emergency Departments & Shelters in Atlantic Canada

Many people who use drugs (PWUD) have multiple health and social needs, and research suggests that this population is increasingly accessing emergency departments (EDs) and shelters for health care and housing. This qualitative study explored the practices of those working in EDs and shelters when providing services to PWUD, with a particular focus on key challenges in service provision.

EDs and shelters were conceptualized as 'micro environments' with various components (i.e. social, physical and resource). One-on-one interviews were conducted with 57 individuals working in EDs and shelters in Atlantic Canada.

The social, physical and resource environments within some EDs and shelters are key forces in shaping the challenges facing those providing services. For example, the social environments within these settings are focused on acute health care in the case of EDs, and housing in the case of shelters. These mandates do not encompass the complex needs of many PWUD. Resource issues within the wider community (e.g. limited drug treatment spaces) further contribute to the challenges.

Structural issues, internal and external to EDs and shelters need to be addressed to reduce the challenges facing many who work in these settings when providing services to PWUD.

...Within the ED environment, challenges related to non-acute health issues often centre on the significant time required to address these issues. As noted by a few participants, the environment within an ED is focused on providing a medical assessment and service relatively quickly, and this stands in contrast to what is often required in addressing a chronic health issue such as a mental health concern, or an addiction issue. One participant working in an ED noted that if someone has a mental health concern, and the mental health nurse working in their ED is available, the person would be called. Sometimes, however, the mental health nurse is not available and in such instances it can be difficult to find the time for the patient.

… I find that we don’t have time for mental health patients or someone seeking addiction services. If they come in and they’re under the influence [of drugs], we have to deal with the [urgent] medical problems of the influence first. [A17ED]

Some shelter staff also noted that the multiple and complex needs of PWUD, beyond housing, can present a real challenge. One shelter staff participant pointed out that staff sometimes feel ‘ill-equipped’ to deal effectively with these complex issues, and commented that the number of clients presenting with addictions and/or mental health concerns has increased in the recent past.

Drugs, alcohol, mental health are a big part of what we deal with now [more] than 30 years ago … from a staff perspective, our front-line staff are extremely challenged. They often feel out of their element … So staff often feel ill-equipped to deal with a lot of the issues that they’re being faced with. [A18S]

This participant also described how the time required to help PWUD, and refer them to a social worker or mental health counsellor, is not always available as it ‘depends on what’s happening at the time [in the shelter]’ including the number of staff on duty [A18S]...
Full article at:

  • 1School of Health and Human Performance, Dalhousie University , Halifax, NS , Canada ; Atlantic Health Promotion Research Centre, Dalhousie University , Halifax, NS , Canada.
  • 2Atlantic Health Promotion Research Centre, Dalhousie University , Halifax, NS , Canada.
  • 3Department of Sociology and Social Anthropology, Dalhousie University , Halifax, NS , Canada.
  • 4AIDS Saint John , Saint John, NB , Canada.
  • 5Faculty of Nursing, University of New Brunswick , Fredericton, NB , Canada.
  • 6School of Social Work, Dalhousie University , Halifax, NS , Canada. 
  •  2014 Jun;21(3):244-253.

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