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The voice of Scotland’s vibrant voluntary sector

Published by Scottish Council for Voluntary Organisations

TFN is published by the Scottish Council for Voluntary Organisations, Mansfield Traquair Centre, 15 Mansfield Place, Edinburgh, EH3 6BB. The Scottish Council for Voluntary Organisations (SCVO) is a Scottish Charitable Incorporated Organisation. Registration number SC003558.

Reducing harm in practice: our own perspective

This opinion piece is over 4 years old
 

Dan Mushens looks at the issue of harm reduction in helping those living with alcohol related brain damage (ARBD)

As a service we’re fortunate to have a really committed staff team and we support people experiencing ARBD to live safely and independently in their homes.

ARBD can be described as the result of chronic alcohol abuse combined with a lack of adequate nutrition. It can manifest itself by affecting a person’s mobility, balance, gait, memory, motivation and cognitive functioning – making everyday tasks such as walking, making phone calls, opening letters or preparing meals difficult to complete.

As a service delivery model, when needed to, we use a harm reduction approach when providing support. We recognise that not everyone may be at the stage of being able to commit to aiming for total abstinence.

The desire for change and the aspiration to live free from the chains of alcohol needs to come from the individual. Sustained recovery is more likely when the behavioural change comes at a time of one’s own choosing rather than being forced upon someone.

Therefore, we support people who may on occasion be under the influence of alcohol and present as intoxicated. We’ve come to learn that this needn’t be a barrier and rather than retreating due to no meaningful engagement being likely, we now try to stay and ensure that any risks to someone’s safety and welfare are considered and reduced.

Examples of reducing harm

Mitigating the impact of memory deficits is most common. For example, making sure someone’s mobile phone is topped up, charged up and switched on takes just minutes to ascertain, but can act as a communication lifeline in the event of an accident or emergency. If we can’t locate someone when we arrive for support then the contingency of being able to call them on their mobile to make sure their safe is vital.

Also, checking their electricity meter to ensure it has enough credit is simple but really important. Being intoxicated and confronted with no electricity in the darkness of night, can cause real anxiety and potentially lead to trips and falls.

Sufferers can often overlook any mail that might arrive in the post and simply put it in a drawer unopened and forget about it. Providing support to open a letter and respond to it can make a real difference. We often find letters with upcoming health appointment details or welfare benefit notices unopened, so offering encouragement to open them and respond accordingly is a really important life skill that most of us take for granted.

Dan Mushens
Dan Mushens

At a really basic level, people living with ARBD can forget to eat a meal, and when you consider ARBD is partly caused by a lack of nutrition, this is a really significant issue. So if we arrive to find someone intoxicated and not being able to recall when they last ate, then offering support to prepare a meal or order food to be delivered helps to fulfil essential dietary needs. Sometimes people aren’t able to physically stand up or walk very far meaning they’re unable to go to the shops to buy groceries to feed themselves.

Other common harm reduction interventions include prompting people to take their medication doses that they might forget to take as well as using memory aids such as whiteboards, diaries and calendars to input information such as upcoming support times, appointments, tasks to complete, contact numbers in the event of an emergency or any other pertinent information that they might need to know. When a person sporadically glances at these details on a whiteboard throughout the course of the day, it helps to reinforce them.

A dual approach

We don’t always deliver support just with harm reduction interventions in mind, lots of social and therapeutic work is also achieved. Abstaining from alcohol is the preferred pathway to recovery from ARBD and alcohol dependency, so this is what some other services solely promote. Of course, we promote abstinence too but whenever the occasion requires, we utilise harm reduction approaches as well.

When our service was in its infancy; steadily developing and looking for its own identity, our admission criteria was that a person needed to be, or at least have the desire to be abstinent and living alcohol free. Therefore, support from us would come to an end if we arrived at someone’s home and found them presenting as intoxicated.

We’d remind them of our abstinence policy and leave them without support because they were under the influence of alcohol. It was always contentious and made staff feel uneasy. Social care employees do tend to have an innate desire to help people after all.

To disengage and retreat when someone had relapsed and potentially in distress was considered a little ironic. This is the precise moment when they were at their most vulnerable and more likely to come to harm. Irony wasn’t our intention and change was clearly needed.

This coincided with a new management regime arriving and after much discussion and deliberation, we decided to reclassify our access criteria and service delivery model as a whole.

The promotion of total abstinence and the promotion of harm reduction don’t necessarily have to be polar opposites when delivering support. A mixture of each can be a useful combination in a practitioner’s toolbox. They can compliment eachother depending on how you find somebody presenting when they open their door to welcome you into their home.

We would never expect our staff to go to work in an unsafe environment and on that note, the only harm we tend to witness is the physical and emotional harm that people experience themselves due to the effects of alcohol abuse.

Service users don’t actually consume alcohol in the presence of staff, but if they present as intoxicated when we arrive, then we’ll do our best to reduce any risks that could lead to their harm. Even when someone is intoxicated, so much can be achieved that can reduce harm and contribute to the overall safety and wellbeing of a service user.

Checking their mobile phone is switched on, their electricity meter is topped up, their post has been opened, their whiteboard has been updated, their meds have been taken and offering help to order a take away can take a total of just five minutes.

Five minutes to keep someone safe. It’s the least we can do.

Dan Mushens is a recovery practitioner for Scottish mental health charity Penumbra