Another recurring theme raised in the conversations as a significant barrier to effective partnerships was the negative attitudes of many service providers towards people who use illicit drugs. In the following section I discuss some of the comments made during the conversations that indicate this has been another impediment to successfully engaging people who use illicit drugs in partnerships.
“Tough on Drugs”, the National Illicit Drug Strategy launched by the Howard Coalition Government in 1997 identifies ‘training and skills development for front line workers who come into contact with drug users or at risk groups’ (DOHA 1998) as one of the key priority areas in efforts to reduce drug related harms. Phillips and Bourne (2008) have also identified how the values of workers can impact on
outcomes for consumers of drug treatment services. Hinton’s research also found that service providers attitudes were a ‘key determinant and require a long term process of
cultural change reinforced through awareness raising, training, supervision and mentoring’ (Hinton 2010:10). A number of conversational partners, from across all three cohorts, expressed views that this had not been successful and that many
workers in the sector continued to hold stereotypical views that people who use illicit drugs were somewhat dangerous and difficult to work with. This fits with the view of Ross and Darke that illicit drug users are often considered ‘mad, bad and dangerous to know’ (Ross and Darke 1992).
One service provider described their experience of working in a clinical setting and expressed concern that stigmatisation of clients was widespread in the drug treatment sector
When I started at this organisation, I found that it was terrified of its own clients. It had policies that were defensive, almost paranoid, around the clientele that it dealt with. It had a whole range of explanations and constructions as to why we had these policies and philosophies. A lot of it was based on the self-fulfilling prophecy that our clients are dangerous, and of course if you treat our patients as dangerous they become
dangerous.
I had a senior psychologist here explain to me when I started about how dangerous our patients were. This person said our clients can look quite normal, they can act like normal, even for weeks at a time, but suddenly without warning they will turn on you. I thought it was more like a crocodile farm than a clinic!
It’s often about power and control and behavioural management of clients perceived to be dangerous. And with an organisational culture such as that it makes it difficult, or impossible, to work effectively with a drug user group. We are really primitive in our approach. There is a real fear of our clients (Respondent 4).
Several user advocates described their experience of the stigmatisation of illicit drug users by service providers, both in mainland States as well as in Tasmania
One of the main barriers is that people are afraid to identify as users because of a fear of discrimination and because of the law. So prohibition and the discrimination that people are used to facing when accessing services, particularly from health services, when they identify as illicit drug users is a real problem (Respondent 5).
There’s a lot of ex-users employed in the drug and alcohol sector and I think it goes along with this NA [Narcotics Anonymous] philosophy around if you are using, ever, then you are really sick and anything you do is never any good (Respondent 14).
While several of the policy documents analysed in Chapter Five discuss the need for professional development of staff in the sector, conversational partners felt such entrenched values are difficult to change, particularly in a political climate where people who use illicit drugs are demonised and vilified. Several conversational partners considered that addressing this issue was critical if governments were to bring about meaningful change. Involving people from user organisations in training programs for staff of service delivery agencies was considered one means of bringing about such change. According to several of the conversational partners this is
happening more frequently in some States, however, given Tasmania’s lack of a funded peer-based organisation this has not been possible since the demise of The Tasmanian Users Health Support League (TUHSL).
While stigmatisation of people who use illicit drugs was considered one significant barrier to successfully engaging users in partnership arrangements, an issue that I discuss in more detail in the following chapter, some consumer advocates felt a fear of breaches of confidentiality was another key factor in limiting the effective involvement of consumers
I think there is a perception that a lot of drug and alcohol services breach confidentiality. Particularly when they have a few components to their service like a needle exchange and a counselling service, and people go
for court counselling. And I’m not sure if it is real or perceived but some people feel that their confidentiality is breached. I think that to help overcome this we need to have people really involved in the service delivery policies and planning and then people can have input into confidentiality policies and sharing information policies. And then they can actually see them at work. Being told that a service has a
confidentiality policy and that staff are not breaching that is all well and good, but if you experience it in practice and are part of building that then maybe you will have more confidence in it (Respondent 5).
Not all conversational partners, however, felt that efforts to address the negative attitudes of service providers towards illicit drugs users had been unsuccessful. One user advocate discussed how the organisation they were involved in had made
concerted efforts to overcome such discrimination on the part of service providers and had met with some success
One of the things we found was there was a lot of discrimination from other services towards a user group, but one of the things we found over the years was that if we could manage to get them in through the door and work on something with them, like some joint partnership project, that they always left impressed and with their views totally changed. And they’d tell everyone how wonderful we were. So there was a lot of work to break down the stereotypes of users but it was really worthwhile (Respondent 5).
In this section I have highlighted the theme of service provider’s negative attitudes that was raised by several conversational partners as a significant barrier to the meaningful involvement of users in partnerships. This theme, along with a lack of institutional support and adequate resourcing, and the lack of an enabling
environment in which user groups could operate were considered key barriers to the success of partnerships. These themes reflect that traditional conservative morality continues to significantly influence drug policy and service delivery processes and represent a challenge to developing effective responses based on rational, evidence- based approaches to substance use as would be expected under an ‘ideal
governmentality’ model. It also highlights that a form of ‘authoritarian rule’ (Hindess 2001, 2005) continues to apply to those deemed not capable of bearing the
responsibilities of freedom available to those deemed to have developed appropriate ‘technologies of the self’ (Dean 1999; Hindess 2001, 2005).
In the following section I discuss issues that were raised during the conversations relating specifically to Tasmania. These are important as they highlight some of the difficulties faced in establishing a sustainable user advocacy organisation in a State that has some unique characteristics and which has had a history of failed attempts at establishing such groups.