Author: Nigel Brunsdon

People rarely talk about suicide directly, but many of our participants suffer from serious depression and think about suicide a lot.

One of the things that organizations might consider is ensuring that all of their staff are trained in Mental Health First Aid. There is more information in the section on Mental Health First Aid.

A person’s behavior may change drastically, or they may begin to talk about wanting to disappear or go away. In the event that people begin to talk like this, it’s important to perform a basic standard assessment of the seriousness of suicidality and help participants form a survival plan and/or connect with emergency services as needed.

Sexual assault is another topic that people will rarely be direct about. Instead, they may talk in euphemisms or even be confused that their experience was consensual when it could not have been, especially for minors.

The fact is that disproportionate numbers of people who struggle with substance use have a history of sexual assault. Because of this, it’s a good idea for your staff to be ready to understand and respond to such disclosures.

In the event that a participant does disclose sexual assault, staff and/or volunteers should first assess for issues of immediate safety and then work with the participant to see what kinds of harm reduction support plan they can make with the person.

As with any group of humans, some of the people who access harm reduction are violent towards others and, moreover, they occasionally disclose this to harm reduction workers—in part because harm reduction services and spaces offer non-judgmental environments in which people often feel safe enough to disclose their violence, or they may be so agitated that they share their feelings of wanting to commit violence in the moment.

These disclosures are some of the most difficult that harm reduction workers face. Because so many of us are survivors of abuse, dealing with other people who disclose having been abusive is often the most challenging thing that we deal with in our work.

The first thing to remember in those situations is to keep yourself centered through breathing techniques or other methods so that you can focus on continuing to provide services to the person. Please note that you do not have to approve of their behavior, and should not act as if you do. But it’s best if you are not confrontational about it.

This is for two reasons, say leaders—first for your own safety, but also for the safety of potential victims. Confronting or shaming someone who is abusive can often make them lash out at people who are most vulnerable to them. As difficult as that is, the most functionally useful thing to do in those situations is to continue providing services in a non-judgmental manner while remaining neutral about the disclosure. If you cannot do this, if it is beyond your capacity to continue to provide services to someone who discloses they are abusive in a non-judgmental and compassionate way, it is your responsibility to find someone else who can.

Harm reduction leaders were universal in their commitment to providing services, even to the most difficult or problematic members of the community, as long as their behavior was not directed at the harm reduction workers themselves. The reason for this is because harm reductionists universally believe everyone is worth saving.

Beyond that, we are not law enforcement—it is not our “lane”, our style, or within the principles of harm reduction, to confront or punish people for their problematic behavior. Our job is to keep people alive long enough to make better choices for their own well-being. We know by providing people with different tools, better information, and a different, more loving, approach, that people do change their deeply problematic behaviors—and that includes being violent or abusive.

In the second case, where people are threatening immediate violence towards others, it is important to use many of the de-escalation techniques in the next section on immediate de-escalation, including to get people thinking abstractly, to breathe, and to “get on the same page” with them. If you can get the person talking about potential consequences they would face, like catching charges or violating their probation, were they to follow through, you help distract them from being violent, even if they feel it is warranted or even necessary.

Dealing with third party disclosures—that is, when someone is telling you they know of someone else who is experiencing, or has experienced, abuse such as intimate partner violence, sexual assault, child abuse, trafficking, or any situation where a third party is being abused—can be frustrating because, as harm reduction providers, our options are limited.

Harm reduction workers are not mandatory reporters. But even mandatory reporters cannot act on the word of a third party alone. They need direct disclosure or evidence of wrongdoing in order to act. So what is to be done if someone discloses that a friend or other community member is experiencing abuse?

First, talk to the person about what they know and how they know it. It may be that they have direct knowledge, but they may equally have fallen prey to a rumor, and it’s important to differentiate between the two.

Next, explain the limitations of your position and that you are not allowed to share the information with anyone else. After that, provide the person with resources and suggestions for dealing with the relevant issues, such as seeking care or making an exit plan. Finally, check in with the person about how they are dealing with this information, and ask what kind of support they need as well.

Harm reduction leaders state that intimate partner violence (IPV) disclosures are rarely direct.

Rarely will someone say they’re “being beaten” or “abused”; instead, they may hint by saying that someone ”lays hands” on them, or that they “get into it”, or employ some other euphemism. It’s important that people listen to and take these indirect disclosures seriously. The same is true when harm reduction workers see or hear partnerships in which both parties are violent firsthand.

In all cases, harm reduction workers should first assess for issues of immediate safety and then work with the participant(s) to see what kinds of harm reduction or restorative justice plan they can make regarding this partner, up to and including an emergency exit plan.

Emergency exit plans should be specific and contain as many of the following elements as possible:

• Identification of Risks: Track patterns to recognize potential dangers and triggers that may escalate IPV.
• Resource Mapping: Identify and map out available resources and support systems. This includes knowing the phone number for the closest IPV shelter.
• Options Assessment: Evaluate different options and strategies to increase safety.
• Go Bag: Set aside a bag for essential items or copies of items like money, keys, documents, prescriptions and medications. Don’t forget to include relevant items for children, pets or other dependents. Have your go-bag ready in a secure and easily accessible place
• Seek Support: Think about safe people like family members, friends, coworkers, or other community members you can turn to in case of emergency or when you are ready to leave.
• Create a Personal Safety Plan: Think about the circumstances under which you would leave and the logistics you need to think about to do so (money, transportation, a place to go, paperwork, contacts etc). Also consider safety issues, such as who you will tell and how you will protect your dependents. The National Center on Domestic and Sexual Violence has an extensive checklist for safety planning that can help.

The need for support for human trafficking victims is rare in harm reduction organizations; however, you should think of having a plan just in case it does come up.

Many communities have existing resources for human trafficking victims, so please do some research to find out what those are in your community so you can add them to your plan.

In cases where participants disclose that they are, or know of, human trafficking victims, staff and volunteers should first assess for issues of immediate safety and then work with the participant to see what kinds of harm reduction plan they can make regarding the situation, up to and including an exit plan.

People starting out in harm reduction sometimes have concerns about participants possessing weapons at site. But the reality of most participants’ lives is that certain weapons, especially knives, are essential for general life purposes rather than nefarious ones.

It’s therefore a burden to ask people not to carry these tools. Instead, many harm reduction organizations simply ask people to conceal them at site because they can be upsetting to others.

It should be self-evident that having law-enforcement at service sites with criminalized populations would discourage those populations from coming there for services.

Long-time harm reduction leaders assert that the decision to call 911 should always be weighed against the very real possibility that the police could victimize your participants rather than help the situation in any way.

In general, it is antithetical to harm reduction best practices to call the police except under the most extreme life-or-death circumstances.

Not only can police escalate the situation further, but calling them in will erode the reputation of the program, as well as any community credibility and trust you had established.

If it is necessary to call 911 for a medical emergency, indicate to the dispatch officer that only paramedics are needed.

One hack is to reach out to various ambulance companies and see if any of them are willing for you to call them directly so that you avoid calling 911 altogether. This may not be possible in smaller jurisdictions, but in larger ones it is very possible, and you may find that some ambulance services are more compassionate towards your participants than others.

Some of the most escalated situations in harm reduction spaces are conflicts between participants that are pre-existing and have nothing to do with the site.

Because of this, harm reduction leaders offered a few hacks to minimize or prevent these situations from getting out of hand before they got started:

• Make it clear to participants that they should keep their internal conflicts outside your space.
• Anticipate that people will break any boundary you set.
• Do not participate, but keep an ear out for gossip about who has beef with whom so you can be aware if those parties should both arrive for services.
• Treat everyone with respect.
• DO NOT take sides—ESPECIALLY WITHOUT A TRANSPARENT PROCESS

Like kids at site, the first thing to know about youth participants (12-18) is that most harm reduction workers are not mandatory reporters. This is not true of harm reduction workers who also happen to have certain kinds of licensure; however most people who work at harm reduction programs are not mandatory reporters, which allows them the discretion to not report if they see children in mandated reporting situations.

The knowledge that young people are using drugs would typically be such a situation. However, harm reduction organizations are not beholden to that standard. Instead, youth should absolutely be offered the most intensive services. Special referrals, education, and support should be offered to anyone under 18.

This very much includes drug education. These are the people that it is most critical to share information with around safer drug use so that they can set good habits as they move through their drug use and hopefully beyond.