Are people with mental illnesses more violent? - answer-According to Canadian Mental Health Association, 2014
- People with mental illnesses are no more likely to be violent than the general population
- In fact, people with major mental illnesses are 2.5 times *more likely to be victims* of...
Are people with mental illnesses more violent? - answer-According to Canadian Mental Health
Association, 2014
- People with mental illnesses are no more likely to be violent than the general population
- In fact, people with major mental illnesses are 2.5 times *more likely to be victims* of violence than
other members of society
- The facts indicate that the strongest predictor of violent behaviour for anyone, including those with
mental illnesses, is *excessive alcohol and other drug use and a history of violent behaviour.*
What are the three types of stigma? - answer-Stigma: a negative stereotype
1. Structural stigma
- Discriminatory social structure, policy, and legislation
- Lack in quality and quantity of mental health services
- Poor training of mental HCP trainees with respect to mental health
- Disproportionate resource allocation
2. Interpersonal stigma
- problems of knowledge, attitudes, and behaviour
- Emotional reactions to people with mental illness
- Prejudice or assumptions that certain individuals are prone to violence or not as competent as others
to bit fit for office
- Feeling dismissed or not heard by healthcare providers
3. Intrapersonal stigma (self or internalized stigma)
- shame, acceptance of mental illness stereotypes, sense of isolation
- Negatively correlated with empowerment
Do people with mental health issues tend to get help? - answer-Almost *one half* of those who feel
they have suffered from depression or anxiety have *never gone to see a doctor* about this problem
Over *two thirds* of people with a diagnosable mental illness have not sought help for their mental
health issues
What can you do about stigma? - answer-- Reflect on the language you use
- Know the facts
- Be aware of your attitudes and behaviour
- Educate others
- Focus on the positive
- Support people
- Include everyone
,How can you say "addict, abuser, junkie user/crazy, lunatic, wacko, psycho" in a respectful term? -
answer-Person with an addiction or mental illness
How can you say "schizophrenic" in a respectful term? - answer-Person with schizophrenia
How can you say "person who is normal, personal who is not normal" in a respectful way? - answer-
Normal: an able person
Not normal: person with a disability
Take home messages about stigma - answer-Stigma impacts all aspects of care (ex: access, openness to
seeking treatment, availability of treatments, etc)
Clients/patients and clinicians can reflect on how stigma impacts their care, and their ability to provide
care, respectively
Interventions exist to address stigma on micro- and macro-levels
Harm reduction - answer-
What is harm reduction? - answer-"...seeks to reduce the *health and social harms* associated with
alcohol and drug use, without necessarily requiring that users abstain"
What does Bill C-224 (may 2017) do? - answer-Offers protection from arrest if an individual is in breach
of: parole, pre-trial release, probation orders, simple possessions, conditional sentences
It does NOT provide legal protection against:
▪ Outstanding warrants
▪ Production and trafficking
▪ All other crimes not outlined within the Controlled Drugs and Substances Act
Some jurisdictions (ex: Peel) will arrest people, but once they come into the station they aren't actually
convicted
What is pragmatism in harm reduction? - answer-Accepts that some use of psychoactive substance is
inevitable, and that some level of substance use is expected in a society
What should we think about peoples decision to use alcohol and drugs? - answer-The substance users'
decision to use alcohol and other drugs is accepted as his or her choice; no moralistic judgement is made
to condemn or support the use of substances (regardless of level of use or mode of intake)
Focus on respect in harm reduction - answer-Be respectful
- Engage the patient without scaring them off
Respect the patient's autonomy
- Not giving needles will not change whether or not they use substances
- You can use this as an opportunity to allow safe use of illicit substances - ex: naloxone distribution
,- Engage the person in conversation about the purpose of the needles in a private and safe environment
- we could respectfully inquire about their use - we can then refer them to a rapid access
methadone/suboxone clinic
What is the goal with harm reduction? - answer-Focus on harms
- The extent of a person's substance use is secondary importance to the harms resulting from that use
Heirarchy of goals
- Most pressing needs are addressed first - have a conversation with the patient!
What are the harms associated with substance use and abuse? - answer-- Development of a substance
use disorder
- Accidents
- Aggression and violence
- Spread of infections diseases (ex: Hep C)
- Alcohol and drug-related crime
- Exclusion from housing and education
- Restrictions on travel
- Health and social effects of imprisonment
Give some examples of harm reduction - answer-Provision of sterile injection equipment: Reduce spread
of bloodborne diseases
Distribution of controlled quantities of alcoholic beverages: Curtail the ingestion of non-beverage
alcohol products
Amendment of penalties for cannabis possession to remove criminal sanctions
Nicotine gum and patches
RIDE program
Methadone and buprenorphine
- Some people view methadone/buprenorphine as a harm reduction strategy, while others view it as a
treatment for OUD
- Given that it has such substantial data for bringing back into the community and treating addiction, it is
so much more that just harm reduction
- Reintegration back into society and treating harms of substance use go together!
What are some harm reduction supplies - answer-Safe injection equipment
- Needles and syringes in various sizes and brands
- Sterile water (some may even resort to puddle water for injection)
- Alcohol swabs
- Tourniquet, filters, acidifiers, and cookers
Safe smoking equipment
- Pyrex stems
- Brass screens: Prevents solid infiltrates from being inhaled
, - Chopsticks
- Mouthpieces
Note: condoms and lube are often included in these kits! - in a way they are part of the harm reduction
because they decrease the risk of STIs; disinhibition and increased unprotected sex associated with
substance use
What are some techniques we should be using when providing harm reduction supplies? - answer-No
limit on the number of injection equipment (per client, per visit)
- Limiting sets the idea that there is a certain appropriate amount
- It lifts the stigma if instead a person can pop by in a discreet way and pick up kits whenever - helps
them feel less anxious
Provide pre-packaged safer injection kits with individual safer injection supplies concurrently
Dispose of other injection equipment in accordance with local regulations for biomedical waste
Provide multiple, convenient locations for safe disposal of used equipment
What education can you provide for people when you give them harm reduction supplies? - answer-
Educate clients about the *risks associated with sharing* and reuse of other injection equipment and
correct single-person other injection equipment
Educate clients about the *proper disposal* of other injection equipment
How do safe injection sites work - answer-What they are: *Legally sanctioned and supervised* facilities
designed to reduce the health and public order problems associated with illegal injection of drugs
How: Patrons inject *pre-obtained* illicit drugs in a low-risk, hygienic environment
Why do we have safe injection sites? - answer-- Reduce transmission of bloodborne viruses (HIV, Hep C)
- Reducing morbidity and mortality associated with overdose
- Reducing public order problems (ex: public drug use, disturbances, drug-related litter)
- Increasing contact time between people who use drugs and providers of health and social services
What is societies general view on safe injection facilities? - answer-Don't want needles lying around
everywhere
It is propagating addiction rather than treating it, so why would we just let them use?? It excuses and
permits it!
Just giving them supplies to use
What is Insite? - answer-North America's first supervised injection site - opened in 2003
Operates under a constitutional exception to the Controlled Drugs and Substances Act (CDSA)
Vancouver's Downtown Eastside
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