drugs worker in the unit that had changed his life , he took clients to a local shop , where the shopkeeper whispered to him , ‘ I don ’ t know how you could work with these people ’. It shocked him that there was still so much to do . ‘ Every single client has identified stigma as a barrier to treatment ,’ he said .

INSTITUTIONAL STIGMA For some parts of the population , including people experiencing homelessness , the layers of stigma and discrimination could seem insurmountable . ‘ By and large the support and care is done in siloed forms ,’ said Dr Colm Gallagher , clinical psychologist at Manchester mental health homeless team . ‘ Often it ’ s fragmented , it ’ s inconsistent and when people find it very difficult to access mainstream services , that ’ s partly probably because of stigma from organisations and indirect discrimination .’ He talked about an overwhelming sense of rejection – ‘ rejection from family , rejection from services and society as a whole ’.

Running training sessions for frontline homeless sector staff , he asked them to think about the societal narratives around homelessness – that it was seen a lifestyle choice , that the person was a nuisance , lazy , manipulative and always in trouble with the law . They were encouraged to think about how this affected the person ’ s motivation to seek help , when they ‘ think that they are not worthy , rejected from society , they ’ re not wanted , that they can ’ t be trusted , that this is their own fault , that no one cares … this is going to have an effect on how willing they are to engage ,’ he said . ‘ Why would they go about seeking help if they think they are going to be rejected again ?’

TRAUMA-INFORMED Gary Broderick and Paula Kearney described being involved in the Dublin Citywide Stigma Campaign , run by Trinity College . The findings of the programme were important because they came from women who were actively using services and actively experiencing stigma . They explored the idea of a traumainformed approach and realised that people were traumatised not just in a childhood or because of things that had happened in their lives , but also by the services they went into . When people were treated completely differently it became an everyday thing , so that they didn ’ t even realise the damage that was being done and the impact it was having on their self-worth . The task in hand involved ‘ upgrading their awareness ’.

SERVICE USER VOICES Talking to people about their experience of stigma was a vital part of learning how to break it down , said April Wareham , director of Working with Everyone , which aimed to bring the voice of lived experience to policy and practice in health and social care .

In a project that gathered feedback on stigma from people with lived experience ( commissioned by NHS APA ) all participants felt that people who used drugs were stigmatised . ‘ What we found was that people experience stigma in different ways ,’ said Wareham . As well as preconceptions about race , culture and a criminal past , there was often

‘ Stigma is surely the reason why our fantastic evidence-based treatment services are completely underfunded , why our workforce is underdeveloped … and why we are working out of buildings that are falling down .’ Ed Day , recovery champion

‘ It ’ s really important as a field that we come together . We really need to seize the day and the Dame Carol Black report and wave it in politicians ’ faces … Stigma says more about the person that ’ s judging someone than the person they ’ re judging .’ Stuart Green , service manager , Aspire Doncaster

‘ Starting this [ review ] I put the stigmatised person at the centre . For me , it was – what is needed to help the person with the drug dependency problem really start the road to recovery ?’ Dame Carol Black

‘ Stigma doesn ’ t just attach itself to the drug and alcohol user , it attaches itself to friends and families around them … a family has a vital role to play in somebody ’ s recovery but they also need support for themselves and this is often neglected or ignored .’ Viv Evans , chief executive , Adfam

‘ Focus on the person not on their behaviour , focus on the person not the policy intervention that they ’ re being targeted with . That ’ s about language , but it ’ s also about behaviour .’ Oliver Standing , Collective Voice

a disconnect in treatment ranging from stigma about the drug of choice to dismissing mental health problems before the drug problem was addressed , or vice versa .

The manner of communication played an important part – ‘ I was spoken to badly – none of my opinions seemed to matter ’. A key finding was , ‘ if people experienced poor treatment or stigmatising behaviour once or more than once in one service , it meant that they were unlikely to go back to the service and ask for help again .’ One

of the biggest effects of stigma was a feeling of isolation .

Things needed to change , but the hard bit was ‘ changing the way we think and act ’, she said . And a main action point was , ‘ don ’ t deny our lived reality . Don ’ t tell us something doesn ’ t hurt when we know it does .’ One of the worst pieces of feedback she heard regularly from services was , ‘ our service users don ’ t feel that way – it doesn ’ t happen here ,’ she said . ‘ Don ’ t take away our lived reality from us . We know what we ’ ve experienced .’

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NOVEMBER 2021 • DRINK AND DRUGS NEWS • 7