Bereavement is an experience that is unique to everyone, but few jobs experience deaths in the context that we do. Upon dealing with the news of a death for someone I had a very good relationship with within my service, the police turned up and announced that they were here due to her suspected drug related death and they had to check her flat for the evidence of drugs. To the police, all they knew was that she was a woman who used drugs, and it was their job to try to find one possession: drugs. Of course that is their job, and they can’t possibly know everyone individually, however I thought at that moment of all the things she was other than a woman who used drugs, something that paled in comparison to her many qualities and the essence of who she was.

She was a sister, a friend, a daughter, and had the most endearing sense of humour. She was fair and level headed, slow to anger, and quick to apologise. She enjoyed company with her select few friends, and rarely deviated from this. I thought of her possessions: her beloved hamsters (she once confided that the scuttling around made her feel less alone, it was ‘unthinkable’ for her to be without them), her many animal trinkets that I came to find out she had been collecting since she was a child due to her deep and intrinsic love of animals. Her huge stack of cards for any and all occasions which were quick to be given out, particularly thank you cards which said a lot about her ability to be grateful for what she had, despite her life being characterised for so long by people who were not able to extend the same kind of kindness. The Drug Deaths are a yearly statistic that is symbolic of so much more than a number for workers. These are people who we get to know closely, we have seen them at their worst but also in beautiful, joyous, celebratory moments. We know their favourite songs, and still think of them when we hear them on the radio - especially, and tragically, when we need to play it at their funeral.

It is said that ‘the opposite of addiction is connection’, and connection can be life saving. As a service, adopting a harm reduction approach since 2020 has undoubtedly saved many lives across our services. We have lost 2 lives in my particular service since then, which is awful and 2 too many, however I have no doubt that this would be much higher otherwise. A resident of the service I work in was interviewed by Sky News this week when speaking on our harm reduction strategy, stating: ‘It has saved my life’. Rarely does a sentence hold so much weight. We see from the residents’ reluctance to divulge information relating to their drug use as they first come into the service that they have been used to services and systems that are zero tolerance and where abstinence is the benchmark. We can then see the difference in them with our harm reduction strategy and how we are able to gain their trust over time, when they realise they can be honest with us about their drug use. This results in appropriate and potentially life saving checks, harm reduction conversations and feeling comfortable reaching out to staff for not only emotional support, but support with both substance use and mental health, where we try our best to signpost.

In terms of drug related deaths, I continuously consider the role that stigma plays in substance use and mental health issues. It is so far reaching and pervasive that we even see it within communities of people who use substances, where you often hear for example: ‘I might (drink/take valium/snort coke) but at least I don’t (inject coke/heroin)’ which seems to function in a hierarchy of sorts. One thing that I have consistently witnessed is the shared commonality of experiencing discrimination and stigma within healthcare, which often prevents people from accessing vitally important care. We simply can’t discuss substance use and drug deaths without discussing healthcare and access to mental health support. With regards to the second resident we lost in the last year; our staff team, and particularly our fantastic colleague Michelle, worked relentlessly in the days prior to try to get her immediate mental health help due to drug induced psychosis; however with each turn we were unable to secure this due to GPs & MH teams deeming it not appropriate for house calls. The individual in question had crippling social anxiety in addition to psychosis so this was not a feasible option. She was taken into hospital briefly however was discharged in the early hours of the morning (a very common occurrence within homelessness/substance use), and was found having passed away in her bedroom in the hours that followed.

It begs the question, what will it take to receive help for people in this position? What does dignified, trauma informed healthcare look like and how can we put this into practice? Many of our residents ‘fall through the cracks' due to not being abstinent so can't receive mental health help, and at times not being ‘chaotic’ enough to receive other specialised help - the need for services to 'take people as they are' and not operate on such a rigid binary is huge. I had this conversation with someone only 2 days ago who said 'I wish I could get therapy and help and they'd just take me how I am'. I would love to see more training in healthcare services, with an emphasis on seeing those who struggle with substance use as people in their entirety and not being defined by their circumstances. Stigma can be deadly, but connection can be life saving.