MENTAL HEALTH CRISIS HARM REDUCTION INTERVENTIONS

Harm reduction is an umbrella term for interventions aiming to reduce the problematic effects of behaviors. Most frequently associated with substance use, harm reduction also applies to any decisions that have negative consequences associated with them. For example, at one end of the spectrum, harm reduction may seek to reduce the risk of HIV transmission by supporting needle exchange programs. Harm reduction techniques may also prioritize less risky drinking habits for underage college students to reduce the risk of alcohol poisoning. Other suggestions may include encouraging safe sex, replacing binge eating with healthier alternatives, providing clean razors for those engaging in cutting/self-harm behaviors, or supporting even 5 minutes of exercise per day.

At its core, harm reduction supports any steps in the right direction. Critics may contend that harm reduction somehow enables or excuses poor choices. Although abstinence may be the ultimate goal, and is of course the only way to avoid all negative consequences associated with substance abuse, the harm reduction practitioner seeks to meet with the client where he or she is in regards to motivation and ability to change. The practitioner’s goals are secondary to what the client wants. This does not imply that the practitioner has no opinion; rather, the practitioner respects the client’s decisions both for and against change.

The harm reduction practitioner frequently uses nonjudgmental but directive techniques, including motivational interviewing (MI) to allow the client to explore reasons for change. MI entails expressing empathy to build rapport with the client, developing discrepancy between what the client wants and where he or she is currently, rolling with client resistance to build the relationship and move toward change, and supporting self-efficacy in the client to take the necessary steps. Within a cognitive-behavioral framework, the practitioner may also assist in setting reasonable goals, practicing refusal skills, identifying alternative behaviors, and considering relapse prevention.

One major difference between harm reduction and abstinence-based programs is the definition of therapeutic progress. If a client presents after 1 month of treatment and reports consuming five drinks on each of the past three nights, a traditional program would count that as a failure. If abstinence was required for certain services, including housing, that client may be turned away from further treatment. Alternatively, a harm reduction practitioner would first ask how much the client drank at the beginning of therapy. If the client were drinking 10 drinks every day, then the consumption of five drinks a day would be a therapeutic success, or steps in the right direction. If the client’s goal were to abstain, then the therapist would continue to work with the client to troubleshoot the problematic areas and develop other coping skills. If the client’s goal was to avoid blacking out, and five drinks would keep the blood alcohol level below the risk of blacking out, then treatment would be a success. The therapist might continue to explore with the client any other negative consequences that he or she would prefer to avoid, but ultimately the client’s goal has been met.

Harm reduction interventions provide additional tools for clinicians working with clients who, for whatever reason, may not be ready, willing, or able to pursue full abstinence as a goal. Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with mental health challenges including drug use. Harm Reduction is also a movement for social justice built on a belief in, and respect for, the rights of people living with mental health challenges as well as those who use drugs.

Harm reduction incorporates a spectrum of strategies that includes safer use, managed use, abstinence, meeting people who use drugs “where they’re at,” and addressing conditions of use along with the use itself. Because harm reduction demands that interventions and policies designed to serve people who use drugs reflect specific individual and community needs, there is no universal definition of or formula for implementing harm reduction.

However, World Mental Resilience Programs considers the following principles central to harm reduction practice:

1. Accepts, for better or worse, that mental health challenges and licit and illicit drug use is part of our world and chooses to work to minimize its harmful effects rather than simply ignore or condemn them.
2. Understands mental health challenges and drug use as a complex, multi-faceted phenomenon that encompasses a continuum of behaviors from severe use to total abstinence, and acknowledges that some ways of using drugs are clearly safer than others.
3. Establishes quality of individual and community life and well-being — not necessarily cessation of all drug use — as the criteria for successful interventions and policies.
4. Calls for the non-judgmental, non-coercive provision of services and resources to people with mental health challenges and people who use drugs and the communities in which they live in order to assist them in reducing attendant harm.
5. Ensures that people with mental health challenges or lived experiences, people who use drugs and those with a history of drug use routinely have a real voice in the creation of programs and policies designed to serve them.
6. Affirms people with mental health challenges and who use drugs (PWUD) themselves as the primary agents of reducing the harms of their mental health challenges or harms of their drug use and seeks to empower PWUD to share information and support each other in strategies which meet their actual conditions of use.
7. Recognizes that the realities of poverty, class, racism, social isolation, past trauma, sex-based discrimination, and other social inequalities affect both people’s vulnerability to and capacity for effectively dealing with mental health challenges or dealing with drug-related harm.
8. Does not attempt to minimize or ignore the real and tragic harm and danger that can be associated with illicit drug use.

To facilitate healing, rehabilitation, immunity and recovery opportunities, World Mental Resilience Programs covers the gap of availability, accessibility, affordability and embracement of sustainable mental health services, solutions, systems and programs such as psychotherapy and counselling services, drug testing and detoxification, mental health support groups as well as rehabilitation services to the general community at large. We offer tailored affordable solutions answering to the unique needs of different individuals, groups, physically and mentally impaired populations, families, learning institutions, religious and cultural institutions, public and private sector companies, organisations and agencies globally physically and virtually through our pool of licensed and registered psychiatrists, psychologists, social workers, occupational therapists, counselors, sociologists, developmental practitioners, life coaches and mentors as well as medical practitioners.