I’m going to talk today about the idea of using a full name and date of birth for needle programme clients. You see, I think we should use peoples real names. I think there are some very good reasons why we should, and they are mostly for the benefit of the client.
So, as anyone working in needle programmes probably knows it has been traditional to have a fully anonymous service. Different services manage this in different ways, some giving out colour coded keyrings, some assigning a number and others working from initials.
The reasons for this have always been to protect client identity, and a perception that nobody would attend for sterile equipment if they thought they'd have to give a real name.
In most places I’ve worked when an attempt is made to increase the amount of information collected from clients there has been great resistance, but this has never been from the clients. It's usually staff resistance with comments like “If we start asking those questions no clients will come in.”
Reasons for using names
- Improved treatment journeys: While I’m all for allowing anyone to be given a service under the name Mortimer Mouse, it’s really difficult to arrange a hepatology referral for Mr. Mouse. Needle programmes as I’ve said many times, are gateway services that attract people at earlier stages and refer into appropriate treatments, that’s one of the main arguments we have for continued funding. Using full names and dates of birth means we have the evidence of the work we do for each client.
- Better services: If you assess people properly for their needs you can provide better more targeted services. Not something that is fully possible when they are identifying themselves through a number (every service I’ve worked in using ‘number IDs’ has had issues with people just giving a random number when they attend). Also if you keep a regular record of the work done during an exchange then you can follow up on previous advice as well as minimising repetition. (This is also a way of evidencing the work we do to commissioners).
- The most important reason: What is the message given to the client when the first thing we say is don’t worry you can use any initials you want, no one will know you are coming etc etc. Personally I feel we are at risk of it seeming like “don’t worry about your dirty guilty secret, you should be ashamed, no one will find out.”. It’s just not normal to use initials when talking to people, I use names when I talk to clients or anyone else, not using names separates the process out as different, unusual, clandestine. Our clients are stigmatized enough by the rest of society, we shouldn’t be adding to this. Treat your clients with respect and use their names.
Of course we need to get clients to understand that services are still confidential, but that can be done by having robust confidentiality systems. At first presentation you should be explaining to people in what way information is kept, why it’s kept and the limits on how confidential we can be within current UK law (or whatever the local law is to you). You should be doing this for EVERY client you work with anyway.
Staff 'buy in'
It’s no good just asking people to start doing robust assessments for needle exchange visitors if they don’t understand the advantages to the service and the clients. Because of this it is important that you get all staff on board with any changes you make before letting them loose on your clients.
If someone doesn't want to give a name this shouldn't be a barrier to recieving a service, I'd in no way condone forcing people to give names. My point is more that we shouldn't avoid using names as this could be even more stigmatising to a group that already gets enough stigma in their lives.
Nigel Brunsdon is the owner of Injecting Advice.com. He's been working in harm reduction since the 1990's, although he's previously a frontline needle programme worker he now spends most of his time developing online resources for drugs workers and users.