Occasionally someone will come though an exchange with injecting issues that don't fit into any 'standard' drug training. The client I saw last week had issues that challenged my background in drug services, mental health services and expectations.
Some people may have issues with both the advice given and the fact that the client left the exchange with equipment in their hand, if so please feel free to leave a comment on how you would have handled the situation.
The client was in his early 50s and not known to the service previously, we have a short needle exchange assessment which I went though with him. This covers confidentiality issues, if the person has a GP or not (but not the details of the GP), some stuff on pin storage and returns. All the way though this the guy was in a good mood but also wrote everything he or I said on a bit of paper he had with him, and when I say everything, I mean everything.
When we got to the stage where I was asking him about what he would be injecting he told me "that's my business and I'd rather not tell you", I explained to him that this was fine but would of course limit the advice I could offer him. We continued and he asked for one 2ml barrel, 2 long blue needles and 2 orange needles, he already had a 2ml barrel which I asked if he wanted to dispose of as used equipment is an obvious risk. He said it had only ever been used for filling a printer with and he wanted to keep it for this.
Now of course we don't give pins out for filling printers and I let him know this. At that he decided he would tell me what he did want the equipment for. He started talking about the Hemlock Society and Exit and asking if I was aware of them, which I am. Both are information and advocacy services for people wanting to end their lives. He said that he wanted the equipment 'in case' he wanted to kill himself at some time in the future.
We talked about this at length including him telling me how he would do it and what he would use. It is important at this stage to note, he was NOT talking about killing himself in the near future, but was saying that if he became ill in the future and it seriously effected his life he would want to be prepared.
We talked about his mental health and I asked had he ever been diagnosed with Bipolar Disorder (manic depression) or with Obsessive Compulsive Disorder as his note talking and need to prepare so far in advance seemed to indicate this, he stated that he had only ever been diagnosed with mild depression and wasn't currently seeing mental health services.
The whole session was relaxed and he was talkative and open (after he had talked about what he intended).
After the session I had a long phone conversation with my manager to go over the issues raised, She agreed that although the client was talking about ending his life the fact that he was talking about some possible time in the future and only in a limited range of situations there was no duty to break confidentiality, and that given the situation at the time it was better to give him the small amount of equipment he requested rather than refuse him on the grounds that we are only commissioned to give equipment to substance users.
I think in these situations the important thing is to always check in with your manager if you get something really out of the ordinary, yes it's after the fact, but as long as you have a robust confidentiality agreement that the client is aware of this shouldn't be a problem.
Like I said at the start of the article, I'm sure that some people may not agree with what I did, but if that's the case, or if you have questions please leave a comment and I'll reply.
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.