Health and social interventions in the context of support and control: The experiences of marginalised people who use drugs in Australia

Health Soc Care Community. 2020 Jul;28(4):1152-1159. doi: 10.1111/hsc.12946. Epub 2020 Jan 6.

Abstract

People who use illicit drugs frequently become targets for welfare intervention, often positioned both as complicit in the reproduction of intergenerational poverty and marginalisation, and as sources of hope for interrupting such patterns. This article draws on empirical research exploring the experiences of highly marginalised people with histories of illicit drug-use to investigate how they negotiate service encounters in the context of the participants' previous experiences with welfare interventions. In doing so, the article seeks to texture the conception of the support and control nexus, drawing out the systemic and service level factors of welfare services which inhibit people who use drugs from benefitting from available support. We conducted 12 in-depth interviews with participants subject to interventions by health, social or legal services between July and September 2018. All interviews were audio-recorded, transcribed verbatim and coded in NVivo. Transcripts were analysed using a grounded theory approach where data were subject to an iterative process of constant comparisons to identify emergent themes and theoretical concepts. The findings suggest that the blending of welfare services and systems of control has unintended and often negative consequences for highly marginalised people. In effect, the drug treatment programme's aims of assisting people to reduce harm and increase stability are significantly undermined by control mechanisms such as mandatory reporting policies. A better understanding of the ways in which welfare service processes alienate marginalised people from seeking support, as well as from benefitting from the support available, might provide a way to address these concerns.

Keywords: drug treatment; drug-use; mandatory reporting; marginalisation; social welfare policy; welfare services.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Australia
  • Drug Users / statistics & numerical data*
  • Female
  • Grounded Theory
  • Health Services Needs and Demand / statistics & numerical data
  • Humans
  • Illicit Drugs*
  • Male
  • Mandatory Reporting*
  • Poverty / statistics & numerical data
  • Social Marginalization*
  • Social Welfare / statistics & numerical data*

Substances

  • Illicit Drugs