Harm Reduction: From Festivals to Hospitals
Mental health and the re-emergence of psychedelic-assisted therapy is a complicated landscape with many opposing opinions. In regards to drug addiction, some might say things like, “We need more extreme laws and regulations,” while others might say, “The War on Drugs was a huge failure! We need to legalize everything.” The path forward for mental health can be equally as divided. Regardless, whatever direction people believe we need to move in, our current results speak for themselves.
Over the past few decades, mental health issues have been rising, along with concerning statistics of increasing suicide rates. This, combined with the opiate epidemic, has led to the need for change in our approach to aid those struggling. Whether it be otherwise healthy individuals going through their first mental health crises, those working through childhood trauma, or problematic substance use, we need to try something new.
This is where harm reduction comes in. It is an arms-wide-open approach to exploring everything from simple mental health awareness, to safe injection sites, to researching psychedelic-assisted therapy, all in an effort to mitigate and solve some of these key problems we face today.
Some methods may simply decrease harm in the immediate, such as social worker teams stationed in ER’s, while others provide promising long-term solutions. It all serves the same purpose: To change our environment and strategies to something that will one day make such pathologies, like treatment-resistant depression, a thing of the past.
Harm Reduction In The Least Likely Place
On a whim, I decided to volunteer at Shambhala Music Festival. Creative costumes, dancing until sunrise, funky electronic music and a little first-aid action on the side. What I didn’t expect was to be joining one of the world leaders in harm reduction. That was in 2014, after which I went back to Shambhala for another four years.
Coming from Vancouver, I was used to clubs that kicked people out when they drank too much. Shambhala does the opposite. Instead of bouncers who kick you onto the street and hope you make it home safely, security would contact medical staff for assistance. From there, we treat patients for any medical concerns and, once they are back to good health, let them return to the party or send them to The Sanctuary.
Next to the medical building, The Sanctuary is a calm and quiet place nestled under the trees that is staffed by social workers and therapists. When you walk in, you’re met with gentle lights and beds everywhere. This place is the middle ground for those who are medically sound but still need a safe place to work through any mental health or substance-related issues.
Finally, there is a place called Ankors, the drug testing facility placed at the main entrance. No judgement testing, information on any and all drugs, and notices about drugs laced with dangerous substances to avoid. This acknowledges that many partygoers will do drugs instead of turning a blind eye like many other events. By doing so, it empowers and educates guests so that they can be proactively involved in their own harm reduction practices.
It’s worth noting that, to my knowledge, only one person has ever died at Shambhala. This became the wake-up call for an aggressive change regarding harm reduction practices many years ago. Despite 15,000 guests annually, at worst, only a small handful of people require transfer to hospital for a higher level of care. This system not only takes the lead in reducing harm for its guests but also in reducing its impact on the local health care system.
This was my first taste of a place that doesn’t pretend like drug and alcohol use doesn’t happen. While it doesn’t condone illegal drug use, it encourages people to seek knowledge before the party starts and seek help when things go awry. This is a place that is leading the way for harm reduction.
Sadly, public health care has been slow at best to join the party. When I began working in Vancouver as a Paramedic, the environment was a stark contrast to how we treat mental health, drug use, and overdoses. It was a serious letdown.
Contrast In Medicine
Mental health emergencies make up a huge portion of 911 calls. Even medical and traumatic emergencies often have a mental health component. So I think it’s worth sharing a little about the medical system, what it does well, and its limitations.
When a call is made to 911, paramedics will respond, along with police and firefighters if needed. From here, we can treat any emergent medical conditions. Paramedic schools focus on big medical emergencies and only skim over mental health. Give us a big car crash or heart attack, and we have you covered. The latter, however, is something we all have to learn on the job.
Once at the hospital, nurses and doctors are able to treat any remaining pathophysiology and ideally refer patients to a mental health team. If the sun really shines on us, a mental health team will be present and available in the hospital too. Sadly this is not the status quo.
Afterwards, many patients will have to wait upwards of weeks to months before their referral for social workers or therapists comes to fruition; in my opinion, way too long after the initial emergency occurs. Even more frustrating are those who fall between the cracks of bad and unable to help themselves, but not bad enough to receive immediate help.
A good example is someone within my extended bubble who was recently suicidal again. The police were called to do a wellness check, in which they confirmed this person was in a rough state and required help. However, because this person didn’t say the magic words “I want to kill myself,” the police could not do anything. Even if they did say the magic words, it’s likely that the hospital will only be able to offer drugs such as anti-anxieties, antipsychotics and antidepressants, and unlikely to have a therapist or social worker available on the spot.
In saying this, let’s take into consideration what medical schools actually teach. If you want someone who specializes in mental health, you seek a psychiatrist or therapist. If you want someone specializing in the movement of the body and physical health, you seek a kinesiologist or physiotherapist. If you want someone specializing in human biochemistry, anatomy, physiology and pathophysiology, you seek a doctor of medicine.
With that in mind, one form of harm reduction I’m going to propose is having a floor in hospitals that isn’t filled with medical doctors but with therapists and social workers. Much like The Sanctuary, once a patient is medically stable, we can get them mental health treatment immediately and start fixing what led to the medical emergency in the first place. What benefits might we see if hospitals could provide psychotherapy or even psychedelic-assisted therapy on the spot while a person is in the midst of their mental health crisis?
Without this immediate secondary care, many of these patients will be sent home only to have another mental health emergency. Know that I don’t say this to be grim. I say this because I’m often the one who gets called to these repeat patients who are struggling and unable to get the support they need. I say this because many paramedics, nurses and doctors are also experiencing their own mental health burnout. We work in a system that, while great at fixing acute emergencies, is suboptimal with regards to treating chronic illnesses, mental health and substance abuse issues.
Concluding
What’s clear to me is that we are in an era of mental health crises. Perhaps it’s because we are no longer sweeping it under the rug. Perhaps our environment has changed with some unintentional consequences. Or, perhaps modern life demands more of our minds than ever. The simple fact that we don’t completely understand the cause is a strong argument for why harm reduction is becoming more relevant than ever.
Whether it’s psilocybin-assisted therapy to treat addiction, MDMA-assisted therapy to treat PTSD, safe injection sites, or emergency therapists working in hospitals, it’s all for the same purpose. Harm reduction is the umbrella term that simply means “let’s find a better way” and “no person left behind.” Hopefully, it’s a term that will one day mean that we are not transporting every patient to the hospital but to a team of mental health experts.
My hope is that one day, our world holds more value and knowledge towards understanding mental health. With better harm reduction strategies and the safe use of things like psychedelic-assisted therapy, we can make promising and therapeutic impacts on humanity.
