DRINK & DRUGS NEWS :: Q&A

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Thanks to this issue's respondents for their contributions.

Question:

As a worker in the drugs field I sometimes suspect that clients may be behaving in a way that poses a risk to themselves and to others - behaviour that could mean that they or I do not have the protection of our confidentiality policy. For example, I suspect that at least one of my clients has hepatitis C and may be sharing their works, or is sexually active in a way that may put his partner(s) at risk. Can readers give me any advice as to whether I should be reporting this to someone, and if so, who? Please don't say 'my manager' as I'm sure she would have the same question. [Jane, by email]

Your replies...

Hi Jane

I think you're right to worry about the effect your client's behaviour is having on others but unfortunately I don't know of anyone you could report this to - and even if there were 'Risky Behaviours Police' it wouldn't necessarily stop your client from participating in unsafe sex or sharing works.

All you can do in this situation is support your client by delivering harm minimisation, such as introducing him to needle exchange services which I am sure you are already doing. If you can get him to take some responsibility for his own health and behaviour, you then can stop others from being at risk.

Although others may be at potential risk, we have to remember that for many we are talking about consenting adults. If two adults choose to take part in risky behaviours then no crime is actually being committed. We can only provide services to those who we come into contact with, but if we educate and support them we minimise harm to those in the wider community.

There was a case where someone who was diagnosed with HIV intentionally infected others and I think one of those affected brought legal action; however your case is very different to this.
I think your client needs education so he can make informed choices and help to raise his self-esteem so he can take care of his own health therefore decreasing his risk to others.

If you suspect he has hep C symptoms, I would suggest you talk to him openly and honestly and ask him if he would like to be tested. Showing you care for his health may encourage him to care for himself as he too is at risk from his behaviour.

Harm minimisation and sexual health are the answer and I am sure you are already doing this.

Keep up the good work.

Mel Riley, drugs worker and counsellor

Dear Jane

I read your question with interest. I am a burnt out social worker and addict and have spent most of my years working with young people in vulnerable positions.

I feel that us addicts are like children when we finally take the step and choose to do something about their addiction. It is similar with the young people I have worked with: they all had challenging behaviours and to initially gain their trust and confidence, the team and I sat them down and, with my support, let them write out a contract of their expectations.

We always agreed that confidentiality was very important and high on the agenda. However, I always pointed out that if they disclosed anything that would be against their own welfare, which is paramount, or if it were harming friends, family, police or whoever, we would obviously talk about it and for everyone's safety, pass this information on.

I never had a problem with this method and it empowered the individual to start taking responsibility for their actions and behaviour. Maybe your team could adopt a similar approach, as those who use the services are crying out for support and help and need to be guided like a child in many ways. I hope this is of some use.

Sean Rendell, Hertfordshire

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