Supporting the Supporters: Understanding the Training and Support Needs of Staff Serving Clients who Use Drugs with Mental Health Challenges

Abstract

The changing needs of people who use drugs, particularly those with unmet mental health needs, pose significant challenges for organizations that provide harm reduction or “low-threshold” services, whose non-clinical staff manage complex cases. Unfortunately, there is a shortage of mental health providers to meet the needs of people who use drugs with co-morbid mental health challenges, placing additional burdens on non-clinical organizations and staff. To meet the increasing demand for low-threshold services, staff must take on more complex cases, placing them at risk for burnout and overextension. Despite this increasing demand, little is known about the training and support needs of this workforce. A pilot intervention with low-threshold program staff was developed to identify and support staff training and capacity-building needs. This doctoral project analyzed secondary, qualitative data from this pilot to understand the training needs of this workforce and provide recommendations to similar low-threshold organizations. Staff needs were thematically analyzed, and themes were stratified using a five-level, staff-centric, socio-ecological model: • Individual level: Emphasized the importance of self-care, preventing and responding to burnout, addressing secondary trauma, and developing skills grounded in adult learning principles. • Interpersonal level: Highlighted the need to understand the interaction between substance use and mental health, focusing on mental health medication, psychosis response, client engagement strategies tailored to people who use drugs, and improved crisis management and safety protocols. • Organizational level: Identified the necessity for enhanced training and education on harm reduction practices, clinically-oriented supervision and support, and real-time feedback mechanisms. • Community level: Identified challenges related to resource and referral limitations for clients with mental health needs and adapting to the evolving drug use landscape. • Societal levels: Highlighted the challenges of addressing stigma associated with drug use and shifting support from individuals in recovery to those actively using substances. The findings show that training and support for non-clinical staff are essential to client and staff wellbeing but are not alone sufficient to bridge mental health service gaps. Organizational investment is crucial to provide comprehensive staff-centric training and support and foster a low-threshold service workforce that is empowered, well-supported, and better equipped to support their clients' complex needs.