New articles: Stigma and healthcare access for people who consume drugs

In 2019 the DruGS team completed work on a qualitative interview-based research project on stigma, conducted with South Western Sydney Drug Health Services. Two journal articles were written from the project and have now been published.

The first article was recently accepted for publication in Sociology of Health and Illness. Entitled ‘Exclusion and hospitality: The subtle dynamics of stigma in healthcare access for people emerging from alcohol and other drug treatment’, this article was led by Suzanne Fraser. In contrast with much research on healthcare stigma that analyses explicitly discriminatory practices, this piece analyses the often subtle operations of stigma within healthcare services, noting that these subtle operations exclude people who consume drugs in ways that are often hard to identify. By interviewing people exiting an in-patient withdrawal management service, all of whom had a history of contact with healthcare services while experiencing drug issues, it identified a range of dynamics shaping their experiences of healthcare. Drawing on these findings, it further found that stigma can inflect the atmosphere of healthcare services, excluding people who consume drugs by failing to take account of their past experiences of discrimination. When these experiences are ignored, necessary signals of welcome and encouragement are neglected, and the sense of care experienced by other members of the community is absent. Taking up insights from contemporary theories of hospitality and welcome within the cosmopolitan tradition, and pointing out that hospitality gave hospitals their name, the article argues that these subtle stigmatising dynamics require equally subtle, yet urgent and comprehensive, responses.

As Suzanne explains,

This research project emphasised the complexity of the healthcare stigma faced by people who consume drugs. Our findings highlight that common answers to stigma such as education or professional training initiatives, while well meaning, are unlikely to produce on their own the thorough changes needed to improve healthcare access for people who consume drugs.

The second article written from our project data is published in Health Sociology Review. Entitled ‘Basic care as exceptional care: Addiction stigma and consumer accounts of quality healthcare in Australia’, this article was led by Adrian Farrugia. Taking a closer look at healthcare engagement after participants exit the in-patient withdrawal management service, this piece looks at how stigma operates to shape consumer understandings of quality healthcare, even where overt discrimination is not present. It argues that routine experiences of discrimination faced by participants in mainstream healthcare settings work to constitute even basic care as exceptional. For many, this means healthcare encounters that are not characterised by explicit discrimination come to be experienced as exemplary, even when they offer only routine, or even minimal, levels of care that would likely be taken for granted by other members of the community. In making this argument, the article highlighted two key issues for healthcare access among people leaving in-patient withdrawal management services. First, people who consume drugs often have complex healthcare needs and already encounter obstacles to accessing the care they need. Second, people who consume drugs are routinely subtly positioned outside the purview of mainstream healthcare, thereby obstructing their fundamental right to care.

As Adrian explains, this research has important implications for future research,

Our finding that stigma makes quality healthcare not only less accessible but also less imaginable is especially important for the design of future research on healthcare satisfaction. Without properly accounting for this dynamic, assessments of satisfaction may produce accounts that are naïve to stigma’s impact on how consumers understand and experience quality healthcare.

These two new articles are the first in a series of publications due from the DruGS team’s productive collaboration with South Western Sydney Drug Health Services.

References

Farrugia, A., Pienaar, K., Fraser, S., Edwards, M. & Madden, A. (2020) Basic care as exceptional care: Consumer accounts of quality healthcare in AustraliaHealth Sociology Review. (accepted for publication 10 June 2020)

Fraser, S., Farrugia, A., Moore, D., Edwards, M. & Madden, A. (2020) Exclusion and hospitality: The subtle dynamics of stigma in healthcare access for people emerging from alcohol and other drug withdrawal management treatment. Sociology of Health and Illness. (accepted for publication 3 July 2020)