Lago Rozilaine Redi, Peter Elizabeth, Bógus Cláudia Maria
Present address: Health Science and Sports Center, Federal University of Acre, Room 212, University Campus, Road BR 364, Km 04, Industrial district, 69.920-900, Rio Branco, Acre, Brazil.
L. S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.
Subst Abuse Treat Prev Policy. 2017 Mar 8;12(1):12. doi: 10.1186/s13011-017-0098-1.
People seeking care for substance use (PSCSU) experience deep social and health inequities. Harm reduction can be a moral imperative to approach these persons. The purpose of this study was to explore relationships among users, health care providers, relatives, and society regarding harm reduction in mental health care, using a trust approach rooted in feminist ethics.
A qualitative study was conducted in a mental health service for PSCSU, and included fifteen participants who were health care providers, users, and their relatives. Individual in-depth and group interviews, participant observation, and a review of patients' records and service reports were conducted.
Three nested levels of (dis)trust were identified: (dis)trust in the treatment, (dis)trust in the user, and self-(dis)trust of the user, revealing the interconnections among different layers of trust. (Dis)trust at each level can amplify or decrease the potential for a positive therapeutic response in users, their relatives' support, and how professionals act and build innovations in care. Distrust was more abundant than trust in participants' reports, revealing the fragility of trust and the focus on abstinence within this setting.
The mismatch between wants and needs of users and the expectations and requirements of a society and mental health care system based on a logic of "fixing" has contributed to distrust and stigma. Therefore, we recommend policies that increase the investment in harm reduction education and practice that target service providers, PSCSU, and society to change the context of distrust identified.
寻求物质使用治疗的人群（PSCSU）面临严重的社会和健康不平等。减少伤害对于接触这些人而言可能是一项道德要求。本研究的目的是采用基于女性主义伦理学的信任方法，探讨使用者、医疗保健提供者、亲属和社会在精神卫生保健中减少伤害方面的关系。
在一家针对PSCSU的精神卫生服务机构中进行了一项定性研究，纳入了15名参与者，包括医疗保健提供者、使用者及其亲属。进行了个体深入访谈和小组访谈、参与观察，并查阅了患者记录和服务报告。
确定了三个嵌套层次的（不）信任：对治疗的（不）信任、对使用者的（不）信任以及使用者的自我（不）信任，揭示了不同信任层次之间的相互联系。每个层次的（不）信任都可能放大或降低使用者产生积极治疗反应的可能性、其亲属的支持程度，以及专业人员在护理中的行为方式和创新能力。在参与者的报告中，不信任比信任更为普遍，揭示了信任的脆弱性以及在这种环境下对禁欲的关注。
使用者的需求与基于“修复”逻辑的社会及精神卫生保健系统的期望和要求之间的不匹配，导致了不信任和污名化。因此，我们建议制定相关政策，增加对减少伤害教育和实践的投入，目标是服务提供者、PSCSU和社会，以改变所发现的不信任环境。
