With peer support, Hamilton hospital helps build trust, provide comfort for those in substance use program
Pilot at St. Joseph’s Healthcare Hamilton expanding to other hospitals in the city
Marcie McIlveen never thought she'd work in a hospital.
Due to her negative experiences in treatment for substance use disorder on about 14 occasions, "I hated health care, did not like it, wanted nothing to do with it," McIlveen said.
What she endured, however, has led to the work she does today. McIlveen is a peer support supervisor of a new St. Joseph's Healthcare Hamilton project — it involves people who've experienced addiction offering support to patients in the substance use program.
Peer supporters keep patients company, get them comfort items and talk through problems.
So how did someone who loathed hospitals end up spearheading a pilot? It started with handing out lunches to people in need.
About five years ago, McIlveen was sober and looking for work. She started a job giving out food with the Hamilton organization Keeping Six, not realizing it was connected to physicians with the Hamilton Social Medicine Response Team (HamSmart), she said.
"Even then, I didn't want to help people," McIlveen told CBC Hamilton. "I didn't want to be part of a system that tells people how they have to get well."
Keeping Six and HamSmart practise harm reduction, which focuses on keeping people who use drugs safe, as opposed to taking a treatment- or abstinence-first approach to care.
Eventually, McIlveen got to know Dr. Tim O'Shea and Dr. Robin Lennox, both of whom worked with those organizations.
"I grew to trust these people because I'd seen what they were doing," McIlveen said.
After visiting hospitals to be with people they knew who were receiving care, the three started talking about how they could formalize peer support.
McIlveen was hesitant, but resolved, "If I'm going to do this, we need to be transparent in the fact that some people fall through cracks."
Satisfied she could work with the hospital and be true to her values, she agreed.
The proposal for the project was developed by O'Shea, who co-founded HamSmart, and Lennox, a family physician specializing in substance use care who was recently elected member of provincial parliament (MPP) for Hamilton Centre.
The project received $100,000 from James A. Burton & Family Foundation to get started, then successfully applied to Health Canada for four years of funding.
Pilot to expand to hospitals across Hamilton
Although peer supporters have been active at St. Joe's for years — particularly in mental health care — this pilot is the first to bring them into the department of medicine. Talks are already underway to expand the program to include other hospitals in the Hamilton Health Sciences network.
McIlveen describes the work as "walking with people."
No matter their reason for coming to hospital, patients needing help are referred to the substance use team, McIlveen said. She brings them candy and asks what she can do to make their care more comfortable.
From there, it varies. McIlveen got one patient crochet hooks and helped set another one up with a TV. On one patient's birthday, her team prepared a card. For someone without clothes, they got new ones.
Peer support not about demanding treatment
While support conversations may turn to treatment, the point is to meet people without expectation — not to tell them to stop using substances, McIlveen said.
You wouldn't tell a cancer patient "you have to do this or you're done," she said, and people with substance use disorder also need different forms of care.
Patients are eligible for three months of followup support after they're discharged from hospital.
McIlveen said she's heard some people call her team enablers, or describe harm reduction as "placating drug users," but she says that's not true. Health care, she said, shouldn't depend on what you put in your body.
"If you do drugs, you should [still] be able to get your heart checked out," for example, she said.
McIlveen added she didn't get sober until she chose treatment for herself.
Dr. Madeleine Verhovsek, chief of medicine at St. Joe's, said the hospital seeks to address gaps in care and acknowledge patients can have "challenging interactions with the system."
She said doctors may never be able to fully relate to people who use drugs, but the hope is a peer supporter can.
They can be like patient advocates, Verhovsek said, but advocates who are backed up by a nurse and mental health worker, and can access patient records and hospital resources.
"By having the peers there, it's helping to make the care environment friendly and compassionate in a way that folks can settle in."
Team to include 6 peer supporters
There are days when McIlveen doesn't love working in a hospital, but other days, "this is amazing," she said.
The program is expanding to employ about five more peer supporters, some of whom will work part time, Verhovsek said.
The team looks after one another, McIlveen said, talking through tough days and difficult situations.
It means a lot for St. Joe's to support the program despite the political backlash against harm reduction, she added.
She said the hospital recognizes "you can't just tell someone not to do drugs" and expect that to work.
In Hamilton, people will have one less place to go for help as the Ontario government forced the impending closure of the city's only supervised consumption site, by March 31. At the site, attached to the downtown St. Paul's Presbyterian Church, people could use substances under the eye of medical professionals.
The province approved the operator, Hamilton Urban Core Community Health Centre, to run a new kind of homelessness and addiction treatment centre that won't include supervised consumption, which is considered a form of harm reduction.
Kathryn Burton, whose father started the James A. Burton & Family Foundation, said there's a clear need for more harm reduction in Hamilton.
She worked with O'Shea, Lennox and McIlveen to get the peer support program started, and said she hopes it gives patients a solid foundation and "the ability to grow a community that will help them."
"People need support and people need to be able to trust that they're going to get care," McIlveen said. "We're here for you whatever that looks like. Whatever changes you want to make or not make, we're going to ensure that you get health care."
ABOUT THE AUTHOR
