The importance of emotional safety, including trust, acceptance, feeling safe, and developing relationships was described by participants in relation to the following components: therapeutic activities; and staff empathy and lived experience.
Therapeutic activities
There were two types of therapeutic activities described by participants: groups (e.g. 12-Step, morning therapy and psycho-educational groups); and individual counselling (described as one-on-one time with a counsellor). A majority of clients perceived the therapeutic groups to be the most helpful therapeutic activity during treatment. Groups gave them an opportunity to share experiences about their problems, feel understood and learn from others experiences. For instance, one client said:
“The groups have been unreal... When staff are talking it’s like they’re taking everything out of my head and just saying it. It’s like they’re only talking to me, like I’m the only person in the room with the problem… It’s good to listen, just to sit there and listen” (C12).
This was found to be especially beneficial for clients who reported vulnerabilities with expressing themselves or their emotions. As such, a critical element of OH’s groups, as identified by clients, was that “you’re allowed to share if you want, but they don’t force you” (C10). Clients consistently reported a preference to listen when they first arrive, and then they gradually “talk more and more” (C3) each time as they build their confidence and trust within the group. Given this, trust was perceived as a very important enabler for clients to share their experiences, as they felt more accepted into the group:
“We’ll talk about our stress every morning instead of holding it in… We talk in a circle and we all know it stays in the room” (C1).
According to the clients, there were two types of individual counselling provided at OH. First, most clients reported receiving individual counselling from the visiting psychologist or psychiatrist at the local Aboriginal Medical Service (AMS). The focus or content of these sessions was not described. Second, several clients described “having a yarn” (C4) with OH staff in more informal settings. These clients reported feeling staff were approachable and were “always there to have a talk” (C1) both day and night when they were “worked up and need a chat” (C3) or felt like leaving the program.
Staff empathy and lived experience
All clients reported positive perceptions about the OH staff, stating “it’s not just a job for them… they go out of their way” (C7) and that staff are “always available for a chat… genuine, easy to get along with and feel caring” (C11). Staff reinforced the importance of providing client-centred care:
“We’re all on the same page, the whole purpose of the job is to help these fellas in their journey to do something different with their life” (S4).
Clients reported staff related to them better because they had “been there done that” (C11), meaning that they were aware that staff had lived experience of substance misuse which clients perceived as a strength of the program. One staff member reflected on how their shared experiences are similar:
“Since I’ve come here I’ve worked with a lot of the guys and there’s not much difference in our stories, the only difference is that some of the guys end up in jail, but all the traits were the same, all the habits, what we did was the same” (S3).
An example of how a staff member used their lived experience to relate better to clients was when talking to them prior to admission to OH, using their lived experience to reframe their understanding by feeling empathy for clients:
“I tell them that, “You’re going to do it hard… but if you use before coming, it will be harder.” But, I have to remember about my experiences, because, when I was going to rehab I would have used that much… to get that last hurrah” (S5).
Staff lived experience was also viewed by some clients as more important than formal qualifications:
“It’s pretty good here too because all the staff that are here have been through it, they’ve been in the same boat, whereas some of the city rehabs and that they’re just people out of university and that, so it wouldn’t work as good” (C10).
Staff with lived experience demonstrate by their example that recovery is possible, and sharing personal experiences in the group setting can reinforce this notion of recovery. For instance:
“Sometimes when I talk about the past it brings back a lot of memories, but when I walk out clients come shake your hand and say, “Thank you,” because they didn’t expect it” (S8).
However, a small number of staff reported university or other relevant training related to their role. One staff member reported that he progressed up the ranks through “on the job training” (S3):
“I started off as a residential care worker, I did cooking, cleaning, assessments... As each opportunity came, I grabbed it… I really enjoy it! I couldn’t imagine where I’m at, and since I’ve been here I’ve been offered training, I actually finished university last year, which I never, ever thought I’d be able to do, I never dreamt of it” (S3).
Staff additionally conveyed that identifying as Aboriginal or from the region helped to build rapport and develop cultural bonds with clients, and was perceived as a strength by both staff and clients:
“I think a lot of boys feel comfortable if you say, “Where are you from, brother?” I always ask them where they’re from, “Oh, do you know such and such,” because nine out of ten times they know the people we know…“Yeah, Unc, I know him... You know him?” “Yeah” (S4).
“I'm Ngemba... this country is Ngemba. My great, great, great grandfather, that’s how far I go back, he was the Chief of this tribe… I’m connected to this land strongly” (S8).
As a result of employing a mix of staff with lived experience, formal qualifications, links to the region or identifying as Aboriginal, clients and staff report mutual respect and genuine connection, which appears to reinforce a perception of safety that promotes healing. For instance:
“They feel safe around us, and when you know they feel safe around you and respect you, you start to see them healing” (S9).
Despite this, some staff reported challenges of working in a remote Aboriginal residential rehabilitation setting, including the difficulty of caring too much about the clients, for example:
“The managers say, “Look, be there, but you’re not their friend, you’re just a worker.” But it’s a hard when you’re with them for three months and you get to know them, and later someone says, “So and so got killed, so and so overdosed, this one’s got locked up”” (S4).
As a result, working in a “24/7 remote service with the most complex, disadvantaged members of society” (S6) was described as “mentally draining” (S3), with staff reporting feeling overwhelmed.