Addressing staff burnout and community grief in harm reduction settings

What is community grief?   Community or collective grief occurs when a group of people experience the fallout from a death or multiple deaths. Within the harm reduction community, collective grief has become the norm due to losses from overdose — particularly since the introduction of fentanyl into the broader drug supply.   Also, harm reductionists face collective grief through other experiences such as suicide, incarceration of staff members and participants, and other consequences of the “War on Drugs.”   Grief surrounding overdose is unique due to the stigma related to substance use. Common feelings related to overdose loss include:  

• Helplessness that an individual could not prevent their loved one’s death.
• Frustration over lack of support and understanding from others about drug use.
• Feeling isolated from support systems.
• Bame for yourself or others

Grief can manifest in different ways, and everyone grieves differently. People may feel sadness, anxiety, loneliness, and/or emptiness or numbness while experiencing grief. People often have physical symptoms of grief like fatigue, restlessness and inability to sleep or focus.   Some factors that contribute to complicated experiences of grief include: 

• Sudden or traumatic death.
• Social stigma surrounding overdose death, especially victim blaming and judgment of loved ones who have lost someone to overdose.
• Experiences of multiple losses.
• Limited social support systems.

Syringe service programs are uniquely positioned to provide support systems to address collective grief amongst both staff and participants. There are multiple forms of grief, including ambiguous grief resulting from loss that occurs without closure or understanding. Additionally, disenfranchised grief occurs when loss is not acknowledged or validated due to societal norms, including stigma surrounding substance use.  Addressing collective grief in harm reduction   Losing a loved one, colleague or participant to overdose is difficult and every individual grieves in their own way. When someone experiences a loss to fatal overdose, their grief can feel simultaneously ambiguous and disenfranchised. What are the implications of this?  Through virtual community listening sessions, NASTAD and AIDS United have compiled suggested strategies from SSPs to address widespread grief amongst our community. Some recommendations are:  

• Trauma-informed group counseling sessions with a staff member or outsourced mental health professional.  
  • Transforming Reentry Services in Chicago hosts an 8-week mental health skill building training for all staff and volunteers. They report, “Not only does this teach us how to deal with recipients who have mental health challenges, but it also helps us diagnose and regulate ourselves so that we're in a balanced state to apply ourselves to those seeking our assistance.” Many programs can implement similar training programs such as Mental Health First Aid.  
• Community events for staff and participants alike featuring sessions focused on unwinding, relaxation and release, such as (but not limited to):  
  • • Yoga: a form of exercise of physical postures, breathing techniques and sometimes meditation derived from Hindu Yoga practices
    • Meditation: Guided breathing or solo breathing sessions with a leader engaging people in mindfulness exercises. Typically, these exercises work to remove someone from a train of thought or from hyperfocusing on one matter.  
    • Rage Room: Specialized rooms with spaces and tools for smashing objects (while wearing protective gear) including dishes, car parts, appliances, as well as other objects which can help with physically releasing anger safely.  
    • Community Grieving Sessions: Hosting sessions with community members. This could be a group grieving session with community, staff and/or volunteers leading. Some suggested formats include candlelight vigils, vigils with eulogies, remembrance sessions with items or offerings to the deceased, or collective altar-building.
    • Staff self-care days: Hosting retreats and/or collective days off for staff members to relax.
    • Encouraging staff to take paid time off for grieving if your organization does not offer specific bereavement time off policies. You may consider providing paid time off hours at no cost to the employees in question if they do not have access to bereavement time already.  
    • Participating in each other's grieving processes and rituals, especially with food and community support. Requests to do so may come from colleagues, participants or volunteers. Participate if you feel comfortable sharing these experiences with staff or community members you work with.  

• Recognize that everyone grieves differently and honor how each processes loss. Provide adequate time and space whenever possible for staff to take time off work if needed and/or provide onsite support if individuals choose to continue working.

Staff Burnout in Harm Reduction   Alongside collective grief, those working in harm reduction face a range of challenges, including post-traumatic stress and vicarious or secondary trauma, which is defined as the emotional response to continuous exposure to the traumatic stories and experiences of others through one’s work.   Staff burnout, a long-term stress reaction and process that often results from stressful work, is common among employees at SSPs, from frontline to executive staff. Burnout has been especially common among SSP staff during the COVID-19 pandemic, as they have continuously worked on the frontlines without extra benefits like other health care workers. Working on the frontlines of the pandemic and overdose crisis has been emotionally and physically exhausting.   Examples of common symptoms associated with burnout include feelings of being emotionally overextended, depleted, emotionally exhausted, unmotivated with work and self-doubt. Staff burnout can result from workplace conflict, overload of responsibilities and consistent exposure to traumatic events, such as fatal and nonfatal overdose and incarceration. Workplace practices to address burnout When employees and volunteers are experiencing burnout, SSP leadership can implement organizational changes to address it and relieve some stress. It is up to an organization's leadership to address burnout internally, and to their benefit. Burnout in a workplace can lead to several problems, one of which being the “revolving door” of staff turnover that so many organizations struggle with. If you have consistently found yourself hiring waves of excellent, empathetic employees then consider some of the recommendations below. These workplace practices vary based on programs’ capacity, size, and location.   Examples of workplace practices to address burnout include:  

• Providing opportunities for staff to provide feedback openly and anonymously on workplace policies and experiences. This helps make sure staff feel their voices and experiences are heard and recognized. 
• Providing trauma-informed counseling sessions and/or group listening sessions to discuss emotional challenges with working in harm reduction spaces.
• Implementing trauma and/or crisis response training to provide staff members with the skills to respond to those in crisis, such as Mental Health First Aid and/or de-escalation training.  
• Creating shift schedules to prevent COVID and/or other infectious disease exposure and spread. 
  • When an employee tests positive for COVID-19 or is exposed to COVID-19, programs often split into two teams to conduct outreach to avoid COVID spread and program shutdown.  
• Bronx Movil has established rest periods for their staff and contractors who are in direct service. These two weeks are paid time off after two of the busiest times of the year which are the July Fourth weekend and New Year's celebrations. This gives their team time to regain their energy and refocus.  
• Inland Empire Harm Reduction has workplace policies establishing clear boundaries with their participants and staff to ensure employees can remain focused and content at work. One example of a workplace policy with boundary setting in mind is asking for consent prior to physical touch such as a hug or handshake.  
• Creating spaces for staff to relax and refresh themselves before or after outreach shifts.  
  • This can be a sort of “green room” that enables your teams to prepare themselves for a shift. Such spaces may feature snacks and drinks for energy, a way to play music and/or some of the important materials they may need at the last minute for outreach.
• Feeding employees regularly can be another way to increase workplace morale and address any potential food insecurity. If your organization already features a kitchen, being in community with one another for meals can be motivational and team building, allowing another method to build rapport amongst staff and volunteers. Potlucks are also a great way to share cultures, food and experiences.  
• Ensuring employees are compensated for their work.  
  • There are many actions coming from labor movements as well as SSPs across the country to ensure equitable pay. Ensuring employees are paid at a rate accounting for inflation, rising rent and/or providing cost of living adjustments for your area can help ensure employees feel they are being paid appropriately for the hard work they are putting in.  
  • Many harm reduction organizations lack incentives that are typical in more well-resourced spaces. Consider exploring whether there is room for bonuses or financial incentives for employee performance (ensuring that the incentive structure does not encourage participant pressure or coercion to engage in services). Explore other staff rewards within budget that feel meaningful. 

Workplace practices to support staff and prevent burnout:   SSP employees, especially frontline staff, face trauma and burnout from their work. SSPs can implement policies and practices to better support staff, especially during times of crisis.  Workplace practices to support staff include:  

• Development of a workplace culture to encourage taking paid time off, with reasonable notice and coverage plans, including by leadership to model work/life balance.
• Development of staff self-care days.
  • Multiple SSPs noted that implementing staff self-care days has been effective for staff and volunteers to decompress and promote sustainable outreach.  
  • Holler Harm Reduction in North Carolina develops staff self-care retreats where staff engage in offsite activities to bond and spend time with each other. 
• Providing downtime at work for employees to avoid burnout.  
  • Downtime includes additional time without conducting outreach in the community.  
• Collaborating with other agencies and the hiring of adequate staff helps individuals feel more comfortable taking time off.
  • Many individuals during our listening sessions highlighted that they felt guilty for taking time off to prevent or address burnout. Ensuring adequate task coverage by hiring more staff and/or partnering with other agencies is beneficial for both staff and the organization.

Ultimately, providing SSPs with sustainable, flexible funding to implement wellness programming (including, but not limited to the ideas above) is the best way to prevent employee burnout. Collective grief and staff burnout are prevalent among both SSP employees and participants, but programs can implement policies and interventions to better support their communities.