‘When You Use Drugs, Where Do You Go for Mental Health Care?’: Experiences of Trauma and Barriers to Mental Health Care Among Women in Harm-Reduction-Oriented Housing

Abstract

Women who utilize harm-reduction services have largely been overlooked in Norwegian research and policy, despite known health risks associated with substance use and evidence that women face particular challenges regarding mental health. This study is part of a larger qualitative project with 22 women living in harm-reduction-oriented housing in Oslo. Using health ethics as an overall frame and a phenomenological feminist approach, we explore women's lived experiences of trauma, mental health problems and care in harm-reduction settings. In this article, we focus on seven interviews, analysed with a thematic approach informed by narrative analysis to maintain empirical closeness and highlight participants’ voices. We use concepts of embodiment and vulnerability, and understand gender as both bodily, social and structural. Our analysis yielded four types of accounts: (1) participants described mental distress as a pressing and enduring concern; (2) they expressed that, while they wanted to talk about their difficulties, they were also hesitant to do so; (3) this hesitancy was linked to insufficient support and protection in harm-reduction and housing services and (4) this left them with few options beyond ‘self-treatment’, such as trying to ignore traumatic experiences, avoiding help-seeking and using drugs to cope. An embodied perspective illuminates how trauma is deeply rooted in the body, exposes women's precariousness and shows how their precarity is intensified when systems meant to protect them fail. Based on women's experiences, we recommend integrating trauma-informed care into harm-reduction-oriented housing, establishing low-threshold mental health support in harm-reduction services and developing tailored inpatient psychiatric assessment and treatment for those with more severe conditions. This requires training staff in trauma-informed, gender-sensitive, relational approaches and reshaping harm-reduction services to prioritize holistic care. Future research should examine trauma-focused treatment and include men and intersectional perspectives on care within harm reduction.