Eight focus groups were conducted; two in the Fraser region (one in Coquitlam, one in Maple Ridge), two in Vancouver Coastal and four in Island Health (Victoria) (see Figure 1).
Each focus group had three to six participants; the groups were intentionally small to allow participants enough time to voice their thoughts within one hour. A total of 31 experiential workers participated in the focus groups. The demographic profile of these participants is presented in Table 1. Just over half of the focus group participants were male (55%). Of those that completed the demographic questionnaire, 56% were over the age of 40 and all reported having received at least some high school education.
The survey was completed by 50 experiential workers; 17 from the Fraser region (nine from Coquitlam, eight from Maple Ridge), 16 from Vancouver Coastal, and 17 from Island Health (Victoria) (see Figure 1). The demographic profile of survey participants is presented in Table 2. Similar to the demographic profile of focus group participants, the majority of the survey participants were male (54%), over 40 years old (58%), and had obtained at least some high school education (94%). Also, most survey participants self-identified as non-indigenous (68%)
Stressors and Challenges Faced by Experiential Workers
Several subthemes of stressors and challenges in experiential work were identified by focus group participants. These themes and subthemes are summarized in Table 3 and presented sequentially in more detail below.
In cases where the survey data for a particular theme from the focus groups was available, they are presented (see Tables 4 and 5 in the appendix).
1. “Scrape up money”: Financial Insecurity
Poor financial situation of workers was consistently mentioned as one of the key stressors among focus group participants. As one participant stated: “Honestly, my biggest hurdle is trying to do my job and then try and scrape up money outside of work trying to just get by.” This sentiment reflects the severe financial hardships and often ‘hand-to-mouth’ situation many experiential workers are faced with.
Similar to focus group participants, survey participants also indicated financial insecurity as a key stressor. When asked to choose from a list of 16 potential stressors (see appendix), overall 72% of participants listed financial situation as one of their top three stressors (Table 4). Although prevalent, financial situation as one of the top three stressors varied between the four cities (ranging between 62.5% and 88.9%), but was not significant p=0.71.
Inequitable Pay
Several focus group participants attributed their financial insecurity to the inequitable pay they received. Participants spoke about getting paid much less than other support staff employed by their organizations, despite doing the same work. This is apparent in one participant’s words: “[Support workers] are making one amount. [Experiential workers] are making another, doing the exact same job.”
Some participants suggested that the pay inequity may stem from the higher value that organizations place on formal education and certification over expertise acquired though lived experience. As one participant mentioned: “We’ve got people that […] took an eight-month course […] with two months of addictions training and somehow that certification is valued above lived experience.” Inequitable pay may also be a result of stigma against PWUD which leads to negative attitudes towards experiential workers.
The idea of pay inequity was also echoed by survey participants. When asked if individuals feel they get paid a fair amount, 45% of the participants that responded disagreed and 14% were neutral (Table 5). The proportion of participants that disagreed ranged between 14% to 69% in the four cities.
These focus group and survey results indicate that experiential workers perceive pay for their work as inequitable and this may contribute to their financial insecurity.
Job Instability
The financial insecurity experiential workers face is accompanied by job insecurity. Many experiential workers mentioned that their jobs rely on government funding to non-profit and other organizations and that they do not have formal long-term employment contracts. As one focus group participant described, “how much sooner is our ‘well’ going to run dry? When [will] I [be] unemployed? That scares the hell out of me. Am I going to be here next year?”. The use of the metaphor of a “well” indicates that that experiential workers work in a precarious environment, often characterized by job instability and this can be a cause of stress for them.
2. “Sets us apart”: Lack of Respect and Recognition at work
One of the top stressors that emerged from the focus group data is the lack of recognition and respect for experiential workers. Several experiential workers felt that they were not taken seriously or given due respect by their work colleagues and by other professionals they encounter in their work.
The lack of respect seems to stem from stigma against PWUD. Many experiential workers expressed that the use of the term “peer” is not an adequate job title as it sets to define the work of experiential workers solely by their history of substance use, rather than by the important work they do and the lived experience and context they provide. As such, it is stigmatizing and derogatory. As one experiential worker mentioned, “This term “peer,” I’m really quite uncomfortable with [it]. […] It divides us. […] It sets us apart from normal society.” This quote indicates that defining experiential workers’ role in relation to their substance use can be othering and leads to differential treatment of experiential workers by support workers.
The lack of recognition and respect for experiential workers is apparent in the lack of basic resources provided to most working professionals, such as photo IDs or business cards. As one experiential worker mentioned, “We don’t have the exact same things as the other support staff”.
Focus group participants also pointed out the absence of formal job descriptions and contracts for experiential workers, leading to lack of role clarity among supervisors as well as their support worker colleagues. Several focus group participants mentioned that they are often assigned to menial tasks and are looked down upon despite their extensive expertise and skillset. As one participant described:
“Sometimes when I get [to work] and I’m barely even in the door [support workers are] like, ‘you gotta go upstairs and go clean the kitchen. You gotta go in here and clean the staff room’”.
This quote indicates the constant struggles that experiential workers face at work and how they are given minimal respect due to their history of substance use.
Experiential workers also expressed that they do not feel respected by other professionals they encounter in their work. One experiential worker described a situation that they faced with the police:
“Today, for example, a guy was O.D.’ing just across the street here. [We] went over, we had our Narcan kits and we had everything under control. We were doing our job. Next thing you know we got eight cop cars there and they’re telling us we’re going to be arrested if we don’t leave.”
This quote shows how police officers and other service providers may not understand the life-saving work experiential workers constantly perform. A similar sentiment was expressed by another experiential worker who recounted their experience with paramedics:
“I think there’s a little bit of stigma from the ambulance people [and] from the first responders. […] I find that they can come in, take over and kind of push the peer aside. I think that there is a lot of stigma against peers.”
This quote indicates that the lack of respect for experiential workers is rooted in deeper societal stigma that uniformly characterizes experiential workers by their substance use.
Similar to focus group participants, survey participants feel that they don’t always get the recognition that they deserve for their work. For the question, “when I do a good job, I get the recognition for it that I should receive”, half of the participants (50%) disagreed or were neutral (Table 5). The proportion of participants that disagreed ranged from 12% to 78% in the different cities. Furthermore, more than a third of the survey participants (40%) listed “work situation (including working conditions)” as one of their top three stressors (Table 4). This ranged from 12.5% to 77.8% in the four cities (p=0.03).
These results highlight how much importance experiential workers place on being recognized and respected at work; lack of respect can be a stressor for them.
3. “A hoarder’s nest”: Poor Living Conditions
Another stressor identified by experiential workers was poor living conditions which in turn impacts the ability to sustain work. Several participants expressed that they would like to have “somewhere [they] can call a home”. Having a safe place one can call ‘home’ is crucial for experiential workers’ productivity and ability to help others. As one participant explained:
When you’re able to look after yourself financially and physically and mentally and emotionally, then you’re able to do so much more for other people. Because you’re together. You’re not worried about that. Stressing out, [worrying] about [how] after this, I got to go home to my shithole and try to figure out what I’m going to do for […] dinner. You’re together and you’re in a position where you can actually help.
Several focus group participants mentioned that their housing situations jeopardized both their security and their health. For example, participants mentioned being assaulted in their buildings, having accommodation infested with bed bugs, and having small quarters that felt like a “jail cell”. For experiential workers, the conditions of their homes seem to add stress rather than offer a respite to alleviate it.
Some participants mentioned that they felt helpless and were unable to move because they often encounter problems in acquiring housing. BC is known for its exorbitant housing rental prices [46–48], which makes safe housing unaffordable for experiential workers with meager wages. One participant mentioned that their home felt like “a hoarder’s nest…but I can’t move anywhere else. I can’t afford to move.” This quote indicates that many experiential workers are forced to endure poor living conditions due to a housing market that favours the wealthy and privileged.
Some experiential workers described that they find it difficult to find a home within their communities, surrounded by people that they feel safe with. One participant mentioned: “I don’t want to leave my community. […] I still want to stay in [my community]. It’s where my friends, my family is.”
Like focus group participants, survey participants also listed living conditions as a common stressor. More than a third (38%) of the survey participants listed housing-related issues as one of their top three stressors (Table 4). Perception of housing situation as one of the top three stressors ranged from 12.5% to 66.7% (p=0.31) in the four communities.
When asked if individuals faced housing challenges due to their substance use in the last 30 days, almost a half (48%) of the participants indicated that they ‘always’, ‘often’, or ‘sometimes’ faced such challenges PWUD (Table 5). Although not the majority, 48% is a large percentage of respondents that faced housing challenges in such a short amount of time (30 days). In some cities, almost all participants reported having faced housing challenges in the last 30 days (Table 5). Clearly, acquiring acceptable housing is a challenge for experiential workers and this can add considerable stress to their lives.
4. “Not enough social support”: Inability to access or refer individuals to resources
Experiential workers often serve as a bridge connecting PWUD to social services and other supports. Several focus group participants stated that PWUD may be unable to access the resources that they need in order to support those they are working with. However, other focus group participants mentioned that in some cases, although resources do exist, experiential workers are not equipped with the skills or credibility to make referrals, despite a genuine desire to help. This creates a sense of powerlessness, and often adds to experiential workers’ stress and dissatisfaction. This sentiment is expressed by one participant who mentioned, “I’m not as worried about myself as the clients, but there’s not enough social support… in all aspects.”
The following quote highlights the desire of an experiential worker to be able to do more:
“If you want to help somebody you don’t want to turn them away […] without getting an answer or resolving their enquiry. You want to help them and it bothers you ‘cause you’ve been on that side where nobody’s helping you and it’s frustrating.”
Several examples of resources which PWUD find hard to access were provided by focus group participants, including ‘detox’, legal services, welfare and income assistance, and civic services such as government identification.
Some experiential workers expressed that even when services do exist, PWUD are hesitant to use them as they do not feel welcomed to access those resources, and fear being judged. Healthcare is one such resource; many experiential workers feel that the stigma against substance use often clouds healthcare providers’ ability to provide compassionate care. As one participant mentioned, “I feel like a real asshole, like, trying to convince anybody to go to the hospital because I know why they don’t want to go”. Albeit subtly, this quote communicates a powerful message; it indicates that experiential workers, along with PWUD, feel helpless as they are denied of their fundamental right to compassionate healthcare and left to navigate their own physical and mental health challenges.
5. “Living through our losses”: Constant exposure to death and trauma
Several experiential workers mentioned that the constant loss of lives and trauma that they are exposed to is emotionally taxing and stressful. Unlike most other first responders, experiential workers have a unique understanding of the lives of PWUD, and can relate to their traumatic stories, which can amplify the stress they feel. In this same vein, the individuals that experiential workers support are not mere clients; they are often friends and family members who are close to them. Losing a client, therefore, is so much more difficult. As one participant mentioned, “I lost a couple of my best friends in the last couple of years and it’s just been really friggin’ hard.”
For experiential workers, personal and professional lives are heavily intertwined. Their work is a 24-hour job; unlike other professionals, experiential workers do not get to unwind after a stressful day at work because they are constantly trying to keep their loved ones alive, even outside the work environment. This constant worrying can take a toll on experiential workers’ mental health. As one participant stated:
“I just get worried about people that I know, like, friends that [are] still doing the same old thing. You like worry about [whether] they [are] going to […] OD or if they’re going to be okay.”
Experiential workers live and work in an environment so often punctuated by loss. This idea is summarized by a focus group participant who mentioned that the most stressful thing for them was:
“Living through the bad days. Living through our losses. Living through somebody [going] to jail. Living through somebody [getting] beat[en] up down on the corner and [having] their head bashed in, [spending] six months in the hospital. Living through […] we found a dead body in the garbage. Living through those things together. I think that is a lot. I think that’s it, really.”
Consistent with the focus group results, two-thirds (68%) of the survey participants that responded were at least sometimes “affected by the traumatic stress of those they help”, i.e. the sum of those that stated ‘always’, ‘often’ and ‘sometimes’ (Table 5). Furthermore, almost half (47%) of the respondents reported that they “feel worn out because of their work” (Table 5). A similar proportion of respondents (47%) reported that they “find it difficult to separate their personal lives from their lives as experiential workers” (Table 5).
Despite the traumatic stress and burn-out experiential workers report, only slightly over a quarter (28%) of the survey participants indicated “caring for others” as one of their top three stressors (ranging from 0% to 44.4% across the four communities) (Table 4). The vast majority (98%) of survey respondents reported they “have happy thoughts about those they help and how they could help” and 94% of respondents “feel a sense of pride in doing their work”. Furthermore, 94% and 95% of respondents respectively report that their “work makes them feel satisfied” and that they “make a difference through their work”. This clearly indicates that even through their work can be emotionally draining and stressful, experiential workers genuinely care for their community and like to help others.