Thresholds in a low-threshold setting: an empirical study of barriers in a centre for people with drug problems and mental health disorders.

BACKGROUND: Some services for drug users with mental health disorders can be characterised as low-threshold services. These aim at making help easily accessible for people who are not able to request help from services at higher levels. In this study we examine what kind of thresholds are experienced by clients at a low-threshold centre.
METHODS: Ethnographic field work, including participant observation, individual interviews and focus group interviews with clients and staff in a low-threshold centre for the most vulnerable drug users in Oslo were employed.
RESULTS: Our analyses agree with other studies in showing that the following three thresholds are significant, also in services for drug users with mental health disorders: the registration threshold, the competence threshold and the threshold of effectiveness. In addition to these, we suggest that a fourth threshold is of importance for this group: the threshold of trust. In the low-threshold centre we studied, we observed that for the clients, crossing the threshold of trust seemed to be an essential precondition for subsequently being able to cross the other thresholds in order to receive the help they need. We suggest that focus on the four thresholds can improve our understanding of clients' access to services. We also suggest that processes of recovery may be improved if increased attention is given to the barriers that clients experience.
CONCLUSION: The threshold of trust seems to be particularly important for people suffering from drug problems and mental health disorders. The results have implications both for practice and policy because if taken seriously into consideration, more clients could access the services they need. Services for this group may be improved by focusing on the fourth threshold: trust.