The snakes and ladders of access to emergency shelters for persons who use substances and are subject to relationship violence

This paper presents a critical ethnographic study of a Norwegian emergency shelter for persons who use substances and are subject to relationship violence. These persons face barriers to accessing shelters which provide respite, recovery, and supported transition to a life without violence. The underserving of this population poses a persistent social and public health challenge, endangering their safety, health and healing.Levesque, Harris, and Russel (2013) framework for access to health care is used to analyse access to emergency shelters. The shelter’s approachability, acceptability, availability, affordability, and appropriateness are in the hands of the providers. Victims of violence or their proxy (e.g. friends, police) must be able to perceive a need, seek, reach, pay and engage in utilizing the shelter’s services. Applying Levesque et al.‘s framework uncovers how survivors of relationship violence become underserved due to factors on both the provider and recipient side. The shelters’ implicit demands on health, social, and welfare literacy create barriers to access. Long-term effects of substance use deplete resources for self-care, seeking and utilizing shelter services, and for healing and transition to a future without violence.Barriers to access to emergency shelters can be framed as a violation of human rights and as structural violence. Despite this, service recipients and providers affect service design through incremental steps, planned or serendipitous encounters, cross-professionalism, political engagement and advocacy. The shelters have a window of opportunity to bring health care to where people are for harm reduction and health promotion, which is not yet utilized.