Guest editorial: Substance Addiction Bill briefing

It’s been a long hard road and taken considerable time, but we’re now close to having new legislation to help deal with addicted people who can no longer help themselves. Matua Raki National Manager Vanessa Caldwell explains some of the changes in the draft Bill.

After almost 30 years, more than three official reviews and a Law Commission report, we finally have the Substance Addiction (Compulsory Assessment and Treatment) Bill ready
 to replace the outdated and unworkable Alcoholism and Drug Addiction Act 1966.

This new legislation was drafted under the Prime Minister’s Methamphetamine Action Plan 2009 and was introduced into Parliament on its final day of sitting last year. At the time of writing, it is before 
the Health Select Committee.

Although the numbers of people requiring this legislation are few, this is a last-resort opportunity to intervene with these people and their whänau when they no longer have the capacity
to do this for themselves. People who experience the severe effects of addiction are very unwell and require an intensive level of intervention.

You may think it would take many years of heavy substance use for things
to get this bad, and for a number of people, that is true. However, it is also true that younger people can rapidly develop very severe symptoms. Sadly, addiction is a potentially fatal condition, and many of
us in the field have lost family members,

friends, fellow travellers or clients as a result of their addictions. These deaths are potentially preventable, and effective legislation is one way we can provide an opportunity for those experiencing the severe effects of addiction to receive restoration and treatment.

The purposes of this proposed legislation are to:

• protect the person from harm
• facilitate an assessment of their condition
• stabilise their health
• protect and enhance their mana and dignity
• facilitate an opportunity to engage in treatment voluntarily.

A number of stakeholders were involved in drafting this Bill back in 2010/11 via various activities facilitated and conducted by Matua Raki, including consumer focus groups of those under committal, working groups, hui and research into family involvement.

Although much of this draft Bill mirrors some of the Mental Health (Compulsory Assessment and Treatment) Act 1992, including the title, there are some key differences. There are significant improvements in terms of the rights of the client, the duration of the compulsory period and the criteria and process of application. The roles and responsibilities of healthcare professionals involved have also been clarified. Some of these features are summarised below.

Criteria

Anyone over the age of 18 can apply
for a committal order on behalf of someone else, although the application needs to
be supported by a medical certificate
from a GP. There are four criteria that
must be met under which a court will consider a committal:

• The person has a severe substance 
addiction.
• Their capacity to make informed 
decisions about treatment for addiction 
is severely impaired.
• Compulsory treatment is necessary.
• Appropriate treatment for the person 
is available.

In this context, the definition of severe 
addiction is a continuous or intermittent condition of a person that involves the compulsive use of a substance and is characterised by at least two of:

• neuro-adaptation to the substance
• craving
• unsuccessful efforts to control use
• continued use despite harmful 
consequences
and is of a severity that it poses serious danger to the health or safety of the person and diminishes their self-care.

Further, a person is deemed to have impaired capacity to consent for treatment if they are assessed as unable to understand 
 he information relevant to the decision (such as treatment options or the likely outcome of not having treatment), to retain that information, to use or weigh up the options or to communicate their decisions.

Duration

One of the significant changes is the reduction in the period of time during which the committal can be enforced. The revised legislation seeks to ensure that this time period is within acceptable limits of detention (without committing an offence) under the New Zealand Bill of Rights Act 1990.

The proposed duration of the committal period is eight weeks or until the person
no longer meets the criteria (usually meaning capacity to consent is restored), whichever occurs first. In addition, there
is the opportunity to apply for a further eight weeks if there is evidence of a
brain injury. This is to allow time for appropriate assessment and for longer-term care and support to be arranged. At the point someone is no longer under a committal, they can continue to remain
in treatment voluntarily.

Because people who require this level of intervention typically do require long-term support, it is hoped they will stay engaged in intensive treatment for as long as it is needed. A long-term discharge plan, developed in consultation with those involved in the person’s care and support, is required to be in place to assist in the person’s return home or to an alternative care facility.

Young people

There are special considerations for young people who may meet the criteria for a committal, including whether or not the young person may be better served under the Children, Young Persons, and Their Families Act 1989.

Support people

Another change is the consideration given to the inclusion of support people in the process. The person under committal
will be asked to nominate one or more support people, or one can be appointed. Support people/nominated family are to be informed of what is occurring at each stage of the treatment process including absences, transfers, treatment plans and discharge plans. It is made overt that the views of the person and their family are to be taken into account by clinicians while the interests of the person under committal are paramount.

Service implications

Currently, the treatment options following a medical detoxification for those under a committal are limited to those services that are gazetted under the Alcoholism and Drug Addiction Act 1966. It is anticipated that other facilities will be able to treat people under the new Act so they have appropriate options available. This is particularly true in regards to meeting
the requirements to provide culturally appropriate treatment options as well as programmes that recognise the challenging behaviours people with these cognitive difficulties can present.

Almost every person under a committal will be experiencing co-existing mental health issues, including depression or anxiety, as well as considerable physical health concerns and cognitive difficulties related to their substance disorder. The primary goals of the first eight weeks of treatment will be to achieve stabilisation, a comprehensive assessment of the person’s condition and development
of a multifaceted treatment plan that addresses these issues. Ongoing support and coordinated care are critical to providing an opportunity for recovery- focused success. This will require a high level of service cooperation.

As part of the implementation of this legislation, once it is enacted, the Ministry of Health will ensure that information about the process, practice guides and workforce training will be made available. Information for families and people with addictions will also be available and promoted.

The proposed new legislation presents a significant change to the addiction treatment sector and has been designed
to improve the treatment process for those who have a severe substance disorder. This change could not come soon enough for the many family members who have struggled to navigate the current system to get the support they so desperately need.

Resources

Submissions on the Bill closed on 27 April. The Health Select Committee will report back to Parliament by 15 September (at the latest).

Read the Bill and background documents

Photo credit: instragram.com/radiieso