Changes To South Island Alcohol & Other Drug Services Announced
Following an extensive review of current services for alcohol and other drugs (AOD) treatment throughout the South Island, a set of initiatives has been announced that are aimed at improving local and regional services.
More than $1million of new money has been allocated for specific residential initiatives which will enable real AOD growth in the South Island. This will be in addition to the $800,000 funding pool previously associated with the now closed Hanmer Clinic services and which will be used for the development of new intensive treatment services around the region.
In Canterbury, the youth service at Odyssey House will be modified to meet additional needs, and the CDHB is currently working on establishing a regional Kaupapa Maori intensive treatment service which includes the selection of a provider or providers.
The review which was undertaken by the South Island Mental health Network on behalf of the six South Island District Health Boards (Southland, Otago, South Canterbury, Canterbury, West Coast and Nelson/Marlborough) involved extensive consultation with clinicians, providers, consumers and families.
review’s recommendations include:
- increasing the level of intensive outpatient treatment services linked to new short term residential options
- developing new regional AOD services to meet identified gaps. Specifically a youth service and a kaupapa Maori service which will include day programmes and accommodation
- increasing the emphasis on aftercare and reintegration into the community for people with severe problems
- providing higher quality treatment for specific groups such as Maori, women, Pacific peoples and youth
- offering greater support for family and whanau members
- building stronger clinical relationships between the different components in the AOD treatment system
- increasing the capability of the AOD workforce.
Ongoing AOD planning work will continue over the next three years, including the development of significant projects which will address the needs of people with both AOD and mental health disorders, and people requiring methadone maintenance treatment.
It is anticipated the new initiatives will be implemented from 1 July.
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Question 1: Why was the Review undertaken?
DHBs recognise that alcohol and other drug (AOD) abuse has a high flow-on cost in terms of health, accidents, crime, reduced productivity and social problems. Therefore effective AOD treatment services are a critical element of any strategy to reduce these problems through the health system.
DHBs wish to ensure that the limited AOD resources available are being utilised to achieve the best outcomes for the most people possible.
Because many of the intensive residential treatment and inpatient detox services are South Island wide in coverage it makes sense for DHBs to take a regional perspective that builds on district needs and services.
Question 2: What is the time frame for implementing the Review?
The objectives are expected to be implemented over a three year period from 1 July 2004. However the majority of new service developments will occur in the first twelve months as the funds will become available in that period.
Question 3: What are the priorities for development?
The Review has identified the
following objectives as the priority areas for
a) Development of intensive outpatient programmes.
b) Increasing the capacity and capability of kaupapa Maori services.
c) Family participation in treatment and increased support for family/whanau members.
d) Increased aftercare/re-integration services.
e) Provision of a regional youth day/supported accommodation intensive treatment programme.
f) Workforce development across the spectrum of health workers in the AOD treatment sector.
g) Improved integration and flexibility of the treatment system.
h) Reviews of models of care and clinical pathways for key population groups.
i) Increasing the level of gender appropriate services for women, including women with dependent children.
Question 4: What priority does the Review give to residential services?
The Review advocates for residential services being retained and expanded as a core service element but clearly targeted at people for whom outpatient treatment by itself is not considered an option. Eg. Those with low levels of social support and extensive rehabilitation needs.
Recommendations include the development of two new regional services based on an innovative model consisting of an intensive day programme linked to supervised accommodation. Specifically a youth service at Odyssey House in Christchurch and a Kaupapa Maori service for which a process is underway to develop a service model and select a provider in the South Island.
Currently the main form of intensive treatment is residential, however there is limited evaluation research evidence for the efficacy of residential treatment services compared to intensive outpatient services especially for dependent people with less complex needs. Consequently the Review recommends the greater use of intensive outpatient services for people with less severe dependency disorders, who up till now have been traditionally treated mainly in residential settings. This is not necessarily a cheaper option but is predicated on the clinical principle of enabling people to maintain their family and social links during treatment and obtain new recovery skills in the context of the real world.
The Review also believes that residential resources could be better used by the greater use of short term inpatient care, which will increase capacity, and by providers offering flexible combinations of intensive outpatient and inpatient care.
A small number of existing treatment and supported accommodation beds will be reduced (10.5 in total) where they are either redundant due to new residential developments, where there are low utilisation rates, or there is a need to develop intensive outpatient and aftercare options in combination. However the overall impact of the Review will be to increase the number of residential beds in the South Island from the current total of 117 to over 130.
Question 5: How does the Review deal with the gaps created by the closure of the Hanmer Clinics and Queen Mary Hospital?
The temporary CDHB provider arm intensive outpatient service that employs staff from the previous Hanmer Outpatient Clinic in Christchurch, will continue until replacement services are in place by February 2005.
New residential services are being developed based on the priority needs groups. See Q4. The proposed Kaupapa Maori service will meet the need for a dedicated intensive regional treatment service for Maori that will offer a more culturally effective service compared to what was previously available.
The funding ($815,000) previously associated with the Hanmer Clinics contract for the South Island will be used to develop intensive outpatient, aftercare and weekend/day treatment retreats/wananga options across the region.
Question 6: Why isn’t methadone maintenance treatment getting more resource?
Waiting lists are an issue for some DHBs, however there are limited opportunities for increasing funding of methadone without reducing other AOD services. The Review believes there is room for significant growth in methadone delivery by the greater utilisation of the primary care sector.
A major regional project will address a number of issues around methadone and other forms of opioid substitution including capacity in 2004/05.
Question 7: Who is responsible for ensuring the Review is carried out?
Each DHB is responsible for implementing the objectives for its own district. DHBs will work together where objectives require inter-district collaboration.
Final decisions on the funding and planning of alcohol and other drug services remain the prerogative of each DHB both individually and collectively. Individual DHBs may choose to undertake further AOD service developments outside of the Review.