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Turia Speech To ALAC 'Cutting Edge' Conference

Hon Tariana Turia
13 September 2001 Speech Notes

Opening speech to the Alcohol Advisory Committee's annual 'Cutting Edge' Conference, War Memorial Centre, Napier

Mihi

I would like to thank you for the invitation to open this year's 'Cutting Edge' conference. I would like to acknowledge all those that make this conference a reality. The opportunity for those working in the alcohol and drug field to meet and share experiences and innovation is a vital ingredient to improving our understanding and the effectiveness of alcohol and drug services.

I was pleased to be given responsibility for the alcohol and drug area of the health portfolio from the Minister of Health, Annette King earlier this year.

I am very glad to see the theme for this the 6th Cutting edge conference is focused on the role of whanau and family, partners and our community in improving health and wellbeing for the individual.

Conferences of this nature are important for those striving to find treatments for alcohol, drugs, addictive disorders that work for all of those people facing these problems. I believe you are showing leadership in taking up the challenge of addressing issues, which relate to the alcohol and drug field.


While preparing for this speech I was discussing in my office 'the old days' as it was so nicely put by one of my younger staff members. We were discussing a cartoon strip that used to appear in the Sports Post on a Saturday afternoon and later in a book. The cartoon strip was 'Hori and the half-gallon jar'.

The 'Hori' character was of course Maori, lived with his wife, mother in law and his children. Hori seemed to have two central loves, one was his love of food, and one was his love of the half gallon jar of beer, otherwise known as the flagon.

I wonder if any of you remember 'Hori'? I wonder if you remember anything of the writer of this strip, he was actually W. Norman McCallum, of Remuera, Auckland, a New Zealander of Scottish descent.

The purpose of cartoons such as 'Hori', I do not believe were ever just created to entertain. Stereotypes must be promoted and are usually promoted by those who stand to gain from creating those specific perceptions. Hori was promoted as a stereotypical Maori male, happy as long as he had a flagon within arms-length. Such a perception has added to the situation we face today as a country.

We must break down the stereotypes that have been created such as the 'Hori' character. Stereotypes do not assist us in dealing with people's alcohol and drug problems and the impact on their families. Stigma attached to problems of this nature must also been broken down. This can occur as people become more aware and understand the way addictions can affect people.

I have been advised that there are about 700 dedicated alcohol and drug workers in New Zealand. To the 300 who have been able to make this conference, I hope that you take back and share your experiences from this conference. You are the leaders in this field with the responsibility of improving peoples understanding of addiction.

You have travelled from all over New Zealand to share your experiences and to learn from others. Whether you are from a provider, or training institutions covering a range of services from community assessment and treatment, detoxification, methadone, day programmes such as after care, residential treatment, consulting and liaison activities, and workforce training, all of your knowledge is vital.

Your experiences make up the knowledge and the opportunity for progress in the alcohol and drug field. Yours is the task, by working together and with the families concerned, to develop more effective ways to assist families overcome the challenges they face.

I am sure that the theme of this year's conference centred around the whanau, family and community will be much more than a welcome relief for many Maori who have promoted this approach for some time.

I myself believe that whanau, hapu and iwi have the knowledge and the ability to assist their whanau overcome difficulties they may face. I have an absolute belief in our whanau. While others may disagree, it has always been my belief that if the problems affecting us reside in the whanau, then, therein also lies the solutions.

I have often seen the media promote stereotypes such as the 'Hori' character as the norm for Maori. While they may have their excuses, I have never heard any of them say that by presenting information in deliberately specific ways they are assisting the development of the specific field.

My challenge to you all, is to never allow those stereotypes the time of day. Do not allow them to pervade your thinking and negatively impact on the way in which you operate, or the belief you have in the people and families with which you work.

Everyday we are improving how we might address the environments, the families and the individuals that we might meet in our work. We need to look broadly at possible responses, we must encourage the development of new practices or recognise those acknowledge practices that have been working anonymously in the field.

In the past there has been a focus on the clinical or medical responses. More and more these days we are beginning to focus on communities, on people, families and relationships. This focus has allowed us to find new and innovative ways of meeting challenges in this field.

We must acknowledge the role of the collective in the development and maintenance of wellness. While I will be the first to say tangata whenua do not have a monopoly on this approach, it is clear for many of our people that those who best understand working with whanau, hapu and iwi are themselves.

I would like to quote a passage from the late Julius K Nyerere, former president of Tanzania, who in discussing development said:

"Development brings freedom, provided it is development of people. But people cannot be developed; they can only develop themselves. For while it is possible for an outsider to build a person's house, an outsider cannot give the person pride and self-confidence in themselves as human beings. Those things people have to create in themselves by their own actions. They develop themselves by what they do; they develop themselves by making their own decisions, by increasing their own knowledge and ability and by their own full participation as equals in the life of the community they live in. People develop themselves by joining in free discussion of a new venture and participating in the subsequent decision; they are not being developed if they are herded like animals into the new ventures. Development of people can in fact, only be effected by the people.

I know you will be hearing from overseas guest speakers Dr Francedco Piani and Dr Janis Fairburn who be addressing working with families, significant others, community involvement and social networking. I welcome them to this conference and I know they will provide valuable insights into the developments happening in their countries.

One of the strengths of the alcohol and drug workforce is the high number who are in recovery themselves and can provide a consumer perspective to some aspects of their work. We must still encourage current consumers to participate in the development of treatments. Their experiences are invaluable.

National Mental Health Strategy
The National Mental Health Strategy set clear directions for the development of mental health services including increased community mental health services, increased quality of service delivery and increased consumer and Maori participation in service planning and delivery.

Standard Nine of the National Mental Health Standards requires consumer participation in the planning, implementation, and evaluation of mental health services (including alcohol and drug services). Although many consumers often don't have or want, ongoing contact with the treatment sector, this consumer perspective needs to be engaged in service policy and development processes.

The New Zealand Health Strategy
The New Zealand Health Strategy is a long term plan for improving the health of New Zealanders and signals a shift towards a population health framework which better recognises that populations are not homogenous in health status, and therefore focuses on tackling inequalities in health.

The National Drug Policy has an overall goal "¡Kas far as possible within available resources, to minimise harm caused by tobacco, alcohol, illicit and other drug use to both individuals and the community".

Alcohol and drug-related problems occur within a social context, and there is a growing acknowledgment that factors external to the health care system can and do impact on the health and wellbeing of individuals, communities and the population as a whole.

I am totally supportive of the growing recognition that health services need to adapt to meet consumer needs rather than trying to fit all consumers into generic programmes. The challenge for service providers is to design treatment interventions that work for individuals and families and are flexible enough to consider and incorporate new ways of reaching at-risk groups.

Treatment services need to enhance their professional profile in their local community as high-quality specialist services that offer both treatment and consultation liaison services within a wider network of primary community health and social services.

It is important that there is a wide range of treatment options available to those with alcohol and drug-related harm as no one-size-fits-all approach can be effective for all consumers.

Part of the challenge for the future includes consideration of the provisions of the Treaty of Waitangi in health care, formalised involvement of consumers in the development of alcohol and drug policy, funding, service planning and evaluation of treatment interventions.

Without this consideration and involvement we run the risk of continuing to do more of what has been done before, missing opportunities to explore different ways of delivering ways of delivering alcohol and drug services and minimising alcohol and drug related harm.

A & D Service issues and developments
The Ministry is soon to release a 'National Strategic Framework for Alcohol and Drug Services' and many at the conference contributed to its development. It was written to provide a national direction for the ongoing development of alcohol and drug treatment service and will be a key guide for DHBs.

Of interest to many is the current review of the Methadone Maintenance Treatment Protocols. These guidelines for opioid substitution treatment will be but one component that will contribute to improving the health and well being of some families and communities. This work will be completed towards the end of the year and some of the issues raised in the review I am sure are likely to arise during the conference.

The extension of the ADA Alcohol Helpline to include other drugs is seen by the Association as a natural development. Resourcing of this expansion is currently being investigated.

The Alcohol Drug Association is committed to forming collaborative relationships in various regions in the North Island, to assist communities to develop pro-active and empowering approaches to alcohol and other drug related issues. I see this as a positive step towards an integrated and coordinated approach. Certainly it will not be achieved over night but will require determination and wide sector support to bring to fruition.

It is my understanding that the National Treatment Forum currently tries to represent the interests of treatment providers. Its members are elected from those present at the annual general meeting held at Cutting Edge. Their vision of this group is to be a Peak Body for the treatment sector.

ALAC set up and have supported the National Treatment Forum. It is an important forum where providers can voice they concerns and also work towards addressing those concerns for the benefit of all.

It is important for the field to have a representative body that can carry forward their views on alcohol and drug treatment in a pro-active and considered way.

I challenge those here to ensure the Forum will be truly representative of the field and include Maori and consumer voices to assist it to step up to the challenge of the treatment sector.

Practitioner competencies will be launched at the conference and this may lead to the development of a professional body. I will watch with interest how these competencies are monitored and the impact they have. This body would need to pull together the diversity of people working in the alcohol and drug treatment sector.

Additional specific Maori and Pacific nations competencies are still in the process of being developed. The competencies were, and are being developed with input from workers and significant participation by Maori and Pacific nations which will make them more effective.

In June this year I launched the Mental Health Commission competencies. They identify historical context too long ignored, and demand mental health workers competencies include an understanding of the recovery principles, experiences in New Zealand, demonstrate the application of the Treaty of Waitangi not the rhetoric.

Recovery requires fundamental change in the practice, expectations and education of all health workers. It is about attitudes and knowledge as much as behaviours and skills.

The Mental Health Commission competencies address many similar aspects of the work within the alcohol and drug field and they are another valuable resource that you can access to support you in your work.

The development of a skilled workforce is vital. The current workforce needs to be both increased and its skill-base expanded. Some have suggested that the competencies may signal the need to review workforce development initiatives to move towards 'short' courses aimed at raising competencies rather than courses of study towards formal tertiary qualifications.

We will need to assess this at a later point, as we continue to improve our knowledge and understanding of the issues and the solutions.

We do need to develop the capacity to respond to the local needs while at the same time, consolidate the specialist skills and knowledge gained through undergraduate and post-graduate study. The new competencies are designed to assist in this process.

I believe there is a new handbook to be launched at this conference, the New Zealand editor is Dr Gavin Cape, from the University of Otago. It is designed for health professionals with contributions from Australian and New Zealand practitioners ¡V particularly those providing alcohol and drug education to medical schools. To those who participated in developing the resource, I say congratulations, I know that many of you are attending this conference.

That there are many services and programmes with innovative approaches that are empowering or have affected practice is exciting.

Some of these include a greater use in some areas of social and home detoxification: the introduction of reintegration houses for those returning from residential treatment; more inclusion of family oriented and systemic approaches to treatment; short residential courses followed by intensive ¡¥outpatient¡¦ follow up and more assertive outreach services.

Such approaches that aim to improve the ability of people to access the services they need are worthwhile.

Alcohol and drug programmes for teenagers similarly acknowledge that there are much wider and complex issues facing teens that develop these problems.


There are many Maori initiatives that are using innovative programmes to address the whole situation throughout the country.

MAORI INITIATIVES

„h There is a collaborative venture between Te Ngaru Learning Systems and the National Centre for Treatment Development to develop some basic training for Maori working with coexisting disorders. This is an exciting model of partnership that should be congratulated.

„h The workforce development work of Nga Manga Puriri and Northland Health in offering Te Wero me Te Aranga allows an opportunity for clinical skills to be offered and learnt in supportive and relevant environments thus increasing the transfer of knowledge.

„h The Tatou i a tatou initiative in the far north which will be explained during the course of the conference has been a positive form of community development particularly for Moerewa. This is part of a World Health Organisation pilot programme and has been particularly supported by ALAC and Nga Manga Puriri.

„h The development of a Maori centred clinical research project by the National Centre for Treatment Development in conjunction with various Maori service providers from throughout the country, will help provide a systematic guide to what is working for Maori who present for treatment. Whilst there has always been a lot of research on Maori by others, there has been a dearth of research by Maori for Maori in this particular sector. This project I understand is to be described at the conference.

„h The Alcohol Advisory Council have been supporting a series of Kaumatua wananga in the far north and the next is at Waitangi in two weeks time. These hui are to help Kaumatua be in a better position to help rangatahi working in the field of mental health so they can make ¡§nga taonga tuku iho¡¨ more accessible to nga tangata whaiora and to Maori kaiawhina.

Many of these programmes and others that have been developed challenge the established models. While the clinical approach will remain important, there is much development and innovation in the community models that are being delivered.

When the emphasis of a field changes, such as the community development occurring that is building momentum, pressure is placed on the established and generally inflexible purchasing frameworks as they struggle to respond to the changes in the field.

It is the challenge for providers to seek contracts for work they know the community needs and maintain their commitment to provide those services. It is a very difficult for providers to refuse to accept contracts for services that are different to what you know is needed. We need to be pro-active in addressing this when it occurs.

Conclusion
Conferences such as Cutting Edge offer an opportunity for workers to exchange knowledge and experiences. Without this kind of opportunity New Zealand alcohol and drug workers will look overseas where the drugs of choice differ, the systems of care differ and where the knowledge of New Zealand's indigenous people are not.

You are involved in a dynamic and innovative area. The old ways are constantly being questioned and new innovations are being trialed, making the difference. I encourage your innovation at a time when we are talking about catching the knowledge wave. We need to support the knowledge of all of those in this area that have developed ways of achieving positive results for families/whanau.

I want to also acknowledge the positive impact your success has, with the people and families with which you work. The positive has far reaching impacts on families who are able to learn to overcome alcohol and drugs. The precious time you give to this sector and to those people and their families assists and supports them to learn how to take control of their lives.

Lastly, I would like to thank you all, and to thank your families, because I know that without your families support your work in this area, would be all the more difficult. Thank you for your tireless work, it is an innovative, challenging, and rewarding field of the health sector to which I am fully committed.

Na reira, tena koutou, tena koutou, tena koutou, katoa.

ENDS

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