Speech at Addiction Treatment Leadership Day

There is no doubt that the financial cost of addictive behaviour continues to be widespread, affecting individuals, families, communities, employers and companies.

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Kia Ora,

Thank you for the invitation to speak at the Addiction Treatment Leadership Day.

It is a privilege to be here to address people at senior levels in the field, from policy development through to delivery, as well as consumer representation in the addiction treatment and allied fields.

I would like to thank all of you for your attendance and your commitment to providing the best treatment for people with addictions in New Zealand.

I have been asked to speak to you today on:

The interface between addiction (AOD and problem gambling) and justice/corrections systems in the provision of services for all offenders, which contribute significantly to reducing re-offending and supporting rehabilitation into communities; and

How this reflects the big challenges we face for us to improve mental health and addiction outcomes.

It is well known that the causes of alcohol and other drug misuse or problem gambling are complex and many-sided. Most people accessing addiction treatment services have coexisting mental health problems.

The detrimental effects of addiction are wide and varied. Our approach to tackling this problem therefore, needs to be responsive, comprehensive and tailored to meet the needs of individuals and their families.

There is no doubt that the financial cost of addictive behaviour continues to be widespread, affecting individuals, families, communities, employers and companies. There are also significant economic costs - to the health sector, as well as the criminal justice sector, the police, labour, welfare system and our education system.

For all of these reasons, it requires a whole of government approach and will involve the cooperation and collaboration of a number of different sectors. As both an Associate Minister of Health and the Minister of Corrections, I already have a unique view of how this issue cuts across different sectors.

We need to integrate various approaches and acknowledge that the individuals we see are part of wider systems. It is especially important to ensure that interventions are available for all those who need it and when they need it.

I am pleased to say that this government has been undertaking significant work in mental health and addiction to achieve this.

Effective Interventions in the Criminal Justice System

The Government launched its package of initiatives (Effective Interventions in the Criminal Justice System) in August 2006 to improve New Zealand's criminal justice system. That is, a system that protects our communities by punishing offenders appropriately - to make better use of our prisons and to cut our re-offending rates.

I am in no doubt that if we get these settings for the criminal justice system right this will lead to further reductions in crime.

In the Prime Minister's August address she stated that an alarming number of inmates with drug and alcohol problems and serious mental health issues were involved in the criminal justice system.

In fact, we know that 60 per cent of offenders are affected by alcohol or drugs at the time of their offending.

The figure is even higher, at a staggering 83 per cent, for those offenders who have experienced addiction issues at some point in their lives. This is two and a half times the rate of the general population.

There is no doubt that a high incidence of mental health and alcohol and drug problems is associated with offending behaviour.

So the Prime Minister announced a broad package to improve sentence processes, and introduce more effective ways for offenders to serve their sentences. And the Prime Minister also specifically highlighted the need to address underlying drug, alcohol, and other such problems, which blight our prison population.

My view is that if we can provide more effective services for offenders with mental health and/or alcohol and drug problems whether in prison, about to leave prison into the community or offenders serving community sentences, then we can do better in terms of supporting their healthcare needs.

This would reduce their likelihood of re-offending behaviour, leading to fewer victims, and take pressure off our Corrections system.

Effective and timely treatment of this group has been seen to reduce re-offending rates and imprisonment. Key to this is the availability of good programmes.

To this end I announced the establishment of two more drug and alcohol treatment units in prisons over the next 18 months. I also had the pleasure last month of opening a third new unit in Christchurch, and a further unit is planned soon for a prison in the Lower North Island.

In total, it will mean that by 2008/2009, 550 prisoners a year will be able to access to extensive treatment programmes that will help them get free of alcohol and drugs.

I am delighted about these developments and I believe there is a real opportunity to make significant improvements in the way we do things.

As part of the Effective Interventions package I have asked Officials to get together and take a look at a number of areas to support this direction to make the system work more effectively.

First I have asked officials from Health, Justice, Corrections and Police to provide advice to the Government on how we can better improve mental health and AOD interventions in the justice sector.

The review will look to address mental health and AOD interventions occurring at all the various stages of the process - at arrest, in court, on remand, under supervision by Probation Services, on a custodial sentence, on a community sentence, on parole.

The review will therefore cover issues relating to offenders both in the community and in the prison.

I have asked officials to review the available evidence on best practice and to ensure that subsequent advice is relevant to New Zealand.

In addition to this work I am very conscious of the need to have good services on the ground, in the community, to meet the needs of offenders with mental health alcohol, drug and gambling problems.

Again, I have asked, in this case, the Ministry of Health to investigate the availability of alcohol and drug assessment and treatment programmes for those offenders in the community.

That is offenders on supervision, parole or home detention, or any of the other community sentences about to be introduced.

All of these initiatives demonstrate that the Government is totally committed to improving the way we do things, both in terms of treatment options to reduce offending and re-offending and make the community safer.

Improving interface between Health and Corrections at an operational level to promote optimal delivery of offender related health services

As Minister for Corrections and Associate Minister of Health, I am particularly aware that we can improve the way Health and Corrections are currently working at an operational level to promote optimal delivery of offender related health services.

Mental health is a particularly important issue for Corrections. The National Study of Psychiatric Morbidity in New Zealand Prisons in 1999 identified significantly elevated rates of mental disorder among prisoners, particularly so for schizophrenia, bipolar disorder, major depression, obsessive-compulsive disorder and post-traumatic stress disorder.

Beyond this we have a group of offenders who fall into the category of personality disorder, which includes borderline, paranoid and anti-social disorders. More than half of those surveyed suffered from multiple disorders.

There has been a tendency to demarcate those with a personality disorder as not clearly within the 'mental health' categories for service. We should ask ourselves if this provides the best possible outcome for offenders' health.

All these conditions are associated with high levels of distress and disability, especially during their acute phases. Adding to the challenge, 90 per cent of those with a major mental disorder also have a substance abuse problem.

From Corrections' point of view, there is a very clear responsibility to manage these problems when they are resulting in criminal behaviour.

I have been working with officials from both Health and Corrections since the start of the year to try to bring them closer together in the way healthcare is delivered to offenders. I believe we are making real progress in this area.

Projects we are working on include:
·providing assessment and treatment services to mentally unwell prisoners, particularly those identified as having acute mental illness.
·identifying addictions among offenders and improving links to treatment services.
·developing and implementing a best practice model for the delivery of corrections health services to health services to offenders.
·exploring opportunities for earlier prevention, identification and treatment of health issues.

Health and Corrections Officials have developed an addiction services pathway for offenders with mental health, AOD and gambling addictions in consultation with the addiction sector. A project by Corrections to address the screening of offenders for addiction (AOD and gambling) is also underway.

A steering group of representatives from Corrections, the Ministry of Health, DHBs and NCAT will be developing business rules to support this new process, as well as align addiction services nationwide to support offender referrals.

Corrections and Health Officials are also working together to revise the Prison Opioid Substitution and Detoxification Protocol so that methadone maintenance treatment will be extended to allow any prisoner enrolled in a methadone maintenance treatment programme to continue the treatment while in prison, and if necessary upon release back into the community.

Another area I would like to talk about is:

Te Kôkiri: The Mental Health and Addiction Action Plan 2006 - 2015

This plan sets the next steps for progressing our 10 biggest challenges for improving mental health and addiction.

Te Kôkiri outlines opportunities to improve the way agencies work together to improve the mental health and rates of addiction among our communities.

Agencies include those involved in education, health, housing, employment, social services, and of course those that are part of the justice sector.

These challenges confirm the need to improve the availability of, and access to, quality addiction services, and to strengthen the alignment between addiction and mental health services.

This ensures that 'any door is the right door' for people experiencing mental illness and/or addiction, so that individuals, families and whanau receive effective treatment and support.

Te Kôkiri identifies specific actions, key stakeholders and responsible organisations and outlines milestones and timeframes for achieving actions.

Two specific actions in the next five years are to:
·develop initiatives to strengthen linkages between primary health care and mental health and addiction services, and between health and wider social services; and
·continue to develop and support intersectoral initiatives and frameworks to ensure the needs of people in the criminal justice and youth justice system are met.

These actions in the plan will have flow on effects for us all.

I know the National Committee Addiction Treatment will be a key stakeholder involved in these initiatives. NCAT has a range of skills, knowledge and experience available to it, which can add value to the work of government agencies, and a conduit for information to be passed to the sector.

Concluding remarks

I would like to conclude by saying the Government is completely committed to improving the way we do things in this area.

This is both in terms of treatment options for offenders but also to reduce offending and re-offending by having more effective rehabilitation services in place.

We need to integrate various approaches and acknowledge that the individuals we see are part of wider systems. It is especially important to ensure that interventions are available for all those who need it and when they need it.

Thank you for being here today, for being part of the addiction treatment sector that strives for the most effective way to minimise addiction harm and meet the needs of individuals, their families and communities in New Zealand.

Thank you again for the opportunity to speak this important forum today. I wish you well for the rest of the day.

ENDS

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