Submission No 36

INQUIRY INTO THE PROVISION OF DRUG

REHABILITATION SERVICES IN REGIONAL, RURAL AND

REMOTE NEW SOUTH WALES

Name: Clr Edwina Lloyd

Date Received: 29 March 2018

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SubmissiontotheHealthandCommunityServicesInquiryintotheprovisionofdrugrehabilitationservicesinregional,

ruralandremoteNewSouthWales

EDWINALLOYD

March2018

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INTRODUCTION 3

MyBackgroundandExpertise 3

EXECUTIVESUMMARY 6

ListofRecommendations 6

EVIDENCEANDCHARACTERISTICSOFSUCCESSFULREHABILITATIONOUTCOMES 7

EXISTINGREHABILITATIONSERVICES 8

RiverlandsDrugandAlcoholCentre 8

TheButtery 8

TheButteryCommunityBasedRehabilitationProgram(CORE) 10

TheButteryPrivate 11

ByronPrivate 12

ABORIGINAL-SPECIFICREHABILITATIONSERVICES 12

NamatjiraHaven 13

Balund-a 13

OTHERPROGRAMS 15

TheMagistratesEarlyReferralIntoTreatment(TheMERITProgram) 15

TheCompulsoryDrugTreatmentPrison 16

TheDrugCourt 18

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Introduction

ThankyoufortheopportunitytocontributeasubmissiontotheInquiry.ThisSubmissionfocusesonthefollowingTermsofReference:

1.Therangeandtypesofservicesincludingthenumberoftreatmentbedscurrentlyavailable.

6.Thewaitinglistsandwaitingtimesforgainingentryintoservices.

9.Thegapsandshortagesintheprovisionofservicesincludinggeographical,resourcesandfunding.

11.Evidenceofrehabilitationservicesthathavehadbothsuccessfulandunsuccessfuloutcomes,includingwhatcharacteristicsconstituteasuccessfuloutcomeandhowreliableisthedatacollectionandreportingmechanismscurrentlyinplace.

12.Currentandpotentialthreatstoexistingrehabilitationservices.

14.Anyotherrelatedmatters.

RatherthanaddressingeachTermofReferenceseparately,Ihaveorderedthissubmissioninfourchapters,witheachchaptermakingreferencetorelevantissues.Thesechaptersare:

• EvidenceandCharacteristicsofSuccessfulRehabilitationOutcomes;• ExistingRehabilitationServices;• Aboriginal-SpecificRehabilitationServices;and• OtherPrograms.

MyBackgroundandExpertise

IamacriminallawyerwithmyownprivatepracticeinLismoreengagedonaregularbasisbytheAboriginalLegalServicesandLegalAidCommission.MyexperienceasadutylawyerworkingabusycourtlististhatinthepastthreeyearsalmosteverysingleindividualIhaverepresentedwasfacingchargesrelatedtotheirsubstanceabusedisorderand/ormentalhealthissue.

IamaCouncilloronLismoreCityCouncil.ThroughtheCouncil,IamalsoestablishingaSocialJusticeandCrimeCommitteetoidentifythelocalneedsandexploreopportunitiesforadrugcourt,andtoconsiderpartnershipopportunitiestoestablishfurtherresidentialrehabilitationcentresandothersocialinfrastructureandserviceswhichaddressesthehighrateofsubstanceabuseissuesinourcommunity.

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Iamalsoinrecoverymyself.Ihavepersonalexperienceassomeonewhohashadasubstanceabusedisorderwhocameintocontactwiththecriminaljusticesystemandprogressedthroughresidentialrehabilitationintorecoveryfromaddiction.

Thereisalargeamountofcriminologicalliteraturedemonstratingastrongassociationbetweendruguseandcrime.Offendersreportamuchhigherprevalenceofdrugusethanthegeneralpopulationandalargeproportionoftheseoffendersattributetheircriminalbehaviourtotheirsubstancemisuse.1

Substancemisuseisalsoofconcernbecauseitisanimportantriskfactorforrecidivismandreturningtogaol.Alcoholandsubstanceabusearesignificantindependentpredictorsofself-reportedcriminalactivityandreincarcerationofparolees.2Substancemisuseisparticularlyproblematicinprisonerswithacomorbidmentalhealthdisorder.3

Ofcourse,noteveryindividualinourcommunitywillhavecontactwiththecriminaljusticesystem,thoughitiscertainlylikelygivenwehavelawsthatprohibitdrugpossessionandgiventheincreaseinmethamphetamine(ice)abusewhichoftenleadstoviolentbehaviouragainstothers,damagetopropertyandengagingindangerousconductduetobeingundertheinfluenceofsuchsubstances.

Inthisregionwearekickinggoalsintermsofleadingthestateinthenumberofdrugoffencescommitted.TheNSWStateaverageis754.5per100,000people.Ourregion’saverageisalmostthreetimesthatat2,183.70per100,000people.4Assuch,itissubmittedthatourregionmustbeanimportantfocuspointforthisInquiry.

Thecosttothegovernmentandtax-payerofdrug-relatedcrimedoesnotjustcomeasahugeeconomicalcosttothegovernmentandtaxpayer,butalsocomesatasocialcosttoourfamiliesandcommunities-acostthatisdifficulttoquantifybuteasytosee.Ifweallagreethatcommunitysafetyistheprioritytheneffective,adequatetreatmentservicesmustbeprovidedtomeettheveryhighneedinourregion.

Thewarondrugsapproachhasfailed,butwhilstthereexiststhecriminalisationofdrugsitisimportanttomakethemostofopportunitieswithinthecriminaljusticesystemthatcanenableindividualstoaccesstreatmentthattheymaynotnormally

1Coghlan,S.,Gannoni,A.,Goldsmid,S.,Patterson,E.,&Willis,M.(2015).DrugusemonitoringinAustralia:2013-14reportondruguseamongpolicedetainees(MonitoringReportNo.27).RetrievedfromAustralianInstituteofCriminologywebsite:http://www.aic.gov.au/publications/current%20series/mr/21-40/mr27.html2http://www.bocsar.nsw.gov.au/Documents/CJB/Report-2016-NSW-Intensive-Drug-and-Alcohol-Treatment-Program-cjb192.pdf(e.g.Ferguson,2015;Kinner,2006;MacKenzieetal.,1999).3http://www.bocsar.nsw.gov.au/Documents/CJB/Report-2016-NSW-Intensive-Drug-and-Alcohol-Treatment-Program-cjb192.pdf(Smith&Trimboli,2010).4BOCSAR.WearealsoleadingtheStateinthefollowingoffencecategoriesthatareoftenrelatedtosubstanceabuse–theft,DVandnon-DVassault,Maliciousdamagetoproperty,disorderlyconduct,Intimidation,alcohol-relatedoffences.

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beabletoduetoanumberofbarriers,suchasgeographicallocationandmostimportantly,duetothestigmaattachedtohavingadrugand/oralcohol‘problem.’

Thestigmawasabarrierformeinaccessingtreatment.Ispent15yearsasanalcoholicandusingillicitsubstances.15yearsoffeelingmarginalisedandashamed,fearfulofbeingjudgedandnotfeelingcomfortabletoaskforthehelpIdesperatelyneeded.

Itwasabrushwiththelawthatledtomeaccessingtreatment.Iamextremelygratefulforthefamilysupportandservicesthathelpedputmebacktogetherandputmebackonmyfeet,withenoughself-confidencetogoonandobtainalawdegree,withhonours,becomealawyer,councillorandlife-longadvocatefordruglawreformandrehabilitationservicesinourcommunity.

But,noteveryonehaswhatIhad-strongfamilysupport,fundsoradequatementalhealthtodowhatisrequiredtoaccesstreatment.Noteveryonehasthecapacitytowaitandnotfalloffordiewhilstonthelongwaitingliststorehabilitationcentres.Noteveryonehasaservicenearwheretheylive.Inregardstothosebarriersand,sadly,‘noteveryone’is‘almosteveryone’inourregion.

Yourssincerely,

EDWINALLOYD

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ExecutiveSummary

TheNorthernRiversandtheNorthCoastregionsofNSWareexperiencingcomparativelyhighlevelsofdrugaddictionandassociatedcrime.Residentialrehabilitationservicesareproventobethemosteffectivewayoftacklingdrugaddictionhoweveraccesstotheseservicesislimitedbyanumberoffactors.InordertotackledrugaddictionintheNorthernRiverandNorthCoast,theremustbe:

1. Significantlyincreasedfundingforbothexistingandnewresidentialrehabilitationservices(includingdetoxfacilities)intheregion.

2. AnexpansionoftheMagistratesEarlyReferralIntoTreatment(MERIT)Program.

3. TheestablishmentofaDrugCourtandaKooricourtfortheregion.ListofRecommendationsThissubmissionmakesthefollowingrecommendations:

• AdequatefundingofRiverlandstocatertoindividualsunder18yearsofage.

• Increasefundingtolocalresidentialrehabilitationscentrestoexpandornewfacilitiestobebuilttomeetthedemandandensuretherecanbeanimmediatetransitionfromthedetoxfacilitystraightintotheresidentialrehabilitationcentre.

• Increasefundingtocurrentresidentialrehabilitationservicestoincludeaspecialistdomesticviolenceandmen’sbehaviourprogramtobedeliveredthroughtherehabilitationcentretoassistinreducingtheprevalenceofdomesticviolenceinthecommunity.

• EstablishawomenandchildrenrehabilitationcentrethatisculturallysensitivetotheneedsofAboriginalwomen.

• AmendtheNSWCorrectiveServicespolicytofacilitateandenableindividualsincustodyaccesstofreephonestoaccessrehabilitationservicessotheyareableundertaketheassessmentprocesswhilstincustody;

• IncreasefundingtoMERITtoenablemorestaffandresourcestocatertothedemandincludingenoughresourcestomanageclientswithdrug/alcoholandmentalhealthissues;

• ExpandMERITsoitcanbemadeavailabletoindividualsfacingchargesintheDistrictCourt;

• ExpandMERITtoincludeindividualswithalcoholabuseissues;

• ReinstatetheMERITpolicyenablingindividualsincustodytoapplyfortheprogram;and

• Establishadrugcourtforthisregionandexpandtheeligibilityofdrugcourtcriteriatoincludelocalcourtmatters.

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• EstablishaKooricourtforbothyouthandadultAboriginalpersonsthathasjurisdictionoverchildrenandadultlocalanddistrictcourtmatters.

EvidenceandCharacteristicsofSuccessfulRehabilitationOutcomes

Substanceabusedisorderisacunningandbafflingcondition.Relapseisanormalpartofrecovery.About50%ofindividualswhoreceivetreatmentwillrelapseafteroneyear.Motivationisanimportantfactorcontributingtothesuccessofdrugtreatment.Inthisregionthereexistslongwaitinglistsforresidentialrehabilitationcentresandlessofademandfornon-residentialtreatment.Thisobjectiveevidencemakesitclearthatindividualsaremotivatedtoenteraresidentialrehabilitationcentreoverandaboveoutpatienttreatmentprograms.Theterm‘TherapeuticCommunity’(TC)isgenerallyusedtodescribesmall,cohesivecommunitieswherepatients(sometimesreferredtoas‘residents’)haveasignificantinvolvementindecision-makingandthepracticalitiesofrunningtheunit.Keyprinciplesincludecollectiveresponsibility,citizenshipandempowerment,andTCsarestructuredinawaythatdeliberatelyencouragespersonalresponsibilityanddiscouragesunhelpfuldependencyonprofessionals.5Individualswithsubstanceabusedisordersareusuallymedicatingapasttrauma.Atherapeuticcommunityisasafespacewhichenablesparticipantstolettheirguarddownandsharetheseexperienceswhichleadstogaininginsightintohowsubstanceabuseisoftenacopingmechanismtodealwiththepainthatmayordinarilyfeelunbearable.Thesharingofonesexperiencesinthissettingleadsotherstofeelcomfortablesharingtheirownpain.Asignificantreasonattributedtothesuccessofresidentialrehabilitationinreducingrelapseeventsisthatthesettingallowsindividualstoworksolelyonthemselveswithoutthedisturbanceandinterferenceoflifestressorssuchasfamily,financialandlegalissues,whichareusuallythetriggersforrelapse.Residentialrehabilitationcentresteachindividualshowtomanagethesetriggerswithoutresortingtorelapse.Thisisaweakness/riskofrelapsewhichexistsinoutpatient,communitybasedrehabilitationprograms.

Thereisalsosignificantevidencethatdrugaddictiontreatmentcanbeaneffectivecrimecontrolmeasureandtherapeuticcommunitiesareaneffectivemodeltoadopt.6

5JulianStern,CorePsychiatry(ThirdEdition),2012https://www.sciencedirect.com/topics/nursing-and-health-professions/therapeutic-community6WouterVanderplasschen,KathyColpaert,MiekeAutrique,RichardCharlesRapp,StevePearce,EricBroekaert,andStijnVandeveldeTherapeuticCommunitiesforAddictions:AReviewofTheir

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ItisimportantthattheInquirytakesnoteofthelongwaitinglistsintheresidentialrehabilitationsector.Itishopedthatthisresultsinarecommendationofincreasedfundingtotheresidentialrehabilitationsectorinourregionasthisisthetypeoftreatmentthattheindividualswhoneedhelpareaskingfor.

ExistingRehabilitationServices

RiverlandsDrugandAlcoholCentreRiverlandsisa16-beddetoxificationunit,pharmacotherapyclinic(methadone&buprenorphine),clinicalliaisonandoutpatientservicesandaneducationalandtrainingfacility.7Riverlands,asadetoxificationunitisnotadrugandalcoholrehabilitationunit.Riverlandsallowspeopletosafelydetoxundermedicalsupervisionasafirstphaseinthedrug/alcoholrehabilitationprocess.

Gaps&Shortages

Thisserviceisnotavailableforpeopleunder18yearsofage.

Thereisnoeasytransitionfromthedetoxstraighttoaresidentialrehabilitationcentre.

Oftenthereisonlyanarrowwindowofopportunitywhereanindividual(afterdetoxing)acceptsthattheyneedhelp.Unlessrehabilitationassistancecanbeprovidedwhilstthepersoniswithinthismoment,theopportunityisoftenlost.

TheButteryTheButteryisaresidentialrehabilitationcentreinBinnaBurraabouthalfanhourfromLismoreandhas34beds.TheButteryisatherapeuticcommunity(a‘TC’)andisalong-termresidentialrehabilitationprogramforadultsaddictedtodrugs,alcoholorboth.8

EffectivenessfromaRecovery-OrientedPerspective-https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3562581/7NSWHealthwebsitehttp://nnswlhd.health.nsw.gov.au/about/drug-alcohol-services/riverlands-drug-alcohol-centre/,accessed25March20188“IntheTherapeuticCommunitymodeloftreatment,thecommunityitself,throughself-helpandmutualsupport,istheprincipalmeansforpromotingpersonalchange.Inatherapeuticcommunityresidentsandstaffparticipateinthemanagementandoperationofthecommunity,contributingtoapsychologicallyandphysicallysafelearningenvironmentwherechangecanoccur.Inatherapeuticcommunitythereisafocusonsocial,psychologicalandbehaviouraldimensionsofsubstanceuse,withtheuseofthecommunitytohealindividualsemotionally,andsupportthedevelopmentofbehaviours,attitudesandvaluesofhealthyliving.”(DefinitionprovidedbyAustralasianTherapeuticCommunitiesAssociation.)

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Theprogramisevidence-basedandbest-practiceandinformedbythelatestresearchintoaddictiontreatment.MostpeopleundertakeTheButtery’sresidentialrehabilitationprogramatnodirectcosttothemselvesandcontribute80%oftheirCentrelinkbenefits(e.g.pensionorsicknessbenefits)tocoverfoodandaccommodation.

WaitingLists&WaitingTimes

Thewaitinglistformeniscurrentlyfivemonthsandforwomen,3months.Thediscrepancyisduetotherebeingmoremenseekingrehabandtheneedtoachievegenderbalanceinthetherapeuticcommunityasthisismoreeffectivefortreatment.

Thiswaitingperiodcanbelongeratdifferenttimes.Thesadrealityisthatindividualsdiewhilstotherssinkfurtherintosubstanceabusewhilstonthewaitinglist.WaitinglistsarenotuniquetotheButterybutacrosstheentireNSWresidentialrehabilitationsector.

Gaps&Shortages:

TheButterydoesnottakepeopledirectlyfromcustody.PartoftheprocessofgainingentrytotheButteryandmanyrehabsistherequirementthattheindividualcalltherehabonceaweek(andforsomeuptothreetimesaweek)tocheckin.Iftheindividualdoesnotcallweeklytheyaretakenoffthewaitinglist.Aclientincustodyisnotpermittedtomakethesecalls.Thisputstheoffenderonremandinanimpossiblesituationintermsofaccessingtheprogram.Courtswilloftenonlygrantbailforoffenderswhohaveabedinafacility.TheonlywayforoffenderswhoareincustodytogetabedisbyaskingthecourttorequestanAlcoholandOtherDrugOrderbepreparedbyCorrectiveServices.Thisprocesstakessixweeksandtheoffendermustremainincustodyforthattime.Iftheoffenderiseligible,thenCorrectiveServiceswilltryandarrangeabedinafacilitylocallyandprepareareportforthecourtwhichthendeterminesiftheoffenderispermittedtobegrantedbailtotherehab.TheButtery’srecurrentfundingisthroughNSWHealthandisrenewedyear-to-year.NSWHealthfundingcoversapproximately50%ofthebudgetandthebalanceismadeupbyresidents’contributionsandcharitabledonations.

OtherMatters

AsignificantbarriertotheButteryexpansionisthe‘NIMBYism’ofsomemembersofthecommunity.Somecommunitymembersarefearfulofhavingaresidentialrehabilitationfacility‘intheirbackyard.’ThisoppositionisabarriertothebuildingandexpansionofsuccessfulresidentialrehabilitationcentressuchastheButtery.

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Suchwasthecasein2016whenTheButteryhadtheintentionofpurchasinganexistingretreatatLindendaleforuseasauser-paysfacility.Itwasintendedasanearlyinterventionforemployedpeopleinneedoftreatmentfornon-acutementalhealthissuessuchasanxiety,burn-outandearlystagesubstancemisuse.ThevendorsubmittedaDevelopmentApplication(a‘DA’)toLismoreCityCouncilforachangeofuse.

LismoreCityCouncilstaffrecommendedtoCouncilthatconsentbegrantedtotheapplication.Unfortunately,duetoahighnumberofcommunitymembersopposingtheprojecttheapplicationwasrefused.

Someoftheconcernsraisedbycommunitymembersincludedsafety,security,trafficgeneration,impactonamenityandwell-beingofsurroundinglocalresidents,downturninpropertyvalues.9

TherefusaloftheDAwasunfortunate,especiallygiventhatsuchfearshadnoteverbeenrealisedatthecurrentButteryfacility–whichislocatedclosertoresidentsandjustoutsideofBangalowandhasbeeninexistenceasaresidentialrehabilitationcentresince1973.IndeedtheneighbourstothecurrentButteryfacilityprovidedtestamentstoCouncilofthisfact.10

TheButteryCommunityBasedRehabilitationProgram(CORE)LastyeartheButteryreceivedfundingfromtheNorthCoastPrimaryHealthNetworktopilottheCOREprogram.COREisashort-termmid-intensityrehabilitationprogramdeliveredinthelocalcommunity.Itisa6weeknon-residentialstructuredprogramforpeoplewhoareunabletoattendresidentialrehabilitationprogramsduetopersonalcircumstancessuchastheircaringrolesasparents.Theprogram,whenitisrunning,caterstoupto15peopleandruns5daysaweekduringschoolhoursandrotatesbetweenByronBay,LismoreandTweedHeads.Theprogramisfundedforthenext4years.Theprogramisdesignedtomeettheneedsofpeoplewhowishtoundertakearehabprogrambutwho,duetocareer,parentaloremploymentresponsibilitiesareunabletotakepartinalong-termresidentialprogram.

9BusinessAgenda-LismoreCityCouncil,12April2016,https://www.lismore.nsw.gov.au/infocouncil2/Open/2016/04/OC_12042016_AGN_AT_WEB.htm10BusinessAgenda-LismoreCityCouncil,12April2016,staffcommenttosubmission:https://www.lismore.nsw.gov.au/infocouncil2/Open/2016/04/OC_12042016_AGN_AT_WEB.htm

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WaitingLists&WaitingTimes

TheCOREprogramisfullysubscribedanddemandforaplaceexceedsthenumberofavailableplaces.Initialfeedbackfromparticipantsinthepastthreeprogramshasbeenverypositive.

TheButteryPrivateTheButteryPrivateisTheButtery’snewsocialenterprise.SurplusfundsfromtheprogramareappliedtoTheButtery’scharitableworks.Itisanewresidentialrehabilitationinitiativewhosefocusisona‘WellbeingProgram’designedtocomplementmedicalin-patient(28day)programsforpeoplewhoare(priortoentry)physicallydetoxedandpsychologicallystabilised.Theserviceisdesignedforpeoplewhomayneedtotaketime-outtoaddresstheissuesunderlyingtheirconditions.Thisisundertakeninasmall,confidentialresidentialsetting.TheButteryPrivateisanevidence-basedprogramforpeopleexperiencing:

• Workplaceburnout• Exhaustion• Stress• Anxiety• Depression• Trauma• Substanceabuse11

WaitingLists&WaitingTimes

Therearenowaitinglists.Feesfortreatmentarenotcoveredbyprivatehealthinsurance.Thecostislessthanbutcomparabletootherprivatefacilities.Thecostisabarrierformanyinparticipatinginthisprogram.

11ButteryPrivatewebsite,https://www.butteryprivate.org.au/for-referrers/,accessed25March2018.

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ByronPrivateTheByronPrivateisaprivately-funded12-bedresidentialfacilitythatprovidesa6-weektreatmentprogramfordrugaddiction,alcoholism,eatingdisorders,PTSD,anxietyanddepression.EntranceintoByronPrivatecostsaround$40,000forthesix-weekprogram.ThefacilityqualifiesasaPrivateHealthFacilityunderthePrivateHealthFacilitiesAct2007,thereforethecostoftreatmentatByronPrivateisprohibitivetotheoverwhelmingmajorityofindividualswithsubstanceabusedisordersinourregion.12

Aboriginal-SpecificRehabilitationServices

AboriginalandTorresStraitIslanderpeoplemakeup6.1percentoftheLismoreLGApopulation.Thisissignificantlyhigherthanthenationalandstateaveragesof2.9percent.13UnfortunatelythisalsomeansthatadisproportionatenumberofIndigenousandTorresStraitIslanderpeoplefromourcommunityareimprisoned.A2017crimereportbyBOCSARindicatestherehasbeenaStateaverageincreaseof25%inIndigenousimprisonmentsince2013.

IthasalsobeenreportedthatthestatisticsrevealthatinourregionofNorthernNSWtherehasbeena50%increaseinthenumberofIndigenouspeopleimprisonedsince2013.14

AboriginallawyerandacademicNoelPearsonhasarguedthatIndigenousdrugandalcoholabusearefarmoreimportantcausesofIndigenousincarcerationthaneconomicandsocialdisadvantage.15

ThereisaclearneedfordrugrehabilitationservicesinourregiontoaddressthehighratesofsubstanceabuseamongAboriginalpeople,particularlyyoungAboriginalpeoplewhounfortunatelyfrequentlycomeintocontactwiththecourts.Fundingofservicestoaddressthesubstanceabuseissuesisparamounttoreducingthedisproportionateincarcerationratesandtoaddresstheongoinginter-generationalimpactofsubstanceabuseandincarcerationontheAboriginalcommunity.

MyexperienceasadutylawyerforAboriginalLegalServiceisconsistentwiththestatisticsofdrugandalcohol-relatedcrimeandIcancountononehandthenumber

12BryonPrivatesubmissiontotheInquiryintotheProvisionofDrugRehabilitationServicesinRegional,RuralandRemoteNSW,December2017,p2132016CensusQuickStats,Lismore(NSW)http://www.censusdata.abs.gov.au/census_services/getproduct/census/2016/quickstat/SSC1234414https://www.northernstar.com.au/news/solution-to-reduce-indigenous-prisoners-in-jails/3199773/15DonWeatherburn,Disadvantage,Drugs&Gaol:Re-thinkingIndigenousOver-representationinPrison-Keynoteaddress,ConferenceoftheAustralasianSocietyonAlcoholandotherDrugs,CairnsConventionCentre,5th-8thNovember,2006.

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ofAboriginalpeopleIhaverepresentedwhohavenotbeenchargedwithacrimerelatedtoasubstanceabusedisorder.

NamatjiraHavenNamatjiraHavenisanAboriginalcommunitycontrolledorganisationprovidingresidentialprogramsforAboriginalmenrequiringassistanceindealingwithsubstancemisuse,abuseanddomesticviolenceissues.Thecentrecurrentlyhas14bedsandislocatedonNSWNorthCoast2.5kmsfromAlstonville,25minutesorsofromLismore.Italsoprovidesoutreachfamilyhealthandwellbeingsupportservicestofamilymembersofresidents.16Balund-aTheBalund-aProgramisaresidentialdiversionaryprogramestablishedin2015operatedbyCorrectiveServicesNSW,formaleoffendersover18yearsofage.17LocatedatTabulam(almost2hoursfromLismore),theprogramcanhouseupto70residentsanditsaimistoreducere-offendingandenhanceskillswithinaculturalandsupportivecommunityenvironment.OffendersentertheprogramasaconditionofaSection11Bondforaninitialassessmentperiodoftwoweeks.OffenderscanalsobereferredtotheprogrambyCommunityCorrectionsstaffwhenrevocationofparoleorcommunity-basedorderisbeingconsidered,orwhenfactorsemergeinthecourseofsupervision,andareassessedasrequiringintensiveresidentialintervention.Followingacceptanceintotheprogramoffendersparticipateinstructuredprogramswithinaculturallysensitiveframework.Programsaddressspecificareasofrisktoassistonimprovinglifeskillsandreintegrationintothecommunity,forexample,cognitivebasedprograms,drugandalcohol,angermanagement,educationandemployability,domesticviolence,parentingskillsandlivingskills.Culturalactivitiesincludeexcursionstosacredsites,music,danceandart.Eldersemployedbytheprogramprovidesupportandassistresidenttorecognise,restoreandvalueculturallinkswiththeirlandandhistory.Thepropertyissituatedon534hectaresandalsooperatesasafarmingandbeefcattlepropertygivingtheresidentstheopportunitytodevelopagriculturalskills.Thelengthofstayattheprogramvariesaccordingtoindividualneedshoweveraminimumperiodof6monthsisrequired.18

16NamatjiraHavenwebsite,https://namatjirahaven.com.au/about-us/accessed25March2018.17TheimpetusfortheestablishmentofBalundawastheRoyalCommissionintoAboriginalDeathsInCustody,1987.18DepartmentofJusticewebsite,http://www.correctiveservices.justice.nsw.gov.au/Pages/CorrectiveServices/Community%20Corrections/offender-management-in-the-community/balund-a_tabulam.aspx,accessed25March2018

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WaitingLists&WaitingTimes

MyexperienceofBalund-aisthatthewaitinglistisusuallyonlyafewweeksbutthereasonforthisisthatindividualsarenotstayingattheprogramforthedurationsobedsbecomeavailable.

MyexperiencewithNamitjiraHavenisthewaitinglistismonthslong.

Gaps&Shortages

ThereisadesperateneedforaspecialisedKooricourt.ThereisonlyoneyouthKooricourt,operatingonedayaweekinParramattathathasjustcompletedthefirst12monthtrial.Inotethatmorethan60youngAboriginalpeoplehavetakenpartintheYouthKooriCourtsince2015,whenitbeganoperatingonedayaweekatParramattaChildren’sCourt.TherearecertainlyenoughadultandyoungAboriginalpersonsbeforethecourtinthisregiontosupportaKooricourtthatoperatesonedayaweek.NSWJusticenotethattheYouthKooriCourtincreasesAboriginalinvolvementinthedeliveryofjustice,ensuringoutcomesareculturallyrelevantandhavemoreimpactontheoffender.19TherehasnotyetbeenaformalevaluationcarriedoutontheyouthKooricourtbutinitialreportssuggestitssuccessinreducingrecidivismratesandincreasingemploymentandstableaccommodation.Inaddition,thecostoftheYouthKooricourthasledtoanetsavingtoNSWof$36,540.20Theinvolvementofelders,whositalongsidetheMagistrateandtheindividualisfarlessintimidatingthantheregularwesternisedcourtsandisbasedonprinciplesoftherapeuticjustice–focusingonthecrimogenicneedsoftheparticipant.Participantsarelinkedwithsupportagenciesandcasemanagedplanswhichensurecompliance.

OneonlyneedstolookatthenumberofAboriginalpeopledisproportionatelyrepresentedinourgaolsasaresultofdrugandalcohol-relatedcrimestograspthesignificantshortageoftreatmentopportunitiesinourregion.

Thereisahighrateofdrug(methamphetamine)andalcoholrelatedviolentoffencesamongtheAboriginalcommunitiesinourregion.Domesticviolenceissadlytooprevalentanditisthisoffendingthatoftenresultsinincarceration.ThereisalsonofacilityforAboriginalwomenandchildren.

19http://www.justice.nsw.gov.au/Pages/media-news/media-releases/2017/$220000-funding-boost-for-Youth-Koori-Court.aspx20https://crimlawcommittee.wordpress.com/2017/03/05/trial-of-the-new-nsw-youth-koori-court-success/

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OtherPrograms

TheMagistratesEarlyReferralIntoTreatment(TheMERITProgram)TheMERITprogramisavailableattheLocalCourtsinourregion.Eligibleindividualsareabletohavetheirmatteradjournedtoallowthemtofocusontreatingtheirsubstanceabuseproblem.Thetreatmentprogramistailoredfortheindividual’sneedsandcanincludedetoxification,methadone,residentialrehabilitation,individualandgroupcounselling,casemanagementandwelfaresupport.Itisusuallyplannedasa12-weekintensiveprogram.Successfulengagementintheprogramcanbetakenintoaccountinsentenceproceedings.21Anevaluationfoundthatcompletionoftheprogramreducestheriskofrecidivismofanytypeofoffenceinthenexttwoyearsby12percent.22

WaitingLists&WaitingTimes

Asadutylawyerincourtonmostdays,ImakereferralstoMERIT.TherehavebeenafewoccasionswheretheMERITofficehasnotifiedusthattheir‘booksarefull’andtheycannottakeonanymoreclients.IamawareofinstanceswhereMERIThasclosedtheirbooksforalmosttwomonths.

Gaps&Shortages

ThereareanumberofgapsandshortagesintheMERITprogram.Theseinclude:

• InabilitytoaccessMERITduetotheir‘booksbeingfull’;• MERITisonlyavailabletopersonschargedwithmattersthatcanbefinalised

inthelocalcourt;• MERITcannotbeappliedforifincustody,asanindividualmustbegranted

bailbeforetheycanapply.IunderstandthisfairlyrecentpolicychangewasbroughtabouttolimitthenumbersofindividualsapplyingduetolackofstaffandresourcesattheMERIToffice;

• TheButteryrehabhasfourMERITbedsonlyandthesebedsareinfrequentlyavailableduetothelongwaitinglistandthelengthoftheprogram;

21LocalCourtPracticeNoteCrim1:CasemanagementofcriminalproceedingsintheLocalCourt[12.1].22SubmissiontothisInquirybyNSWLegalAid-RohanLulhamTheMagistratesEarlyReferralIntoTreatmentProgram–Impactofprogramparticipationonre-offendingbydefendantswithadruguseproblem(2009)NSWBureauofCrimeStatisticsandResearch.Lulhamalsonotedthattheliteraturestronglysuggeststhatsmallchangesintherateofconvictionsareassociatedwithmuchlargerchangesinactualoffending:at9.

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• Anindividualwhois“self-medicating”amentalhealthissuewithillicitsubstancesmaynotbeeligible,duetothelackofresourcesintheMERITofficetocaterforclientswithspecialisedandcomplexneeds;

• TheLismoreMERITprogramonlyacceptsindividualswithdrugabuseissues.IndividualswhohavealcoholabuseissuesarenoteligiblefortheMERITprogram.ThiseligibilityrestrictionmeansthatmanyindividualsaremissingoutonthevaluableassistanceofferedbyMERITandanopportunitytoaddresstheircriminalbehaviours.

TheCompulsoryDrugTreatmentPrisonIn2006inNorth-WestSydney,ParkleaCorrectionalCentrehousestheCompulsoryDrugTreatmentProgramforoffenderswithsubstanceabuseissuesandwhohavebeensentencedto18months–6years.Theprisonhas70bedsandisonlyavailabletooffendersintheSydneymetroarea.TheimpetusfromtheNSWStateGovernmentforcommencingtheprogramarosefromaperceptionthat,despiteacomprehensivearrayofsupply,demandandharmreductionstrategiesaimedatreducingdrug-relatedcrimeanddeaths,thereremainedapersistentgroupofdrug-relatedoffenderswhokeptreturningtothecourts.23

Theprogramincludesanemphasisonrewardsandsanctions.Theobjectivesofthelegislationprovidetheblueprintfortheservicedeliverymodel:(1)toprovideacomprehensiveprogramofcompulsorytreatmentandrehabilitationunderjudicialsupervisionfordrugdependentpersonswhorepeatedlyresorttocriminalactivitytosupportthatdependency,(2)toeffectivelytreatthosepersonsfordrugdependency,eliminatingtheirillicitdrugusewhileintheprogramandreducingthelikelihoodofrelapseonrelease,(3)topromotethere-integrationofthosepersonsintothecommunity,and(4)topreventandreducecrimebyreducingthosepersons’needtoresorttocriminalactivitytosupporttheirdependency.

OnceaCDTOismade,amultidisciplinaryteamdevelopstheCompulsoryDrugTreatmentPersonalPlan(thePersonalPlan)withparticipantsforapprovalbytheDrugCourt.24

23AstridBirgden(DirectoroftheCompulsoryDrugTreatmentCorrectionalCentre)andLukeGrant(AssistantCommissioner,OffenderServicesandPrograms,CorrectiveSerives,NSW),Establishingacompulsorydrugtreatmentprison:Therapeuticpolicy,principles,andpracticesinaddressingoffenderrightsandrehabilitation,2010,AustraliasianJournalofCorrectionalStaffDevelopment:https://pdfs.semanticscholar.org/d2b7/b98d72a0fc431464c9ecf9c368f277249f4d.pdf24OnceaCDTOismade,amultidisciplinaryteamdevelopstheCompulsoryDrugTreatmentPersonalPlan(thePersonalPlan)withparticipantsforapprovalbytheDrugCourt.ThePersonalPlanisatreatmentplan,acasemanagementplan,andacontingencycontractcombined.ThePersonalPlanidentifiesdynamicriskfactorsforre-offendingaswellashumanneeds,identifiestheconditionsfordrugtreatmentandrehabilitation,andspecifiestherewardsformeetingthespecifiedconditionsandthesanctionsfornotmeetingthespecifiedconditions.SuccessinmeetingtheconditionsofthePersonalPlanisrewardedwithprogressiontowardcommunity

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Intermsofexit,participantscanbereluctanttoleavethesupportoftheCDTCCparticipantsareincreasinglyrequestingthattheynotbegrantedparolebutremainontheCDTOforafewfurthermonthsinordertoreceiveongoingsupportinthecommunity.

Significantimprovementswerefoundinoutcomemeasuresofmentalandphysicalhealth,highscoresontreatmentreadinessandtherapeuticalliance,andlargelypositivecommentsabouttheProgram.25

AreviewoftheProgrambytheBOCSARfoundevidencethattheprogramwassuccessfulinmeetingitsobjectives.Thereviewfoundthat:

• Theproportionofparticipantswhofelt'sure'thattheyneededhelptokeepfromrelapsingtodruguse;and

• Theproportionofparticipantswhofelt'sure'thattheyneededhelptokeep

fromtakingpartinfurthercriminalactsorbehaviourbothfelloverthecourseofthetreatment.26

AtAugust2009,preliminaryCDTCCpsychometricdataanalysisindicatedthatpositivechangeswereoccurringfortreatmentreadiness,impulsecontrol,criminalthinking,problemsolvingskills,perceivedqualityoflife,andsoon.27

Inotherwords,theprogramwassuccessfulinenablingparticipanttokicktheirdrughabitsandbreakthecycleofdrugsandcrime.28Addressingthecorereasonforusingalcoholordrugsisthebeginningoftherehabilitativeprocess.Thisthecorereasonwhysuchaprocessisunlikelytoworkinanormalprisonsetting,whereprisonershavetokeeptheirguardupatalltimestoreintegration.FailuretomeettheconditionsofthePersonalPlancanresultinsanctionsofincreasedmanagement,regression,orultimatelyrevocation(withareturntomainstreamprisontocompletethenon-paroleperiodofthesentence.25AstridBirgden(DirectoroftheCompulsoryDrugTreatmentCorrectionalCentre)andLukeGrant(AssistantCommissioner,OffenderServicesandPrograms,CorrectiveSerives,NSW),Establishingacompulsorydrugtreatmentprison:Therapeuticpolicy,principles,andpracticesinaddressingoffenderrightsandrehabilitation,2010,AustraliasianJournalofCorrectionalStaffDevelopment:http://www.bfcsa.nsw.gov.au/journal/ajcsdhttps://pdfs.semanticscholar.org/d2b7/b98d72a0fc431464c9ecf9c368f277249f4d.pdf26JoulaDekker,KateO’BrienandNadineSmithANEVALUATIONOFTHECOMPULSORYDRUGTREATMENTPROGRAM(CDTP)NSWBureauofCrimeStatisticsandResearch(2010)http://www.bocsar.nsw.gov.au/Documents/l20.pdf27AstridBirgden(DirectoroftheCompulsoryDrugTreatmentCorrectionalCentre)andLukeGrant(AssistantCommissioner,OffenderServicesandPrograms,CorrectiveSerives,NSW),Establishingacompulsorydrugtreatmentprison:Therapeuticpolicy,principles,andpracticesinaddressingoffenderrightsandrehabilitation,2010,AustraliasianJournalofCorrectionalStaffDevelopment:http://www.bfcsa.nsw.gov.au/journal/ajcsdhttps://pdfs.semanticscholar.org/d2b7/b98d72a0fc431464c9ecf9c368f277249f4d.pdf28*CompulsoryDrugTreatmentCorrectionalCentreEvaluation,BOCSAR,http://www.bocsar.nsw.gov.au/Pages/bocsar_publication/bocsar_mr_L20.aspxaccessed25March2018.)

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avoidviolence.Inotherwords,beingvulnerableinaprisonsettingisnotsafe,unlessofcoursetheprisonsettingisatherapeuticsettingestablishedforthepurposeofrehabilitationfromsubstanceabusedisorder,suchastheCompulsoryDrugTreatmentCorrectionalCentre.TheDrugCourtTheexperienceincourtsoftherapeuticjurisprudenceintheUnitedStates,theUnitedKingdomandCanadastronglyinfluencedtheestablishmentofaDrugCourtinParramattain1999.TheDrugCourtnowsitsintheSydneyCBDandtheHunterRegion.TheDrugCourtwasevaluatedin2002and2008bytheBureauofCrimeStatisticsanditssuccesshasensureditcontinuestoday.

The2008re-evaluationoftheNSWDrugCourtrevealedittobemorecost-effectivethanprisoninreducingtherateofre-offendingamongoffenderswhosecrimeisdrug/alcoholrelated.IndividualswhoprogressthroughtheNSWDrugCourtaresignificantlylesslikelytobereconvictedthanoffendersgivenconventionalsanctions(mostlyimprisonment).29

ThecurrentfindingsestimatethattheDrugCourtprogramprovidesanetsavingof$1.758millionperyearwhencomparedwithconventionalsanctions.Thelongtermsavingsareevengreaterbecauseofthereductioninrecidivismofoffenderswhocompletetheprogram.Inotherwordsitischeaperandproducesbetteroutcomesthanthealternativecustodialsanction.30ThisconclusionmeansthattheNSWDrugCourtislikelytobeacost-effectiveapproach.31

GapsandShortages

ThereisnodrugcourtforourregiondespitetheobviousneedborneoutfromtherecentandlongtermBOCSARstatisticswhichhasourregiontriplingtheStateaverageindrugoffendingandsignificantlysurpassingtheStateaverageinotherdrugandalcoholrelatedoffending;

29StephenGoodall,RichardNorman&MarionHaas,ThecostsofNSWDrugcourt,(September2008)CentreforHealthEconomicsResearchandEvaluation,http://www.bocsar.nsw.gov.au/Documents/CJB/cjb122.pdf-TheeconomicanalysisconductedbyCHEREshowedthatthetotalcostoftheDrugCourtprogramis$16.376millionperannum.Thelargestdriversofthisfinalcostarethecostoffinalimprisonment(forthosewhodonotcompletetheprogramsuccessfully)andthecostofstaffingandrunningthecourt.30StephenGoodall,RichardNorman&MarionHaas,ThecostsofNSWDrugcourt,(September2008)CentreforHealthEconomicsResearchandEvaluation,http://www.bocsar.nsw.gov.au/Documents/CJB/cjb122.pdf-TheeconomicanalysisconductedbyCHEREshowedthatthetotalcostoftheDrugCourtprogramis$16.376millionperannum.Thelargestdriversofthisfinalcostarethecostoffinalimprisonment(forthosewhodonotcompletetheprogramsuccessfully)andthecostofstaffingandrunningthecourt.31http://www.bocsar.nsw.gov.au/Pages/bocsar_media_releases/2008/bocsar_mr_cjb121.aspx

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92%(127,227)oftheNSWcriminalmattersarefinalisedintheLocalCourtyettheeligibilityforthedrugcourtisdistrictcourtmattersonly.32

32BOCSAR,CriminalCourtStatisticsMay2017:http://www.bocsar.nsw.gov.au/Pages/bocsar_court_stats/bocsar_court_stats.aspx3%inhighercourts,5%inChildren’sCourt.