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
17
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.)
18
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
19
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.
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