Until 2003, alcohol policy in New South Wales was determined by the NSW Youth Alcohol Action Plan 2001-2005 and the NSW Adult Alcohol Action Plan. The strategic approach set by these two policy frameworks has been subsumed by the recommendations made at the NSW Summit on Alcohol Abuse and this report in response to those recommendations.
A number of documents will also be developed to set the strategic approach to health and treatment services, over the next four years. These include:
§ NSW Drug and Alcohol Treatment Services Development Plan 2006-2015
§ Alcohol Disease Prevention Action Plan 2005-2009
§ NSW Health Drug and Alcohol Workforce Development Strategic Plan
§ Quality Framework for Managing Drug Treatment Services.
A. DISEASE PREVENTION
|
Development of new alcohol disease prevention approaches
3.1 A range of disease prevention initiatives be further developed to address alcohol related disease (eg. thiamine fortification of alcoholic beverages). |
Government Response
Alcohol disease prevention
The Deputy Chief Health Officer, NSW Health, will convene a Committee on Alcohol Disease Prevention including medical and population health experts, non-government organisations and the liquor industry to examine options for disease prevention. The Committee will report in 2005 through the development of the Alcohol Disease Prevention Action Plan 2005-2009. Other chronic and complex disorders attributable to alcohol that will be addressed through the action plan include:
§ Alcoholic Cardiomyopathy
§ Alcoholic Ketoacidosis
§ Alcoholic Liver Disease and Cirrhosis
§ Alcoholism
§ Alcohol Withdrawal Syndrome
§ Ethanol Abuse
§ Foetal Alcohol Syndrome (FAS)
§ Glycol Abuse
§ Isopropyl Alcohol Abuse
§ Methanol Abuse.
Thiamine fortification of alcoholic beverages
Thiamine fortification is an evidence based public health strategy for reducing brain damage.
In Australia, since 1991, it has been a mandatory addition to bread as a prevention strategy for brain disorders such as Wernicke-Korsakoff Syndrome (WKS), a severe neurological disorder caused by vitamin B1 (thiamine) deficiency. Studies have indicated some 10-20 percent of Australians are thiamine-deficient and that Australians have one the highest prevalence of WKS in the world. Heavy drinkers are considered most at risk of developing the disease due to alcohol being the main calorie intake for this group. The syndrome responds well to thiamine supplementation, with marked clinical improvement evident in most cases after treatment.
In 1987, the National Health and Medical Research Council (NHMRC) recommended addition of thiamine to beer and flagon/cask wine to reduce the incidence of WKS. However this did not proceed.
Currently, the Food Regulation Ministerial Council is looking at the issue of fortification and is preparing a position paper on mandatory fortification. NSW Health will seek further advice from the Intergovernmental Committee on Drugs (IGCD), the Australian Health Minister’s Council (AHMC), Foods Standards Australia and New Zealand, and the NHMRC on whether it is advisable and feasible to mandate a minimum level of thiamine in beer under the Food Standards Code.
|
Education and information to promote awareness about risks of drinking levels
3.2 Given that a major barrier to treatment is a lack of knowledge about and acceptance of the dangers of alcohol, a range of education and information campaigns, including mass media campaigns, be developed to promote awareness of the risks associated with different levels of drinking.
The major purpose of these campaigns be to reduce the cultural acceptance of high levels of drinking and to encourage people to seek interventions. General campaigns be also framed to target specific groups, i.e. youth. |
Government Response
The NSW and Commonwealth Governments currently run campaigns to raise awareness about the dangers of high levels of alcohol consumption, challenge the drinking culture, and to educate people about drinking guidelines.
Further education and information issues are to be addressed through new initiatives such as the new Alcohol Education and Information Taskforce, a new NSW Alcohol Communication Plan, enhanced partnerships with the liquor industry, community action groups, non-government organisations and liquor accords, and the promotion of safe drinking guidelines and responsible industry advertising. (These initiatives are outlined in the response to recommendations concerning The Community – Section 1.)
The taskforce will identify the key information issues raised during the Summit such as the current lack of education regarding the health and disease risks associated with alcohol abuse. The taskforce will be responsible for promoting the coordination, consistency and quantum of information and education programs.
Specific communication and information initiatives elsewhere in this report will also be referred to the taskforce for consideration, such as the information and education requirements of specific populations groups, including young people and Aboriginal communities.
The NSW Alcohol Communication Plan will be developed by NSW Health to build on current State and Commonwealth Government education and information initiatives relating to alcohol abuse. It will include all the initiatives being undertaken by Government agencies represented on the taskforce.
In addition, NSW Health will:
§ Further reinforce key alcohol messages through a number of population based strategies, including the Chronic Disease Prevention Strategy 2003-2007, a strategy which aims to tackle the major determinants of the burden of disease in New South Wales through primary prevention initiatives.
§ Undertake a chronic disease prevention campaign, addressing alcohol issues. It will include the development of television and radio advertisements, along with GP training and will be trialled in two regions.
§ Develop a series of Fact Sheets on drug and alcohol use for distribution to Area Health Services, as well as on the Department’s website.
Top
B. WORKFORCE DEVELOPMENT
|
Education and training for health workers and General Practitioners
3.3 NSW Health in consultation with the Australian Professional Society on Alcohol and Drugs, the Chapter of Addiction Medicine (RACP), the College of Nursing, other professional bodies and relevant tertiary institutions should investigate an appropriate means to facilitate professional education and training about alcohol (and other drugs) for generalist health workers and non-government organisations and to provide more advanced training for specialist drug and alcohol workers.
Training for health workers on early identification and brief intervention
3.4 Ongoing training should be provided to generalist health workers and community workers in early identification of alcohol related problems and provision of brief interventions.
3.5 Support and training should be provided to General Practitioners with the aim of enhancing both their identification of alcohol related problems and the interventions provided by them. This program would be provided by multiple disciplines and would involve both Government and non-government agencies.
3.17 Provide training to frontline health workers in brief intervention. This should be a mandatory component of training for all primary health care workers and should be aimed at both Aboriginal and non-Aboriginal workers. |
Government Response
Professional education and training including early identification and brief intervention of alcohol problems for health workers
NSW Health is developing the NSW Health Drug and Alcohol Workforce Development Strategic Plan, to be considered by the new NSW Drug and Alcohol Workforce Development Council for submission to the Government.
Current activities will be maintained and strengthened including:
§ Provision of drug and alcohol education curriculum content in the Master of Social Health, Post Graduate Diploma and Postgraduate Certificate in Social Health offered by the Department of Psychology at Macquarie University, and the University of Sydney Medical School drug and alcohol curriculum. Both are funded by the NSW Government.
§ The NSW Health Alcohol and Other Drug Nursing Project (Clinical Guidelines and Framework for Progress 2000-2003 – Alcohol and Other Drug Policy for Nursing Practice in NSW). The project provides nursing staff with the expertise required to effectively manage patients with alcohol and drug related illness, injury or concerns. The framework and Clinical Guidelines are currently being reviewed and updated for release as the Framework for Progress 2004-2007.
§ The Drug and Alcohol Allied Health Worker Advisory Committee established in 2003 by the Centre for Drug and Alcohol at NSW Health. Key issues being examined by the Committee include training and education, standards and emerging clinical issues.
§ Establishment of a Vocational Training Order (VTO) to enable an apprenticeship in the drug and alcohol field. The NSW Community Services Industry Training Accreditation Board has established a new apprenticeship in Certificate IV Alcohol and Other Drugs. NSW Health has provided funding to the Community Services ITAB to develop and pilot resources for the Certificate IV in Alcohol and Other Drugs. These resources will support the processes of Recognition of Prior Learning (recognition of current competence), the pending traineeship for this qualification and workplace based assessment for workers in the drug and alcohol sector in New South Wales. The resources are scheduled for completion in 2005.
§ Certified alcohol and drug prevention and intervention courses provided by TAFE for community health professionals that comply with the Community Services Training Package. In addition new assessment resources are being developed by the NSW Department of Community Services and the Health Industry Training and Advisory Body to support training by TAFE in the drug and alcohol field. This is an effective way to fast-track frontline workers toward a vocational qualification, as well as develop skills in drug and alcohol.
§ Training and development programs for non-government organisations that provide Supported Accommodation Assistance Program (SAAP) services including courses for relapse prevention, motivation, and assisting parents who are substance abusers.
Key new initiatives over the next four years will include:
§ A Drug and Alcohol Workforce Development Toolkit for managers of non-government organisations, including a guide to identifying workforce needs, professional development strategies, human resource planning, strategic planning and partnerships.
§ Better training for health workers tackling complex presentations of drug, alcohol and mental health. The Department of Community Services and the Mental Health Coordinating Council has commenced a project to assist frontline workers and staff in non-government organisations work with families affected by dual diagnosis. This will be completed in 2005.
§ A directory of drug and alcohol training due for completion in 2004.
See Recommendations 7.4-7.8.
Support and training for General Practitioners
A Drug and Alcohol General Practitioner Liaison Officer (GPLO) has been funded in each of the 17 Area Health Services (AHS) since the Drug Summit of 1999 and provides assessments of the needs of General Practitioners (GPs) in this area, and develops links between AHS, Divisions of General Practitioners and GPs to meet these needs. The NSW GP Drug and Alcohol Support Project:
§ facilitates training, development and resources for local GPs
§ builds the capacity of Area Health Services, Divisions of General Practice and GPs to collaborate in the management of clients with drug and alcohol problems
§ increases GP participation in drug and alcohol treatment and intervention
§ increases the choice and access to comprehensive treatment for clients.
Key future action:
§ An evaluation report on the GP project is due later in 2004 and will be used to assess and determine the future direction of the project.
§ NSW Health will include training and support in alcohol assessment and intervention on the General Practitioners Project Business Plan. This will provide a broader skill base for General Practitioners and greater options for Continuing Professional Development (CPD) training.
§ NSW Health will work with professional medical organisations to encourage a greater range of professional training options for GPs including:
§ extension of GP Liaison roles to assess the training needs of GPs in relation to alcohol assessment and intervention
§ training through the Royal Australian College of General Practitioners or drug and alcohol training providers with the provision of Continuing Medical Education (CME) points
§ business planning process to incorporate an outline of how Area Health Services plan to approach the role of primary care in alcohol interventions
§ Area Health Services being required to develop networks that ensure GPs have the support and training required specifically to provide alcohol assessment intervention.
|
Training for health workers providing services to Aboriginal communities
3.15 Establish and provide funding for an Aboriginal community controlled and culturally appropriate training program for awareness, treatment and addiction, aimed at communities and frontline workers, with involvement from Elders and other community experts. Training to be provided by the Aboriginal Health and Medical Research Council of NSW Health College.
3.16 Provide cultural trainers in Aboriginal communities who are able to provide cultural training to enhance the clinical skills of frontline workers involved in alcohol and other drugs.
3.17 Provide training to frontline health workers in brief intervention. This should be a mandatory component of training for all primary health care workers and should be aimed at both Aboriginal and non-Aboriginal workers. |
Government Response
Training by Aboriginal organisations
Over the next four years, NSW Health will work with the Aboriginal Health and Medical Research Council of NSW to achieve the following outcomes:
§ Development of a new Aboriginal Drug and Alcohol Traineeship, which will involve Aboriginal workers in the community controlled sector being placed in Area Health Services, related agencies, and vice versa.
§ New Training Agreements between Government agencies and community controlled services, to obtain greater access to training for all Aboriginal workers, and mechanisms to allow for the exchange of agency staff.
§ Development of an accredited drug and alcohol course for Aboriginal health workers at the new Aboriginal Health College (Prince Henry Hospital) by the Aboriginal Health and Medical Research Council of NSW.
§ A culturally sensitive education booklet titled What Works? for Area Health Services, Aboriginal Community Controlled Health Services, and non-government service providers, looking at what works in alcohol treatment and prevention approaches for Aboriginal communities.
§ A resource on Working with Drug and Alcohol Carers in Aboriginal Communities for organisations using volunteers as a human resource in service delivery.
§ The development of the Aboriginal Family and Carers Training Project includes community consultation and focus testing to determine the nature and content of the resources being developed to assist Aboriginal families and communities. This is being undertaken by Streetwize Communications.
These initiatives will be backed up by:
§ The new Aboriginal Drug and Alcohol Network (ADAN) established in 2003 by NSW Health, the Commonwealth Department of Health and Ageing and the Aboriginal Health and Medical Research Council of NSW (AH&MRC) to support Aboriginal health workers with information and training.
§ The expansion of the Network of Alcohol and Drug Agencies (NADA) Drug Summit IT Project, which will involve support for Aboriginal Community Controlled Health Services, as well as build their information technology and reporting capacity. This will be done through collaborative work undertaken by both NADA and the Aboriginal Health and Medical Research Council of NSW to build an Aboriginal drug and alcohol website.
§ The NSW Health Aboriginal Workforce Development Strategic Plan 2003-2007 which guides the work of Area Health Services and other services in building a workforce that has the capacity to address Aboriginal drug and alcohol issues.
§ An additional 50 Aboriginal nursing cadetships (20 registered nurses and 30 enrolled nurses) to encourage increased numbers of Aboriginal people becoming nurses.
§ The Department of Community Services annual Aboriginal Officer’s Conference for all Indigenous staff, which addresses the effective management of drug and alcohol issues for clients.
§ TAFE NSW three accredited courses that train Aboriginal drug and alcohol workers. The courses include an Advanced Diploma and Certificate II in Aboriginal Health and a Certificate III in Aboriginal Studies. Each of these courses trains workers in delivering flexible, and culturally and community appropriate approaches to workforce development.
Local initiatives will continue to reinforce state-wide developments. For example, the Hunter Centre for Health Advancement, in partnership with Awabakal Aboriginal Medical Service, has developed the Walkabout Learning Program. The program includes drug and alcohol training, community education and Aboriginal cultural competency training for mainstream health workers. The Walk-a-bout our Kulcha, online learning program is complemented with a one and half day face-to-face training session. A one day training session has also been developed titled Bout Us, as well as a commonly asked questions and answers booklet to assist in communication with Aboriginal people titled Didja Know?
Cultural training
The NSW Government recognises the importance of addressing the skill and competency level of the mainstream workforce, to ensure the effective management and provision of care for Aboriginal people in all services. By increasing the cultural competency of the mainstream workforce, some of the access issues facing Aboriginal people entering mainstream services will be reduced.
NSW Health is currently refining a framework of principles and protocols for the Aboriginal Cultural Respect and Communication training program which is designed to improve health outcomes, achieve a culturally competent workforce and ensure the workplace is culturally safe for Aboriginal staff. Similarly, the Department of Community Services runs a Bridging Cultures Program which is delivered to all staff to improve awareness of the needs of Aboriginal families and communities. NSW Health will pilot a training program in 2004 in the Department itself, and an Area Health Service. The state-wide training roll-out will commence in 2004.
Mandatory training on brief interventions for primary health care workers in Aboriginal communities
Over the next four years, NSW Health will work with the Aboriginal Health and Medical Research Council of NSW and the NSW Divisions of General Practice to educate and train GPs through the NSW GP Drug and Alcohol Support project.
As an initial step this will be done through the distribution of the Talking About Alcohol with Aboriginal and Torres Strait Islander Patients – A Brief Intervention Tool for Health Professionals flip-chart. This resource was developed by the Centre for Aboriginal Economic Policy Research with funding from the Office of Aboriginal and Torres Strait Islander Health (OATSIH).
Top
C. DRUG AND ALCOHOL TREATMENT SERVICES
|
Planning for alcohol treatment services
3.6 An appropriate range of services for people with drug and alcohol related problems should be available in Area Health Service regions. This range of services should include enhanced capacity in consultation-liaison, case management, counselling, support of generalist clinicians, including General Practitioners, treatment of people with combined drug and alcohol and mental health problems, treatment of alcohol-using pregnant women, pharmacotherapies, specialist medical services, where appropriate, residential rehabilitation, and recognising and responding appropriately to the impact of the client’s alcohol misuse on other family members.
The range of services should be detailed in an Alcohol Clinical Services Plan linked to the existing NSW Drug Treatment Services Plan 2000-2005. |
Government Response
The types of services referred to in the recommendation are run by both Government and non-government service providers and are in a range of locations throughout New South Wales. The 1999 NSW Drug Summit led to a significant increase in resources for services focused on illicit drug abuse and many of these new services also provided specific services for clients with alcohol abuse issues, for example detoxification and rehabilitation services.
Following the Drug Summit, NSW Health developed the first NSW Drug Treatment Services Plan 2000-2005. A second plan, for 2006-2015, will be developed and will incorporate alcohol related services.
The second plan will incorporate a plan for clinical services for alcohol. NSW Health will work with Area Health Service Drug and Alcohol Services, medical experts, and the non-government sector in the development of this plan which will cover all areas of disease prevention, dependence and treatment.
It is recognised that not every locality can have every treatment service type. The continued loosening of stringent entry criteria to alcohol treatment and improved collaborative partnerships between services and sectors across geographical boundaries will assist facilitate access to specialist drug treatment services.
NSW Health is currently undertaking a number of evaluations of programs that will inform the development of the NSW Drug and Alcohol Treatment Services Development Plan 2006-2015 including:
§ an evaluation of the rural counsellor and Clinical Nurse Consultant program
§ an evaluation of the non-government organisation residential rehabilitation beds program, along with an independent costing study
§ an evaluation of the General Practitioner project
§ an evaluation of the drug and alcohol information and data base services program
§ an audit of the pharmacotherapy program
§ a review of the range of outreach services provided by Government and non-government agencies.
In addition, NSW Health has engaged a health economist to undertake a costing study of each of the treatment streams provided by NSW Health to drug and alcohol clients. This will enable the establishment of costing benchmarks for drug and alcohol programs.
|
Provision of detoxification services
3.7 Area Health Services should develop improved infrastructure for a full range of detoxification services, including outpatient and home detoxification, having regard to existing or potential government and non-government services. |
Government Response
Since the NSW Drug Summit, the Government has substantially increased detoxification services throughout the State and provided an additional 42 detoxification beds. The NSW Drug Treatment Services Plan 2000-2005 outlined a new approach to the management of detoxification services and this approach has been adopted including the development and implementation of Detoxification Clinical Practice Guidelines 1999.
Detoxification services provide health care and support to manage the symptoms of alcohol withdrawal, and occur in an inpatient and outpatient setting. It is important that detoxification treatment is available in a range of settings such as general hospitals, mental health hospitals, in outpatient or community health services, in people’s homes and from the surgeries of private medical practitioners, from designated detoxifications units, in prisons and in police cells.
A range of models are currently used for providing detoxification services. These include:
Inpatient services:
§ fully medicated specialist detoxification facilities with the capacity to manage acute conditions such as the Wyong and Nepean detoxification units
§ partially medicated specialist facilities that can manage alcohol withdrawals such as the Herbert St Clinic at Royal North Shore Hospital
§ non-medicated government and non-government facilities that handle uncomplicated withdrawals such as Gorman House at St Vincent’s or the William Booth Institute run by the Salvation Army and funded by NSW Health
§ general hospital beds, particularly in rural areas where no alternatives exist. All general hospitals are able to manage alcohol withdrawal
§ mental health facilities where an acute mental health condition coexists.
Outpatient services and home detoxification:
§ local GPs run outpatient detoxification from outpatient counselling units or their own surgeries in most local Area Health Services
§ supported home detoxification services run by a number of Area Health Services, including Southern, Central Sydney and South Western Sydney Area Health Services.
Over the next four years, NSW Health will:
§ examine the current capacity, distribution and mix of detoxification services in developing the new NSW Drug and Alcohol Treatment Services Development Plan 2006-2015. Workforce development strategies will also be considered in this context
§ review the current NSW Health Detoxification Protocols to ensure they remain up to date and address any gaps identified since they were first introduced in 1999
§ review and update existing clinical practice guidelines on detoxification
§ undertake research to determine benchmarks for detoxification services in New South Wales
§ promote agreements across Area Health Services for assessing and transferring patients to specialist detoxification services where appropriate.
|
Effective case management of people with an alcohol dependence
3.10 A holistic 'case management' approach should be adopted to address the range of issues facing those with alcohol dependence. Fundamental to this is a chain of care which links services to guarantee individuals smooth passage through the different levels of the service system. |
Government Response
NSW Health is presently developing state-wide Case Management Guidelines for drug and alcohol treatment and a policy framework for such case management. The chain of care model represents an effective system for establishing cooperation between all agencies and services and ensures that when a person makes contact with one link in the chain, they are engaged with all other relevant links, and their transition to another service is managed effectively.
This is being developed under the auspice of the NSW Health Drug Program Council. A special Case Management Sub-Committee of the Council has been established and will have guidelines and a framework completed during 2005. The Committee includes non-government representatives and the Centre for Mental Health.
At this stage a preliminary discussion paper on a state-wide approach is being developed, in the light of a survey of the range of case management approaches, policies and practices already operated by Area Health Services. Some of these case management approaches are limited to case management of pharmacotherapy program clients, but many are broader and encompass other drug and alcohol clients.
The Sub-Committee is currently examining the issue of case management and enhanced care. The work of the committee is not due for completion until later in the year. Guidelines for the provision of enhanced care has been included as part of the work plan for this group.
In addition to case management within health services, broader collaborative case management approaches linking health services for people with multiple needs, to housing services, mental health services, employment and other services are increasingly promoted by Area Drug and Alcohol Services.
The Far West Area Health Service and South Western Sydney Area Health Services have been funded to develop local Case Management Guidelines for working with local Aboriginal communities and to develop and facilitate links to services.
Area Health Services will develop formal Memorandums of Understanding with social support agencies to ensure clients can easily be referred to appropriate services. Wentworth Area Health Service has a service agreement in place with Centrelink, which provides for fortnightly attendance by a representative of Centrelink to facilitate the processing of key welfare issues for patients.
This approach will be supported by the finalisation of Interagency Guidelines for the Early Intervention, Response and Management of Drug and Alcohol Misuse which have been developed following the Drug Summit, and aim to ensure a multi-agency approach to drug and alcohol issues and treatment pathways for non-drug and alcohol services. The guidelines are expected to be released to health services, other agencies, and the non-government sector later this year.
Other agencies also run case management programs which include components to tackle drug and alcohol abuse and dependence. These include:
§ The Department of Juvenile Justice administered Community Funding Program (CFP), to reduce the likelihood of re-offending by young people by helping them with their alcohol and drug problems, living situation, employment and training prospects and engagement with the community.
§ General and Bail Accommodation Support Programs, managed by the Department of Juvenile Justice to assist young offenders through housing, alcohol and drug programs, living skills programs and case management services.
§ Programs run by the Department of Community Services such as the family support for parents with drug and/or alcohol using adolescent children or the Getting it Together scheme, which funds projects to develop specialised services that help vulnerable young people who are unwilling or unable to access conventional youth services. Support is provided to help these at-risk young people with employment, education, training, linking them to their communities and, where appropriate, reconnecting them with their families.
|
A quality framework for managing drug and alcohol treatment services
3.11 A process should be put in place to improve the quality of treatment provided to people with alcohol related problems. A Quality Framework for Managing Drug and Alcohol Treatment Services in New South Wales should be developed and implemented, and the effectiveness of treatments should be monitored over time. |
Government Response
A Quality Framework for Managing Drug Treatment Services is being developed by the Centre for Drug and Alcohol in NSW Health, which has established a Health Care Quality Unit. It will be extended to incorporate alcohol treatment. The framework will be finalised in 2005.
The framework is being developed by a Quality in Treatment (QIT) committee of the NSW Health Drug and Alcohol Council. This group comprises senior Government and non-government drug and alcohol clinicians.
The framework will be included in the NSW Drug and Alcohol Treatment Services Development Plan 2006-2015 and will build on the commitments and action concerning the management of the quality of drug treatment services outlined in the 2000-2005 plan, including clinical governance, quality control, quality care indicators, accreditation for all service providers (Government, non-government and private) and outcomes.
In October 2003, infrastructure grants were allocated to non-government organisations to improve their capacity to meet accreditation standards.
NSW Health has established a Health Care Quality Unit to monitor the quality of programs run throughout the state, including alcohol treatment.
|
Interagency services agreements
3.12 Interagency service agreements be developed outlining agreed protocols for referral pathways, service delivery criteria and joint working arrangements in each Area Health Service region.
One model that could be adopted is that currently being undertaken in the Hunter as part of the Intoxicated Persons Protocol (this program has successfully case managed homeless people with alcohol problems into a range of services, including public housing). |
Government Response
It is anticipated that over the next four years cooperative interagency approaches combined with better case management and links with the non-government and private sector providers will be further enhanced. This approach will focus on:
§ continuing to develop and implement protocols involving intoxicated persons
§ management of early intervention in drug and alcohol presentations
§ management of homeless people with multiple needs and problems
§ management of people with multiple disorders such as drug and alcohol and mental health problems.
Some of the key initiatives and areas of action and priority are outlined below.
Intoxicated persons
Future action in this area is outlined in Part J of Section 8.
Drug and alcohol presentations at health and or community services
An important initiative providing interagency cooperation and better client case management and referrals will shortly be completed by the finalisation of new Interagency Guidelines for the Early Intervention, Response and Management of Drug and Alcohol Misuse. These guidelines were a recommendation of the 1999 Drug Summit.
The new guidelines were trialled in Goulburn and Nowra and provide a framework to assist agencies across sectors who work with drug dependent individuals to provide improved and coordinated service delivery. The guidelines aim to ensure a multi-agency approach to drug and alcohol issues and treatment pathways for non-drug and alcohol services. The guidelines are expected to be released to justice and human services later this year.
The Drug and Alcohol Case Management Guidelines and Policy Framework currently being developed will also include guidelines on interagency referrals, coordinated management and follow-up support for people presenting with drug and alcohol addictions (Rec. 3.10).
Homeless people with multiple needs and multiple problems
Other key interagency protocols which will complement these guidelines include the NSW Government’s Partnerships Against Homelessness initiative which recognises that the causes of homelessness are complex and that service responses need to be multi-faceted.
Key initiatives under this umbrella are:
§ The Inner City Homelessness Action Plan of Government agencies, local government and community organisations to provide better services and solutions for homeless people.
§ The Signpost two year pilot program delivered by Mission Australia to develop new service delivery models to address homelessness in the Hunter region. The project supports local agencies in ways to increase housing and other services for homeless men and women in the area.
§ The proposed development of the Western Sydney Homelessness Action Plan is being lead by the Department of Community Services, in conjunction with a range of other Government agencies.
Mentally ill people with a drug and alcohol problem
Improved referrals and case management of mentally ill people with drug and alcohol problems is a key area for priority action over the next four years (Rec. 3.13). The development of management protocols between government agencies, and the non-government sector will be a key component of future action.
|
Strengthening dual diagnosis services
3.13 In dealing with alcohol related problems more attention needs to be paid to people with dual diagnosis, especially in regard to interagency cooperation, and building and further strengthening joint services.
In order to promote understanding of the relationship between alcohol dependency and other mental illnesses, better coordination of alcohol drug and mental health services is required. |
Government Response
Steps to achieve this have been put in place:
Health services
In 2000, following the Drug Summit, NSW Health issued The Management of People with Co-existing Mental Health and Substance Use Disorders: Service Delivery Guidelines. The Guidelines provide a framework for health service providers to cooperate on meeting the needs of this specific target group, including homeless people.
A review of the guidelines found that most Area Health Services have made significant progress towards implementation, and a recent report by the Commonwealth Department of Health and Ageing which undertook an audit of activity relating to comorbid presentations of mental health and drug and alcohol problems across all Area Health Services in New South Wales also found significant activity at local levels for this client group.
Area Health Services have undertaken specific initiatives, including:
§ The Northern Rivers Area Health Service eight week program on substance abuse and mental illness (the INTRA Dual Disorder Program).
§ A service model for young people experiencing dual disorders and other severe mental health problems (YIPPI-IA) being developed by the Central Coast Mental Health Service.
§ Provision by the Hunter Dual Diagnosis Service of consultation, liaison, and a variety of treatment and ongoing maintenance and support programs for clients, families and health professionals working with comorbid clients.
§ A Northern Sydney Health specialised ten bed inpatient unit at Macquarie Hospital providing intensive psychiatric rehabilitation for patients with a psychotic illness in the 18 – 35 year age group. The patients are generally referred to the unit because of their high rates of relapse and re-hospitalisation due to non-compliance with community treatments and recurrent substance abuse.
§ Practices for joint assessment and case management of dual diagnosis patients developed during 2000-2001 in all Area Health Services. These practices will be assessed through a formal independent analysis of current barriers to service provision that will be commissioned by the Centre for Drug and Alcohol. The outcomes of this analysis will be incorporated into the NSW Drug and Alcohol Treatment Services Development Plan 2006-2015 to ensure effective systems and structures address the health concerns of dual diagnosis patients.
Key directions by NSW Health for addressing this issue in the future are:
§ Coordinated state-wide delivery of services to people with dual diagnosis disorders. The Centre for Drug and Alcohol will commission a formal independent analysis of current barriers to service provision and presenting patient characteristics and incorporate the outcomes from this into the NSW Drug and Alcohol Treatment Services Development Plan 2006-2015.
§ Implementation of joint service delivery mechanisms for those populations that have a high incidence of dual disorder cases. Subsequent to the Centre for Drug and Alcohol analysis of dual diagnosis services, service planning will occur in each Area Health Service to determine whether local patient characteristics demonstrate a need for specialist dual diagnosis services.
§ Establishment of eight new dual diagnosis projects in eight Area Health Services over a period of three years which will facilitate strengthened dual diagnosis management for these patients by promoting models of care and links to drug services, mental health services, NGO services and other services. These projects will aim to achieve better identification, referral and treatment of these complex patients.
In addition, the Australian Government has provided funding under the National Illicit Drug Strategy Strengthening and Supporting Families Coping with Illicit Drugs for a dual diagnosis project for families. The funds will be used to develop information resources for children, families and carers; improve the capacity of NSW Department of Community Services’ caseworkers and other family support services to work with families affected by dual diagnosis; and to employ a project officer (Dual Diagnosis), who will work with the Mental Health Coordinating Council in consultation on complex cases, developing networks, assisting in the recruitment and training of specialist carers and coordinating training needs.
Service delivery for people with mental health and substance use disorders
In December 2001, the Government established an Advisory Committee on Best Practice Service Delivery for People with Mental Health and Substance Use Disorders, comprising 13 clinical and non-clinical experts. The Committee met during 2002 and 2003 and the report will be submitted to the Government shortly.
The report makes recommendations, primarily focussing on improving service delivery to key at-risk groups (young people, homeless people and Indigenous people) and proposes that three models of coordinated housing support and clinical care are trialled. As a result of the report, the Government will consider running three key trials addressing dual diagnosis and comorbidity:
§ Homeless People: A trial of strategies targeted at homeless people with comorbid mental health and substance use disorders. The Department of Housing, in conjunction with NSW Health and the Department of Community Services is developing three supported housing projects to be trialled in 2004/2005 to 2005/2006 for people with coexisting mental health and substance abuse disorders who are homeless or at risk of homelessness. A service model is being developed.
§ Young People: A trial of early intervention and prevention strategies specifically targeted at young people with coexisting mental health and substance abuse disorders. This trial could be undertaken in cooperation with the School Link program, and related initiatives within the Department of Community Services, NSW Health and relevant non-government Organisations. The possibility of another trial targeting 16-25 year olds in the Greater Murray Area Health Service will also be investigated.
Education Department officers liaise with School Link coordinators from NSW Health in the promotion of mental health programs and practices in schools. Schools will continue to utilise services identified and accessed through this partnership to ensure students with alcohol and drug problems receive support. NSW Health will develop Phase 4 of the School Link training program which will specifically address issues of comorbidity of mental health problems with drug abuse including alcohol. Planning is to commence in 2005.
§ Indigenous People: The exact nature of this trial will be determined by a research project under the Better Futures Regional Strategy, as well as full consultation with Indigenous communities.
NSW Health also signed a Memorandum of Understanding (MOU) with NSW Police in 1998, which was reviewed and refined in 2000 and 2002. The MOU provides a framework for managing people who require the services of both organisations.
See also Recommendations 4.15 and 4.16.
The management of persons in a state of intoxication with a dual diagnosis presentation is also addressed in Part J of Section 8.
|
Preventing relapse into alcohol addiction
3.23 Reduce the chance of relapse by following up treatment with intensive post discharge support services and activities. |
Government Response
Over the next four years the Centre for Drug and Alcohol will:
§ Ensure all Area Health Services and funded non-government organisations provide appropriate training for drug and alcohol staff in motivational interviewing and relapse prevention as part of the delivery of all drug and alcohol services.
§ Develop discharge plans that clearly provide clients with information on post treatment health support and intervention services and actively encourage further contacts. All Area Health Services will be obliged to ensure Government services provide such plans, and ensure that it is a condition of funding that non-government organisations providing alcohol treatment services comply with the NSW Health discharge planning framework. This will include an investigation of the use of referral networks, telephone contact links and drop-in groups, dependent on the local circumstances.
§ Ensure performance and funding agreements exist between drug and alcohol health services and non-government organisations and Government agencies that deal with welfare and psychosocial issues related to drug and alcohol dependency. Further, the Memorandums of Understanding between human service agencies that deal with alcohol dependent individuals will be reviewed and enhanced as appropriate.
§ Investigate the use of the internet as a way of delivering drug and alcohol information and counselling to geographically isolated individuals.
§ Investigate the feasibility of non-government organisations providing ongoing follow-up and support services to clients.
§ Introduce an Outcome Treatment Measure for alcohol, counselling and detoxification. This will involve a greater focus upon following up clients on a periodic basis. This will then allow additional support and services to be offered as required.
§ Finalise guidelines regarding the management of psychosocial issues related to alcohol dependency. These guidelines will incorporate recommendations on models for joint-action with other Government agencies. These guidelines will be incorporated into the NSW Drug and Alcohol Treatment Services Development Plan 2006-2015.
The Corrections Health Relapse Prevention Group Work Program for offenders in custody currently operates across New South Wales. The program assists offenders identify those triggers that possibly create relapse situations and develop coping strategies that facilitate behaviour changes.
|
Research on alcohol policy, treatment, and harm prevention issues
3.14 In relation to research:
§ Research should be undertaken to monitor policy changes and individual modalities to allow comparison of the cost-effectiveness of different approaches. Pharmacological intervention should face the same cost-effectiveness criteria as non-pharmacological interventions.
§ The NSW Government fund research by tendering research questions.
§ Consideration be given to the development of longitudinal research studies to understand the outcomes of alcohol treatment and that research relevant to public policy be facilitated in understanding alcohol treatment outcomes.
§ Research projects involving Aboriginal communities should comply with the Aboriginal Health and Medical Research Council Ethical Guidelines and the NSW Aboriginal He | | 
