Substance Addiction (Compulsory Assessment and Treatment) Bill

I move, That the Substance Addiction (Compulsory Assessment and Treatment) Bill be now read a second time. This bill represents a significant and long-overdue change to the way in which we provide compulsory treatment to people with severe substance addiction. It provides for compulsory treatment to be part of a wider treatment pathway while protecting the rights and respecting the wishes of people who are subject to compulsory treatment. The bill has the potential to make a very real difference for a small group of people who are gravely ill.

I want to thank the Health Committee for its hard work and its consideration of the bill. That select committee, under the chairmanship of Simon O’Connor, took the time to listen respectfully to the views of submitters and to consider the issues raised by the bill. I also thank everyone who took the time to make submissions on the bill. The select committee has recommended that the bill proceed with a small number of amendments, which I fully support. Since its introduction in late 2015 I have seen this bill cause a real movement within the addictions treatment sector, not only in terms of the ways in which the sector is thinking about the practicalities of the new legislation but in its thinking about how compulsory treatment fits into a much broader pathway of care for people with severe substance addiction.

This bill repeals and replaces the current Alcoholism and Drug Addiction Act 1966. This legislation is outdated, it is rarely used, it is ineffective in protecting the rights of people subject to compulsory treatment, and it needs to be replaced. Although there are inevitably some concerns with the new Substance Addiction (Compulsory Assessment and Treatment) Bill, known as the SACAT Bill, the legislation is generally accepted as a significant step forward in the management of people who are gravely ill and for whom voluntary treatment has repeatedly failed to be effective. The SACAT Bill fits within a wide range of services available to people who abuse alcohol and drugs, almost all of which are accessed voluntarily.

It is important that the new legislation is seen as part of a continuum of care that recognises the fact that most people with addictions can and will engage in treatment when they are ready to do so, but that for some individuals their addiction has reached a point where a short period of compulsory treatment is the most appropriate means of supporting longer-term engagement in voluntary treatment. Compulsory treatment, when it is used, should be for only a short time in order to enable the person with the addiction to become sufficiently well in order to engage in ongoing voluntary treatment. People who come within this new legislation are likely to be very unwell and experiencing poor health across a range of dimensions, including chronic physical conditions and poor psychological health.

The bill presents opportunities for growth in the addictions treatment sector. People will be subject to compulsory treatment for only a limited period, as I say, and are likely to need ongoing, active support from a range of health services once that compulsory treatment is complete. This means that a range of health services will need to work together, because compulsory treatment is about a lot more than just detox or withdrawal management. It involves a concentrated effort to work with the person to restore social and family and whānau relationships, to enhance daily living and social skills, to manage medical and mental health problems, and to reduce the likelihood of relapse through voluntary engagement with treatment services.

The bill has been the subject of a number of submissions, and has attracted the interest of people with addictions in their families and whānau, health professionals, and those engaged in protecting the rights of people subject to compulsory treatment. Understandably, there have been some concerns about the new legislation, particularly from those who will be responsible for its administration. The addictions treatment sector is for the most part unused to managing people within a legislative framework. This means that this legislation will lead to services needing to get their heads around new ways of working, even with the small population group that is likely to be affected. This will include the development of skills such as the ability to assess the capacity of an individual to consent to treatment for their addiction. I have deliberately required that the SACAT Bill include a 12-month implementation period. This will enable the Ministry of Health to continue its work with addiction treatment services, establishing the systems and the processes that are needed to make this new SACAT Bill work.

I am aware that there was considerable feedback to the select committee about the challenges that services will face in implementing the new legislative structure. That was to be expected. We have a sector that is unfamiliar with compulsory treatment legislation and the concepts that it embodies. But I am very pleased to hear that services are already working towards implementations and that a number of regional workshops have been run to assist this process. It is particularly heartening to see that services are taking strong leadership in this area, and I am confident that we will have a sector that is well prepared for the somewhat daunting task of taking on this new legislation.

But, even more importantly, this bill is promoting a change in the ways in which the addiction treatment sector thinks about the pathway of care for people who have severe substance addictions. It is quite clear that compulsory treatment is not being considered as the only way in which people can access treatment; neither is it being seen as the answer. People in need of compulsory treatment for severe substance addiction are already high users of health services, and I expect treatment providers to actively review the needs of their population to assess how many people are likely to come within the scope of this new legislation. The process of planning for implementation has been well supported by the Ministry of Health, and it will include the publication of information about the new legislation, workforce development, and support for service planning.

Let me now comment on one or two of the other issues raised in submissions on the bill. The threshold for compulsory treatment attracted comment, with some concerned that the criteria will open the floodgates for compulsory treatment, as well as concerns that the legislation will be used simply to facilitate sobering up. I am confident that the criteria that govern access to compulsory treatment are set at an appropriate level to ensure robust assessment and treatment of a profoundly unwell population. The bill makes it clear that compulsory treatment should not be considered as the first line of intervention.

In relation to this, it is important to note that the capacity test is in relation to the participation in treatment for addiction. It is not about the management of a person’s individual affairs nor other decisions that affect their lives. It is only about the treatment of their addiction. I am aware that the testing for capacity, both generally and in a more defined sense, such as that set out in the bill, can be challenging. Addiction treatment professionals will need to learn more about capacity assessment, and the Ministry of Health is looking at how it might best work with those experienced in capacity assessment in order to develop appropriate guidance.

Another aspect of the bill that has attracted some comment is the requirement that before a compulsory treatment order can be issued, treatment must be available for the person. This requirement has been included in recognition of the fact that some people are so unwell as a result of their addiction that ongoing care in a safe environment—and that will in some cases mean palliative care—may be the best option. The bill also recognises that even with compulsory treatment some people will not be able to manage their addiction.

Finally, the bill has attracted comment regarding the appropriateness of compulsory treatment for addiction and the possible impact on the rights of the person subject to that compulsion. I think it is well understood that for the significant majority of people who abuse drugs and alcohol the decision to reduce or stop using those substances is something that people come to in their own time. It can take several efforts to stop using those substances, and the fact that someone returns to using drugs is not a reason on its own for compulsory treatment to be considered.

I reiterate that this bill is designed for a very small group of people—essentially those with a “severe substance addiction”, as defined in the bill—who have severely impaired capacity to consent to treatment for that addiction. Capacity cannot be effectively assessed in someone who is acutely intoxicated; neither can the presence or absence of a severe substance addiction be so assessed. And that will preclude the legislation being used purely for sobering-up purposes, as some have feared. I am well aware, however, of the lack of evidence unequivocally supporting compulsory treatment as a means of treating addiction. But I am also aware that there is no countervailing evidence that suggests that compulsory treatment is ineffective in dealing with addiction.

So I am confident that we have struck the balance right with this bill. I am confident that the ways in which the sector is coming together will lead to the bill working as intended. And I note the select committee’s recommendation that the bill be reviewed after 3 years of operation. I think that is a very important safeguard against inappropriate use, and I fully support its inclusion.

Finally, I also see that the select committee recommends some changes to ensure that a wider range of treatment services can be considered as treatment centres under the bill, subject to certain conditions, and, again, I think that makes sense. It will certainly facilitate care closer to the home and broaden the range of services currently available. I am more than happy to commend this bill to the House.

As a member of the Health Committee, this was an interesting if somewhat confronting bill to work on in the select committee and we had lots of robust discussions about detaining people and the loss of freedom and the like. I think as a committee we got to a really good place. There were lots of robust conversations, and I think that the legislation that we came out with is in good shape.

Addictions, particularly severe addictions, which we are hoping to address with this piece of legislation, are potentially life ending, and that is where this particular legislation is pitched—at people for whom their addictions are so consuming and so overwhelming that they are unable to get the kind of treatment that they need to actually save their lives on their own, or to actually stop them from being at risk of harming others significantly.

So we are talking about a small but quite significant group of people who—as the Hon Peter Dunne has mentioned—have already been significant users of health services in an attempt to deal with their addictions. And they are often people who have not engaged with their community or with their whānau because they have really used their social capital up with the people who can support them, and they are in a position where they need significant amounts of care and support.

We did have lots of conversation about the fact that we are looking to actually take people to undergoing treatment compulsorily, and you do not do that lightly. So we had to have a look at the mechanisms that are already in place to support people around compulsory treatment—and of course we looked to mental health services that have that mechanism—and what we could use from that environment to support people with severe addictions. There is often a crossover between the groups—between those who have severe addictions and those who have mental health conditions—and there was some correlation between how we could work that out. But it is not an insignificant thing to take someone’s freedom away and then compel them to undergo treatment.

So the whole discussion around compulsory treatment versus voluntary treatment was one that was quite interesting, and I know that in the past many with addictions have relied—we have relied as a sector, really—on people acknowledging that they have a problem and then seeking the support from treatment services. But, in this case, their addictions are so severe that it is in our interest, as a society, to ensure that they are compelled into treatment, and for some it is their last hope. This is not about the provision of wet houses, which is a mechanism that some jurisdictions use, where you actually help somebody manage their addiction while they still use the substance; this is actually about making somebody stop using through the use of medication and treatment, and it actually is the last ditch attempt in getting them to stop using before they actually potentially harm themselves fatally.

We had a lot of discussion—and it was raised by one of the submitters—about the types of facilities that might be used to provide this support, because currently I think we have about three facilities in this country that could, tomorrow, provide this kind of care. But we know that more are needed and that there are a range of organisations and facilities that, if they were resourced appropriately, could conduct the work. One of the submitters to the select committee—in fact, it was the Human Rights Commission—did make the point that it was mindful that often the behaviour of a person who is using substances means that they may actually be held in a police cell or some such thing. The Human Rights Commission was concerned that that does not become a default setting for people with severe substance abuse, and we had quite a robust discussion about that. We were very clear in the select committee about ensuring that the wider range of mental health facilities will also be used and be provided with the resources to conduct this treatment. So, hopefully, we have addressed that concern of the Human Rights Commission.

One of the other things we considered was the ability for the children of patients who go into this type of facility to be notified appropriately that their loved one is in the facility and notified of the type of treatment that they are going to receive. So we are required to provide them with a range of information—details of where they are located, the type of treatment they are going to receive, the length of time—and that provides them with, I guess, some oversight from outside the facility.

The other thing that we considered was the role of the district inspectors. The district inspector is a role that is well-known within the mental health sector as being the key oversight to ensure that the rights of the patient are upheld. So in the select committee we did spend some time ensuring that that role was well-defined and that access to the district inspector for the patient occurred within a 14-day period so that they could be clear that they could have their rights ensured.

There are clauses within the legislation that allow patients to consult with approved specialists, and they are able to get second opinions. There were some submitters who commented on the resource to be able to deliver this particular service, and there are some key components that we do need to address before this service is actually able to be delivered competently. That is about ensuring that we have enough professionals with the right types of skills and the right type of ability, that we have them in sufficient numbers, and that the facilities to provide the work are available. The select committee had a discussion on how long an appropriate treatment period is, and we did talk about having treatment that was long enough to ensure that you provided the right kind of care but not so long that it became a matter of detention. So that was a very robust discussion.

I just want to quote from some of the submitters who submitted to the select committee. The Canterbury AOD Consumer Leadership Group made the comment that it was concerned that the threshold for an individual to meet the criteria for compulsory treatment would be set too low. It felt that it needed the criteria of a diagnosis to be set high enough for compulsory treatment, and I think we considered that fully. The Drug and Alcohol Practitioners Association of Aotearoa - New Zealand made the comment that it was hoping for some work in terms of ensuring stronger concepts of recovery, that there were provisions for the consideration of cultural needs within the treatment of people with severe substance addictions, and asked that the inclusion of family and whānau and other support people in decision-making processes be included.

Just to finish, I want to go back to the Human Rights Commission and quote from one of its submissions: “The way that the legislation is implemented in practice will [be the most] important”—I think that we all agree with that—and “this will depend to a large degree on the [availability] of suitable funding, treatment centres, and experienced staff.” We all agree that inadequate resourcing could derail this, but I think that in terms of legislation we have got to a good place, and we are happy to support this bill.

I am very pleased to take a call on this Substance Addiction (Compulsory Assessment and Treatment) Bill. Can I begin by thanking everyone who actually came to our Health Committee to speak. We have just heard, in the contribution from the member who has just sat down, Poto Williams, just a small hint of some of the feedback that we got, which I think we found incredibly constructive in two ways. First and foremost, to help us with the bill itself, but also just to, I suppose, tease out some of the wider issues in the whole substance abuse space. My thanks go out to all of those officials who have helped us to get through, and, of course, to the Associate Minister of Health himself for actually introducing the bill into the House.

It has been noted in the Associate Minister’s speech that this is an update from a bill in 1966, so it is a timely review. I want to acknowledge, too, the work of the committee members, who have suggested that in 3 years’ time we review what we are doing here. I thank the Associate Minister as well for his support of that. I think that it will make a difference to allow this to evolve. I think this is a difficult space for obvious reasons, but the Associate Minister, as well, in the area of evidence around the efficacy of compulsory treatment highlighted that there is still a lot of debate, and so I think that it is important that we evolve with that. I will add my voice to those of a lot of the submitters, and it is somewhat articulated in the select committee report, around that question of ensuring that the resourcing is aligned. I know by the work that the Associate Minister and others are doing that they can see the importance of that.

Look, first and foremost, I think it is really important to stress, as I did in the first reading, that this is not a bill targeting those people with, effectively, a low level of what most people would anecdotally think of as substance addiction. This is for people who are at the absolute top end of addictive behaviour, where their behaviours are such that they are causing injury to themselves—and potentially to others, but fundamentally to themselves—and where they have no conceptual ability to actually engage with treatment. For those who have expressed some concern that this is “the heavy arm of the State”, I would certainly encourage them to get into the early pages of the bill, where we did not actually make any changes, because I think that the criteria laid down about who this applies to is actually really, really clear.

Clause 7, at the moment, talks about the criteria for compulsory treatment. As you might expect, the person has to have a severe substance addiction. Really important are subclauses (c) and (d), and I think it is fundamental, actually, to a rather compassionate approach of the Associate Minister and the Government, that the compulsory treatment is deemed necessary, but, fundamentally, that appropriate treatment is actually available. There is no point in compulsorily pulling someone into treatment that does not exist. That is a challenge for all of us in this House—for the Government, and certainly in the health sector—to make sure that those services are available.

The other important element, too—and this comes up in clause 8, again, unchanged—is I really want to stress to people that this is not about low-level substance addiction. We are talking here about people who are featuring at least two of the following: one is what they call neuro-adaptation. The long and the short of it is that a person’s use of drugs is such that their bodies become totally dependent on it, and are able to function at times, what appears, quite normally. Secondly, they have to have a craving for the substance, and efforts in the past to control have been unsuccessful, and, as I noted a bit earlier, they are causing harm to themselves. It was even mentioned in an earlier speech that you may end up with someone who is actually in their palliative space, and now you are talking about something absolutely serious.

That said, like any select committee process, we have teased things out of it. We wanted to be really clear around a couple of things. The first was what an approved provider is. We thought it was best to align that with existing Acts; we did not feel that we had to double things up. We have removed references to age. The initial draft of the bill that came through had a lot of mentions of 17-year-olds. Again, we thought, let us just line that up with existing legislation. A previous speaker mentioned the use of facilities. We wanted to be very clear about where it was appropriate for these people to be held and treated. We did not want any ambiguity, particularly if those people, for example, are being pulled into police cells and stuff because they have done some harm to themselves. We wanted to be clear that these are not appropriate facilities. There are a whole lot of other suggestions and changes, too, around the oversight of the Ministry of Health, and so on. But I am going to leave it there. I know other members of the committee on all sides of the House will elaborate further. This is a very good bill, and I recommend it to the House in its second reading.

Tēnā koe e Te Māngai o Te Whare. It is my pleasure to speak on this, the second reading of the Substance Addiction (Compulsory Assessment and Treatment) Bill. I am not a member of the Health Committee, but I want to acknowledge the work of the Health Committee, because I think the substance of this piece of legislation is incredibly important, and I think a number of the issues that the select committee has had to deal with have been really well addressed in the select committee report, so I wanted to acknowledge that.

In preparing for my contribution this afternoon, I found a document produced by the Ministry of Health. It is called the New Zealand Drug Harm Index 2016. What that particular report does is look at the social cost of drug-related harm and intervention cost in the 2014-15 period. It is estimated that the cost to New Zealand is $1.8 billion, and that is in terms of personal harm, community harm, and the cost of interventions. I know that they have talked about the limited number of people who have been impacted by this serious addiction issue, but for those who are addicted, the social cost per year, per dependent user, was estimated at $33,800. The cost to families and friends through the pain and suffering that they also have to endure was estimated at $438 million. The other telling information that was communicated in this New Zealand Drug Harm Index 2016 was that the acquisition crime—so this is what users do to support their habits—was estimated at $140 million.

The context of this piece of legislation is incredibly important, and so I want to acknowledge that. I also want to acknowledge that there is a group in Aotearoa New Zealand called Matua Raki, and it is the national centre for addiction and workforce development in New Zealand. When I looked at what it had to say about this piece of legislation, it said it has been crying out for reform for over 30 years. In fact, there have been three official reviews and a Law Commission report, which have led to the creation of this piece of legislation. From its perspective, you know, there are a number of deaths that have been preventable.

Obviously, in terms of the harm to family and community that has been preventable, Matua Raki sees this as a way forward. It sees that the people who are most affected by this piece of legislation will be able to be protected from the personal harm that they endure, that the legislation will provide for a better facilitation of an assessment of their conditions, that we will be able to stabilise the health and well-being of people, that we will be able to protect and enhance their mana and dignity, and that we will be able to facilitate an opportunity to also engage in voluntary treatment. So Matua Raki sees this as a stepping stone, and it sees that people who are severely affected by addictions will, by being supported through a compulsory system, eventually be able to make decisions themselves about what is in their best interests.

So the full criteria that it outlined were: that people have to have a severe substance addiction, that their capacity to make informed decisions about treatment for addiction is severely impaired, and that compulsory treatment really is the only course of action to provide some resolution. Also, there is a big emphasis on providing appropriate treatment for the person who has a severe addiction. It also talked about the definition of severe addiction—what people actually have or the kind of psychological place they are in. So, the compulsive use of a substance is characterised by a neuro-adaptation to the substance; a constant craving for a particular substance; unsuccessful efforts to control the use of that substance; and continued use despite harmful consequences, not only for the person who has the addiction but also for their families. These really are people who are not in a position to make decisions in their best interests.

I was really interested in the number of submissions received by the select committee. There were 39 written submissions, and 15 gave oral submissions. One of the issues that was highlighted—it is on page 2 of the select committee report—was the clarification of an appropriate facility. I note two particular submissions. The first was by Judge Recordon—I hope I am pronouncing his or her name right—that noted there have been instances where 14- and 15-year-olds were detained in police cells for four to five nights. Also, the Human Rights Commission highlighted that under the proposed legislation it was possible for somebody to stay in a police cell for up to 27 days if they did not have a facility for this person to be held in. What has been very good, in terms of the select committee process, is that the select committee has been very clear that that type of situation or scenario will not occur under this new legislation. There will be approved providers who will be able to provide for the person in the interim if they are not able to be housed in a treatment facility. On reading through the select committee report, I think, as Associate Minister Dunne has outlined, that has been a very good recommendation by the select committee that this House will support.

I note that this piece of legislation, with the amendments, has the unanimous support of the House. This is another one of those constructive processes that I have seen this House go through, and again, demonstrated by the Health Committee. I am also heartened, I guess, to see that there is also the right for a person to get a second opinion. Even though they may fit the criteria for compulsory assessment and treatment, the legislation allows for the person to get a second opinion, and also for the patient to get advice from a lawyer.

So, from my perspective, there are a whole lot of safeguards within this legislation that not only support the person through a particular addictive episode but ensure that there are safeguards and that there are people who have their best interests at heart throughout the process—they are not the clinicians, but they are people providing oversight. I am reassured, and I think the House should be reassured, that nobody is going to be captured by this legislation who does not need the support of the State and does not need treatment options. It is really the only way we are going to address the addiction issues that they have displayed. I want to congratulate the Health Committee again, and I commend the bill to the House. Thank you.

It is a pleasure to take a call on the Substance Addiction (Compulsory Assessment and Treatment) Bill in its second reading today. I want to acknowledge the Hon Peter Dunne, who is the sponsor of the bill, and also the person who was forward thinking in terms of putting together the Drug Harm Index that we heard about before. I went to that presentation. The previous speaker, Louisa Wall, talked about the social costs of drug harm being huge. We all know—we hear a lot of anecdotal stuff, out in society, and it is really great that we are starting to measure it.

The bill will enable people with severe substance addiction and severely impaired capacity to decide on treatment, and it is really important to note that it is for the most serious cases. There was a lot of conversation driven through the Health Committee, and we really appreciate the submitters who came in—particularly the oral submitters, because a lot of them were people who work in this space. They live it, inside out, every day when dealing with these people. This bill must also be, as it passes, a relief for the families, the parents, the partners, the children, and the people who live with this every day—for those members of their family who have severe addiction issues, who feel helpless, and who are wondering where on earth they are going to go.

This bill is going to replace the Alcoholism and Drug Addiction Act, and we have heard that it was put in place in 1966. We have heard from the Associate Minister how ineffective it was, and we got a sense of that as we were listening to the submissions. It is very clear that most people who abuse alcohol or drugs do not need compulsory treatment. They can do well, and they can choose to engage in treatment programmes. However, some people really are so unwell that they are just not able to make those decisions for themselves, and this is where this bill cuts in.

I think it is really important too—we have heard about safeguards today. It is not as though we want to go around detaining people all over the place. There are special safeguards to make sure we restrict people as little as possible and that the interference with the rights of those patients is kept to a minimum. The bill allows any person who is older than 18 and who believes that another person has severe substance addiction to apply to the area director to have that person assessed. I believe there is a lot of work that has gone into this bill as it has sat before the Health Committee. That was another good select committee submission process, and I commend this bill to the House. Thank you.

I rise to speak on the second reading of the Substance Addiction (Compulsory Assessment and Treatment) Bill. I did not follow this bill through the select committee process. It was my former colleague Kevin Hague who was on the committee to hear the submissions. I do know that Mr Hague did think this was a very good piece of legislation, and, having looked at it myself, the Green Party will be continuing to support the bill. My understanding is that they did have a very constructive process during the submissions process. As my former colleague said in his first reading speech, it has been for at least the last 30 years that the alcohol and other drug treatment sectors have been calling for an update to the Alcoholism and Drug Addiction Act, which was, of course, enacted in 1966, which is 50 years ago. So this change is well overdue.

Of course I would very much like to tautoko what the Associate Minister was saying, in terms of taking a more wraparound approach to treating the problems of addiction. I think that fundamentally this bill takes at its heart a framework that represents a paradigm shift in how we deal with addiction. The previous Act, which is being superseded by this bill—or will be, hopefully—very much treated it almost in a punitive way. I think that throughout New Zealand in the 20th century—and not just in New Zealand, but in other countries—we did have a tendency to treat drug issues with a criminal approach, as a criminal problem, rather than treating them as a health problem. What this bill recognises, and what I think we would all do well to recognise, is that addiction is a health issue, and we must treat it as such if we want to get better outcomes.

This bill not only updates the guidelines on compulsory drug and addiction treatment but also provides for reducing the time of detention. It has specific provisions around young people, acknowledging the role that family and support people play. It provides for long-term community care for people who have a brain injury from addiction. I think that all of that is just as important. It is not just about the ambulance at the bottom of the cliff and what we do when people are in the very worst state and might actually be at risk of dying from their addiction—in which case this bill sets up the guidelines by which they might be compulsorily put in care to help deal with that addiction. It also recognises that it is not just a personal, individual problem, that addiction takes place in a social environment, and that if we do not address some of the surrounding factors around addiction then we will not be able to treat it.

This reflects a wider paradigm shift about addiction, which is quite interesting: that it is very much a social and environmental problem, as much as something that individuals are susceptible to from particular substances. There are a whole lot of very interesting studies coming out that suggest that people in poor conditions—if they do not have good living conditions, if they are under severe stress financially, if they do not have solid social relationships—are far more susceptible to becoming addicted to a substance that may not actually result in addiction if people are living in a good context and have the basics. We see this in dealing with homelessness. It used to be the case that people would not provide homeless people with homes. They would say you had to deal with all of their addictions and problems first, if the homeless people were indeed suffering from drug and alcohol addiction. But, in fact, the housing-first approach has demonstrated that we cannot even begin to deal with some of the other health problems that people are facing, like addiction, unless they have a warm, dry, secure place to call home. When we understand that addiction is something that happens in a social context, it happens that we come up with far more effective ways of dealing with it.

The Green Party is very supportive of, and has long been an advocate for, treating drug issues as a health issue in order to get far more effective results, rather than treating it as a criminal issue. So we are pleased with this bill and the provisions that it has made, particularly the reference to the support of family and community. There is a very tiny number of people who will qualify for compulsory committal. There is an incredibly high threshold, and this bill actually introduces greater safeguards than what was in the previous Act. The Green Party can support the bill at the second reading. Thank you.

I rise on behalf of New Zealand First to take a call on the Substance Addiction (Compulsory Assessment and Treatment) Bill. New Zealand First supports this bill. The purpose of the bill is to provide provisions for the compulsory assessment and treatment of individuals with severe substance addiction who are totally unable to make decisions about their own treatment. It is definitely needed in today’s world. This bill is repealing the Alcoholism and Drug Addiction Act 1966, legislation that is now 50 years old and well past its use-by date. Much has changed in the field of addictions since 1966. The types of addiction and, of course, the way that we treat people with addictions have changed. As we have heard from submitters when they came to the Health Committee, the current legislation presents some real challenges for health practitioners when they come to use it.

We are under no illusions whatsoever as to the scale of the illicit drug problem in New Zealand. We know that we have got some of the highest drug-use rates in the developed world, and The New Zealand Drug Harm Index 2016, released earlier this year, found that “The estimated social cost of drug-related harms and intervention costs in 2014/15 were $1.8 billion.” That in itself is a truly staggering figure. So it is an area that demands attention, and I am pleased that we are giving it just that this evening.

We know that mental health and addiction problems affect more than just the individual. They affect the community, they affect the family, and yet we remain concerned that there is no mention in this bill of substance addiction causing serious harm to others, only to the individual. We are also concerned that there could be a lack of family involvement in a patient’s care under the current provisions of this bill. The bill does provide for provisions for a friend or a family member who is “most evidently and directly concerned with the oversight of the patient’s care and welfare” to be informed. However, we are concerned that a whānau group may wish to be involved in decisions about the treatment and the care of their loved one, and we believe that a treatment plan should in the main be fully discussed with the family and the whānau, and decisions made in consultation with them if at all possible.

In my office in Hamilton, I have heard from distressed family members who have been left out of such decision making, and this causes a lot of stress and worry for them. They want the very best for their family member and for their loved one, and all of us in this House would too. We do agree that the criteria for compulsory addiction treatment, in clause 7, appear to be robust. They include having a severe substance addiction, having impaired informed decision-making, and compulsory treatment being required.

There is also, in clause 7, a requirement that “appropriate treatment for the person is available.” It is the sector capacity that we are concerned about, and it is an issue that I raised in my first reading speech back in March. It is vitally important that a patient’s condition is continually monitored and reviewed, so that if the responsible clinician believes that the criteria for compulsory treatment are no longer met or that no purpose would be served by compulsory treatment, the patient can be released. An aftercare plan as recommended in the bill is absolutely essential if there is to be a successful outcome for the patient. It is absolutely critical that the patient receives vital wraparound support, and that they receive help not only with their addiction but where other areas in their life are concerned—for example, the cause of the addiction.

We are told that most of those people with addictions will have other areas in their life that are creating challenges. It could be housing, and it could be mental health, because that is a growing area. So it is going to be absolutely critical for Government departments to work together to break down silos and try to get the person back on track. It is not an easy road to get back on track, so the more wraparound services there are, the better it is.

What do we see currently? Too many Kiwis are actually slipping through the cracks of our social services, and every day in our communities we are seeing the results of a lack of investment in this area. The ability to review decisions is vital to protecting the rights of those affected by this bill. We agree totally that a patient or family member should be allowed to apply to the court for an urgent review if they believe that the criteria for compulsory treatment are not being met, or that the compulsory treatment order should never have been made.

The Health Committee received 39 submissions, and we heard from 15 submitters. We must take this time to thank all of those who took the time to submit. It is not an easy area to submit on, and it added greatly to our knowledge of the people who work in this area and are involved in this field every day. Of course, we have to thank the officials, who ensured that we had a really good understanding of the whole issue. The majority of the submitters were in total agreement, as we all are here in this House, that the legislation needed to be updated—that it was past its use-by date. They were supportive of the general aims of the bill, and were generally of the opinion that addiction is a health issue rather than a criminal one.

A major concern raised was that of service capability and capacity. Concerns were raised about the lack of medical professionals with expertise in addiction and a general lack of staffing and funding, and submitters emphasised the need for continued support and treatment once the compulsory period ends. We heard that there is very little evidence that compulsory treatment is effective for those with severe addictions, so there are a few concerns there.

New Zealand First believes that further targeted support for addiction services needs to be implemented by the Government. We need to put more resources into preventing people from getting into the dire situation that this bill is actually intended for. We need to direct resources to our GPs and assist them in supporting those facing addiction in our communities and in helping patients back on the road to recovery.

I think we need to realise that there are barriers for people trying to seek help for their addictions, and these need to be removed. Such barriers include the expensive doctors visits, the perceived stigma, and, of course, lengthy waiting lists. We have previously expressed our concerns that, currently, we have got no idea how many Kiwis are living with severe substance addiction, because mental health and substance addiction services are lumped in together. We regard this as a failing that does need to be corrected.

Many Kiwis are struggling to receive mental health and addiction support. We see it in our communities, and we hear the repeated calls for an independent review of our mental health services. In fact, I know that there is going to be a petition presented at Parliament tomorrow that is adding to the growing sense of unease about mental health services that there is out in the public. We are concerned that longer wait times will result in tragic outcomes, particularly when our suicide rates are as appalling as they are.

We are pleased to support this bill. We look forward to it going through the House. We have some concerns, but we believe that this is a step in the right direction, and we will await the outcome of the Committee stage of this bill. Thank you.

This bill is based on a large body of work undertaken by the Law Commission that was finished in 2010, and it will, when it is enacted, be quite a significant step forward in the management of people with severe and serious addiction to alcohol or other drugs. It replaces the 1966 Alcoholism and Drug Addiction Act, and, essentially—although there are a number of clauses, and given that we still have a number of stages to go through the Parliament, including the Committee stage, there will be a number of opportunities for members to rehearse the various provisions in the bill. I will go through a few in this second reading of the bill.

I think the first task for the Health Committee was to truly understand what a severe substance addiction amounts to in terms of this bill. It was—and this has been mentioned before by previous members—enlightening for the Health Committee to learn the extent of addiction of some members in our society, which causes them to come under the provision of this bill in terms of compulsory treatment.

The bill enables people with a severe substance addiction and, therefore, with a severely impaired capacity to decide on what is best for their lives and what is best for them in terms of treatment for that addiction to receive compulsory assessment and treatment, and that is to protect them. It is to protect them from harm, to protect them from further harm, and to enable some stabilisation of their health. That was a point in the submission period of our consideration: the compulsory nature of this bill allows for people’s conditions to be stabilised, and that is not only addressing their mental health and their addiction issue, but also addresses and improves their physical well-being, which then becomes a platform for, perhaps, better decision-making in the future. It is also about protecting their dignity—and I think that is an important aspect already mentioned this evening—to help restore their capacity to make more informed decisions about further treatment for themselves, and to address the issues around their substance use.

The bill, helpfully and rightfully, sets out the meaning of “severe substance addiction”. Of course, the condition manifests itself in the compulsive use of a substance, and what that means is set out: neuro-adaptation to the substance, craving for the substance, unsuccessful efforts to control use of the substance, and use of the substance despite harmful consequences. There are a number of protections built into this compulsion aspect of this bill—the compulsory assessment and treatment—and, no doubt, those will be canvassed by other members. With this short intervention, I commend the bill to the House.

The next call is a split call. David Clendon—5 minutes.

This is just a brief call to reiterate our support for this bill. The point has been made that currently we have 50-year-old legislation that is no longer fit for purpose and is enabling a probably excessive intervention, to the term of a 2-year detention period, that has too few safeguards to protect the well-being of the people whose rights to make decisions on their own behalf are being taken away from them. It seems that the focus of this new legislation is much more about how quickly we can return people to a condition where they can make their own decisions about their own treatment.

The threshold within this bill for compulsory treatment is set very high, and that is as it should be. Many of these people will be in a situation where, in fact, their lives are at stake directly as a result of ingesting substances or of the behaviours associated with that. So although the threshold is high, we do think that this legislation strikes a much better balance between obliging people to undertake treatment that is necessary to their well-being, and protecting their human rights and ensuring that there is not an overly draconian intervention, if you like, from the State.

I thought one of the most useful submissions was from the Addiction Practitioners’ Association Aotearoa New Zealand. It scoped out the breadth and the depth of the situation out there, in terms of treating people with these very, very severe addictions. It both highlighted the shortcomings in the existing legislation and also pointed out some of the key principles and what will emerge as practice under the new legislation. It also rang a few bells. One that the association particularly referenced—and it has come up before—is that we can have good legislation, but it will only succeed if it is properly resourced. Currently, we see 70 to 80 people a year being treated under the existing rules. We could expect that to increase to about 200 people a year. There needs to be an investment into ensuring that this much-improved legislative tool will get better outcomes, and the only way to ensure that is to make sure that it is properly resourced. The association expressed some concern that it was not evident to it, at least, exactly where the funding would be channelled, and I think that is a fair challenge. In the spirit of goodwill, I do think that, given that this bill seems to have Parliament-wide support, there will be a serious and determined effort to make sure that the funding does get to the place where it can do the most good and where we can see much better outcomes than we have.

I have a great admiration for people who work in the field of addiction. They are dealing with people who are at their very worst, and those must be incredibly difficult people to deal with. Frankly, I do not believe I would be someone who could work in that environment, working with those people. Through the level of patience, the level of compassion, and the level of commitment to getting a much better outcome for those people, they must be very special people working in this environment, and I do hope we continue to resource them, to enable them to get their work done and to get it done well.

Sitting suspended from 6 p.m. to 7.30 p.m.

It is my pleasure to follow on from my colleague David Clendon from the Green Party. When we left for the dinner break he was highlighting a number of issues that I really would concur with around the need for the modernisation of this legislation.

We are talking about legislation around compulsory treatment that was initially drafted, from memory, in 1966, and, as is the case with many bills and legislation in this area, revision is necessary. Evidence and research tell us actually how we should be crafting, in this day and age, effective legislation. When we talk about compulsory assessment and treatment for substance addiction, of course, we are talking about a very small group of people who will ever make it to that particular threshold. It does sound like the extreme—to compulsorily force someone into treatment. That does sound like, in 2016, quite an extreme act, but I do want to highlight that when you read the preliminary provisions, the purpose clause of this bill, it is very clear that the focus is on the patient, as it were, who has that need.

So I want to highlight the purpose clause: “The purpose of this Act is to enable persons to receive compulsory treatment if they have a severe substance addiction”—that has been estimated to be roughly 200 New Zealanders a year—“and their capacity to make decisions about treatment for that addiction is severely impaired, so that the compulsory treatment may—(a) protect them from harm; and (b) facilitate a comprehensive assessment of their addiction; and (c) stabilise their health through the application of medical treatment (including medically managed withdrawal); and (d) protect and enhance their mana and dignity and restore their capacity to make informed decisions about further treatment and substance use; and (e) facilitate planning for their treatment and care to be continued on a voluntary basis; and (f) give them an opportunity to engage in voluntary treatment.”

On first reading, when you see it is 8 weeks that someone may be under an order under this bill, in terms of long-term treatment programmes, that might seem quite short in terms of being effective, but the aim of this bill, as set out in the previous clauses, is ultimately to restore them to a place where they can make voluntary decisions for themselves. Equally, what I want to point out is that of course this is a health-based approach to substance addiction. Ultimately, that is what we should be doing—if we are setting out the proviso here where we are saying that this is not about a criminal justice response; it is about a health-based response. That is a mantra we should be expanding across our legislation. It is what the Law Commission recommended we do. There is a small nudge to it here, and that purpose clause captures it brilliantly for me, but we need to be doing that more and more across our drug laws in New Zealand, as the Law Commission has highlighted we should. It is something that Labour has tried to encourage this House to have a debate on and still absolutely believes.

But, equally, canvassing this bill has highlighted another gap in our legislation and that is the lack of service provision. In the submissions, that issue was raised really concisely, which has been canvassed in this House. There has been an estimate that the 200 New Zealanders who might receive compulsory treatment is going to cost roughly $700,000—I would say probably at a minimum. Whenever we have seen times when the Government has said that the priority now is to either treat, for instance, those compulsory treatment clients, or, for instance, when it highlighted that it wanted a particular number of meth beds, all that has done in the past is suck resources out of other parts of an already stretched system. So resourcing these beds is incredibly important.

Having sat in the back of the alcohol and other drug treatment court in recent times—and I cannot state enough how phenomenal that programme is—it was obvious the need for placement. You had people before the court who had voluntarily put their hand up to be part of the drug and alcohol treatment programme, who were in prison waiting to be part of the programme, but who could not start because they could not find beds for them in rehabilitation programmes. Those are people who have cost a huge amount to taxpayers through our system because of their addiction, who are voluntarily saying: “I am ready to be a part of this.” We need to resource this properly. So we support this bill, but it must be properly resourced—as do all our addiction services need to be—and we will, ultimately, save taxpayers a huge amount of money and harm by doing that very thing.

An earlier speaker in this debate indicated that this was challenging and confronting legislation, and they were absolutely right. This is challenging and confronting legislation because here we have a modernisation and an updating of a 50-year-old piece of principal legislation to try to take account of circumstances that exist today for people who are really ill—people who have lost their own capacity to make good judgments about their health and their well-being and whether or not they receive voluntary treatment for their addictions.

This is a challenging area because it puts us as parliamentarians into the realm of making decisions in a legislative manner that is contrary to an individual’s wishes. What is more challenging for us as parliamentarians is that we are putting these people into an institution, essentially taking away their liberty, for periods of up to 8 weeks.

We heard evidence from professionals in this area who advised us at the select committee that sometimes 8 weeks was needed in order to ensure that people were completely removed from the addictive substances that had produced the situation that meant that they were no longer capable of making good judgment decisions themselves about their own health and well-being.

So this is a piece of legislation that, I think, as nicely and as carefully as we can, balances that judgment call between protecting people’s rights to make their own decisions about how they live their lives but also at a point where the State actually has to intervene on their behalf to protect their best interests. I think we have got the balance about right.

It was a good select committee process. I am looking forward to the debate that we will have in the Committee of the whole House and to the third reading debate. I commend the bill to the House at its second reading.

I enjoyed that contribution from Scott Simpson, albeit brief. He did make a very important point when he began his contribution on this bill in that it was a challenging and confronting piece of legislation, because we know that any legislation that compulsorily requires treatment cannot be entered into lightly and cannot be done without due consideration.

That is exactly what the Health Committee did. We did give this legislation due consideration. We raised a lot of issues at the select committee. We asked a lot of questions. We looked at how we could give as many safeguards as possible in a piece of legislation that is going to replace outdated legislation, which goes back to, as Jacinda Ardern said, 1966—the outdated Alcoholism and Drug Addiction Act. We are putting in place a more modern approach to compulsory treatment.

I am sure the purpose of this bill has been canvassed, but I think it is worthwhile repeating for people why we need to have this new piece of legislation. First of all, the old legislation is outdated and overdue to be updated. But most of all, this new legislation has got some key things that it sets about to do. The first is to protect people from harm. When we are talking about compulsory treatment, we are talking about people for whom there is a very, very high threshold for treatment. It is a situation where the person is considered to have severe substance addiction and does not have the capacity to consent to treatment. So that is a very high threshold—that they have reached a point in their life where they do not have the capacity to consent to treatment.

The first purpose of this bill is to protect them from harm. In the Health Committee we did hear from family members who told us of the harm to their loved one who was addicted, but also about the family members themselves, and of the many efforts that they made over and over again to try to help that loved one, only to have failed. The second purpose is to facilitate a comprehensive assessment of their addiction. That means that you have got to really look into what has caused it and what has happened—a proper assessment. They are no longer a once-over-lightly. They need a proper assessment of what their addiction is.

Then there is, of course, the stabilisation of their health throughout the application of medical treatment, including medically managed withdrawal. We were not just talking about medically managed withdrawal; we were also talking about the fact that many people who are severely addicted have other health issues. So it is not just one issue that they are dealing with. They often have many other health issues that they have collected along the way, perhaps related to their substance abuse, but maybe not always. They could have many co-morbidities. So there is stabilising their health—whether they have got diabetes or whether they have got a heart condition, whatever those issues are. Many of those issues have been neglected over the years as well. They rarely have been to their regular check-ups with their GP, so you need to stabilise their health as well.

It is also about protecting and enhancing their mana and dignity, and restoring their capacity to make informed decisions about future treatment. So it is to get them into a position where, actually, they can take back their lives and start to make some decisions about themselves. Part of the purpose is also to facilitate planning for their treatment and care, to be continued on a voluntary basis. You do not wish to have someone in a mandatory state for the rest of their lives; you would want to bring them to a point where they can then be part of what happens to them, and it is done on a willing and voluntary basis. It also gives them the opportunity to engage in voluntary treatment. So that is the purpose, and they are very laudable goals.

I do want to raise some of the issues that did worry us—it was not just the Opposition; the Government worried about these as well. We have to ensure that if you bring in a new process, that you actually are able to fund it to provide it. I think it was important that we did hear from some of our experts in the field who told us that this will not work if we do not have the funding to go alongside it.

One who comes to mind was the clinical head of addiction at Capital and Coast District Health Board, Tom Flewett, who said the Government already substantially underfunds addiction services—this is in just this region, but you will hear it in other submissions. He said that when the new compulsory treatment law comes into force, existing resources may well have to be redeployed, and that would compromise patient care in other areas. He said: “I know from experience that if you put a new Act in place and there is no new resource, then we have to reconfigure existing resource. That is a given for working in this country.” He does support the bill, but this issue of making sure that we resource it was raised by many of the submitters.

We could not get from the Ministry of Health, at that point, what additional resource would be put in. We are told that it will be phased in, so that they will presumably putting resourcing along with the phasing, but we are unsure as to exactly what that requires. We are told that there could be up to 200 New Zealanders a year who will receive compulsory treatment, and that could cost up to $750,000 annually. That is the assessment; we are not sure whether there are going to be 200 or more.

I think one of the most telling submissions that we received at the select committee was actually from the Salvation Army. Think of the Salvation Army as being probably the foremost provider of residential services for addiction in this country. For many, many years it has been sterling in its efforts to try to help people who have addictions. It made, I thought, probably one of the best submissions to our select committee. The Salvation Army supports the bill in principle. It said: “It is a milestone for the addiction sector following 30 years’ of advocating for change …”. It said it “agrees with the Law Commission that in the case of a small group of people who are severely dependent on alcohol or drugs there is an important public interest that is served by intervening …” on their behalf. However, it said the current Act “administers this intervention in a way that is at times unworkable, does not enhance the dignity and rights of the person [concerned] …”, so it supports that and the change in that.

It does have “reservations and questions relating to specific resourcing, the need for more support of the whanau of those under the proposed regime, and multiple comments on specific clauses …”, which it sets out a little further on. It believes there needs to be more support for this bill. It said that it also agrees that the number could be between 200 a year—this is an increase from the 70 to 80 that we currently have now. It also has concerns that the legislation will place more challenges on people who are providing these services.

I just want, in the short time I have got left, to mention an area that was raised, and that is around what those who are going to be “approved providers”. The issue was raised of whether we will have enough approved providers at the time that this legislation is implemented, and assurances were wanted that we would not only have the funding but we would have the people who would become approved providers under the Act trained and ready and available throughout New Zealand to be able to provide this service to those who need compulsory treatment.

So, overall, it is a good bill, but we will be watching it. In fact, the select committee has said that it wishes to watch and monitor it to ensure that the guarantees that were given by the Ministry of Health that there will be appropriate funding and we will have the approved providers—we will be looking to make sure that happens, because the worst thing that could happen would be if this legislation was to fail after all the work that has gone into it and if we do not make progress at all.

So we will be voting in support of this bill.

It is a pleasure to speak to this, the Substance Addiction (Compulsory Assessment and Treatment) Bill, which, as has been noted, replaces the Alcoholism and Drug Addiction Act 1966 (ADA). Fundamentally, what this bill deals with is the compulsory treatment of people suffering from drug and alcohol addiction. As has been noted, the current Act is 50 years old and it no longer reflects modern views of human rights and modern treatment.

We had 39 submissions to the Health Committee, including from the Addiction Practitioners’ Association Aotearoa New Zealand, the Human Rights Commission, and the New Zealand Law Society, and from clinical groups, the New Zealand Medical Association, the National Nursing Organisation, and the Royal New Zealand College of General Practitioners.

There were four key themes from submitters. The first was that the majority supported a need for review and repeal of the ADA. The second concern was that maybe the compulsory treatment criteria were too broad. Those criteria hinge around clause 7, which states: “(a) the person has a severe substance addiction; and (b) the person’s capacity to make informed decisions about treatment for that addiction is severely impaired;”.

A response to that—there are several things. First of all, the definition of “severe substance addiction” is only one factor in determining eligibility for treatment under the legislation. The definition of a disorder for the purpose of legislation is not the same as that required for diagnosis, and can be qualified with other features or criteria, such as harm to self or impairment of capacity. So we can bring down that concern around broad scope by our definition around diagnosis. I think, secondly, the definition that sits in clause 7(a) and (b) and in clauses 8 and 9 is also consistent with other health and disability legislation. The third concern was around rights and protections. The concern was that the bill be consistent with the New Zealand Bill of Rights Act, and the United Nations Convention on the Rights of the Child, and that it should also respect human dignity and fundamental rights, and this has been brought in with the drafting.

The fourth concern, as the honourable member was just talking about, was about implementation, and particularly capacity and workforce. There are currently 80 people a year who receive compulsory treatment orders and the expectation is that will go up to 200. You would have to ask why. Are we going to find another 120 a year? Well, it turns out the advice we have had is that the current Act is either unclear to practitioners or it is not considered fit for purpose, so people are making other alternatives. This bill is likely to be more suitable, so the numbers will go up to 200.

How will we cope with those 200 people? I think some of the concerns that have been raised are addressed by the advice that we have. Firstly, the treatment workload will be spread throughout the country rather than to a few institutions. Under the current Act the vast majority of patients are sent to the 47 beds at Nova Trust in Christchurch. So only a few organisations may take the greater part of this load. Secondly, the length of the committal period will shorten significantly. Under the current Act, up to 2 years can serve as a committal period. This is being looked at, at 8 weeks, with maybe an 8-week extension, so it comes down substantially.

I think the third factor that is useful is that we had a lot of people support this bill and say to us that, yes, it is really going to advance the cause of those people who suffer from severe addiction and severe addiction disorders. As always, this bill is improved by submitters, whom we thank, and I commend this bill to the House.

Bill read a second time.