Substance Addiction (Compulsory Assessment and Treatment) Bill

It is a pleasure to take a call on the Substance Addiction (Compulsory Assessment and Treatment) Bill. It is a bill that is replacing 1966 legislation, and it has huge potential to reduce the overall cost of addiction to society.

There are a lot of families out there who, for reasons of drug abuse, have family members who have really hit a low, and families are ill-equipped to handle it. The people concerned have got themselves into such a low, low space that they are not able to recognise this and are not able to seek help for themselves. I think that when it gets to that point, it is our role to look after those people, as part of our society.

The bill is about repealing the Alcoholism and Drug Addiction Act of 1966. Most people who use alcohol or other drugs do not need compulsory treatment and can do well when they choose to engage in a treatment programme. They are still in the recognition phase, and they can take themselves off and ask for help. However, some people really are so unwell that they are unable to make that decision for themselves.

Intoxication from alcohol or other drugs, even if frequent or distressing, is not the same as addiction. It is completely different. So we do not want people getting the impression that this is a piece of legislation that is going to be used just for taking people and restraining them in an institution for very little reason. It is going to be taken very, very seriously.

In December 2015 the Government launched the Mental Health and Addiction Workforce Action Plan to help ensure that we have well-trained mental health and addiction staff to meet increased demand and the future needs of New Zealanders. There are four key areas in which this plan works. One of them is primary care and community care; another one is the integration between primary care and secondary care; then we have specialist training pathways; and then we have addiction treatment pathways. Detention is less dependent on the ability to lock doors than it is on the ability of services to keep patients sufficiently engaged in a way that minimises their interest in and opportunities for absenting themselves.

The Health Committee has worked hard on this, and is a great team. We have really good discussions in our committee and it is a pleasure to be part of it. We talked a lot about the meaning of severe substance addiction. For someone to be diagnosed with severe substance addiction, they need to have at least two of the features listed in clause 8(2) of the bill: “(a) neuro-adaptation to the substance: (b) craving for the substance: (c) unsuccessful efforts to control the use of the substance: [and] (d) use of the substance despite suffering harmful consequences.” The test is that the specialists and those who are giving care need to be able to identify two out of four of those features. Generally, the compulsory stage lasts for a minimum of 6 weeks.

I really think this is an important piece of legislation. P and other drugs are causing huge problems to society in New Zealand these days. It is my pleasure to commend this bill to the House. Thank you.

I am pleased to be able to speak to this bill, the Substance Addiction (Compulsory Assessment and Treatment) Bill. It is one that I have not been actively engaged with, particularly. It went, of course, to the Health Committee, which was appropriate for a bill of this nature. But my interest in it has certainly been to the extent that I look at justice issues for the Greens. Obviously, when we are talking about compulsory detention and treatment there are significant human rights issues involved, and for that reason I have sort of tracked the progress of this bill with some interest. I have no doubt that our former colleague and friend Kevin Hague would have made a very useful and positive contribution as this bill proceeded through the Health Committee.

The bill, I thought, had been around a long time, but, actually, it has not been excessively slow. It was introduced in December 2015, and had its first reading in March last year. The select committee had a good go at it. It took about 6 months to come back from the select committee, and that is not inappropriate for a bill of this significance, I think.

What is blindingly obvious, of course, is that the existing legislation that this bill replaces was seriously out of date—it was 1966 legislation. There was broad and deep agreement that that legislation is no longer fit for purpose. Among other things, it enabled the committal—effectively, the detention—of people for compulsory treatment on the say-so of two medical practitioners, but neither of those two practitioners were obliged to have any sort of specialist knowledge or experience as drug practitioners, and that was seen as an obvious flaw in this. It is a highly specialised area of treatment, and medicine, I guess, and it is appropriate that the new bill does put that right. In future it will be required that at least one of the medical officers be a specialist practitioner in this area.

The 1966 legislation allowed for a 2-year committal of a person, which we know, by modern standards, is far in excess of what is reasonable. These are very acute conditions we are dealing with—people who are unable to make decisions on their own behalf, and those sorts of conditions ought not to be prolonged. Certainly it would be unusual for somebody to be retained in that situation for a period of 2 years. The legislation, I believe, now talks of an initial period of some 8 weeks, and that is a much more appropriate period of time.

Again, the 1966 legislation required a court process, which was somewhat cumbersome, slow, and often quite daunting for people who were already in an unhappy situation of needing potentially to deprive somebody of their freedom—of their freedom of choice. It is unhelpful in these, as I say, very urgent and acute situations for there to be a slow or protracted court process, and, again, this legislation does away with that.

Overwhelmingly the feedback that came particularly from the submitters to the select committee was that there were insufficient and inadequate safeguards for the people who might be subject to this sort of legislation, in terms of protecting their human rights and protecting their well-being. I guess it reflects, sort of, the cultural norms in 1966, but the world has moved on since then, in all sorts of ways. Culturally, and in other ways, we are now perhaps a little more enlightened in our understanding that these people are actually, in their own way, victims—they have a health condition. They are not necessarily criminals, although, of course, sadly, drug addiction is often also a driver of criminal offending. But, substantially, we want to move away from the notion that we are dealing with criminals; we are dealing with people who have severe health problems, and the new legislation does recognise that.

I mentioned some of the submitters—Community Alcohol & Drug Services, Auckland, (CADS), made some very useful contributions in submitting on this bill from a very informed position. It is engaging with these people day to day, and I have to say that I have the greatest respect and regard for people who work in the area of addiction, because they are seeing people and dealing with people who are at their worst, frankly—people and conditions that, for a lot of us, would be very easy to dismiss or write off, frankly. Personally, I think I would struggle to engage with some of these people—they are in a dreadful situation. I do really respect the work that is done by the people in these various agencies, who see through that, who just see a human being in need and seek to provide some service to them.

The legislation, as I said, has had fairly rigorous attention from the Health Committee. It had a lot of submitters. As I have said, CADS was in there, as well as organisations like JustSpeak and the Wellington Community Justice Project. A lot of the district health boards submitted, and various other entities and organisations, large and small—the Privacy Commissioner. And it is appropriate that there should be broad and deep submissions on this legislation because, on the face of it, it is actually quite Draconian. It is the State saying to a person: “You’re not fit to make decisions on your own behalf, and therefore we are going to detain you and subject you to compulsory treatment.” That is fairly heavy-handed, but it also, sadly, is necessary.

What I particularly like about this legislation—it is Draconian; it is heavy-handed, but it has a very clear statement of purpose. That is one of the primary defences, I think, of human rights in this bill. The purpose clause of the bill very clearly states that the primary purpose, in this sense, is to protect people from harm. That is a very significant sort of a stake in the ground, to say that the key outcome we are looking for is to protect this person or these people from harm. The purpose clause goes on to say that it is to “facilitate a comprehensive assessment of their addiction;”—so to have a very, very clear understanding of the nature of the addiction and what you are dealing with, in terms of this person or of the health status of these people.

The legislation—the process, rather; the compulsory treatment—is intended to stabilise their health. Clearly, the focus is very much on working out how we get these people back to a situation as swiftly as possible, in as timely a way as possible, so that they can then take responsibility for themselves and ideally then morph away from this compulsory status and into a voluntary programme. There is a phrase in the purpose clause: “protect and enhance their mana and dignity and restore their capacity to make informed decisions about further treatment and substance use;”. One would hope that would be a discontinuation of substance use, because that, obviously, is the end goal for most of these people—to get them away from these very destructive drugs that are doing such terrible things to their health and well-being.

The other approach, if you like, that this bill takes, which I particularly admire, is that it outlines a set of principles. You are going to get a lot of different circumstances; a lot of different situations that people are going to be in. It is very hard to legislate for every particular circumstance or situation that might arise when you have got such a complex area as mental health well-being, to the point that we are demanding compulsory treatment. So, by establishing a set of principles, I think it is a very powerful model to say: “OK, these are the principles that will guide decision making by practitioners, by decision makers.” I think it is a very robust and appropriate form for determining exactly how people will be treated, rather than trying to be too prescriptive about it, because prescription, typically, will fail. With the best will in the world it is hard to imagine 20 to 30 years in advance, and that may well be the life of this legislation, what circumstances might occur.

The principles are very clearly outlined. I think they are robust. For example, clause 12(a) states that where compulsion is necessary, the level of coercion used must always be the least restrictive possible. So we intrude or intervene in a person’s life as little as we must do, to achieve the ends—the outcomes—we are looking for. The views of the patient and the patient’s principal caregiver should be ascertained and taken into account. It is a very thoughtful approach. It is one that recognises that although these people temporarily are not in a good situation, not in a position to make decisions about their own treatment or well-being, it gives the maximum scope to engage them and their caregivers in their treatment and in the compulsion.

So I think this is a well-thought-through bill, it is well framed, and the Greens will be pleased to continue to support it.

I rise on behalf of New Zealand First and my colleague Barbara Stewart to speak on the third reading of the Substance Addiction (Compulsory Assessment and Treatment) Bill. New Zealand First does continue to support this bill as it enters the third and final reading here tonight here in the House. The members of the public will know from the first reading, the second reading, and the Committee of the whole House that this bill will provide a legislative framework for compulsory assessment and treatment of individuals with severe substance addiction who have a reduced capacity to seek treatment for themselves.

The harm associated with addictions does have a significant impact on New Zealand society. If a person’s substance addiction remains untreated there are costs to both society and the individual person. That has a knock-on effect, and that affects people like their family and their whānau. It hurts relationships with people who love them the most. Sadly, this addiction can also incur the penalty that is financial instability, which can lead to homelessness.

The New Zealand Drug Harm Index released in 2016 found that the estimated social cost of drug-related harms and intervention was $8.1 billion. That is $8.1 billion that has become a social cost to our society. It is glaringly obvious that in New Zealand the scale of illicit drugs presents a problem, and this does point to New Zealand having one of the highest drug uses in the developed world. Research shows us that alcohol, a legal drug in New Zealand, is associated with a high level of social harm and is the principal drug used by those seeking treatment for addictions. That came about during the submission period from the Royal Australian and New Zealand College of Psychiatrists.

Therefore, as we have heard in the House tonight and previously, this bill will repeal the Alcoholism and Drug Addiction Act of 1966, and we have all said on this side of the House and on the Government side that this bill is needed to modernise it to fit within the 21st century so that it looks at the drugs that are in our community now. The drugs that are around us in our society are more harmful than what we have ever known before, and the impact on our community members and whānau is too high a price to not have this legislation modernised for today.

We have had robust discussions in this House, and I do say that I am aware that these actually occurred within the Health Committee too. I do, on this note, want to commend the Health Committee, which I did not take part in. It has done a fantastic job, along with advisers, in scrutinising this bill to make sure that it fits within what we need in New Zealand today and tomorrow. I think that the particular bill of interest here is not one that any side of this House took lightly at all. I know through discussion that there is an initial fear in Kiwis out there, and perhaps even in some of the members of the House, that we will go back to the old days of when institutionalised patients were, effectively, mistreated. I guess we have tried in great depth to ensure that this bill does protect the rights of the patient, with involvement of their whānau so that they are also involved in the care plan. So I and New Zealand First do think that this decision has not come about lightly. The bill is for the people out there who have no ways or means of understanding that they cannot take care of themselves. Sometimes in this House, members—as we have all discussed in some way, shape, or form—have to step up to the plate and realise that there is a real need out there in our community. Members have to step up to the plate and ensure that legislation here is fit for purpose for our community.

So New Zealand First will continue to support the broad intent of this bill. But throughout the process we have also had some reservations, and I think we have to gain some strength from this in that some of the reservations that came through actually were identified by the New Zealand Law Commission. The commission talked about things about the infrastructure and the service potential and the capacity of the mental health system to actually endeavour to—how is this legislation when it comes down to patients? We know already that throughout New Zealand, across all of our district health boards, they are running major deficits.

What is also happening, and I do not think it has actually been touched on here enough tonight in the House, or in previous readings, is the impact through the mental health care services, because the addictions and substance issues of our members in our community are not taken out and recorded as a standalone issue—they are dumped into the mental health system. So there is no clear, accurate way that the Hon Peter Dunne could say that he is expecting that maybe 40 to 60 people per year might be affected by this bill. I would like to go so far as to say, from speaking to the community sector, the mental health sector, and volunteers, that they expect this to be in the hundreds—the hundreds.

What I want to know with the reservations is: how could this little number of 40 to 60 per annum be an estimation, when we are looking at putting such important legislation together to help protect the future and current addictions that are so seriously harming our community? What I also learnt through asking the community and volunteer sector is that the issue is bigger than that.

At the moment, and it was only reported in the paper in the weekend, and it has got specifically to do with this particular bill—in the report we have a facility that was in Porirua that has never seen an upgrade in any way, shape, or form whatsoever, yet its new, modern facility is going to house only 14 beds. In 1992 this establishment was opened.

The Hon Peter Dunne, with the backing of his Government, has introduced this bill to the House and is not allowing for any more beds to open up to take care of the patients, who could be 40, 60, 200—whatever, because nobody knows. I just think that this is a gross oversight by this Government to implement a bill and get the support, as it has done, but we have not factored into the account here where these patients are going to go. Where are they going to go? There are no additional beds for them. There are no additional people specialised in addiction to substances who can actually help them through this process. Yes, they said tonight, from the Government side, 6 weeks. The Greens have pointed out 8 weeks. There is actually an extension, too, to patients particularly who need additional support. Where are their community support wraparound services going to come from? Where are they going to come from? That Government has sat there and not even answered that question right throughout the process.

I think it is a shocking indictment on this Government to introduce a bill like this and have no follow-up services or commitment that the associated costs, estimated in 2010, to be brought by this bill, $775,000—7 years ago. In today’s world this cost is going to be much more major than that.

So, yes, New Zealand First will be supporting this bill in its broad intent, but we are also going to be watchdogs in making sure that this legislation is fit for our community, that it is going to actually help people get the real services that they deserve when they cannot have a choice, by their addiction, to get or to find services by themselves that they can access readily.

In closing, we do say that this bill is needed. We have to address the issues that we have got in our society now. We have to address the addictions that people have, and I come across many people in my electorate who actually cannot help themselves. I think that although this bill has all the right intentions, there are major reservations as to how this bill is going to look and feel to the patient who actually has to go through this bill. I really feel that this bill will have a huge impact on the mental health sector and it will have a huge impact on the community and volunteer sector within the mental health sector. I think that this has been a gross oversight by the Hon Peter Dunne and the National Government. Thank you.

Thank you so much for the opportunity to take a call on the Substance Addiction (Compulsory Assessment and Treatment) Bill. As a new member of the Health Committee, I would like to, first of all, start by commending the work that the committee has done. It does important work and I am only just sorry that I have not been part of the deliberations on this very important bill, but I am here to support the third reading of this bill.

This bill will help support the needs of people with severe substance addiction and significantly impaired capacity to decide on treatment to get better and to get the help that they actually require. Having actually had the experience of intervening on a friend who was impaired by drugs and who was very suicidal and almost homicidal, although that was many years ago, I can say it is quite a stressful thing for friends and family who are involved with people who have a drug addiction. I also have seen friends’ families break apart as a result of the meth addiction of their children. As a parent of a teenager, you always wonder whether drugs are going to be around them, and you are always frightened for your children.

So it is important for all of us, as New Zealanders, to support the vulnerable in our community, and a key way of doing this is reaching out and ensuring that those who have had long-term and high-risk dependency on substance abuse can be cared for appropriately, rather than receive the stigma and punitive punishment that they can actually endure currently. I agree with some of the comments that were made in this House earlier.

As other members have said, the bill originated as part of an extensive work undertaken by the Law Commission in 2010, and it will make significant and workable steps towards getting treatment for tough alcohol, drug, and other substance abuse issues. The bill will repeal and replace the Alcoholism and Drug Addiction Act of 1966, which is very outdated. So, without wanting to waste the time of this House, I commend this bill, which is really fantastic.

The next call is a split call. Denise Roche—5 minutes.

I rise to take a short call for the Greens. You have heard from my colleague David Clendon earlier that we will be supporting this bill. Initially, we did have some concerns about the whole issue of compulsory treatment, but, on balance—and having gone through the select committee process and looked at the changes that were made and also at the reassurances that came through—the bill as it stands at the moment is a much better piece of legislation than the original, outdated 1966 Act.

I was not on the Health Committee, but I did read through some of the submissions, and I want to carry on with the theme that was raised by Ria Bond, which is actually about what other services are currently provided for the people who would be under a compulsory substance abuse treatment order. What we heard from the Capital and Coast District Health Board in its submission—it put it really quite eloquently, when it said that the current treatment is that there are mental health providers and clinics and centres, which are sometimes for people who are under compulsory orders, but those are specifically for mental health issues. Then there are residential treatment centres for people with addiction issues, but those are for patients, or clients, with substance abuse problems who are actually undergoing that treatment willingly. So where do you treat the people who will be under a compulsory order who are not actually that willing in the first place? Where do you put them?

The point that my colleague from New Zealand First made was that we have a mental health system that is frequently shored up by the not-for-profit sector, but it is woefully underfunded, and, in fact, the entire health system has been underfunded cumulatively over the last 8 years of this Government. So the question is: where do we put people? Then there is also the concern about how many clients there will be. How many people will be under a compulsory treatment order? The reason we should be concerned about that is the P epidemic.

The Greens were privileged to be at Te Tii Marae on the day before Waitangi Day and to be in that whare when the hīkoi—the march—of the community people who were marching against having P in their communities came through the pōwhiri and into the whare, and talked and put their take on the floor. The concern they have is that there is a scarcity of treatment options available, when you consider that even the Salvation Army, in its state of the nation report last week, is saying that P is the scourge in our communities, and that it is basically wiping out entire communities and families and is having a huge impact. It is a generational problem, and we are not seeing access—and appropriate access—to treatment either, when you consider that Māori are more impacted in this kind of area. There are some statistics. From 2015, a report showed that amphetamine and cannabis use was much, much higher—disproportionately so—in the Māori population. Similarly with hazardous drinkers, Māori made up 35.3 percent of all people seen by alcohol and drug addiction teams, while being 15 percent of the population.

So we have to wonder: will there be services that are culturally appropriate? Will there be services that are actually focused on prevention? That is the cheapest option, and that is the thing that is best for our families and communities, but that takes investment, and I challenge this Government to invest in our communities, and particularly in the regions. Thank you.

I call Jenny Salesa—5 minutes.

Thank you for this short call on the Substance Addiction (Compulsory Assessment and Treatment) Bill. Labour supports this bill. The intent of this bill is very worthy. It is indeed well past time that we replace the outdated Alcoholism and Drug Addiction Act 1966—legislation that is at least 50 years old—with a piece of legislation that reflects modern approaches to the treatment of severe alcohol and drug addictions, with current medical and health practices, while protecting the rights of our patients. We welcome this initiative as part of a suite of tools to reduce the harm to individuals, the harm to families, and the harm to our communities.

Compulsory treatment is a very serious issue, and it raises concerns—especially the individual human rights concerns of folks who will undertake this compulsory treatment. This bill, however, gives us tools to assist in situations where an individual is considered to have a severe substance addiction but is not capable of giving genuine consent for treatment of their addiction. It enables patients to have their overall health stabilised, their addiction treated, their rights respected, and their dignity restored, such that they can make informed choices about ongoing treatment.

Along with other members of the Labour Party, however, I have serious concerns about the implementation of this bill. We are concerned especially about the lack of resources, which is already evident right throughout New Zealand’s healthcare system. We are particularly concerned about the fact that our mental health services—and our addiction services, in particular—are really overstretched. We know this because of the underfunding of the health sector that we have seen over the last 8 years—underfunding of at least $1.7 billion.

Submissions to the Health Committee—that is a committee I do not attend as a committee member, but, in reading the summary of the submissions to the Health Committee, we can see that they raised doubts over the capacity of our current health system to be able to deal with the extra services and the extra staffing that they would have to deal with just to implement this new legislation in addition to what they already have to deal with. Counties Manukau District Health Board is one of the largest district health boards in New Zealand, and it covers the majority of the electorate of Manukau East, which I represent. It made a submission to the Health Committee that stated that “Specialist treatment interventions and programmes, including those provided on a compulsory basis, cannot improve the mental health of our population alone.”

We are mindful of the fact that implementation of this proposed bill may not—we hope—divert resources that should be deployed to the current mental health services and addictions sector, away from that sector’s focus on early interventions and more effective integration of the current primary health services as well as secondary care services.

The Ministry of Health must ensure that there is adequate service infrastructure in place to implement this new legislation. We already hear, and we know this from constituents coming through to our electorate offices, of the fact that community mental health services—

I am sorry to interrupt the honourable member. The time has come for me to leave the Chair.

Debate interrupted.

The House adjourned at 10 p.m.