Substance Addiction (Compulsory Assessment and Treatment) Bill

When the House was last considering this bill, Jenny Salesa was speaking, and she has 1 minute remaining.

Thank you, Mr Assistant Speaker, for this opportunity to complete my contribution on the Substance Addiction (Compulsory Assessment and Treatment) Bill. We should look at the current resources that New Zealand already desperately needs in the mental health services, and we should also look into the resources that will be needed in addition, just to implement this new proposed bill. We must ensure that mental health services and addiction services are adequately resourced. Our families’ health is at the core of the Kiwi Dream, but our hospitals are understaffed right now. Our doctors and our nurses are overworked. Our services have been cut. Our Kiwis are missing out on the latest medicines. Labour will invest in health. Labour will ensure that mental health and addiction services are adequately resourced. Thank you.

It is a pleasure to take a short call in the third reading of this somewhat truncated—or, in fact, elongated; it is exactly the opposite—debate on this Substance Addiction (Compulsory Assessment and Treatment) Bill, because it has been debated now over several sittings of Parliament, which is not in any way to discount the importance of this piece of legislation. It seeks to modernise a principal Act that dates back to 1966. Essentially, what this Act does is it provides a framework and a structure for the State to intervene and compulsorily incarcerate a person for their own good. That is a step that the State takes in only very rare circumstances. In this situation, the bill seeks to ensure that people who are so ill—they are so deeply and dysfunctionally addicted to drugs and other medications, and all sorts of things, that they are not able to form their own ability to seek medical attention for their own protection.

So getting the balance right has been something that the Health Committee has grappled with during the course of its work and its endeavour. I am pleased to report to the House that the select committee did, I think, very good work in this area. I think that this piece of legislation finds the balance about right. It is a difficult area, it is a challenging area, and it is a charged area. But it is an area where we, as a Parliament and as a society, sometimes have to intervene for the benefit and the good of someone who is not able to act in their own best interests. I commend this bill to the House because the bill seeks to achieve exactly that.

I want to make a contribution. I want to touch on three main points in this particular piece of legislation. This bill sets out to support those people for whom substance and alcohol abuse is so problematic that it actually becomes life-threatening.

This piece of legislation traverses a whole lot of significant issues and significant areas with regard to people’s freedoms and rights. In that regard the select committee process was rather elongated because there were many issues that we had to traverse in order to ensure the proper safeguards were put in place. When you hold somebody against, I guess, their free will and require them to undertake treatment, you must make sure you have got adequate safeguards in place.

I want to start with the area of capacity and resources. It became very clear early on in the discussion and the debate around this piece of legislation that we had a concern in the health system about being able to fully engage in this service because we did not have enough fully qualified people to be able to provide the appropriate treatment from the first day that this bill is enacted. Some work will be required to bring people up to speed. The area of substance and alcohol addiction is so complex. It involves people with co-morbidities, often mental health or other types of issues. The clinicians who are required to service this cohort of people—and we are not talking about a large group of people. It is somewhere in the region of, maybe, 200 or so a year. But the clinicians and the level of understanding required to treat that cohort of people is something that we are not fully able to facilitate currently in this country. So there will be some retraining required. On top of that, the resource, in terms of the facilities that we need to house and treat the people who will come under this legislation—we are not completely prepared for that to occur.

What this has highlighted during the process of this bill is that not only are we not fully resourced in this significant area but all the way down the line, where people could potentially receive treatment before they got to the level of being compulsorily required to undertake treatment, a lot of the preventative work also is not in place. So there is a chain reaction of need all the way down the area of alcohol and substance abuse that we should be addressing in this country.

The issue of taking somebody into care and then requiring them to undertake treatment was one that we spent quite some time dealing with. We decided to start, as a base, with the Mental Health (Compulsory Assessment and Treatment) Act. The requirements under the provisions of that particular piece of legislation were our baseboard, I guess. We looked at ensuring that when a person comes into the service, they are able to be monitored by an independent group of people, and we used the model of the district inspector, which is currently used under the mental health legislation. But also, provision was made to ensure that other independent monitoring was provided—that the patient, the consumer of this service, was also able to have some independent advice brought to the party and that their loved ones and their family members were also advised of the fact that the person was in treatment.

Often, when you are severely affected by substance abuse, your relationships with your family members become quite disturbed and disrupted and you are not always in touch with your family. But having your family know that you are in this treatment also offers a safeguard to you. You know that there is an independent person who is monitoring your care, from outside.

So compulsion was an aspect that we looked at. Compulsion—to be required to undertake treatment means that your ability, your capacity, to make decisions about your own treatment is compromised. We spent quite a bit of time discussing the period of time that was required for somebody to be in compulsory treatment. I think the length of time that we settled on, in the end, was somewhere in the region of 56 days. We spent quite a bit of time talking about ensuring that the period was not too long, because then it would become potentially a breach of someone’s human rights, and not too short, so that the treatment could be effective, and that at various points during that treatment period the patient has the ability to be tested to ascertain whether they are able to then provide consent for this treatment themselves.

It is quite a comprehensive bill. The Health Committee was a very interesting select committee to sit on. There were some huge issues around freedoms, which were discussed during the select committee process. We had several submitters who asked us to think very carefully about the area of compulsion, the area of consent—being able to ensure that there was independent support and advice to this cohort of consumers. I think that we on the select committee did a reasonably thorough job of addressing those key issues. I do not want to hold up the passage of the bill. I commend it to the House.

I rise as a newly ordained member of the Health Committee, in support of the Substance Addiction (Compulsory Assessment and Treatment) Bill at this, its third reading. Although I did not sit on the committee while this bill was being heard, I can certainly relate it to a series of bills that I heard at the Government Administration Committee with regard to harm-minimisation of gambling. As part of that process, we heard from submitters who had family members who were addicted or who were themselves addicted to gambling. They were not able to control themselves. They were addicted to gambling, with all that that entails. What we heard was the devastation that occurs to the sufferer, and not only in respect of their health and well-being and their finances, but in respect of their families—their families suffer as they watch the demise of a loved one who is addicted to gambling.

The submissions on that gambling bill, I believe, can be related to this bill. Substance abuse is equally as devastating. This is a bill that is long overdue. It looks to put in place mechanisms to protect people who are severely and seriously addicted to and abuse substances. It is a very good bill. As I said, it is well overdue. It has been debated very much in the select committee, and puts in place checks and balances to make a decision for that person who is incapacitated through substance abuse. We are looking to protect them from harm, to create an assessment as to the extent of the addiction, and then to put in place a treatment plan that empowers them to then make decisions as to their own treatment.

We heard in the previous speech that there was a lot of debate around the protections of patients’ freedoms versus their health, but I believe this bill has landed in a very good space. It is only proper that this bill is passed, as we look to protect those people who are suffering from severe substance abuse. With that, I commend this bill to the House.

Bill read a third time.