TRANSFORMATION JOURNEY OF TREATMENT AND REHABILITATION

PROGRAMS IN MALAYSIA:COMPULSORY OPEN ACCESS SERVICES

CURE & CARE

DR. SANGEETH KAURNATIONAL ANTI DRUGS AGENCY

MINISTRY OF HOME AFFAIRSMALAYSIA

Treatment Scenario in Malaysia

Compulsory Treatment

• Provided for drug dependants since 1983

• Drug Rehabilitation Centers (DRC) & Supervision in the Community

• 22 DRCs – capacity of 7,000 residents• Supervision - 55,000 estimated in the community

How can N.A.D.A take care of the

massive numbers in the community?

Success Rate 75% ?50% ?20% ?10% ?

Compulsory Treatment

Reluctant & Resistant Clients Problems in the

DRCs

Treatment Services

Programs in DRCs and those

undergoing Supervision

Parents, Families

StigmatizedResidents – criminalized

(records)

Changes Impact of New

drugs on ClientsNeed for Clinical

Approach

Why NADA needs to Transform?

Stakeholders

GTP & NKRAConcept of 1Malaysia

Success Rate 75% ?50% ?20% ?10% ?

Compulsory Treatment

Reluctant & Resistant Clients Problems in the

DRCs

Treatment Services

Programs in DRCs and those

undergoing Supervision

Parents, Families

StigmatizedResidents – criminalized

(records)

Changes Impact of New

drugs on ClientsNeed for Clinical

Approach

We ask ourselves…..? ? ? ?

..what matters most to the

‘rakyat’/people or clients

…what do we want to transform

?

….how can we touch the hearts & souls of the people or clients with big

fast results…

?

?

TRANSFORMASI

Treatment Wards

Registration Office– Sg. Besi

Psychiatrist/ Medical Officers

CONCEPTOPEN ACCESS SERVICES

Voluntarism or Walk-in Support from parents or

family Referral Outreach / Motivate

No Legal Implications No Pre-conditions

No stigma Private and Confidential Options for clients Community-based

Program Clients as patients

# #

INPATIENT

1, 2 & 3 Months PackageClients Needs and Assessment

OUTPATIENT

4, 5 & 6 Months Package

Appontment Based

CLINICAL SERVICES

Medical Detoxification

METHADONE MAINTENANCE

THERAPY

REFERRAL AND ADVOCACY

Public, Family dan Clients ( Hospital, Social Welfare.

TRANS CC

1-3 bulan package

SCOPE OF SERVICES

Psychiatric Interventions

Opiate Clients

Temporary transit

Hypnotherapy

FUN, EFFECTIVE & EASY TO IMPLEMENT APPROACH

• EARLY RECOVERY

• RELAPSE PREVENTION

• SOCIAL SUPPORT GROUPS

• FAMILY PROGRAM

• COUNSELING & GUIDANCE

• OUTING/EXCURSIONS

C

&

CC

1M ’s i a

1MSIA

C&C 1MALAYSIA MODEL

• MEDICAL & HEALTH EDUCATION

• RELIGIOUS & SPIRITUAL

• VOCATIONAL SKILLS TRAINING

PSYCHOSOCIAL

• MEDICAL DETOXIFICATION

• METHADONE MAINTENANCE

• PYSYCHIATRIC INTERVENTIONS

• HIV/HEP/TB/STI TREATMENT

• INHALAN

• DENTAL SERVICES

C

&

CC

1M ’s i a

1MSIA

C&C 1MALAYSIA MODEL®

• ALCOHOL & NICOTINE

• IMMUNIZATION • INFECTIOUS DISEASES

SCREENING

CLINICAL SERVICES

DRC VS. C&C CLINIC

DRUG REHAB. CENTERS

C&C CLINIC

Compulsory Treatment & Admission through the Law; Criminal Records; Stigma

Open Access Services – Voluntary Admission; Considered as Patients

Focus on medical, psychiatric & clinical treatment

Treatment-based services only

Treatment for opiate-based addicts; all males and separate for women

Treatment for all substance abusers (opiate, ATS, inhalant) – males, females & adolescent are separated

Treatment Duration – 2 years Treatment duration – 1-3 months (inpatient), 4-6 months (outpatient)

Capacity for residents in DRCs – 7,350 Number of clients that accessed services at 8 C&C Clinics – 9,041

Cost of food – RM8.00 x 30 days x 12 months /person = RM 2,880

Cost of food – RM8.00 x 30 x 3 months = RM720.00

Loss of Property caused by violence, arson No incidence of violence or arson

C&C CLINICSCLIENTS

REFERAL AND ADVOCACY TOTAL

INPATIENT OUTPATIENT

SG.BESI 724 364 1036 1491KOTA BHARU 92 130 757 742

BKT MERTAJAM 497 75 1200 954TAMPOI 467 465 784 1072

KUCHING 30 60 138 161PAPAR 94 94 106 188TAMPIN 175 99 263 487

JERANTUT 207 243 35 450KARANGAN 118 19 251 388

TOTAL 549 126 117 737

ACCUMULATIVE TOTAL 2012 2404 1549 4570 5,933

ACCUMULATIVE TOTAL

2010-20126098 4580 8767 16,855

OUTPUT ( NO OF CLIENTS)

Julai 2010 - Jun 2011 Julai 2011 - Jun 20120

2000

4000

6000

8000

10000

12000

55694619

5864

10820

COMPARISON OF CLIENTS AT COMPULSORY DRC AND CLINIC CURE & CARE FOR 2010 -

CCRCC&C

OUTCOME STUDY AT C&C CLINIC

• 94.4%

• 90%

• 61%• Reduced by

37.1%

Injecting drug use 46% to 8.9%

Confident of not using drugs in the near future

Clients satisfied with services

Ready to recommend the clinic to family and friends

OUTCOME STUDY AT C&C CLINIC

Drug use history

Substance30 days

BEFORE first visit to C&C

Past 30 days

Heroin 67.1% 4.8%

Benzos; Dormi, Clona, Valium, Xanax

12% 2.0%

Syabu, Meth, Ice 13.9% 2.1%

Pil Kuda 3.3% 2.2%

3 or more substances in the same day

10.8% 1.7%

OUTCOME STUDY AT C&C CLINIC

• In general, how satisfied are you with the medical attention you receive for your health problems (other than drug addiction) at the Cure and Care Clinic?

Satisfied 69.3%Very satisfied 23.9%

Not very satisfied 5.6%

Health status, needs and accessOUTCOME STUDY AT C&C CLINIC

Qualitative analysis: Opinions and feedback on C&C program and services.

• Overall, happy with the C&C concept• C&C encourages voluntary and ambulatory care and

rehabilitation • MMT is seen as a stabilizer giving 2nd chance • Programs offered by C&C were well received • Good support from C&C staff, Counselors and Medical Team

OUTCOME STUDY AT C&C CLINIC

20112010

Example text

METHADONE MAINTENANCE PROGRAMME

CCSC 1024

CCRC 0

Klinik C&C

0

Jumlah 1024

CCSC 1380

CCRC 21

Klinik C&C

351

Jumlah 1647

2012

CCSC 1530

CCRC 40

Klinik C&C

1735

Jumlah 3305

936 (67.8%) clients employed in 2011 compared to 543 (53%) clients in 2010.

OUTCOME STUDY AT C&C CLINIC

56.3% • Helped maintain jobs

42.7%• Helped get into government support

services

54.3% • Continued education

77.6% • Improved family relations

72.1% • Obtained permanent homes

75.9% • Prevented arrest into prisons

OUTCOME STUDY AT C&C CLINIC

73.8%• Prevented admission into

Compulsory DRCs

78.3%%• Helped family or friends to get

treatment and rehabilitation

76.7% • Access to medical care

94.9%• Very satisfied with the methadone

maintenance programme

94.4% • Reduced drug cravings

65.4% • Obtained skill training

KAJIAN KEBERKESANAN PROGRAM KLINIK C&C OLEH UNIVERSITI MALAYAOUTCOME STUDY AT C&C CLINIC

CRIME HISTORY

Institution BEFORE C&C Since coming to the C&C

Lock-up 3.50 0.57

Prison 1.06 0

PUSPEN 0.61 0

Average number of times inpatients and outpatients have been sent to prison, lock up, or PUSPEN

KAJIAN KEBERKESANAN PROGRAM KLINIK C&C KOTA BHARU OUTCOME STUDY AT C&C CLINIC

Mental Health

Experienced serious depression, sadness, hoplessness, or loss of in-terest

Experienced serious anxiety/tension-uptight, unreasonably worried, inability to feel relaxed?

0

5

10

15

20

25

30

26

22

11 11

30 days before coming to C&C

In the Previous 30 Days

KAJIAN KEBERKESANAN PROGRAM KLINIK C&C KOTA BHARU OUTCOME STUDY AT C&C CLINIC

AFTERCARE SERVICES

AFTERCAREOptions for Aftercare Services after discharge from C&C Clinic :

as outpatient with the same C&C Clinic or other facility; or

CCSC (Cure & Care Service Centres); or

CCH (Community Caring House)

CCVC (Cure & Care Vocational Centre) – vocational skills training

TransCC – Transitional Cure&Care facility

Outpatient

CCSC

CCH

CCVC

TransCC

NADA District Offices

THANK YOUTERIMA KASIH

We Care, We Serve