Dr Emma Schwarcz, Clinical Director, CADS

A quick romp through NZ history A quick reminder of the Act’s key objectives and key

criteria A quick reminder of the yellow brick road to Nova Uptake: The numbers so far The sticky sour crunchy bits:

▪ Capacity and the law, service impact, continuity, equity of access to service, the money.

The sweet chewy tasty bits: ▪ Whoppertunities for improved models of care, increased

focus on social determinants, addiction sector status and advocacy for clients with AOD

Reformatory Institutions Act 1909:‘to make provision for the establishment and control of reformatory institutions for the reception of habitual inebriates and of fallen women’

Alcoholism and Drug Addictions Act 1966 transferred responsibility from Justice to Health department, from penal to therapeutic approach.

SACAT Act 2017

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2010: Law Commission Review:

ADA Act no longer relevantADA too longNot responsive No ‘aftercare’Compulsion should only be to stabiliseCapacity should be at the heartHumans Rights issues

…And so SACAT was born

Came into effect 21st February 2018 Process modelled on the MHA 1992 Rights 2nd opinion Legal advice Complaints Breaches Additional rights for young people

The purpose of this Act is to enable the person to receive compulsory treatment if they have a severe substance addiction and their capacity to make decisions about treatment for that addiction is severely impaired, so that compulsory treatment maya) Protect them from harmb) Facilitate a comprehensive assessment of their addictionc) Stabilise their health through the application of medical

treatment (including medically managed withdrawal) protect and enhance their mana and dignity and restore their capacity to make informed decisions about further treatment and substance use

d) Facilitate planning for their treatment and care to be continued on a voluntary basis

e) Give them the opportunity to engage in voluntary treatment.

A person may be subject to the compulsory treatment under this Act only if (section 7):

a) The person has a severe substance addiction, AND

b) The person has severely impaired capacity to make informed decisions about treatment for that addiction, AND

c) Compulsory treatment is necessary, ANDd) Appropriate treatment for the person is

available.

7a: ‘Dependence’ includes risk to self and self neglect

7b: Capacity is severely impaired if unable to;a) Understand the info relevant to the decisions; or

b) Retain that information, or

c) Use or weigh that information as part of the process of making the decision, or

d) Communicate the decisions. 7c: Least restrictive 7d: Appropriate treatment = 1 of 9 beds at Nova

Director of Addictions: Dr John Crawshaw (also MO of Medicines Control, Director MH and now Addictions)

Area Director: 7 around NZ. Applicant: The person concerned about the proposed

patient. (Over 18, seen in last 5 days) Authorised Officer: Expertise in addictions, initial

assessment, signs a memorandum (like a crisis nurse and DAO in one)

Approved Specialist: Ensure criteria met, sign the CTC (Compulsory Treatment Cert) (like sxn 10,11)

Responsible Clinicians: Treatment (inpatient: ‘detox’ then residential, transferred) re-assessment of capacity

Training, writing SoPs, MoC… ages Field phone enquiry 30 mins AO assessment 20 to 30 hours

▪ d/w applicant, person, visit, assess, organise medical certificate or memo, serve notice, +/warrant, transport etc

AS assessment 4 to 6 hours Inpatient detox 14-21 days

▪ File CTC, DI, lawyers, Rx plan, court submission, meetings Judge - CTO 4 hours Coordinating admission to Nova 10 - 80 hours Flight to Ch-Ch with AO A day At Nova 56 +56 days max Return home to… TAU…

Enquiries 72/Applications 34/AO assmt 21/AS assessment 16/CTC signed 9/Nova 3, 2 in IPU

Of 9 signed and admitted to detox (IPU):

▪ 8 alcohol, 1 methamphetamine/MHS. Severe.

▪ 5 went home (all relapsed in a week…), 1 still IPU

▪ 3 went to Nova (vs jail, re-admission, meth& run)

▪ 1 is now back. ‘I just have to do this for 6 more weeks (probation) before I can do my own thing’

No evidence for compulsory treatment… ??? Empty pockets and a new intensive service. Boutique service for a few… = a cost to others? Continuity of care beyond the Nova oasis… Health does not equal wellbeing. Much more.

CHIME, recovery, social determinants – housing, employment, meaningful lives, belonging, community, connection

Capacity is not proving to be helpful. Judicial approach to capacity is fluctuating and objectives sidestepped

‘…(the doctor’s) view is that at the point in time of the assessment today she does have the ability to use or weigh the information. However he says that given all that he knows of ‘Ann’, her background and her addiction to alcohol, he says it is “highly likely” that upon release she will immediately return to drinking. The question for me then is whether Ann’s fluctuating capacity, as a result of her high likelihood of relapse, is a relevant consideration under the capacity test.’ ‘…The criteria for compulsory treatment must be met on an ongoing basis. Based on the short period of relative capacity experienced by Ann and the consequences of relapse which would be to return Ann to an incapacitated state, I consider that capacity is not met.’‘…If the capacity test is taken as a ‘snap shot’ on the day of the interview/hearing, then many cases within the Act will have capacity because the detoxification process will have allowed patients to regain capacity at the time of the review.’

▪ Doctors says yes, judge says no.

▪ Relapse does not equate to a loss of capacity

▪ Act permits detention on basis of losing capacity at some time in the future – which runs contrary to objective of Act…

▪ Lawyers and Judges using ‘best interests’? requesting CTO

▪ There is a big gap between capacity and compulsion, craving and salience

▪ And anyway, is locking people up actually going to help when services still look the same?

Opportunity to jump up and down Maybe services don’t have to look the same Now have Director of Addictions at MoH Professionalisation of workforce Shines the light on the gaps - continuity of

care, PPPR Act, placement, money… A chance to collaborate – NGOs, provider

arm, PHOs, F&P, MoH…

Nova Trust: www.novatrust.org.nz

The Act in full is here:) http://www.legislation.govt.nz/act/public/2017/0004/latest/whole.html#contents

MoH webpage, about SACAT, rights, resources, forms: http://www.health.govt.nz/our-work/mental-health-and-addictions/preparing-commencement-substance-addiction-compulsory-assessment-and-treatment-act-2017

Matua Raki, handy learning module (sign in) https://www.matuaraki.org.nz/initiatives/introduction-to-the-substance-addiction-compulsory-assessment-and-treatment-act-2017/183