National Leadership Forum on Ice – Compendium of Jurisdictional Achievements (5)
5. Treatment and Other Support Responses
National Action
National Clinical Guidelines for the management of drug use during pregnancy, birth and the early development years of the newborn have been developed under the auspices of the Ministerial Council on Drug Strategy to support health workers care for newborn babies and pregnant women with a drug or alcohol problem.Australian Government
Guidelines for the Management of Acute Behavioural Disturbances. Under the National Psychostimulants Initiative, the Australian Government has funded the development and dissemination the following national guidelines:- A brief cognitive behavioural intervention for regular amphetamine users – A treatment guide, was launched in November 2003.
- Guidelines for General Practitioners for the management of patients with psychostimulant use problems (released nationally in 2004).
- Guidelines for Police for the management of acute behavioural disturbances (released nationally in 2004).
- Guidelines for Ambulance Services for the management of patients with psychostimulant toxicity (released in September 2006).
- Guidelines for Emergency Departments for the management of patients with psychostimulant toxicity (released in September 2006).
The Australian Government will commit $22.9 million over two years in new funding to be delivered through the Amphetamine-Type Stimulants Treatment Grants Program. This funding will enable non-government drug and alcohol treatment services to better equip their facilities to provide treatment to users of Ice and other amphetamine-type stimulants.
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New Zealand
Needle Exchange Programme - New Zealand's national NSEP was established in 1987. The purpose of the NSEP is to enable Injecting Drug Users (IDUs) to use a new needle and syringe every time they inject and therefore reduce transmission of blood borne viruses amongst IDUs and in the general population. The program is delivered through approximately 13 peer-based dedicated needle exchanges and 180 pharmacies around New Zealand.Mental Health and the drug and alcohol treatment plans - Te Tāhuhu – Improving Mental Health 2005–2015: The second New Zealand Mental Health and Addiction Plan, published by the Ministry of Health aims to improve addiction services and the management of addiction and co-existing mental health problems.
Drugs in Prisons - The Ministries of Health and Justice are jointly leading a review of the interface between mental health/alcohol and other drug (AOD) services and the criminal justice system. The New Zealand Police and the Department of Corrections are contributing to this work. The review is examining issues for the general offender population, as well as for Māori, Pacific peoples, women, and youth. The objective of the review is to develop proposals to improve the way in which the mental health and AOD treatment needs of people within the criminal justice system are met.
Treatment services - New Zealand has 21 District Health Boards charged with meeting the health needs of their populations including the provision of emergency services and treatment for drug dependency.
NSW
The NSW Amphetamines, Ecstasy and Cocaine: A Prevention and Treatment Plan was released in November 2005 to guide the health sector's response to the abuse of these types of drugs. It covers action for education, early intervention, treatment approaches, research, monitoring and evaluation, special populations, and partnerships to tackle the problems associated with the consumption of these drugs, especially by young people.New Clinical Guidelines for Assessment and Management of Psychostimulant Users were also released.
The NSW Stimulant Treatment Program (STP) - trial commenced operation on 30 November 2006. Two sites have been selected for the initial stages of the trial. The program provides a range of services to stimulant users within a stepped care framework. Patients are provided with comprehensive assessment followed by a range of psychosocial and pharmacological treatment interventions. Access to the program is through referral from other services and self-presentation. There will be a direct link between Psychiatric Emergency Care Centres (PECC) and the STP.
Psychiatric Emergency Care Centres - Psychiatric Emergency Care Centres operate a 24-hour brief admission service within the emergency departments at Liverpool, Nepean, St George and St Vincent's Hospitals. Interim Psychiatric Emergency Care Centres have also been established within the emergency departments at Blacktown, Hornsby, Wyong, Campbelltown and Wollongong Hospitals.
The Langton Centre - in South East Sydney has developed an outpatient amphetamine treatment program that engages combination therapy including CBT, narrative therapy, pharmacological interventions and assertive follow-up. This program has been tailored to suit client needs and to deliver a service that addresses all of a patient's needs in the one location. This style of therapy was used in the multi-agency mirtazapine trial between NSW and WA.
NSW Mental Health Emergency Care (MHEC) program - The MHEC program aims to provide for people presenting to hospital emergency departments with acute mental illness or disorder and at risk of behavioural disturbance and/or substance abuse comorbidity. The Centres are functionally integrated into the mainstream emergency departments service. They provide an opportunity for mental health triage, assessment and behavioural management within the emergency departments for up to 48 hours.
A Medical Restraint Device Trial - has recently commenced in 21 locations around NSW in response to the need for a device to transport patients who are a physical risk to themselves or others often through intoxication by substances such as methamphetamine.
NSW Patient Safety and Clinical Quality Program - A statewide incident management system for Area Health Services was introduced by NSW Health in 2004.
Nepean Drug and Alcohol Service - commenced operations in Western Sydney in July 2005. This new service provides health and welfare support to young people between 12 to 20 years who have a substance abuse problem including methamphetamine use.
Compulsory Drug Treatment Correctional Centre - The Centre, the first in Australia, provides a new rigorous judicial supervision and treatment option. The program allows courts to send entrenched drug offenders to a correctional facility focused on drug treatment and rehabilitation.
Magistrates Early Referral Into Treatment program (MERIT) - MERIT is a court based, pre-plea diversion program under which arrested defendants, with illicit drug use problems including methamphetamine use, may be bailed to undertake treatment and rehabilitation.
SMART Recovery, the Drug and Alcohol Addictions Program and associated Relapse Prevention Program, and the Criminal Conduct and Substance Abuse Treatment Program The NSW Department of Corrective Services has a range of CBT based programs addressing drug use and offending behaviour with all suitable for treatment of methamphetamine users.
Mental Health Act Review - A review of the Mental Health Act 1990 has been taking place in NSW. A key issue under consideration is the impact on police resources of transporting persons affected by illicit drugs such as ice to hospital and guarding them while they await medical assessment and care.
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Victoria
Primary Health Services have been established in five 'hotspot' municipalities to address the unmet health needs of injecting drug users. The five hot spots are City of Greater Dandenong, the City of Maribyrnong, the City of Melbourne, the City of Port Phillip and the City of Yarra. An evaluation of the Primary Health Services conducted by Turning Point Alcohol and Drug Centre found the services to have been effective in improving the health and wellbeing of injecting drug users and to provide pathways into drug treatment. The government has extended the funding of primary health services for a further four years.Needle and Syringe Program (NSP) - DHS has made funds available over two years for an after-hours needle and syringe program. Following discussions, a proposal has been submitted by the Salvation Army's Health Information Exchange (HIE) Primary NSP in St Kilda for a 12-month pilot project, extending opening hours to 24-hours. HIE is Victoria's busiest NSP, providing condoms, sterile injecting equipment and safe disposal options for used equipment, as well as information and education around safer injecting practices and referral to other health and welfare services, including Access Health targeting injecting drug users.
A Mobile Overdose Response Service operates across Melbourne linking overdose survivors with treatment, and providing crisis support and early intervention for users whose behaviour indicates the use of methamphetamines. In addition, mobile drug safety workers have been appointed at 11 sites across Melbourne and rural Victoria to provide education on drug safety in areas of high drug use. Workers are trained in resuscitation and refer drug users to treatment.
The Melbourne Metropolitan Ambulance Services' Guidelines for Clinical Practice address the management of patients who have taken methamphetamines.
Custodial Health and Alcohol & Drug Nurses Project (CHAD Nurses Project) - DHS and Victoria Police have jointly developed an alcohol and drug treatment support service for prisoners in police cells across Victoria. CHAD nurses provide a timely and accessible health service to people held in police custody by undertaking health assessments of detainees within one working day of incarceration. Detainees with a demonstrable drug problem and who may be experiencing drug withdrawal are offered drug treatment or substitute pharmacotherapy services while they are in detention. CHAD nurses also refer detainees to alcohol and drug services within the community upon release or in prison if sentenced.
Victoria Police has a Drug Diversion Program, to divert adult and juvenile offenders detected by police for the use and/or possession of small quantities of illicit drug (other than cannabis) into assessment and treatment programs. Once a person is deemed eligible, the police officer will contact the Drug Diversion Appointment Line to make an appointment for the person to attend assessment and treatment. The person will receive a Drug Diversion Caution Notice with all of the details required to attend the assessment appointment.
Clinical Treatment Guidelines Turning Point Drug and Alcohol Centre has developed - Treatment Guidelines for Methamphetamines- Working with Clients as part of the Clinical Treatment Guidelines series. The Guidelines will provide a range of useful information for working with methamphetamine users, including practical tools and strategies, information sheets and work sheets. The Guidelines were released in March 2007.
Training for Drug and Alcohol Workers - $100,000 has been allocated to train alcohol and drug workers in the use of the Clinical Guidelines for the Treatment of Methamphetamine Users.
Family Drug Help- $30,000 has been allocated to train staff and volunteers of the family Drug Helpline and the Drug Information Line in the latest up to date information about ice.
In collaboration with Queensland, NSW and South Australia, The Department of Human Services (VIC) has developed an amphetamine education resource to redress a lack of resources around amphetamine use. The resource includes topic-specific information cards to assist frontline workers conducting brief interventions with clients, a recovery guide for amphetamine users, and a manual for NSP workers and other healthcare professionals.
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Queensland
Ice Breaker Strategy – Statewide assessment of public and non-government drug treatment facilities and other interventions currently available, identification of service gaps and the development of recommendations to improve responses for people with problems with ATS use and dependence.Dissemination of a CD-ROM - "Managing Psychostimulant Users" with appropriate mental health training for police.
Queensland Health's statewide network of Alcohol, Tobacco and Other Drug Services deliver comprehensive drug treatment, including screening, comprehensive assessment, detoxification, early and brief intervention, and counselling, which includes treatment for amphetamine use and withdrawal. In the last 12 months these services provided over 1,600 episodes of care for people with amphetamines as the principal drug of concern.
A range of services are funded to provide residential treatment and rehabilitation services for people with substance use problems of moderate-high complexity, including amphetamine use and dependence
13 new dual diagnosis positions have been funded by Queensland Health's Mental Health Services to increase the capacity of both mental health and alcohol and drug services to respond to people with dual diagnosis, including amphetamine users who experience psychosis, depression, anxiety and other mental health disorders.
The COAG funded Queensland Illicit Drug Diversion Initiative improves the health of clients and reduces their involvement in crime by providing brief (2 hour) through to intensive (6 months) treatment interventions. Amphetamines were a drug of concern for about 14% of Illicit Court Diversion Program clients with more than 750 clients in the past 3 years.
Queensland Health's Drug Court program provides comprehensive treatment and rehabilitation for offenders who are dependent on illicit drugs including amphetamines.
South Australia
Guidelines for the medical management of patients with methamphetamine-induced psychosis - Prepared to aid emergency, general, medical and psychiatric staff in the treatment of patients with methamphetamine-induced psychosis in emergency settings. The package of resources includes a complete set of guidelines and an abbreviated version for quick reference.Management of Methamphetamine Psychosis – This research report presents the findings of the Acute Care and the Assertive Community Care Trials, which are part of the Methamphetamine Research Program currently being undertaken by Drug and Alcohol Services South Australia. The trials investigated treatment options for methamphetamine-induced psychosis, and explored the characteristics of individuals presenting with the condition to acute care facilities.
SAPOL General Order relating to Prisoners includes a section titled Prisoners affected by stimulants. This section incorporates the National Drug Strategy's (NDS) Guidelines for Police Services.
The SAPOL Psychostimulant Working Group comprises members from within SAPOL policy, training and operational areas to oversee the appropriate dissemination of national psychostimulant resources within SAPOL and ensure that the information is integrated into relevant training programs and SAPOL General Orders.
The Adelaide City Watch House Community Nursing Service is a joint initiative between SAPOL and DASSA. Nurses employed by DASSA are located within the Adelaide City Watch House to provide a number of interventions to detainees and to support police.
The Clean Needle Program is an important public health initiative aimed at reducing the spread of blood borne viruses, including Hepatitis B, Hepatitis C and HIV. The program aims to increase access to sterile injecting equipment, education about safer injecting and referrals to primary health care amongst injecting drug users (IDU). The program has developed an outreach project targeting priority populations including young, Aboriginal, homeless and/or sex worker IDU.
Hospitality First Responders Training course - Training developed in partnership with the SA Ambulance Service to assist staff, and the management of hotels, clubs and other licensed venues to appropriately manage the first response to a medical emergency. This includes medical emergencies due to alcohol intoxication, illicit drug use, collapse and trauma that may occur in licensed venues.
Drug and Alcohol Services SA has been conducting Treatment Trials for users of amphetamines. This is a five-year project consisting of several phases and involves the development of innovative treatment options for amphetamine users being trialled in specialist drug services. The trials will further enhance and expand treatment options for amphetamine users. An important outcome of this project has been to raise the profile of amphetamine treatment in specialist services and in the community, as well as provide more options for clients and additional staff to administer this treatment.
Manuals for treatment are being developed and will be disseminated, together with training. DASSA's Clinical Advisory Service will also provide advice to practitioners on the treatment of clients on an ongoing basis, using and building on the expertise gained through the project.
Alcohol, Substance & Smoking Involvement Screening Test (ASSIST) questionnaire - The DASSA World Health Organization (WHO) Collaborating Centre for Research in the Treatment of Drug and Alcohol Problems has played a major role in developing the Alcohol, Substance & Smoking Involvement Screening Test (ASSIST) questionnaire. This instrument is a simple method of screening for hazardous or harmful use of alcohol, tobacco and illicit drugs in primary care settings.
Police Drug Diversion Initiative (PDDI) – The PDDI diverts juvenile and adult offenders detected for simple possession offences relating to possession of illicit drugs and or related equipment (excluding cannabis related offences for adults) into drug assessment and treatment services.
Save a Mate - South Australia Police contribute to the Australian Red Cross, South Australia, Save-a-Mate program, by providing advice and participating on the Reference Group. The program aims to reduce incidents of harm and fatalities associated with the use of alcohol and other drugs by young people aged between 12-25 years.
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Tasmania
The Tasmania Illicit Drug Diversion Initiative enables Tasmania Police officers to use their discretion to divert minor ATS offenders to health providers for education, counselling or appropriate treatment.The resource Psychostimulants – management of Acute Behavioural Disturbances Guidelines for Police Services has been distributed to all Tasmania Police officers to complement training.
Tasmania Police Manual sets out clear procedures covering detention and care of drug affected offenders.
Northern Territory
NT Police Custody Manual extensively covers care and wellbeing of intoxicated offenders regarding both alcohol and other drugs.Research is being undertaken with Western Laboratories to examine previous years urine drug screen results to allow the correlation of relationships between various drugs and a decrease or increase in drug use whilst on treatment programs.
Increased liaison with Mental Health Services has resulted in a number of shared case management episodes with co-morbid clients.
Within specialist clinical services, violence and aggressive acts toward staff and other clients has resulted in substantial upgrades to building design and security including the installation of a duress alarm system designed to allow an immediate response to violent and unacceptable
behaviour.
Alcohol and other Drugs Services (ADS) moved to a case management system in 2004. This allows closer supervision of clients with a focus of changing drug use behaviours. ADS case managers work in conjunction with the ADS clinical team to devise ways of increasing clients motivation to cease extraneous drug use.
The Northern Territory Illicit Drug Diversion Initiative commenced in 2002 and consists of two separate programs:
The Northern Territory Illicit Drug Pre Court Diversion Program (NTIDPCDP), administered through the Northern Territory Police, allows Police to divert first time drug offenders in possession of non-trafficable quantity of drugs to education and treatment, to expiate the offence in lieu of court proceedings; and
The Court Referral Evaluation and Drug Intervention Treatment program, Northern Territory (CREDIT NT) is administered through the NT Department of Justice and provides a system of diverting substance users arrested for drug related offences, into treatment programs.
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Western Australia
The resource Psychostimulants – management of Acute Behavioural Disturbances Guidelines for Police Services distributed to police officers within WA Police along with a training package.A statewide network of Community Drug Service Teams provides treatment services including outpatient residential (detoxification and rehabilitation) to amphetamine users and their families. All services are skilled to deal with amphetamines. A neuropsychology assessment service is based at the Drug and Alcohol Office's Next Step East Perth Centre.
In Western Australia Next Step in research partnership with the Langton Centre NDS, have been testing the efficacy of mirtazapine in the treatment of amphetamine withdrawal and narrative therapy as an adjunctive treatment in placebo and active groups.
In Western Australia treatment services are offered through:
- A statewide network of Community Drug Service Teams that provide counselling and treatment services to amphetamine users and their families. They also support local communities in implementing prevention campaigns.
- A comprehensive range of non-government organisations including specialist youth, women's and family services offering outpatient and residential counselling and programs.
- The Drug and Alcohol Office Next Step Drug and Alcohol Services, which comprise a specialist clinic providing outpatient services, a residential detoxification centre, which includes dedicated beds for Aboriginal patients and clinics throughout the metropolitan area.
Clinical Guidelines for the Management of Acute Amphetamine Related Problems have been produced for the management of acute amphetamine-related problems in health settings. This was a joint initiative between the Drug and Alcohol Office and Office of Mental Health. Training for use of the guidelines is being rolled out statewide.
The State Dual Diagnosis Planning Group is an expert planning and advisory group of key senior and consumer and carer representatives from the mental health and alcohol and drug sectors in Western Australia.
The role of the group is to facilitate the development, implementation and evaluation of effective and appropriate service delivery for people with alcohol and drug and mental illness comorbidities. Current projects include:
- Development of formal and robust linkages between local alcohol and drug and mental health by establishing formal memoranda of understanding between key agencies, and
- Capacity building through joint practice development initiatives.
Australian Capital Territory
Practical Guide: Persons In Custody, clearly outlines the responsibility of police when taking a person into custody when under the influence of drugs and/or alcohol. A specific guideline for dealing with people under the influence of psychostimulants is currently being developed.ACT Diversion strategies provide a graded response to illicit drug offences and demonstrate a partnership approach between health, police and non-government agencies. Opportunities for diversion exist at community, pre-court, pre-sentencing and post-sentencing stages.
The ACT Policing Early Intervention and Diversion Program focuses on the diversion of minor drug offenders prior to involvement in the judicial system through referral to a variety of education and treatment options. The ACT model involves police referral to the Assessment and Coordination Team, a new team formed by the Alcohol and Drug Program, ACT Community Care. The Assessment and Coordination Team is responsible for assessing offenders and recommending appropriate diversions to education and treatment services.
The ACT Government funds ten non-government agencies and operates a government service which provide assessment, treatment planning, withdrawal, rehabilitation, counselling and support services for people seeking assistance with harmful licit and illicit substance issues.
The Amphetamines Education Resources (AER) have been disseminated to alcohol and drug agencies. Alcohol and drug and mental health workers have undertaken the train the trainer program to equip key staff members with necessary information and skills on the use of the AER when working with amphetamine users.
Page currency, Latest update: 16 May, 2007
