NT govt’s ‘problem drinkers’ policy: reasons to be concerned

The NT Government recently announced that “problem drinkers” in Katherine, Darwin, Alice Springs and Gove will be subject to mandatory treatment as part of a new policy starting in July. It expects up to 800 people will be required to undergo treatment.

According to this statement, “problem drinkers” placed in protective custody three times in two months will be assessed for mandatory rehabilitation.

People in and around Katherine who meet the criteria will be treated at the Venndale rehabilitation facility for a period of up to 12 weeks. At Alice Springs, at least 80 people are expected to face mandatory treatment, while in Darwin the program will use an $18 million, 100-bed facility at Royal Darwin Hospital funded by the Commonwealth to provide short-term patient accommodation.

But what will be the policy’s impact?

A review commissioned by the Aboriginal Medical Services Alliance Northern Territory via the Aurora Project suggests there are significant grounds for concern. Win Yee Tan and Melanie Johnson report below on their review of the literature.

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This policy is not grounded in evidence, it is discriminatory and it risks causing wider harms

 Win Yee Tan and Melanie Johnson write:

The Northern Territory Government has proposed a civil commitment model of mandatory rehabilitation for “problem drinkers”.

Alarmingly, there exists little evidence regarding the effectiveness of civil commitment. As this proposal would result in significant disruptions of people’s lives against their will, it is imperative that the model of mandatory rehabilitation be ethical and positive.

There are several areas of concern regarding the current proposal:

Access – Alcoholics forced to enter rehabilitation programs will ‘clog up the system’. Individuals who voluntarily seek treatment will endure longer waiting times before acceptance into rehabilitation centres. The dynamics of treatment centres may also be negatively affected as some move towards a “secure” system similar to incarceration.

Criminal justice system – Despite some evidence that forensic rehabilitation programs can reduce the contact of offenders with the criminal justice system, no such evidence exists in civil commitment programs.

Ethics – Is there justification for the government to dictate treatment for alcoholics, and deprive them of their liberty? (The Universal Declaration of Human Rights states that ‘Every patient shall have the right to be treated in the least restrictive environment…)

Indirect discrimination – Indigenous people are over-represented in the criminal justice system and civil commitment programs, yet participate less in forensic diversionary programs. They are more likely to face incarceration without having committed a crime, and are treated more harshly when they do commit offences. Furthermore, non-Indigenous people who consume dangerous amounts of alcohol in private locations are less likely to be targeted by the legislation.

Motivation – Evidence regarding the negative effects of coercion on treatment is greatly varied. It is hard to determine whether mandatory rehabilitation is a rational use of resources.

Discompassionate approach – Alcohol issues should be addressed within the health, not justice system. There have been criticisms that the NT government has forgotten to consider the “human face” of the problem.

Legal considerations – Civil incarceration implies that the government would have to reinstate laws that make public drunkenness a crime. This directly contrasts the recommendations from the Royal Commission into Aboriginal Deaths in Custody. Other issues include the right of sentence appeal, and review procedure; also important to consider is who will have the discretion and power to incarcerate individuals.

Trauma, and the ‘band-aid’ solution – Alcohol abuse is a known effect from intergenerational trauma. Rehabilitation programs may not have long lasting positive effects if they do not address issues such as dispossession of land and culture.

International examples – International public opinion of civil commitment schemes is divided. Many schemes are decreasing in popularity in countries such as New Zealand; however, civil commitment remains publicly supported in Sweden.

Current Alcohol and Other Drug treatment centres – Creating new centres to house hundreds of patients may divert funding from current AOD centres, thus placing a strain on the AOD workers and support staff in the NT. This could negatively impact upon the provision of treatment in all rehabilitation locations.

The Northern Territory Government must address and further clarify a number of issues with their proposal, as elaborated below:

• Evidentiary basis of program
• Underlying reasons for alcohol abuse e.g. trauma, socio-economic disadvantage
• Ethical and legal support for the removal of autonomy in light of evidence of effectiveness, re-criminalisation of drunkenness, lack of judicial review
• Indirect discrimination against Indigenous persons
• Impacts of removing family members
• Justification for adding to the high crime rate of Aboriginal people in the NT.

 The following are aspects that should be further investigated and considered by the Northern Territory Government:

• After-care
• Alcohol culture
• Less invasive treatment programs, e.g. outpatient schemes
• More effective and appropriate treatment for Indigenous people, i.e. holistic treatment
• Adequate long-term funding and appropriate staffing
• Supply reduction through floor pricing and reduction in take away hours
• Increased funding and resource distribution for existing rehabilitation centres under a voluntary model
• Provision of AOD and mental health services as part of comprehensive Primary Health Care
• Investigation of underlying causes of alcoholism
• Maintenance and expansion of community alcohol restrictions such as those in remote NT and regional towns
• Provision of AOD support workers and teams throughout communities to support patients upon completion of treatment.