Dunne Peter: Substance Addiction (Compulsory Assessment and Treatment) Bill — First ReadingText is incorporated into the Bound VolumeDunne Peter: Substance Addiction (Compulsory Assessment and Treatment) Bill — First Reading[Sitting date: 15 March 2016. Volume:712;Page:9700. Text is incorporated into the Bound Volume.]Hon PETER DUNNE (Associate Minister of Health): I move That the Substance Addiction (Compulsory Assessment and Treatment) Bill be now read a first time. I nominate the Health Committee to consider the bill. This bill will repeal and replace the Alcoholism and Drug Addiction Act 1966. Repeal of that outdated 1966 Act is one of the actions in the Government’s Methamphetamine Action Plan and it is a long-overdue reform of the law for severely addicted people. The bill represents a significant step forward in the management of people who because of the severity of their addiction and their lack of capacity to engage in treatment are at significant risk of deteriorating health and premature death.New Zealand has allowed for compulsory residential treatment of people with addictions for over a century—The ASSISTANT SPEAKER (Lindsay Tisch): I am sorry to interrupt the honourable Minister. The time has come for me to leave the Chair for the dinner break.Sitting suspended from 6 p.m. to 7.30 p.m.Hon PETER DUNNE: When the House adjourned for dinner I was on the point of saying that New Zealand has had a compulsory residential treatment programme for people with addictions for over a century. But we have moved on from incarceration and isolation as the best way of treating people with substance abuse problems to understanding that they do better now when they receive their treatment close to their homes and families.The old 1966 Alcoholism and Drug Addiction Act which this bill replaces is infrequently used today. It is poorly understood both within the addictions treatment sector and amongst the judiciary. It fails to protect the rights of people who are subject to committal and difficulties in making applications under the Act cause significant distress for families and whānau who try to use it and consequently they do not use it. The purpose of this bill is intended to enable people with a severe substance addiction and severely impaired capacity to decide on the treatment for that addiction to be committed to a place where their addiction can be assessed and they can have the opportunity to begin to engage in treatment. The purpose of compulsory treatment is to protect those individuals from harm and to stabilise their health. It is also to protect and enhance their mana and their dignity that has been robbed from them by the addiction and to restore their capacity to make informed decisions about further treatment and substance use.Let me be quite clear that this bill is not intended to deal with unwise substance use or abuse. This bill is not a means of social control. What it does is provide only for the most vulnerable people who are at the most severe end of the substance abuse spectrum. Compulsory assessment and treatment should be only for those for whom there is no other option. It should not be the first choice nor should it be used for people who will not benefit from treatment.We all know addiction is a complex condition. It is not defined by ethnicity or social class and it is not a matter of willpower. People who need specialist addiction treatment services are often extremely vulnerable estranged from family and friends and facing significant barriers to recovery. Some people are reluctant to engage in treatment or care and are ambivalent about it and there is still significant social stigma about substance addiction. We are talking about a small number of people almost all of whom will be well known to addiction treatment services emergency departments and the justice sector over a number of years. As I say the bill is not designed to cure people of their addictions but it does provide a mechanism by which they can be brought to a point where they can begin to engage in longer-term treatment.The sad reality is that addiction is a chronic relapsing illness and some people will relapse irrespective of treatment. For others compulsory treatment will not be effective in tackling their addiction. But the evidence does show that the longer a person chooses to remain connected to treatment the better his or her chances of recovery. That is why the bill is designed to support people with severe addictions to engage in voluntary treatment once they are no longer subject to compulsion. A significant improvement will be the requirement for a continuing care plan when someone returns to the community. They just cannot be left to their own devices and their families are going to need ongoing support.The bill does not allow for the courts to sentence people to a period of compulsory treatment. This bill is a matter of civil law not criminal law. There are existing mechanisms that enable people whose offences are related to their use of alcohol or other drugs to be directed by the courts to undergo treatment.In developing the principles that underlie this bill the Law Commission considered whether there was a role for compulsory treatment. The fact that some people need treatment and are reluctant to engage with addiction treatment services is not actually of itself an argument for compulsion. Coercion or compulsion can bring people into treatment but it cannot ensure or require that they actively participate and engage in that treatment over the longer term. For this reason the bill is intended to bring people into treatment for a period that enables medical oversight particularly while that person is withdrawing from alcohol or other drugs and supports them to voluntarily engage with services. There is a clear and a rational connection between interventions such as medical detoxification and the objective for protecting a person from serious harm by restoring his or her capacity to make decisions about treatment and continued substance use.Proportionality requires that the limits imposed on a person’s right to refuse treatment go no further than necessary. That means that the benefits of those limits must outweigh the harm arising from the infringement of their rights because for most people who are dependent on alcohol and drugs the acute risks of harm tend to be short-lived. Only a relatively short period of compulsion can be justified and most people with a substance abuse disorder do not require compulsory treatment. Some will attend treatment voluntarily or as a result of informal coercion from family or friends or a more formal coercion perhaps as a condition of employment. Others will be compelled to attend treatment by the criminal justice system. It may well be a part of their sentence.Some people will refuse treatment but compulsory treatment would not be appropriate for them because they have the capacity to make that decision for themselves. In that instance it will be the responsibility of the addiction treatment services to work with people and their families and whānau to motivate them to engage in treatment and to support them to remain sober. This means that services developed will need to be accessible acceptable and responsive to a range of needs and cultures. As I said a small group will always refuse treatment but will not benefit from compulsory treatment because they have reached a point in their illness where alcohol and drug treatment of whatever type can no longer help them. As I previously noted people with severe substance addiction are often people who are highly vulnerable.Those who receive compulsory treatment must have their rights to that treatment balanced with the specific protection of certain other rights including the right to seek legal advice to receive and send mail including emails and to have the company of others. The bill is explicit as to how it intends to protect individuals’ rights. Furthermore it provides for district inspectors to ensure that the rights of patients are protected and that breaches of rights are investigated. The use of district inspectors has a long history in mental health legislation and it has proven to be an effective means of safeguarding the rights of people who are subject to compulsory treatment.Finally this bill is designed to fit within the range of addiction treatment services. I am aware that a number of those services will need to make some changes to enable the legislation to be used effectively. Planning for the implementation of those new services has already begun and will continue to develop as the process unfolds. As I say there will be those who object to any form of compulsory treatment and I understand that is an issue that will inevitably engender polarised positions but I am satisfied that this bill has been through a very comprehensive consultation and development process spanning some years now but the select committee process will also see a variety of complementary and opposing positions raised. That is how it should be. That is why we have select committees. I have every confidence in the Health Committee to guide this bill through to its second reading with the interests of our most vulnerable people very much to the fore.As I said the bill has been a long time in the development it replaces a piece of legislation that is very elderly and it gives me huge pleasure today to be bringing this bill to the House and to speak to what I think is a particularly important piece of health legislation. With pride I commend this bill to the House.