Substance Addiction (Compulsory Assessment and Treatment) Bill — First ReadingText is incorporated into the Bound VolumeSubstance Addiction (Compulsory Assessment and Treatment) Bill — First Reading[Sitting date: 15 March 2016. Volume:712;Page:9700. Text is incorporated into the Bound Volume.]Substance Addiction (Compulsory Assessment and Treatment) BillFirst ReadingHon 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 Repeal of that outdated 1966 Act is one of the actions in the Government’s Methamphetamine Action Plan and it is a long-overdue reform of the law for severely addicted people.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.Dr DAVID CLARK (Labour—Dunedin North): I rise to announce the Labour Party’s support for this bill at least through to the select committee. It is very nice to be able to support a Government bill in the health area. We are painfully aware of the effects of the $1.7 billion in cuts to the health sector by this Government. I guess perhaps we should note that this bill comes from the Hon Peter Dunne who is a member of a minor party in the Government rather than the major party which seems to be increasingly out of touch with ordinary New Zealand and the aspirations of ordinary New Zealand which include being able to go to the doctor and being able to have affordable and accessible quality medical care and that goes for the vulnerable of course as well as everyone else. So Labour will support this first reading to update the Alcoholism and Drug Addiction Act 1966. It is 50 years—Hon Peter Dunne: It’s to replace it not update it.Dr DAVID CLARK: Replace it—my apologies. The Minister is correct. It is to replace it. The Act is 50 years old. It is time for it to be replaced. It is not in line with modern clinical practice and delivery. So it is good to see the recommendations of the Law Commission being picked up and finally being put into legislation.Under the current 50-year-old legislation two medical certificates are required to make an application to the court for compulsory treatment and neither has to come from a specialist drug or alcohol practitioner. Therefore we on this side of the House support the idea that it will be a requirement that compulsory treatment can start only via an approved list of specialists when the criteria for compulsory treatment are met. It seems a sensible step.There are of course risks that go with the change and we must safeguard the rights of patients undergoing compulsory treatment. There is a risk that these new measures will be taken up in greater number because it is seen to be more relevant or shorter term or for whatever reason—these are the debates as the Minister points out that we will have in the select committee—and there is a risk that in that process with more people going through the system the safeguards will not be observed in the way that they might be. But I think these are risks worth taking because it is time to update this legislation and there is no doubt about that. But we just must find the balance so that patients have the same rights as those held under existing mental health legislation.Having a shorter time period—8 weeks with the option of extension with the goal of moving an individual into voluntary treatment—seems a far more progressive approach to treating severe substance abuse where patients are unable to make a treatment decision. It is a transition and ultimately we want the patient in so far as they are able to take responsibility as a part of their own care and rehabilitation back to the state they would like to be in. The statutory period for treatment under the current legislation is 2 years which far exceeds the time frame needed for treatment in many cases.The regulatory impact statement indicates a best guess of 200 orders per year being the result of this legislation as opposed to the 70 orders that are currently the case. On this side of the House we want to raise questions about whether that will be adequately funded. The regulatory impact statement makes the claim that there will be net economic benefits and there is a study quoted an American study that says—and this is from the regulatory impact statement provided by the Government—that “It is estimated that for every dollar spent on addiction treatment programmes there is a $4 to $7 reduction in the cost associated with drug-related crimes. With some non-residential programmes total savings can exceed costs by a ratio of 12:1.” We must take that of course with a grain of salt. It is coming from the USA and it is not looking at the New Zealand context. The results may vary as the saying goes. But there is a clear indication that there is likely to be a net benefit from looking after those with addictions and looking after the mental health issues that go with them. That of course is something that I suspect will be accepted around this House.The question comes as to how it will be funded. It is a net benefit to the economy but that does not mean that it does not come with an accompanying cost in the health system. We are told in the papers produced by the Government that there has been $775000 given to the health sector for implementing similar legislation annually and that that should cover the cost of this increase. I guess the jury is out on that and we will invite submissions to the select committee about whether that will realistically cover the costs in the sector which is already stretched—hugely stretched.Members of this House will have people coming to see them in their electorate offices to describe some of the unfortunate consequences of having a stretched health system in the area of mental health and addictions. I am sure all members of this House have had people come to speak with them about those issues many of which end in very tragic circumstances. It is incumbent I believe upon this House to ensure that these kinds of changes are properly resourced so that the intent of looking after the vulnerable is realised rather than platitudes merely being mouthed in this House.We have got plenty of evidence that the health system is squeezed. There are 20 district health boards that have sent 160000 people to their GP without specialist appointments since 2010. There is a constant flow of information about the implications of having an underfunded health sector and with that figure of $1.7 billion in underfunding it is little wonder that those areas where people are more vulnerable are the ones that tend to get squeezed first. The Labour Party has discovered through Official Information Act inquiries that this financial year a further $163 million worth of cuts are being enforced across 17 district health boards and of course that all flows through. That number dwarfs the $775000 that is claimed to fund this particular activity as is listed in the regulatory impact statement.So we have got a health sector that is being squeezed by this Government and that is having negative consequences for the public of New Zealand who are recognising that they cannot access the health care that they would expect to in a prosperous nation. We have seen things like the drug Keytruda erupting into public debate and I think that that is a symbol of a wider concern that New Zealand cannot afford medications that are funded in the UK in Australia and elsewhere because it seems the current Government does not place the same priority on health care that a Labour Government would.We on this side of the House in the Labour Party believe that the public health system must ensure essential health-care services are provided free for all New Zealanders and we believe that that health system is currently under threat. The health system is no longer able to provide Kiwis with high-quality safe patient care where and when it is needed in every case and that is a sad situation to be in. So I come back to the point that the promises in this legislation will need appropriate resourcing in order to be realised.There are other points in the regulatory impact statement that warrant highlighting in the first reading of this bill. There is very little international evidence on the effectiveness of civil compulsory substance addiction treatment in achieving good long-term outcomes for individuals. One might hope that shortening the period of compulsory treatment might go some way towards addressing that and if a modern progressive approach is used—where the buy-in of the patient comes earlier in the piece—perhaps new evidence will emerge that that is a more successful approach. But we must acknowledge that the evidence around compulsory substance addiction treatment is thin and that is acknowledged indeed by the Government in its regulatory impact statement.We must also recognise that there is little data in New Zealand on the number of people in New Zealand who have a severe substance addiction and who may meet the proposed threshold for compulsory treatment so we just do not know how many people this will apply to. The estimate of 200 that the Government has brought to the table is a guess—it really is a guess—and the estimate of funding that will be supporting it is based upon the funding that it believes will be necessary to support a guess. The number of people who qualify for this or who may fall under the legislation may be a far greater number particularly in this day and age when we are observing growing inequalities in society which have been very clearly linked through the literature to an increase in mental health concerns within a society.So we have got a case where we have a New Zealand that is not as it should be where we have financial pressures growing on far too many and where the 1 percent are charging ahead under a Government that looks out for their interests—a Government that is increasingly out of touch with the lot of ordinary New Zealanders—and therefore we have a growing number of people presenting with mental health issues. You just need to go and speak with the police. A significant proportion of the police’s work these days is concerned with mental health cases. That happens increasingly in a society where there is that gap between the very very wealthy—the ultra-wealthy—and the rest of the country and where that gap between the richest and the poorest grows ever more.So let us bear that in mind when we look at the estimates of the cost and the support that has been given to the district health boards to implement this legislation. That is where our concern will lie with this legislation—that the resources simply are not there. District health boards are being asked to make over $163 million in cuts across 17 district health boards this financial year alone. In that circumstance it is very hard to imagine just how they will afford to put this kind of legislation in place effectively in the spirit in which it is intended.More than half of the district health boards in the country are running deficits at present. Indications from Treasury are that cost pressures demographic changes and an ageing population will require even more significant changes to the health system over the coming years. This Government does not seem to have a plan for our health system. This is one piece of legislation though that we can support because it modernises something and is in line with the recommendations of the Law Commission which seem very very sensible.SIMON O’CONNOR (National—Tāmaki): I am very pleased to take a call on this first reading of the Substance Addiction (Compulsory Assessment and Treatment) Bill. I want to thank the Associate Minister for introducing it into the House. I think it is just another example of this Government’s good work in this space and there is a lot of work going on. This basically fits in a broader context with the Government’s Methamphetamine Action Plan amongst other things in basically working in the space of mental health and with a particular focus on youth. I think also it touches on some of the wider areas that the Minister himself is leading around work-drug control. So again thanks to the Minister for that.I think the Health Committee is looking forward to taking the bill and to teasing it out. It is quite a complex bill. I would not say “complicated” but it is a complex bill. There are a number of elements to it and probably the two that create the major tension are ultimately the desire to help and serve a particular individual or individuals but importantly to balance that with their rights.I was not pleased—well I was going to say “disappointed”. Actually let us start with the positive. I was pleased to hear that the Labour Party is supporting this bill at the first reading and I am hoping that other parties in the House—New Zealand First and the Greens—will be doing the same so that we can tease this out.I have to say for the record that I became a little bit disappointed but not completely surprised that the particular points of this bill were then taken to basically start a whole lot of predictable clichés attacking the Government in the area of health.Hon Ruth Dyson: What were they again?SIMON O’CONNOR: Well there is no point in actually putting them out again because they are all sort of falsities. And the fact that the Opposition just continues to put them out time and time again—it is that sort of old axiom that if you say it long enough people might believe it. The only problem we have is that when I am in my own electorate and around the country people are actually very grateful for the work that this Government is doing in the health sector and there is nothing like results to prove that.Sue Moroney: How patronising.SIMON O’CONNOR: See here we go again. We have been accused now of being patronising. You see it is just that classic ad hominem emotional attack without any facts going right back—Sue Moroney: Ha ha!SIMON O’CONNOR: And now they are laughing again. It is just so predictable really. I tell you what.Had I studied psychology I could have done multiple theses on these people.Hon Member: Theses?SIMON O’CONNOR: Theses—it is the plural of thesis. Gosh we really do need to do more work on Latin declensions here!We have a very good story to tell in the health space. We have increased the health budget now to $15.9 billion. The health budget is increasing. The attempts to jump through hoops and spin things that there is actually somehow a decrease basically falters very fast in the face of the facts.Hon David Cunliffe: Except for inflation.SIMON O’CONNOR: Here we go. Now we have got a little bit of alliteration thrown in there as well. Importantly in this particular context the funding for mental health has actually gone up from about $1.1 billion to $1.4 billion. Really important and a fact that the Opposition particularly Labour at this point has forgotten is that the whole point of district health boards in the way that they are structured is for them to choose how they want to allocate moneys to support people in their area. I think as a Government we are very supportive of that and we heard that through the district health boards as they came before the select committee. They are making choices all the time on behalf of their communities. So where there may be areas where we need more support in substance addiction I have every confidence that they will do so.I am quite interested in this bill from a personal point of view as well. It goes back a few years but I used to work in an addiction centre a drop-in centre in King’s Cross in Sydney of all places. It was a real eye-opener to understand that addiction particularly around drugs and alcohol is a disease. This is something that all people in many ways do not choose. The devastation that can bring not only to the individual but to the family and the wider community was very clear to me day after day week after week working with these people.One of the things I found working at this centre is how profoundly human those suffering this disease and addiction are. I mention that because it is all very easy to sort of put it outside or to demonise them stigmatise them and so forth. But actually they are human beings like you and me but they have their problems. And we as a society have to choose how to engage appropriately and I would stress proportionately. I think that is what this bill ultimately does.So if someone has an addiction—alcohol is the one that jumps to mind but of course various forms of drugs—how do we respond proportionately as a society to help them? Because by and large they do want help. That has certainly been my experience. A big part of that is to try to work alongside them to bring them to that situation themselves where they can understand what is occurring and to enable the help to be given in a way that enables them to release from the addiction from the disease.In most cases that is voluntary—it is voluntary—and those who understand they have a problem and need assistance will get the best results. But as we heard from the Minister there are a very small number of people in society who will never voluntarily seek help and of fundamental importance their level of addiction their substance addiction is so strong and so high that it is causing them immense harm. Importantly I want to stress again the addiction not only causes them harm but it has been very clear to me over the years from that experience in Sydney or in other places here in New Zealand that it has an immediate and profound impact on the family the whānau and the wider community. This is not something that is ever isolated and therefore we as a community have a duty—I would argue a moral duty—to step in and assist in these rare cases.So again this is not compulsory for all people by any means. It is for a very limited number. If you will excuse me for reading out a couple of my notes here—there are four elements within the purpose of the bill to describe when it is required. Of these four two are needed is my understanding. So the first test if you will is if someone has a neuro-adaptation to the substance. For those who do not know what a neuro-adaptation is basically it is when your body compensates for the presence of that particular chemical or substance and enables you to function quite normally. It is not quite at this level but we often talk about high-functioning alcoholics. They can knock back an incredible amount of booze or others smoke various substances or inject but somehow they are able to keep on functioning and working and you do not know how. That is neuro-adaptation: the body is able to compensate. So if the doctors and clinicians can see that this is at work that is one of the conditions.The other is quite broad of course. It is craving for the substance. That makes a lot of sense. The third one is unsuccessful efforts to control the use of the substance. And the fourth one is the use of the substance despite harmful consequences. It is those last two for me that really typify the point of this bill. If someone is unsuccessful they have tried to treat or have had someone attempt to give them treatment and they refuse it and the continuation of the substance abuse is leading to harm to themselves we as a society need to step in.The bill as outlined provides basically a whole range of steps which the committee will look at further as to how we begin to assist someone. But that brings me back to the first point that this is really balancing two needs: obviously the desire to help a particular person but also to work to protect their rights. From my first look over the bill I think we have got most of that in a very good space but I am looking forward to having it in front of the committee again—I am trusting and hoping—with unanimous support and to tease it out and to bring it back to the House in very good condition. So again thanks to the members and to the Minister.POTO WILLIAMS (Labour—Christchurch East): Tēnā koe Mr Deputy Speaker. Thank you. It is a great opportunity to be able to speak on this bill which as Dr David Clark has said we are supporting to the select committee. The intent of the bill is positive but there are certainly some questions that I as a member of the Health Committee am very keen for the select committee to investigate.There is no denying that when somebody has relinquished their liberty and also when they are provided treatment potentially without their consent there is a fine balance that needs to be struck between their rights as an individual our rights as a community to safety and their rights to not be harmed. It is a balance that we need to get right and there are some questions that need to be answered in my mind before we can actually get to a point where I am comfortable that this is the right way to track down and support people with severe substance addictions.There is no denying that the Alcoholism and Drug Addiction Act is outdated. In 1966 I do not think that many of the substances that are being consumed now or the ways that they are being consumed would have even been heard of. In my earlier days I recall being quite taken aback when people were consuming glue by sniffing. It was called sniffing but these days young people are huffing all manner of substances that were not conceived of in 1966 when the Act first came into effect. Also society has changed in its attitude to the use of some substances so there is no doubt that we need to update the legislation.As I pick up on the point that Dr David Clark made we currently detain about 74 people with severe substance addiction. The estimation is that this will go up to around 200 under this legislation but we do not know for sure and we cannot know for sure until we have tested out several things. One of the things that we need to test out is the assessment on which someone will actually come within the purview of this legislation. If we are talking about the assessment as will be defined within the legislation it will be based on three criteria: the severity of the substance abuse the risk to that individual from significant harm and whether they have refused treatment.Here is where the concept of compulsion comes into the discussion. Anecdotally I know from work that I have done in the past where I have worked with groups who were compelled to attend various sessions—in this regard I am talking about young people who might have been compelled to go to groups held by the Department of Corrections as part of their probation conditions. Anecdotally it is thought that compulsion is a really important part of the compliance to a treatment and the success of the treatment programme. But that is anecdotally and unfortunately it does not appear that we have the evidence that compulsion is a proven pathway to ensuring that someone who is compelled to do a treatment programme is actually successful at getting through that programme and has a successful result.Here I want to add that the experience of mental health consumers in this regard has not been entirely positive. Mental health consumers will want to I am sure contribute and submit to this bill because of their previous experiences. In that regard I am referring to what may have happened in the past around the electroconvulsive therapy which for mental health consumers was something that they were compelled to do and in many instances was very detrimental to their ongoing mental health. So there is a cautionary tale in that. In discussion with organisations such as the Citizens Advice Bureau the treatment will be residential and it will require us to change our way of working with people with addictions due to the provision of wet houses.A wet house is a place where you can safely use a substance until such time that you can wean yourself off that substance because if you have a serious substance addiction you cannot go cold turkey—it is very dangerous to do that. This is a change in the way we would treat people with addictions. In my view it is actually an option that could be open to a whole lot of other people who have substance abuse not just the most at risk of severe harm. It is a method that is used overseas; it is not something that we use here but it is certainly something that the Health Committee could look at as an option for treatment for people with other levels of substance addiction.This bill also tends not to include the co-morbidities that go along with someone who has a serious substance addiction. Here I am talking about mental illness talking about family violence sexual abuse and other social harms. We cannot see this person in isolation—only around their addiction. We have to actually review the whole environment that this person lives within. Neither can we actually then discharge somebody back into an environment that is completely unsafe because that will mean that they are then triggered by whatever is in their environment and we potentially will not get a successful treatment option for that person. I am hoping that the select committeewill be able within the purview of this legislation to ask questions of health officials about what is going to be provided for somebody post-treatment so that they can have a successful reintegration back into the community.I want to refer to the regulatory impact statement. There is a reference to not including the criterion of significant harm to others within the bill. I just want to quote from the regulatory impact statement. It says: “Existing legislation directed at child protection family violence and other criminal behaviour is available to deal with situations where behaviour arising from the substance addiction results in a risk of serious harm of others.” It concerns me that serious harm to others is not part of this legislation.I want to refer to the Mental Health (Compulsory Assessment and Treatment) Act 1992 where serious harm to others is part of that legislation. For me I am concerned that for someone who is under a compulsory treatment order and is mentally unwell there is a component of risk to others within their assessment. However somebody who has a serious substance abuse addiction does not have serious harm to others as part of their assessment. I think we are missing an opportunity here to ensure that things such as children who are in homes where methamphetamine is being manufactured for example are not a significant risk to that child or that young person. It is my belief that the Health Committee should examine this as something that we should include in the legislation.There is much more that I could say but in conclusion I just want to talk about the Code of Health and Disability Consumers’ Rights because there are elements of this legislation that are in breach of this code of rights. The right to freedom from discrimination coercion harassment and exploitation—the coercion aspect of right No. 2 does come into play here. Right No. 6 the right to be fully informed is about when somebody does have a compulsory treatment order imposed upon them and they are not completely informed. Right No. 7 the right to make an informed choice—there is also an aspect of not being fully informed and being able to give your permission. And right No. 10 is the right to complain. I understand the district inspector service will be part of this legislation and hopefully anyone who is ordered to have treatment as part of this legislation actually has the option to complain. On that note I commend the bill to the House. Thank you.BARBARA KURIGER (National—Taranaki - King Country): It is a pleasure to speak on the Substance Addiction (Compulsory Assessment and Treatment) Bill this evening. In doing so I want to mention that we all know that this is replacing a bill that was written in 1966.I would like to make note of the people led by Maurie Zinsli who have recently taken the time to commemorate those who died at Tokanui Hospital. It is a really sad case of people who were in a psychiatric hospital which is 14 kilometres south of Te Awamutu. A lot of those people in those days when we did not understand as much as we do now about mental health issues substance abuse and the like were taken into that hospital. Many of them were buried there.There is a lovely plaque that has just gone up. It has got “Tokanui Hospital Cemetery 1914 - 1964” which is only a couple of years before the piece of legislation that we are replacing was passed. It says: “May the 500 plus people buried here Rest in Peace.” I think it is significant that we remember them because we have learnt a lot. We have made a lot of medical physical progress over the years but in mental health and substance health and those sorts of things it has taken us a very long time.I would like to comment on something that one of the speakers said before. They talked about the difference between rich and poor people but actually this is a disease that does not distinguish. The bill is not designed to say that it happens only in certain economic classes or socio-economic situations; it is something that can happen to anybody. Often it is stress that leads to mental health issues that then leads to substance abuse—whether it be abuse of alcohol whether it be abuse of drugs—and so I think it is really really important that we do look as the previous speaker Poto Williams said at the links between those things because it fits in quite nicely with a lot of the other stuff that we are doing on the Health Committee.The bill is based on extensive work that was undertaken by the Law Commission in 2010. It is a significant step towards managing people who are seriously ill as a result of their addiction to alcohol or other drugs. The bill in its first reading sets out the criteria for compulsory treatment. “Compulsory treatment may only be given to people who have a severe substance addiction and whose capacity for making informed decisions about treatment for that addiction is severely impaired.” It is really something that is not going to be taken lightly and I am sure that in our debate in our select committee we will ensure that that remains the case.The bill sets out the meaning of severe substance addiction and it also sets out that the definition is applicable only if two of four highlighted conditions are part of the process. Before the select committee’s chair talked about neuro-adaptation to the substance. It could be because of “craving for the substance unsuccessful efforts to control the use of the substance and use of the substance despite harmful consequences.” I know that in a lot of these situations although these people would dearly love to break the cycle themselves unfortunately the addiction and the disease are such that they are unable to do so.The bill states that “compulsory treatment is necessary only if voluntary treatment is unlikely to be effective.” Generally we are looking at an 8-week period. If those who have this severe addiction are under 18 years of age participation by the family in decision making is really important. It also states that the “Area Director must assign a responsible clinician to every patient for whom a compulsory treatment certificate has been signed and this must be done as soon as practicable after the Area Director is notified of the patient’s identity.” So we cannot let these things lag. The bill also says that “a compulsory treatment order for children and young persons who are under 17 years of age may be made only if the court is satisfied that appropriate treatment cannot be given pursuant to an order [or other determination] under the Children Young Persons and Their Families Act 1989.”I am looking forward to this piece of legislation coming to the Health Committee. There has been an increasing shift towards more mental health and addiction services being provided in our communities and this aligns with the updated New Zealand Health Strategy draft which emphasises the importance of care closer to home. Thank you and I look forward to this bill coming to our committee.KEVIN HAGUE (Green): For at least the last 30 years the alcohol and other drug treatment sector has been saying with a more or less unanimous voice that the Alcoholism and Drug Addiction Act 1966 has not been fit for purpose and needs to be replaced. So it is certainly with perhaps an overdue sense of welcome that I thank the Minister for his introduction of the bill today.Several other speakers have referred to the Law Commission’s work and I am going to quote from the commission’s report on this matter. It became interested in this topic largely through its very extensive study on controlling and regulating drugs and alcohol in our lives. What the commission said was that one of the most persistent themes from submitters and experts whom it dealt with during that inquiry was the need for robust and effective treatment services which we often lack.One of the things the commission said when it followed up that work by specifically reviewing this Act was this: “One component of any coherent framework for delivering alcohol and drug treatment is the use of compulsion to require people to undertake treatment. Outside of the criminal justice system the only provision for compulsory treatment specifically for dependence can be found in the Alcoholism and Drug Addiction Act 1966. That Act is now outdated and there are difficulties in reconciling the broad powers of detention with the rights and protections in the New Zealand Bill of Rights Act 1990. Over the years some provisions of the Act have also fallen into disuse and the overall framework of the Act has not kept pace with subsequent changes in allied legislation such as the Mental Health (Compulsory Assessment and Treatment) Act. Reform of the Act is long overdue.” Hear hear!The framework in the current Act in fact is in some ways more akin to punishment. It is as if legislators were confused about what they were attempting to do. Just as with other aspects of the legal framework that we use to regulate alcohol and other drugs the Green Party believes that we need to move this framework from one that is based on justice and punishment through to one that is actually health-based. Certainly we welcome the emphasis that is in this bill on harm reduction and we specifically welcome the fact that compulsory treatment will used only if that is in the interests of reducing harm to the person concerned.The framework that is set out in this bill is a very substantial step forward. The current Act is unwieldy and often inappropriate. Even in those circumstances where the current Act actually would be helpful it is so hard to use that it often is not and that is the sign I should think of an Act of Parliament that is no longer fit for purpose. Change to it—or rather as Peter Dunne said not change but the replacement of it—has been supported almost unanimously by the sector.It is also worth noting that it was a recommendation of the National Drug Policy summit in August 2013 which comprised policy makers and treatment providers as well as other stakeholders like the Principals’ Federation and the Police Association. Very many stakeholders in drug policy came together in Wellington and formed a consensus statement about the direction that drug policy should follow. One of its recommendations was that the replacement of this Act was one of the urgent priorities that the Government should undertake.I was reminded as I prepared for this contribution on this bill of a singular day that I spent as the guest of one of the two alcohol and other drug treatment courts that are currently being trialled through the Auckland District Court. Under that approach what is happening is that offenders who are repeatedly in front of the courts for offending that is caused by or related to their alcohol or other drug use are instead offered treatment options under the jurisdiction of the court and I was particularly struck by the very strongly client-centred approach that was being taken by the court. From the judge on down to every other participant in that process the focus seemed to be on providing the best-possible outcomes for that person—reducing their harm and leading them to the best outcomes that were possible.In the afternoon when I saw the offenders appearing before the court seeing the relationship that those offenders had with the court and with everyone concerned I have never—and I have been in many courts over the years—come across such relationships before. They were genuinely therapeutic in nature. Would it not be great if we were able to augment the limited tools that those alcohol and other drug treatment that courts have at their disposal to give them another tool that was useful for them in actually achieving harm reduction for the people they are trying to help? Would that not be great?Some other speakers have raised some concerns about the bill that the select committee will need to take into account and I am particularly mindful of the very thoughtful contribution from Poto Williams. I thought that was an outstanding contribution to this debate. The select committee will need to look at whether the balance has been properly struck between the powers that exist in the bill that are necessarily still coercive and the rights and freedoms that we have determined to be a necessary part of participation in society. As Poto Williams has rightly pointed out there are some examples such as some of the use of electroconvulsive therapy the use of seclusion in some mental health facilities—or the excessive use of seclusion—and the excessive use of restraint where that balance has been struck in the wrong place. Indeed resource constraints as others have referred to can lead to those techniques being more often used and that is something that the select committee is going to be interested in following up I am sure.There is debate about whether compulsory treatment is ever appropriate. There are some who believe that it is not and I am going to be very interested to hear the views of those submitters on the select committee to see whether we have that set right.David Clark is correct to point out that alcohol and other drug treatment services are currently struggling with resourcing. They have falling resourcing in real terms and have increasing need that they need to service. Well actually we will be cutting off our nose to spite our face if we add to the arsenal of treatment services a useful tool but we then actually hamstring those same services by under-resourcing them. We need to properly resource them to maximise the value of this change that this bill would make.Finally I just want to say would it not be great if we actually took the action that was necessary to prevent harm as well as just to reduce it? I look forward to further action by this House in the bill that we are to debate following this bill and in many others to reduce the harm that can be caused by alcohol and other drug use. Thank you.BARBARA STEWART (NZ First): I am very pleased to rise on behalf of New Zealand First to take a call on the Substance Addiction (Compulsory Assessment and Treatment) Bill. New Zealand First is supporting this bill to select committee and we will be most interested to hear submitters’ views on this complex issue.As others have said the current legislation is outdated and did need to be reviewed. We cannot have an Act that is 50 years old as part of the legislative framework. When we have a look at compulsory treatment we know that there are provisions for compulsory treatment already that are followed by the courts but we also know that the process itself is very complicated and very time-consuming. Applications have to go through the District Court hence the provisions are rarely used.I was most interested to read the regulatory impact statement and to read the concerns of the Law Commission. When I read through those concerns I agreed totally with them so that is one area that we are going to be looking at in the select committee. One of the main problems that was identified was that “although two medical certificates are required before a person can be committed there is [absolutely] no requirement that either [of the medical certificates] be issued by a specialist alcohol and drug practitioner following the personal assessment”. That is quite a concern I believe.The Law Commission also said that “the statutory period of detention is two years which far exceeds what is normally necessary to undertake any form of treatment” and there again I can agree with that particular area. It said “the Act makes inadequate provision for review of the detention decision”—so quite a concern there for people’s human rights—and “there are generally insufficient safeguards to protect the rights of people held under the Act”. One of its biggest areas which I thought was most interesting was that “few treatment facilities are actually certified to accept people under the regime and consequently there is little flexibility in the type of … programme available”. Those are big issues that need to be resolved and no doubt we will be spending quite a bit of time on them at the select committee.All of us in this House know that we have got a problem with illicit drugs. In fact we have got one of the highest drug rates in the world. Although we are aware of this we are also aware that there are no real statistics on this very issue. We are operating in an area where we are uncertain of how big the problem actually is. We do not have any idea of the extent of the problem we are dealing with. We do not know how many people are even likely to be affected by this legislation. We all know though that the devastating effect that addiction has on an individual a whānau and the wider community cannot be overestimated. Of course there are all the resulting hassles that result from that: poor health and education outcomes increased crime and the breakdown of relationships and family groups.In his latest report the Director of Mental Health reported that the number of people who accessed specialist mental health and addiction services in 2014 was quite vast because would you believe addiction treatment is not recorded separately from mental health. So really when we get down to it it is very difficult to determine how many people are actually accessing this specialist addiction treatment.We do know that district health boards are struggling to cope with increased and overwhelming demand. So we are concerned on this side of the House that if there is going to be an increase in the use of compulsory treatment provision our current workforce is resourced adequately to cope with that increased demand. We know too that we have got an “ambulance at the bottom of the cliff” approach to this bill and it is often only when one hits the bottom that the compulsory treatment report comes into being. It should only ever be used in extreme emergency situations where there is no other option. We do not want to see the open-door attitude that the United States often has to compulsory treatment. We have heard very bad stories from across in the United States.But we were pleased to see that severe substance addiction is defined as “the compulsive use of a substance that is of such severity that it poses a serious danger to the health or safety of the person suffering from it or seriously diminishes the person’s ability to care for himself …”. We would also like to see the addition of a clause that states that no other treatment options have been considered or that they have all been considered and tried.We all know that compulsory treatment is not the best way to facilitate treatment so how can we encourage those who actually need help to seek it for themselves? It is quite an interesting challenge there because the stigma towards mental health issues and seeking help has to be removed; therefore we need some funding directed towards the situation. We need education as well as treatment and that in itself is a big ask.We are pleased that there are provisions in the bill to inform family members of the person’s status and to notify them of the centre where their family member is receiving treatment as well as any other information but we believe that families should also have the opportunity to have some input into the decision making. It is difficult to see how the bill will be incorporated as part of the Director of Mental Health’s vision for mental health in 2030 for “a holistic family/whānau-focused model of service delivery”.During the select committee’s consideration we are going to be interested in discussing how the rights of the person can be protected and ensuring that the bill does not contravene the UN conventions. We are adamant on this side of the House—New Zealand First in particular—that any benefits of compulsory treatment have to outweigh any potential infringements on the person’s rights. The criteria around compulsory treatment have to be robust.Additionally we have got concerns about the lack of evidence or otherwise of the ability of compulsory addiction treatment to deter future substance abuse—and of course there are no statistics on that. It is critical that the person is actually receiving the best form of treatment—I think other people have actually mentioned this as well.When this bill passes into law—because it inevitably will—it is expected to cost $775000 to implement. We would like to know whether there is going to be new money allocated for this or whether it is expected to be taken from the existing mental health and addiction budget because that is already stretched at this point in time.New Zealand First supports the bill. We are going to be following the issues that I raised very closely. We look forward to hearing from a wide range of people to carefully consider their views and the issues that they have identified as well. Thank you.SCOTT SIMPSON (National—Coromandel): One of the fascinating things that occurs when one becomes a member of Parliament is that you learn things. Members of Parliament have an opportunity to hear information to absorb information and to participate in decision making in a way that others sometimes do not. On the Health Committee we get an opportunity to do that very frequently in areas that are difficult and sometimes contentious. They are areas that sometimes transcend the moral the ethical and the medical. It is judging the fine line and the balance between those competing and sometimes conflicting priorities for individuals and the State that makes decision making difficult and complicated for us as members of Parliament.This piece of legislation is very timely; in fact it is probably well overdue. I have been very impressed with the careful considered contributions of all members across the House this evening in this first reading debate. I think it is an example of Parliament working at its best when we consider these delicate sensitive but important issues as carefully and as well as we have this evening.This bill has its genesis in some very good work that was done by the Law Commission back in 2010. It seeks to update replace and modernise the principal Act which goes back to 1966. Of course that was a long time ago; so much has changed since 1966 with the way that medicine treatment and even the causes of addiction have transformed people’s lives. Back in the mid-60s most people were concerned with the drugs in fashion at the time and now we find that all these years later those drugs still exist they still inflict harm and damage upon people but now they have been added to by a huge range of more complicated more horrendous and more damaging drugs which cause even greater harm to society and of course to the individuals who become addicted.The question that the Health Committee really will need to address when it considers this piece of legislation and when it hears from submitters is where the balance is in the responsibility of the State to intervene in an individual’s life when that individual either cannot or will not for whatever reason be in a position to address those issues for themselves. At what point do we find that it is right and proper for the State and us as responsible members of society to intervene upon the sacrosanct rights of individuals to make their own decisions in a way that affects them personally?This change in mental health and addiction treatment that has occurred since the principal Act was introduced way back in 1966 is going to be very important not only for the people who find themselves in a situation where they need help and assistance today whether or not they know it but also for those who are yet to come ahead because sadly the scourge of drugs and addiction is going to be with us for a very long time—probably for the rest of time as we know it. So it is right and proper that this Parliament addresses these issues.It is a technical but complicated ethical piece of legislation but it is something that we as politicians and members of the New Zealand Parliament need to get our heads around in an intelligent informed and careful way. I am very confident that under the very capable chairmanship of Simon O’Connor the Health Committee and other members will be able to do that. I commend this bill to the House.Mr DEPUTY SPEAKER: David Clendon—a 5-minute call on behalf of the Green Party.DAVID CLENDON (Green): On behalf of the Greens I am pleased to reiterate our support for the Substance Addiction (Compulsory Assessment and Treatment) Bill to go to select committee for a good investigation there which I am sure it will receive. The point has been made and I will not labour it that the legislation this will replace does date to 1966 and that since that time our understanding of addiction is very different. There are many more substances it would seem to which one can become addicted. Our understanding of what constitutes appropriate treatment has changed.As my colleague Kevin Hague mentioned a shift away from a punitive regime to one genuinely focused on treatment is entirely appropriate. I think those are all things that this bill seeks to achieve. Sadly what has not changed of course is that it would seem that there is still a need to have a legislative power to compel people to take treatment if they are in such a state of mind that they are unable to make those decisions on their own behalf as an option of last resort for people who either lack family or community support or indeed have rejected that in the depths of that addiction.I should just say in passing that I have the greatest admiration for people at the sharp end of this sort of work who work with severely addicted people. I think you would have to have a more than usual quality of compassion because people in that very degraded state would not be the most attractive people to get up close and personal with I believe. It is a credit to those folk who do this work day in and day out that they manage to pick people up out of that pit and help them on to a better path.The Law Commission in 2010 issued a report on which this bill is based and established a number of key principles which we hope to see and indeed there is evidence of them being embedded in the text of the bill. For example there is a very high threshold for compulsion and that is as it should be. It is an extraordinary intervention in a person’s life and it is against their rights in a sense to compel them to take treatment and so the threshold needs to be high and I think this bill does do that. The notion of limited duration—8 weeks—seems to make a great deal more sense than 2 years which does seem excessive. One would hope that after 2 years a person may be in much better shape to make their own decisions. Also there is the notion of protecting human rights of course and the idea that the compulsory treatment should lead directly on to a pathway—that people are not simply brought out of crisis and then abandoned but that there will be an ongoing pathway for them to pursue a voluntary course of treatment for as long as that takes.In terms of protection of rights it would seem the bill does make some efforts to address that. I like the fact that there is a clear definition of exactly what constitutes severe addiction so that those people doing that assessment can make as sound a judgment as can be made. The bill defines clearly what treatment is and excludes certain things that on a bad day may be deemed treatment but in fact would look more like punishment. There are criteria around which the compulsion may be determined to be the appropriate way to go: proof of severe addiction severely impaired judgment and that appropriate treatment is available because of course it makes no sense to compel someone to a course of treatment if in fact there is nothing available to them. One would hope there always would be. So there are these fairly high bars set and a degree of principle underpinning that.We understand that of course the legislation does allow for some use of force if people are unwilling to be taken to a place of assessment or a place of treatment and there are some safeguards around that. I am particularly pleased to see that the treatment centres will be listed in the Crimes of Torture Act as places of detention and therefore subject to the “OPCAP” the Optional Protocol to the Convention against Torture and so the national preventative mechanisms—the Human Rights Commission the Ombudsman and so on—will have oversight of these treatment centres and I think that is an appropriate thing. As I say these will be some of the most vulnerable people in our community when they are in this condition and of course it is appropriate that we have the highest order of monitoring of those sites where they will be treated.So I will simply finally say that if we seriously wish to reduce the number of people who will fall into this category of severely addicted we need to look very hard at the current resourcing of community-based drug and alcohol treatment. I suspect that there is scarcely a provider in the country that has no waiting list and is properly resourced. I would encourage all of us to take that issue very seriously. Thank you.Mr DEPUTY SPEAKER: The Hon Ruth Dyson—a 5-minute call on behalf of the Labour Party.Hon RUTH DYSON (Labour—Port Hills): Can I begin my contribution to the Substance Addiction (Compulsory Assessment and Treatment) Bill by paying a tribute to all those people who in the past under different regimes have died as patients or residents—or inmates as they were previously called; can you believe—in our psychiatric institutions around the country. I have no criticism of the health providers or the decision makers of the time because I think everyone did what they genuinely thought was for the best in the best interests of the person and their treatment. We have clearly come a long way since then and thank goodness for that.I also want to pay a tribute to two women who in my view changed the way that Parliament considered and acted in relation to mental health learning disabilities and drug and alcohol treatment and they are the Rt Hon Jenny Shipley and the Rt Hon Helen Clark. Both of those women as leaders of Labour and National at the time made a conscious decision to stop using people particularly people with mental illness as pawns in this institution that we are privileged to serve in. And I think that was good not just for Parliament but it was also good for our consideration of mental health and therefore the treatment that people got. So I just want to put on record my appreciation of that change.I hope that other changes are driven in Parliament as well. Too often we make—I have only been viewing second or third-hand actually through Twitter. Is it The Bachelor New Zealand? Whatever that programme is I think we make that look quite sophisticated from some of our behaviour. I will just stop there but I hope that we can get some other change driven.I also want to acknowledge the Law Commission. It started this process. It saw an area where work needed to be done. It does mostly really robust thoughtful work and it gives Parliament something very strong to build on and that is evident I think from the contributions that have been made from a range of different parties already tonight.So this bill will throw out the old system—and so it should; it is outdated—and move to a new system that has an entirely different frame. We are no longer talking about penalty and punishment and the justice system in our area of drug and alcohol addiction. Let us wait for other recognition of that move of a frame as well—but at least it is starting in the treatment area—through to a harm reduction. So that health approach I think is a very bold step and it is one that clearly Parliament is up to supporting.My concern is not for any of the specifics or the principles of this legislation. I think the Hon Peter Dunne has done a jolly fine job actually in picking up the Law Commission’s work and then fine-tuning it through the various processes of Cabinet into a bill that we all support. My concern is that in the end the services that we rely on so greatly in our communities have to be resourced well enough to do the job that we expect of them. So we are setting in place here a legislative framework where the provision of services will be different and additional to what we have now.I just want to put on the record that these organisations that do this amazing work around our country need the money to pay for it. They cannot employ cheap monkeys. They have got a high-quality professional job to do and they should pay them properly. So this needs to be resourced. If the $1.7 billion out of the health budget is an indication of how seriously the Government takes this then we should be concerned.I have enjoyed the debate so far tonight and I am sure I will enjoy the remaining few speakers. It is not very often that we have an issue that is so important to so many people—so many individuals and their families—and yet it has such support across the various parties in Parliament. It is I think a long-overdue measure but it is one that has taken the proper time to come to fruition and a proper process. The Law Commission is a very good place to start this work and I think that the process that has been undertaken since then and the discussion papers widely debated throughout the provider and support advocacy group community has ended up with a jolly fine bill as a result.Dr SHANE RETI (National—Whangarei): It is a pleasure to speak to this the Substance Addiction (Compulsory Assessment and Treatment) Bill a bill that looks to help people who have severe substance addiction and substance problems get assessment and treatment. I mention both of them specifically because we have all gone to the compulsion to treatment; just remember that the first step is actually the compulsion to assessment. And certainly I found that the most challenging.When you are on duty doing after hours in a city and you get called by the “DAO” which was the 1992 definition—the duly authorised officer—to come along with them because they have got a patient they are concerned about you go out the back of a block of flats and there is this really large male in various stages of undress who is clearly not coherent. You are always very mindful and grateful to have the experts around you but you are stuck with what the step is. The step to assessment was very complex; it was not clear. And we were looking at each other saying: “Well who does what? What’s the next step? Clearly this person needs assessment.” Well this bill looks to clarify that and it gives us the opportunity to talk about that pathway to assessment because I believe that once people have touched the system and got specialist attention the best outcome that can happen generally does.What this bill says is that when people have a loved one or someone they are concerned about who has substance abuse problems often one of the first contacts is what the bill is calling an authorised officer. That will be a health professional and that professional is appointed by the area director and the area director makes sure there are always enough authorised officers in the region. The first thing that authorised officer does is seek voluntary compliance from the patient. Is there a way that you can help them with their own consent? If that fails what then happens is the authorised officer approaches a medical practitioner. That medical practitioner has two tasks. The first is to assess whether that person has severe substance abuse and the second is to assess whether they have capacity to make informed decisions.As has been mentioned there are four criteria for whether a person has severe substance abuse. Two of those four criteria are required. The first one is neuro-adaptive changes. With substance abuse the common pathway is dopamine in the brain. What neuro-adaptive changes mean effectively is you get down regulation of the dopamine receptors. You get fewer of them and they become less sensitive. We know that as tolerance. So they are looking for evidence of that: craving unsuccessful attempts to control the use of the product and ongoing use despite harmful consequences. I think the second criteria the capacity to make informed decisions can be quite complex. There is a lot of contemporary discussion around what autonomous decision-making means but I think there is a good piece of work here in clause 9 saying it is to understand the relevant information retain that information and be able to communicate that decision.What happens then is the medical practitioner has to document their findings. They have to attest that they are not a relative of the applicant or of the client themselves. If for any reason you cannot get a medical practitioner to do that the authorised officer is able to do that by completing a memorandum. The authorised officer then makes the arrangements and those arrangements can also involve the police and then the person enters the system. They are able to be assessed and hopefully the best of care can be obtained.I think this adds clarity to an area that I have personally found in practice to be really complex. When someone is shouting and when they are threatening you often it is unclear as to who does what. I believe this adds clarity. I personally have no issue with compulsory incarceration or detention for treatment. When you see some people who are clearly a harm to themselves and clearly a harm to the public you just want to get them back to that state where they can make their own decisions. However you do that in a clear and concise way I think is a good thing. I think in its first reading this is a good bill. I support it and commend it to the House.CARMEL SEPULONI (Labour—Kelston): I wish I were on the select committee for this bill; unfortunately I am not but just reading through the Health Committee’s notes before standing up to do this speech it is a really interesting area and an area that I am sure many of us in this House are concerned about. I have an electorate office in west Auckland in Glen Eden that I share with Peeni Henare and Kelvin Davis and on a regular basis we see citizens outside our office who clearly are exhibiting either mental health issues or substance addiction issues or both. So seeing this bill is of high interest to me.The Substance Addiction (Compulsory Assessment and Treatment) Bill sets out a framework for the compulsory treatment of people who are assessed as having a serious substance addiction and lacking the capacity to consent to treatment. The explanatory note states that only a small number of people are expected to be treated and treatment will be for a limited time. The departmental disclosure statement describes the aim of the bill as restoring “the capacity of people with severe substance addictions to be able to engage in and remain in treatment.”The bill seeks to repeal and replace the Alcoholism and Drug Addiction Act 1966. The Act is described as “outdated” by the Law Commission which notes that “there are difficulties in reconciling the broad powers of detention with the rights and protections in the New Zealand Bill of Rights Act 1990.” The bill’s provisions for both compulsory treatment and detention in a treatment centre have been assessed by the Ministry of Justice as being consistent with the relevant sections of the New Zealand Bill of Rights Act 1990.Labour supports this first reading to update the Alcoholism and Drug Addiction Act 1966. The Act is almost 50 years old and not in line with modern clinical practice and delivery. It is good to see that the recommendations from the Law Commission are finally being implemented in legislation. Under the current 50-year-old legislation two medical certificates are required to make an application to the court for compulsory treatment and neither has to come from a specialist drug and alcohol practitioner. We support the requirement that compulsory treatment can start only via an approved list of specialists when the criteria for compulsory treatment are met.We must safeguard the rights of patients undergoing compulsory treatment. There are circumstances where compulsory treatment is necessary due to the incapacity of the patient to make a decision on treatment for themselves. However the rights of patients must be upheld and appropriate safeguards must be in place for situations where compulsory treatment is not found to be necessary. It is important that these patients have the same rights as those held under the mental health legislation.A shorter time period for treatment—so 8 weeks with the option of extension—with the goal of moving an individual into voluntary treatment is a far more progressive approach in treating severe substance abuse when patients are unable to make a treatment decision. The statutory period for treatment under the current legislation is 2 years which far exceeds the time frame needed for treatment. Under the current legislation there is an average of 70 compulsory treatment orders per year and it is estimated in the regulatory impact statement that these changes will lead to an increase to approximately 200 orders per year.Even though it is extremely important and necessary to update this legislation we do have to make sure that at the same time we are resourcing health professionals and the New Zealand Police to enable them to carry out their duties under this bill. At this point I will point out the fact that under the National Government we have seen a $1.7 billion cut over 6 years out of the health system. Of course that has implications for areas like mental health and addictions.It is crucial that any estimated uptick in demand for mental health services is resourced and I have to say that is a criticism that we have of the National Government. Often it puts things into legislation without thinking through the implications and the additional areas that need to be resourced. So we need assurance from the National Government that it will be increasing its resourcing in this area to ensure that all of the good things that are trying to be attained through this legislation are actually able to happen. We have seen the consequences of under-resourcing in mental health and of expecting the New Zealand Police to become the front line of mental health services. It is the police—it is every social service agency that is expected to pick up where the Government has failed.I just want to point out an article that I saw in the New Zealand Herald. It was an opinion piece—I cannot remember who wrote it—over the Christmas period and it was just about the increasing levels of homelessness that this person was seeing and the fact that actually what they wanted to know was that their tax dollars were taking care of these issues so that every day they were not having to be confronted by these issues. I think all New Zealanders will agree that they want to see their tax dollars spent on areas like this so that every day when we walk out of our homes when we walk into our shopping centres and when we walk out of our offices we are not confronted by the homelessness by the mental health issues and by the drug and addiction issues that we currently are confronted by on a daily basis. Jami-Lee Ross laughs but it is not funny.Putting it in legislation creating a bill like this is all good but just going back to what I was saying it is about making sure that the support services—the health professionals the New Zealand Police and everyone who contributes to addressing these issues—are adequately resourced. So that is the challenge we have to put to the Government. The regulatory impact statement states that “Additional resources have been made available to district health boards for medically managed withdrawal beds.” but it will be interesting to see whether the $775000 of additional operating costs is sufficient to cover the increase in orders.Another serious resourcing question arises as to whether these additional costs will result in new funding being given to district health boards or whether as has become standard practice in health services the shortfall is made up from district health boards’ already overstretched baselines. We have seen in recent months—especially I think in Canterbury—cuts to mental health funding. Mental health funding drug and addiction funding—we need the Government to make sure that our district health boards are adequately resourced to be able to address those areas.The bill also creates offences relating to the ill-treatment or neglect of patients undergoing compulsory treatment or for the staff at a treatment centre assisting or allowing a patient to be absent without leave. We have seen recent media cases of patients under compulsory treatment escaping care with tragic consequences. It is noted that this risk is going to be managed by the development of a management treatment plan for each individual and there are provisions in the bill to return a person to a treatment centre by an authorised officer or the police.This is an incredibly important bill. We will be supporting this bill. Not only are we confronted on a daily basis with mental illness with drug and addiction issues and with homelessness but also we come across many families who have this as their daily reality. They are having to live through this with their children having to put up with a whole range of things whether it be the fact that they have family members who are violent because of these issues or whether they have family members who are stealing from them because of these issues—a whole range of consequences of substance addiction. I know that these families I am talking about who have to live this nightmare on a daily basis are going to be supportive of this bill as well. Thank you.MAUREEN PUGH (National): It is a pleasure to stand and take this short call in support of this bill. This Government continues to focus on four priorities one of which is delivering Better Public Services. The Substance Addiction (Compulsory Assessment and Treatment) Bill fits well within that priority. As we have already heard tonight the health budget has grown to a record level of just under $16 billion under this Government. With that core services such as treatment for alcohol and drug addiction continue to receive Government support.This is a sensible bill; it modernises the legislation to reflect the support we offer to New Zealanders who struggle with drug and alcohol addiction. Most people who abuse alcohol or other drugs do not need compulsory treatment; however some people are just so unwell that they are not able to make that decision for themselves. I have confidence that families who have struggled with loved ones suffering from severe alcohol and drug addiction will support this piece of legislation as do I. I commend this bill to the House.Bill read a first time.Bill referred to the Health Committee.