Dunne PeterSUBSTANCE ADDICTION (COMPULSORY ASSESSMENT AND TREATMENT) BILLSecond ReadingHon PETER DUNNE (Associate Minister of Health): I move That the Substance Addiction (Compulsory Assessment and Treatment) Bill be now read a second time. This bill represents a significant and long-overdue change to the way in which we provide compulsory treatment to people with severe substance addiction. It provides for compulsory treatment to be part of a wider treatment pathway while protecting the rights and respecting the wishes of people who are subject to compulsory treatment. The bill has the potential to make a very real difference for a small group of people who are gravely ill.I want to thank the Health Committee for its hard work and its consideration of the bill. That select committee under the chairmanship of Simon O'Connor took the time to listen respectfully to the views of submitters and to consider the issues raised by the bill. I also thank everyone who took the time to make submissions on the bill. The select committee has recommended that the bill proceed with a small number of amendments which I fully support. Since its introduction in late 2015 I have seen this bill cause a real movement within the addictions treatment sector not only in terms of the ways in which the sector is thinking about the practicalities of the new legislation but in its thinking about how compulsory treatment fits into a much broader pathway of care for people with severe substance addiction.This bill repeals and replaces the current Alcoholism and Drug Addiction Act 1966. This legislation is outdated it is rarely used it is ineffective in protecting the rights of people subject to compulsory treatment and it needs to be replaced. Although there are inevitably some concerns with the new Substance Addiction (Compulsory Assessment and Treatment) Bill known as the SACAT Bill the legislation is generally accepted as a significant step forward in the management of people who are gravely ill and for whom voluntary treatment has repeatedly failed to be effective. The SACAT Bill fits within a wide range of services available to people who abuse alcohol and drugs almost all of which are accessed voluntarily.It is important that the new legislation is seen as part of a continuum of care that recognises the fact that most people with addictions can and will engage in treatment when they are ready to do so but that for some individuals their addiction has reached a point where a short period of compulsory treatment is the most appropriate means of supporting longer-term engagement in voluntary treatment. Compulsory treatment when it is used should be for only a short time in order to enable the person with the addiction to become sufficiently well in order to engage in ongoing voluntary treatment. People who come within this new legislation are likely to be very unwell and experiencing poor health across a range of dimensions including chronic physical conditions and poor psychological health.The bill presents opportunities for growth in the addictions treatment sector. People will be subject to compulsory treatment for only a limited period as I say and are likely to need ongoing active support from a range of health services once that compulsory treatment is complete. This means that a range of health services will need to work together because compulsory treatment is about a lot more than just detox or withdrawal management. It involves a concentrated effort to work with the person to restore social and family and whānau relationships to enhance daily living and social skills to manage medical and mental health problems and to reduce the likelihood of relapse through voluntary engagement with treatment services.The bill has been the subject of a number of submissions and has attracted the interest of people with addictions in their families and whānau health professionals and those engaged in protecting the rights of people subject to compulsory treatment. Understandably there have been some concerns about the new legislation particularly from those who will be responsible for its administration. The addictions treatment sector is for the most part unused to managing people within a legislative framework. This means that this legislation will lead to services needing to get their heads around new ways of working even with the small population group that is likely to be affected. This will include the development of skills such as the ability to assess the capacity of an individual to consent to treatment for their addiction. I have deliberately required that the SACAT Bill include a 12-month implementation period. This will enable the Ministry of Health to continue its work with addiction treatment services establishing the systems and the processes that are needed to make this new SACAT Bill work.I am aware that there was considerable feedback to the select committee about the challenges that services will face in implementing the new legislative structure. That was to be expected. We have a sector that is unfamiliar with compulsory treatment legislation and the concepts that it embodies. But I am very pleased to hear that services are already working towards implementations and that a number of regional workshops have been run to assist this process. It is particularly heartening to see that services are taking strong leadership in this area and I am confident that we will have a sector that is well prepared for the somewhat daunting task of taking on this new legislation.But even more importantly this bill is promoting a change in the ways in which the addiction treatment sector thinks about the pathway of care for people who have severe substance addictions. It is quite clear that compulsory treatment is not being considered as the only way in which people can access treatment; neither is it being seen as the answer. People in need of compulsory treatment for severe substance addiction are already high users of health services and I expect treatment providers to actively review the needs of their population to assess how many people are likely to come within the scope of this new legislation. The process of planning for implementation has been well supported by the Ministry of Health and it will include the publication of information about the new legislation workforce development and support for service planning.Let me now comment on one or two of the other issues raised in submissions on the bill. The threshold for compulsory treatment attracted comment with some concerned that the criteria will open the floodgates for compulsory treatment as well as concerns that the legislation will be used simply to facilitate sobering up. I am confident that the criteria that govern access to compulsory treatment are set at an appropriate level to ensure robust assessment and treatment of a profoundly unwell population. The bill makes it clear that compulsory treatment should not be considered as the first line of intervention. In relation to this it is important to note that the capacity test is in relation to the participation in treatment for addiction. It is not about the management of a person's individual affairs nor other decisions that affect their lives. It is only about the treatment of their addiction. I am aware that the testing for capacity both generally and in a more defined sense such as that set out in the bill can be challenging. Addiction treatment professionals will need to learn more about capacity assessment and the Ministry of Health is looking at how it might best work with those experienced in capacity assessment in order to develop appropriate guidance.Another aspect of the bill that has attracted some comment is the requirement that before a compulsory treatment order can be issued treatment must be available for the person. This requirement has been included in recognition of the fact that some people are so unwell as a result of their addiction that ongoing care in a safe environment—and that will in some cases mean palliative care—may be the best option. The bill also recognises that even with compulsory treatment some people will not be able to manage their addiction.Finally the bill has attracted comment regarding the appropriateness of compulsory treatment for addiction and the possible impact on the rights of the person subject to that compulsion. I think it is well understood that for the significant majority of people who abuse drugs and alcohol the decision to reduce or stop using those substances is something that people come to in their own time. It can take several efforts to stop using those substances and the fact that someone returns to using drugs is not a reason on its own for compulsory treatment to be considered.I reiterate that this bill is designed for a very small group of people—essentially those with a severe substance addiction" as defined in the bill—who have severely impaired capacity to consent to treatment for that addiction. Capacity cannot be effectively assessed in someone who is acutely intoxicated; neither can the presence or absence of a severe substance addiction be so assessed. And that will preclude the legislation being used purely for sobering-up purposes as some have feared. I am well aware however of the lack of evidence unequivocally supporting compulsory treatment as a means of treating addiction. But I am also aware that there is no countervailing evidence that suggests that compulsory treatment is ineffective in dealing with addiction.So I am confident that we have struck the balance right with this bill. I am confident that the ways in which the sector is coming together will lead to the bill working as intended. And I note the select committee's recommendation that the bill be reviewed after 3 years of operation. I think that is a very important safeguard against inappropriate use and I fully support its inclusion.Finally I also see that the select committee recommends some changes to ensure that a wider range of treatment services can be considered as treatment centres under the bill subject to certain conditions and again I think that makes sense. It will certainly facilitate care closer to the home and broaden the range of services currently available. I am more than happy to commend this bill to the House."