Alcohol, Tobacco and other Drugs Council of Tas Inc. (ATDC)
Phone: 03 6231 5002
Suite 1, Level 1, 175 Collins Street
Hobart TAS 7000
www.atdc.org.au
Contact: Debra Rabe, CEO
©Alcohol, Tobacco and other Drugs Council Tas Inc.
2012, Hobart, Tasmania.
The Alcohol, Tobacco and other Drugs Council
The Alcohol, Tobacco and other Drugs Council Tas Inc. (ATDC) is the peak body representing the interests of community sector organisations (CSOs) that provide services to people with substance misuse issues in Tasmania. We are a membership based, independent, not-for-profit and incorporated organisation.
The ATDC is the key body advocating for adequate systemic support and funding for the delivery of evidence based alcohol, tobacco and other drug (ATOD) initiatives. We support workforce development through training, policy and development projects with, and on behalf of, the sector.
We represent a broad range of service providers and individuals working in prevention, promotion, early intervention, treatment, case management, research and harm reduction.
We are underpinned by the principle of harm minimisation, which aims to improve public health, social inclusion and co-morbid illness outcomes, for individuals and communities.
We play a vital role in assisting the Tasmanian Government to achieve its aims of preventing and reducing harms associated with the use of alcohol, tobacco and other drugs in the Tasmanian community.
Our Recommendations
1. That the Government provides recurrent funding for a consumer voice (organisation or individual) for people who use alcohol, tobacco and other drugs. Key functions/discrete projects of this group could include:
· Proving policy advice (eg: input into reform processes and policy fora)
· Facilitating a feedback process
· Scope innovative methods of NSP provision, e.g.: outreach, mail order models with the outcome of recommending responsive service approaches to the Tasmanian context.
· Work with TasCAHRD to identify ways to address barriers to HCV treatment from the perspective of people who inject drugs. (reiterated in number 6)
2. That the Government identifies discrete capacity within the Mental Health Alcohol and Drug Directorate/Alcohol and Drug Service and the community sector to support the outcomes of the ATOD Service System Review to enable the reconfiguration of the entire ATOD sector.
3. That the government invests in a consistent data collection and analysis system across the entire ATOD sector (Government, private and community sector organisations) to enable activity and performance reporting obligations to be met and to inform research and planning priorities.
4. That the Government negotiates the development of a sustainable grant indexation formula which is applied to all community sector organisations.
5. That the Government commences a time-limited project to prevent overdose and to identify and address the barriers to accessing Naloxone within Tasmania.
6. 6.1 A review of access and equipment provision in the NSP according to public health imperatives is conducted. The Tasmanian Government must increase access to sterile injecting equipment across Tasmania, focusing on the following:
· In rural and remote areas by working in partnership with community pharmacists
· By increasing the availability of NSP equipment by location and opening hours
· By providing education and support to peers.
· Examining outreach models to supplement fixed site provision.
6.2 An ATOD service user individual/organisation is funded to look at innovative methods of NSP provision, e.g.: outreach, mail order models with the outcome of recommending responsive service approaches to the Tasmanian context.
6.3 Funding is provided to Tasmanian Council for Aids Hepatitis and related diseases to scope and identify further appropriate access points (GPs, Superclinics) to provide HCV treatment.
6.4 ATOD service user works with TasCAHRD to identify ways to address barriers to HCV treatment from the perspective of people who inject drugs
7. That the government invest in the further development and incorporation of AODhelp into frontline health and community services.
8. That Government places an equal and significant policy focus on preventative health and early intervention, alongside regular and acute treatment programs for alcohol, tobacco and other drugs.
1. Fill the long-standing gap in our service system, fund an ATOD service user perspective.
ATOD service user perspectives are a critical component of any ATOD service system. Tasmania currently does not have a funded individual/organisation that provides an ATOD service consumer voice. A consumer voice must exist alongside the formal treatment service system and performs an essential role in facilitating entry to treatment. The criminalisation and stigmatisation of people that use alcohol and other drugs is widely recognised as reducing access to health care and treatment seeking, and this is something ATOD service user perspectives play a key role in countering, by supporting engagement with the treatment system and actively representing the interests of their marginalised constituents in health care and policy settings.[1]
Specifically there are five roles/activities that ATOD service user organisations undertake in supporting treatment:
1. Creating treatment access and entry points
2. Client complaints services
3. Provision of peer-based treatment interventions
4. Advocating for better treatment policies
5. Workforce development and capacity building.[2]
It is well recognised that increasing meaningful input from consumers into program and service design and delivery, as well as policy development, ultimately leads to improved economic, social and health outcomes as programs become more responsive to consumer needs. Fundamental to this for the ATOD sector is engagement with consumers to ensure that those with a lived experience are able to influence and participate in the appropriate development of the service system. Evidence-based best practice identifies that consumer representation is best achieved when consumers are directly involved in policy and program development and in service delivery.
Genuine consultation, engagement and consumer empowerment is complex and time-consuming and will be best achieved in Tasmania via the funding of a consumer voice for people who use alcohol, tobacco and other drugs. This type of organisation of this type will only flourish if it is truly enabled and supported to be self-regulating, sustaining and independent. Establishment and recurrent funding is essential to ensure the ongoing sustainability of such an initiative.
Late in 2014 the Tasmanian User Health and Support League (TUHSL) was incorporated and now operates with a volunteer board. Funding would enable the recruitment of staff and the acquisition of basic infrastructure necessary to fulfil the objectives of the organisation’s constitution. Or alternative a funded position could be located at the ATDC with view of a longer term outcome of raising capacity to develop an independent organisation.
If the ATOD service system continues to operate in the absence of an effective and funded ATOD service user organisation, money invested into ATOD services will not reach its full potential in delivering services to the Tasmanian community.
Recommendation:
That the Government provides recurrent funding for a consumer voice (organisation or individual) for people who use alcohol, tobacco and other drugs. Key functions/discrete projects of this group could include:
· Proving policy advice (eg: eg: input into reform processes and policy fora),
· Facilitating a feedback process,
· Scope innovative methods of NSP provision, e.g.: outreach, mail order models with the outcome of recommending responsive service approaches to the Tasmanian context,
· Work with TasCAHRD to identify barriers to HCV treatment from the perspective of people who inject drugs.
2. Maintain momentum following the ATOD service system review process
Recent factors such as a rise in crystal methamphetamine use and associated problems and challenges to public health and community cohesion (family violence and child protection issues, to name two) as well as implications for housing and wider welfare services has increased urgency to ensure ATOD services are highly responsive and appropriately targeted.
In late 2016, the Mental Health Alcohol and Drug Directorate employed a consultant to deliver a suite of working papers and reports, which at the time of writing, is expected to be delivered in the first half of 2017. This process will culminate in a final report that will clearly articulate options and recommendations to enable the DHHS, working closely with the Tasmanian Health Service, Primary Health Tasmania and the Alcohol, Tobacco and other Drugs Council Tasmania, to develop a single alcohol and other drugs (AOD) service system framework for Tasmania. This will provide a roadmap for reform of the ATOD service system.
The ATDC strongly supports this reform process and maintains that momentum following the review process must be maintained. The ATDC strongly argues that it is critical that the options and recommendations from the Final Report, outlined above, be adequately resourced.
Recommendation:
That the Government identifies discrete capacity within the Mental Health Alcohol and Drug Directorate/Alcohol and Drug Service and the community sector to support the outcomes of the ATOD Service System Review to enable the reconfiguration of the entire ATOD sector.
3. Creating an evidence base for ATOD sector
Currently decisions around the distribution of ATOD funding are made in the context of scant data on Tasmanian drug use and service usage. The collection of data and information is a fundamental component that scaffolds any service system. Such evidence works to enhance the responsiveness of service provision. Data provides a rich asset about the services that are being provided by organisations and to whom and whether successful outcomes are being achieved for individuals and the broader community. Information on region specific drug trends also adds value in service design processes and underwrites responsible decisions around the distribution of public funds.
In regional Tasmania, as in many other rural and regional jurisdictions nationally, there have been many anecdotal reports regarding increased use and availability of crystal methamphetamine (ice). Through media and public meetings, calls have been made for enhanced treatment services and increased policing, with the goal of reducing use of this drug and harms associated with it. However, to date, there has been a lack of any rigorous research conducted in these regional areas of Tasmania to support these claims.
Whilst different organisations may provide a diverse range of services across the public and community sector it is key for service comparison and analysis that some core data is collected and reported on in a consistent manner. It is possible to achieve this consistency without the same information system to be used by all service providers with sophisticated collection and analysis approaches.
Given the investment in ATOD Service System reform processes, it is essential that investment is made in data and information management systems across the entire ATOD sector to enable the collection and analysis of an evidence base. Such a reform will enhance the accountability and responsiveness of processes around the distribution of public funds.
A partnership with the University of Tasmania, as an independent research institute, would generate many benefits. Using the intellectual capital of the University of Tasmania to synthesise existing data collected by all services across Tasmania, used in combination with secondary data sets and existing research projects, a clear picture of drug use, harms, service usage – and consequently issues and outcomes- would be apparent. This type of picture ostensibly scaffolds decision making and is a rich resource for everyone in the ATOD service system.
Recommendation:
That the government invests in a consistent data collection and analysis system across the entire ATOD sector (Government, private and community sector organisations) to enable activity and performance reporting obligations to be met and to inform research and planning priorities.
4. Provide sustainability in funding and service delivery
Despite increasing expectations and demands for the provision of community services, as well as an increase in day-to-day operating costs, the Tasmanian State Government has not adequately indexed funding grants. This continuation of the legacy of the former State Government undermines the viability of the overall community sector which is a key employer within Tasmania. While service demands have remained the same or increased, consumables (e.g.: rent, electricity, infrastructure) have increased in price, this often means that cuts to frontline service provision have to be made in order to account.
In 2001 the State Government introduced a grant indexation funding formula for Department of Health and Human Services (DHHS) administered grants. This funding arrangement was linked to public sector earnings and was in recognition of the inconsistencies in wages between the public and community sector. The indexation arrangements were subsequently abandoned in 2011 and since that time indexation arrangements have been inadequate. Given the Government’s commitment to funding the Equal Remuneration Order (ERO) it is now timely to reconsider and renegotiate indexation arrangements to ensure the ongoing sustainability of the community sector.
Recommendation:
That the Government negotiates the development of a sustainable grant indexation formula which is applied to all community sector organisations.
5. Cut the number of overdose deaths of Tasmanians
Naloxone is a schedule 3 and 4 drug used to counter the effects of opiate overdose. Naloxone is widely used in Australia and internationally by paramedics and hospital emergency department staff in cases of suspected opioid overdose. Where Naloxone has been distributed as part of an emergency overdose kit to heroin and other opioid drug users, this has been shown to reduce rates of fatal overdose.
Naloxone has no psychoactive effect, is not a drug of dependence, and therefore, is not a substance which is likely to be diverted or misused. The purpose of expanding naloxone availability is to further reduce and prevent death, disability, and injury from opioid overdoses through provision of training and resources to opioid users and their friends and family members who could be potential overdose witnesses.
ATOD sector is committed to a project to implement an effective overdose prevention and management framework. Whilst identifying and addressing the issues that limit the safe availability of naloxone other likely project outcomes would include:
· increased effective interventions in opioid overdose management
· comprehensive overdose management training to potential overdose witnesses
· increased access to naloxone under prescription to potential overdose victims
· ultimately, across time, a reduction in opioid overdoses.
A project funded by the State Government to identify and address the regulatory, professional and systemic issues that impede the provision of Naloxone to save the lives of those experiencing opiate overdose is necessary in Tasmania.