Policy Setting

Issues facing the Addiction Treatment Sector

2009/10• Growing number of people experience alcohol

and other drug addictions and gambling related harm.

• Public concern regarding Methamphetamine.• Priorities reflect those of government.• Demonstrate value for money.• Improving services for children and young

people.• Greater understanding of addiction and

ensuring people with co-existing mental health and substance abuse problems.

• Workforce development.

Policy Makers as Stewards

• In WHO’s view, policy makers act as the overall stewards of the resources, powers and expectations entrusted to them.

Policy DocumentsThere are several policy documents that provide the strategic directionfor the addiction treatment sector in New Zealand:

• Te Tahuhu Improving Mental Health 2005–2015: The Second New Zealand Mental Health and Addiction Plan (Ministry of Health, 2005)

• Te Kokiri: The Mental Health and Addiction Action Plan 2006-2015 (Ministry of Health, 2006)

• Tauawhita te Wero: Embracing the Challenge. National Mental Health and Addictions Workforce Development Plan 2006-2009 (Ministry of Health, 2005)

• Kia Puawai Te Ararau; The National Māori Mental health Workforce Development Strategic Plan (Te Rau Matatini, 2006)

• Te Awhiti – The National Mental Health and Addiction Workforce Development Plan, for and in support of, Non-Government Organisations 2006-2009 (Mental Health Programmes Ltd, 2006)

• Te Raukura: Mental Health and Alcohol and Other Drugs: Improving outcomes for children and youth (Ministry of Health, 2007)

• Alcohol and Other Drug Practitioner Competencies (The Drug and Alcohol Practitioners’ Association, Aotearoa-New Zealand)

• National Drug Policy 2007-2012 (Ministry of Health, 2007).

Co-existing Problems

The biggest challenges facing frontline mental health and addiction treatment services:

• Improving the effectiveness and efficiency will make a tangible difference to the lives of an estimated 7.7% of New Zealanders.

• Effectively identify and manage co-existing problems in a more integrated way could reduce the overall workload.

• Early detection and treatment of co-existing.

A large proportion of people who experience addiction problems also experience a range of mental health problems and vice versa:

• Common rather than exceptional among people with serious mental health problems.

• Many people with alcohol and other drug problems experience a range of mental health problems at higher rates than in the general community

• Māori and Pacific people, higher burden of mental health and addiction.

• Problem gambling co-exists with mental health and/or alcohol

• Criminal justice system have a high prevalence of co-existing mental health and alcohol or other drug problems

• Associated with underachievement or failure across a number of key life domains including academic, employment, relationship, social and health.

• Severe co-existing mental health and addiction problems experience greater involvement with the criminal justice system, higher rates of institutionalisation, more failed treatment attempts, poverty, homelessness and risk of suicide.

• People with co-existing problems are a large and heterogeneous group and for this reason present both clinical and organisational challenges for service providers:

– The type, intent and frequency of substance-use, the nature and severity of illness, the age of the user, and the physical and social impact of either or both disorders, all contribute to and expand the scope of problems and complexity of diagnosis (VGDHS 2007:4)

Challenges• Conflicting philosophies of addiction treatment and

mental health services.• Clinical practitioners may miss or choose not to identify

co-existing mental health and addiction problems among their respective clients.

• Primary care providers may be insufficiently alert to the needs of those with common mental health and addiction problems, let alone combinations of those disorders.

• Lack of evidence regarding best practice for treating co-existing mental health and addiction problems.

• There is no ideal service delivery model, need to ensure an array of internal capability or linkages to other programmes to ensure that services are provided in an appropriate, accessible setting based on the needs of the population they serve.

Response from Ministry of Health

• Assisting clinicians to identify and manage co-existing mental health and addiction problems more effectively.

• Building collaborative, intersectoral approaches to the identification, treatment, and management of co-existing mental health and addiction problems.

What does this mean for you as a nurse?

• Attitudes towards those with mental health and addiction issues.

• Addiction is like other serious psychiatric conditions such as schizophrenia.

• Better coordination of services.

• Changing model of care, consider recovery-focused.

Recovery Management

• Pre-recovery identification and engagement.

• Recovery initiation and stabilisation.

• Long-term recovery maintenance.• Quality-of-life enhancement for

individuals and families affected by severe substance use disorders.

Conclusion• A substantially expanded knowledge

base and emphasis on research and evidence based practice.

• Increased commercial and contractual demands on services, particularly non-government services.

• Increased professionalism, and greater accountability.

• Greater connectedness between disciplines and between addiction treatment service and mental health and general health services.