Controlled Substances (Youth Treatment Orders) Amendment Bill

Second Reading

Adjourned debate on second reading.

(Continued from 22 September 2016.)

Ms SANDERSON (Adelaide) (10:47): I rise to support the Controlled Substances (Youth Treatment Orders) Amendment Bill that was introduced by the member for Bragg. The Controlled Substances (Youth Treatment Orders) Amendment Bill would provide for treatment orders without consent to be made by a magistrate, to be supported by a medical practitioner confirming an addiction and risk of harm, and to provide for residence at a facility for up to 12 months. The legislation would apply to people under the age of 18 and would be similar to applying for a mental health order.

Earlier this year the member for Bragg hosted a drug treatment round table in parliament house. She said:

During these discussions, a key problem that was identified was a lack of consistency of support and treatment services and a 'revolving door' of drug treatment which sees people returning to drugs and dropping out of treatment programs.

This is a very important piece of legislation and, having the shadow portfolio of child protection, there have been many incidents of drug abuse and issues when a treatment facility such as this would have been wonderful. In fact, a year or so ago I met with a foster child, in parliament, who was almost begging to be taking into a drug facility because he knew he needed help. The problem is that we do not have facilities available to help people, even when they self-identify that they need help.

Even if we could get them in, if they waited the months and months that it might take to find a facility that had a vacancy, when they get in there and it all becomes too difficult they can just check themselves out. I have had parents beside themselves; they have spent thousands of dollars to put their child into private drug facilities but, because at the moment we do not have coercion or compulsory attendance, they can then change their mind even though they were quite willing when they went in—they had realised they needed help, they had been selling their parents' property and had been getting in trouble with bikie gangs and the law and having terrible, horrific things happen.

Currently, we have no way to coerce or force them to stay in the treatment, even though we know it is in their best interests. On that point, a lot of people you speak to say that, unless a person has chosen to get help for their drug or alcohol abuse, you are wasting your money; if you force them to go in, it will not work. However, I have some quotes from studies and research that the Canadian Centre on Substance Abuse has done, because there are compulsory facilities available now in Canada.

Alberta's Protection of Children Abusing Drugs Act came into effect in 2006. That requires persons under 18 with an apparent alcohol or drug problem to participate, with or without their agreement, in an assessment and subsequent outpatient treatment or in a program within a protective safe house. There was also legislation passed in late 2005 in the Saskatchewan area, namely, the Youth Drug Detoxification and Stabilization Act, which allowed for the apprehension and detainment against the will of the person under the age of 18 for assessment, detoxification and stabilisation of substance abuse problems.

I have some information here on the effectiveness of such programs. A 1970s evaluation of a US civil commitment drug treatment program, the California Civil Addict Program, examined the effectiveness of methadone maintenance treatment programs for those who entered a program under high, moderate or no legal coercion. There was no significant difference in the outcomes for the three groups, suggesting that the regime under which individuals entered treatment had no impact.

A 2001 international longitudinal study of cases involving civil commitment of individuals with alcohol problems indicated that the health of the clients who had undergone treatment had improved overall and was, on average, superior to other clients undergoing treatment at the same facilities at other times. Although it is often thought that individuals mandated or coerced into substance abuse treatment are less successful than those who enter voluntarily, evidence suggests that treatment can have a positive effect on a person's substance use behaviour, despite being coerced to participate. This is largely based on evidence from coercive treatment regimes and not from mandated treatment settings.

Studies have also identified client motivation as having a substantial effect on program retention rates and outcomes. One such study found that internal motivation was a better predictor of retention rates and client engagement in the treatment than legal motivation. So, whether you are forced or not forced, you could have the same outcomes; it is really dependent on the person. I think this is a very worthwhile policy and I do hope that we have the support of the house.

Both the Layton commission of inquiry and the Mullighan inquiry recommended that consideration be given to the establishment of a secure residential care facility in South Australia. At present, secure care can only be provided by the Youth Justice Directorate within the Department for Communities and Social Inclusion or the Child and Adolescent Mental Health Services under the Women's and Children's Health Network.

Youth justice services and the Adelaide Youth Training Centre secure care facility are the only options for the placement of children who are acting out, or exhibiting extreme behaviours that place themselves or others at risk, and who cannot be contained in other ways. The Adelaide Youth Training Centre is a government service designed to provide a safe and secure environment for young people in custody. If a child is experiencing the early stages of a psychotic illness; suffering severe mental disorder, including depression with suicidal component; or experiencing complex or co-existing disorders requiring multiple assessments and specialised care, they may be admitted to the Boylan Ward.

Whether young people end up in a mental health service or youth justice service may depend on how these difficulties are expressed in either harm to self or harm to others. It is very important to note that other jurisdictions in Australia have developed alternatives to youth justice and mental health responses for children in care. New South Wales, Victoria, Western Australia and the Northern Territory have implemented forms of secure care for children under care and protection orders, although these reforms are relatively new.

In New South Wales, an application is made to the Supreme Court, and the child must be in the care of Family and Community Services. In Victoria, the decision to place a child in secure care may be made by the court or the divisional child protection operational manager, depending upon the order sought and the legal status of the child. There are also similar ideas in Western Australia and the Northern Territory. There is a paucity of evidence either way regarding the effectiveness and practice parameters of secure care for children in care, despite anecdotal support for its judicious use.

Secure care cannot be expected to serve a therapeutic function in the absence of case management that includes a clear conceptual model matched to the client need, clear case planning and availability of a range of post-care options, including semisecure, disability, mental health and youth justice options. Care should be taken to match the children's needs with the therapeutic interventions that have been demonstrated to work. In the Nyland report of 2016, recommendation 152 states:

Develop a secure therapeutic care model, supported by legislation, to permit children to be detained in a secure therapeutic care facility but with an order of the Supreme Court required before a child is so detained. The model should include regular evaluation of outcomes for children.

This was also recommended in a similar way in the Layton Review of Child Protection in South Australia, recommendation 73, and the Mullighan Children in State Care Commission of Inquiry in 2008, recommendation 43. It is highly likely that children who get involved in drugs will end up with a lifelong addiction and a battle with the highly likely mental health issues that tend to follow. Many young people are preyed on by sexual predators, particularly when they are drug affected or need money for drugs. Ultimately, many may have children who are born also affected by drugs. I believe that approximately one baby is born per week in South Australia requiring methadone treatment.

Research shows that drugs, alcohol, domestic violence and mental health issues are the major causal factors of children being removed from their parents, with parental substance abuse being 69.4 per cent likely as a characteristic of the parents of children being taken into out-of-home care. With over 3,000 children in South Australia already in out-of-home care, we know that something must be done. Not all programs work for all people. We have some wonderful programs, such as Operation Flinders and others, but more must be done. I commend this bill to the house.

Debate adjourned on motion of Hon. T.R. Kenyon.