Chapter 8 Section F : People with mental health conditions who have alcohol and other drug issues
Many people with mental health conditions have co-existing alcohol and other drug issues. There is considerable evidence that the continued use of some substances leads to mental and physical health difficulties and psychosocial disability.
Some people with mental health conditions use alcohol and non prescription drugs to help them cope with the impact of their illness. This can lead to addiction or dependence on a number of legal and illegal substances that they may use.
Often people with mental health conditions and co-existing alcohol and other drug issues experience difficulty when trying to get treatment for both issues. Many services and agencies only work with either alcohol and other drugs, or mental illness, and are unable for a number of reasons to treat both conditions at the same time.
The NSW Government recognised this was problem when it established the NSW Mental Health and Drug and Alcohol Office (MHDAO), and created consultation liaison services to assist NSW hospitals have timely access to specialist staff to help with the management of patients who have mental health and alcohol and other drug issues. However, specialist staff are not always available, especially in rural and remote hospitals. Click here for more information about the MHDAO. The issue of getting appropriate services in the community also remains a problem for many people with both mental health and coexisting alcohol and other drug issues (AOD).
Similarly, people with mental health and coexisting AOD issues often experience poor physical health. NSW Health has a policy on linking physical care and mental health care and has produced a pamphlet on this issue.
The principles and policies that apply to all health services are available on the NSW Health website.
Each Local Health District in NSW has its own policies and procedures. Click here for a list of NSW Local Health District Services with a links to their websites.
If you are not satisfied with an Area Health Service response, you could complain to the Health Care Complaints Commission (HCCC).
For more information about other drug and alcohol support and information services, click here.
- NSW Users & AIDS Association Inc
- NSW Drug and Alcohol Information
- Drug Info Clearinghouse – Drugs and Mental Health
- Australian Drug Information Network
- Guthrie House: a community-based residential rehabilitation and transition service for women who are involved in the NSW criminal justice system.
- Justice Health and Forensic Mental Health Network
- The Connections Project - more information can also be found here
- Forensic Health Adolescent Health
The Connections Project provides post-release support to people leaving prison in NSW who have a history of problematic drug use. Many of these people also have mental health issues. A Clinical Support Worker assesses people while they are in prison before their release and develops a comprehensive care plan that includes addressing all aspects of the person’s needs. This could include, for example, their physical health needs (linking them with appropriate services), helping them get an ID card, getting them a Medicare card, helping with housing, Centrelink, linking them to drug and alcohol and mental health services, and advocating for them. Support is provided for one month after the person’s release, but can be extended up to three months for people with complex needs and/or who haven't linked into services adequately.
The Connections Project is available in all Correctional Centres in NSW and follow-up is provided anywhere is NSW.
If you are currently in prison and are interested in joining the Connections Project or would like to get more information about it, you can talk to a nurse in the clinic in your correctional centre.
Consent for treatment for alcohol and other drug issues is the same as for any other medical condition: treatment can usually only be given with the informed consent of the person getting the treatment. This means that the treatment must be voluntary.
However, there are laws that allow involuntary treatment for drug and alcohol problems in NSW:
- You can be treated without your consent under the Drug and Alcohol Treatment Act 2007 (NSW).
- If you are charged with a serious criminal offence, you can also be ordered into compulsory treatment by the NSW Drug Court under the Drug Court Act 1998 (NSW).
The Drug and Alcohol Treatment Act 2007 (NSW) provides the legislative basis for NSW Health’s Involuntary Drug and Alcohol Treatment Program (IDAT) click here to find out more information about the IDAT Program.
IDAT commenced on 4 September 2012 to provide short-term care, with an involuntary supervised withdrawal component, to protect the health and safety of people with severe substance dependence who have experienced, or are at risk of serious harm, and whose decision-making capacity is considered to be compromised due to their substance abuse. Under the IDAT Program an Accredited Medical Practitioner at the IDAT Facility can issue a Dependency Certificate that means the person who is subject to the certificate can be detained for up to 28 days in the first instance. There is an option to extend the Dependency Certificate for up to a total treatment period of three months in extreme circumstances where withdrawal, stabilisation and discharge planning may take longer. The IDAT Program also provides 3 to 6 months of voluntary community based treatment and support following discharge.
A Dependency Certificate may be issued in relation to the person only if the Accredited Medical Practitioner is satisfied:
- the person is 18 years of age or older; and
- the person has a severe substance dependence;
- the person does not have capacity to make decisions about their substance use and personal welfare primarily because of their dependence on the substance; and
- care, treatment or control of the person is necessary to protect the person from serious harm, and
- the person is likely to benefit from treatment for his or her substance dependence but has refused treatment, and
- no other appropriate and less restrictive means for dealing with the person are reasonably available.
The accredited medical practitioner can also take into account any serious harm that may occur to children in the care of the person, or other dependants.
The IDAT Program currently operates from two locations in NSW: Bloomfield Hospital, Orange and Royal North Shore Hospital, Sydney, both of which provide a State-wide services. There are up to 12 beds available for involuntary patients at both locations.
Health workers, family members and other concerned parties, in consultation with a Medical Practitioner (MP) or an Involuntary Treatment Liaison Officer, can identify a patient as potentially suitable for IDAT and seek to have a comprehensive assessment conducted for IDAT eligibility. On determining eligibility, the identified person must then be referred by a MP to an Accredited Medical Practitioner for an assessment for a Dependency Certificate.
If you require additional information, please contact:
- ADIS (Alcohol and Drug Information Service) at (02) 9361 8000 or 1800 422 599 (outside Sydney); or
- Your Local Health District Drug and Alcohol Centralised Intake contact number to discuss with the local Involuntary Treatment Liaison Officer.
You can search for the right contact by following this link
*Remember, mobile phone calls to freecall numbers (numbers starting with 1800) are charged to the caller at the usual mobile rate.
A visiting magistrate to the hospital must review a Dependency Certificate as soon as practicable after it is issued.
The visiting magistrate can:
- discharge a patient, or
- uphold, extend or shorten the time of involuntary treatment under a dependency certificate.
Legal aid is available through duty solicitors for the reviews held before the visiting magistrate. Contact Law Access on 1300 888 529* for more information.
*Remember, mobile phone calls to freecall numbers (numbers starting with 1800) are charged to the caller at the usual mobile rate.
If you are unhappy with the visiting magistrate’s decision, you can apply to the NSW Civil and Administrative Tribunal (NCAT) for a review of the decision. For more information about the NCAT, click here.
Independent Official Visitors have been appointed to inspect IDAT facilities regularly. They have the same role as Official Visitors under the Mental Health Act 2007 (NSW). This means that you can contact an Official Visitor if you have concerns about your care and treatment as an involuntary patient as well as to make complaints and concerns about the physical conditions at the IDAT Facility.
To contact the Official Visitors Program:
Postal address: Locked Bag 5016 GLADESVILLE NSW 1675
Telephone: (02) 8876 6301
The Drug and Alcohol Treatment Act 2007 (NSW) also allows you to name a person as your Designated Carer so that they will have access to certain information about you while you are detained under this Act. These parts of the Act are very similar to those relating to Designated Carers in the Mental Health Act 2007 (NSW).
The amendments to the Mental Health Act 2007 (NSW) were assented on the 28 November 2014 by way of the Mental Health Amendment (Statutory Review) Act 2014 (NSW). These changes are now in force.The Mental Health Act 2007 (NSW), has replaced the term “Primary Carer” with that of “Designated Carer”. It also introduces a new category of persons called “Principle Care Providers” who are persons primarily responsible for providing care and support to a person with mental illness. Principle Care providers have a similar right to information about the treatment of the person for whom they care to Designated Carers.
A designated carer can also be a person who is a close relative or friend who has frequent contact and interest in the care of a person with a mental health condition. The 'relative' of a person who is an Aboriginal or Torres Islander includes a person who is part of the extended family or kin of a person according to the indigenous kinship system of the person's culture.
If you plead guilty to a serious offence for which you are likely to receive a prison sentence, and you are drug dependent, you can be referred to the Drug Court provided you also meet certain other criteria.
The Drug Court may make an order directing that you serve your sentence of imprisonment by way of compulsory drug treatment detention under the Intensive Drug and Alcohol Treatment Program (IDATP). IDATP is a residential (live in) program for male and female offenders who have drug and/or alcohol problems linked to their offending behaviour. It is a group program which can take up to 12 months to complete.
IDATP aims to:
- help offenders gain an understanding of their substance dependence and offending behaviour;
- reduce the likelihood of re-offending;
- give offenders the skills, resources and support needed to return to the community, alcohol and/or drug-free and crime-free.
The program incorporates a range of therapeutic, health, education, vocational and pre-release interventions aimed at addressing substance dependence, offending behaviour and reintegration. It is offered to offenders at the John Morony Correctional Centre, the Outer Metropolitan Multi-Purpose Correctional Centre and Dillwynia Correctional Centre.
For more information about the Drug Court, and its eligibility criteria and processes click here .
There are programs available for people with alcohol and other drug issues who face less serious criminal charges. These are usually called ‘diversionary programs’ because they are intended to ‘divert’ a person from criminal behaviour that is linked with alcohol and other drug issues, to treatment for those problems rather than punishment.
Diversionary programs are voluntary, in that they are not carried out with you being held behind locked doors in an institution, such as prison or a psychiatric hospital, but there may still be serious consequences if you fail to finish or co-operate in a program. If you do this you are likely to be taken back to court to have the original offence dealt with again. It is best to get legal advice before you agree to participating in a diversionary program.
Programs such as the Court Referral of Eligible Defendants into Treatment (CREDIT), the Rural Alcohol Diversion Program (RAD) and the Magistrates Early Referral into Treatment (MERIT) are examples of such programs.
There is also a NSW Youth Drug and Alcohol Court (YDAC), which aims to reduce re-offending by young people who have become entrenched in the criminal justice system, by diverting them into diversionary programs to overcome their drug and alcohol problem. Click here to find out more.
- The legal and other information contained in this Section is up to date to 30 August 2015.
- This Manual only refers to the law and practices applying to the Australian state of New South Wales (NSW) - unless it states otherwise.
- MHCC does not guarantee the accuracy nor is responsible for the content or the currency of the content of external documents and websites linked to this Manual.