Part 8 Section F : People with mental illness and coexisting drug and alcohol problems
Many people with mental illness also have coexisting drug and alcohol problems. There is considerable evidence that the continued use of some drugs leads to mental illness.
Some people with mental illness use non-prescription dugs or alcohol to help them cope with their illness. This can lead to addiction or dependence on the drugs and alcohol they use.
Often people with mental illness and co-existing drug and alcohol problems experience difficulty when trying to get treatment for their drug and alcohol problem. Many services and agencies only work with either drug and alcohol, or mental illness, and can't or won't treat both problems at the same time.
The NSW Government acknowledging this issue established the NSW Mental Health and Drug and Alcohol Office (MHDAO), which has consultation liaison services to ensure that NSW hospitals have timely access to specialist staff to help with the management of patients who have both mental health and drug and/or alcohol problems. Click here for more information about the MHDAO. Nevertheless, the issue of getting appropriate services in the community is still a problem for many people with both mental health and coexisting drug and alcohol issues.
Similarly, people with mental health and coexisting drug and alcohol problems 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, 'What to expect from a mental health service'; click here to read.
The principles and policies that apply to all health services are available on the NSW Health website.
Each Area Health Service in NSW also has their own policies and procedures. Click here for a list of NSW Area Health 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.
For more information about other drug and alcohol support and information services, click here.
- NSW Users & AIDS Association Inc
- NSW Drug and Alcohol Information and Treatment Services
- Drug Info Clearinghouse – Drugs and Mental Health
- Australian Drug Information Network - Co-morbidity
- Guthrie House: a community-based residential rehabilitation and transition service for women who are involved in the NSW criminal justice system.
- The Community Forensic Mental Health Service
- The Connections Project
- The Adolescent Community and Court Team
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 health needs (linking them with services), helping them get ID, getting them a Medicare card, helping with housing, Centrelink, links 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 drug and alcohol problems is the same as for any other medical condition: treatment can usually only be given with the informed consent by 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:
- If you live in the area covered by Sydney West Area Health Service, you can be treated without your consent under the Drug and Alcohol Treatment Act 2007 (NSW).
- If you live in NSW but outside the Sydney West Area Health Service, you can be treated without your consent under the Inebriates Act 1912 (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).
People treated under the Drug and Alcohol Treatment Act 2007 (NSW) are part of the Drug and Alcohol Involuntary Treatment Trial and must live in the Sydney West Area Health Service catchment area. For a map of NSW Area Health Services click here.
Under this Act, an accredited medical practitioner can issue a dependency certificate that means the person can be detained for up to 28 days in the first instance.
A dependency certificate may be issued in relation to the person only if the accredited medical practitioner is satisfied:
- the person has a severe substance dependence, 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.
There is currently only one place where people are being treated under this law: the Centre for Addiction Medicine at Nepean Hospital.
A magistrate must review a dependency certificate as soon as practicable after it is issued.
The 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.
If you are unhappy with the magistrate's decision, you can apply to the Administrative Decisions Tribunal (ADT) for a review of the decision. For more information about the ADT, click here.
Official Visitors have been appointed for people participating in the Drug and Alcohol Involuntary Treatment Trial at Nepean Hospital. 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 under the trial as well as to make complaints and concerns about the physical conditions at the hospital.
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 Primary 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 Primary Carers in the Mental Health Act 2007 (NSW).
There are now very few persons being treated against their will under the Inebriates Act 1912 (NSW).
This Act defines an 'inebriate' as a person who 'habitually uses intoxicating liquor or intoxicating narcotic drugs to excess'.
The process under this Act begins with an affidavit (sworn statement) from a family member, a business associate, medical practitioner or police officer that the person is an inebriate. This affidavit must be supported by a medical certificate from a medical doctor (or a second doctor, if a doctor swore the original affidavit).
A court, usually a Local Court, may then make an order for the person to be detained under the Act. The person detained may be treated without their consent in a public psychiatric hospital in NSW for up to 12 months. A court can also discharge the person into the care of a guardian or put the person on a bond that requires them to not use alcohol for a period up to 12 months.
The Inebriates Act 1912 (NSW) contains provisions for the compulsory treatment and diversion of persons charged with criminal offences.
These sections have been effectively replaced by the Drug Court Act 1998 (NSW) and sections 32 and 33 of the Mental Health (Forensic Provisions) Act 1990 (NSW).
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.
The Drug Court may then make an order directing that you serve your sentence of imprisonment by way of compulsory drug treatment detention.
If you are male, you may be detained and treated at the Compulsory Drug Treatment Correctional Centre at Parklea. For more about this Correctional Centre, click here.
There are programs available for people with drug and alcohol problems 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 drug and alcohol problems, 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 doing 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. Click here to find information about the diversionary programs that may be available to you.
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 21 February 2011.
- This Manual only refers to the law and practices applying to the Australian state of New South Wales (NSW).
- 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.