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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 Documents
There are several policy documents that provide the strategic direction
for the addiction treatment sector in New Zealand:
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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 substanceuse, 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 coexisting 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 coexisting 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 nongovernment services.
• Increased professionalism, and greater
accountability.
• Greater connectedness between
disciplines and between addiction
treatment service and mental health
and general health services.