Courtney O’Donnell
The rapid review undertaken as part of QNADA’s Responsive Systems project sought to consider the broader system responses to individuals, families and communities affected by AOD, outside of the treatment and harm reduction sector. Specifically, it examined the ways in which the criminal justice, youth justice and child protection systems intersect with the AOD sector and respond to the social, cultural, and structural determinants of health. In total, the review identified 449 recommendations made between 2010 and 2020 which directly related to individuals, families and communities affected by AOD. Among these, more than a third (35%) focused on improving pathways and programs affecting people who use AOD.
Among the recommendations that fell within the domain of pathways and programs, a large proportion were related to enhancing treatment for people experiencing problems with their AOD use. For example, recommendations included increasing accessibility of treatment, increasing the variety of treatment types available, investing further in treatment, evaluating various existing treatment models and establishing new ones. As we know, the AOD treatment sector is chronically underfunded and overstretched, so it’s encouraging to see that a need for investment in AOD treatment has been recognised across systems. The majority of recommendations that were focused on improving treatment came from the criminal justice system, which might be expected given the high proportion of people who are in contact with the criminal justice system who also experience problems with their AOD use. At QNADA, we believe that greater availability of, and access to, AOD treatment services is crucial to ensuring that people can utilise the right services, at the right time, and in the right place.
This rapid review also illustrated that enhancing AOD treatment opportunities isn’t the only way to improve health and social outcomes for people who are engaged with the criminal justice, youth justice and child safety systems. For example, we also know that a lot of people are in contact with these systems because of their AOD use (e.g. due to criminalisation of minor drug offences). Perhaps unsurprisingly, many of the recommendations that fell within the domain of pathways and programs were centred on diversion and drug courts. Specifically, the recommendations focused on increasing access to, and tailoring, diversion and drug courts to better meet the needs of people who use drugs. This is consistent with QNADA’s position; increase police diversions and non-court support options to keep people, particularly children, out of court.
Importantly, another significant proportion of the 155 recommendations that fell within the domain of pathways and programs were focused on addressing the social determinants of health. The social determinants of health are the non-medical factors that influence health outcomes [1]. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems. Identifying and addressing the social determinants that are likely to see people become engaged in the criminal justice, youth justice and child safety systems is essential to reducing engagement with those systems and problematic drug use. The majority of recommendations that were focused on addressing the social determinants of health came from the child safety system, and included: implementing initiatives to support young people living in social housing who are at risk of losing their tenancies; continuing to fund positive parenting programs; developing and expanding education, training and employment initiatives targeting young people experiencing vulnerability; and expanding initiatives to assist more young people of compulsory school age to engage in education. Implementation of recommendations of this nature, that provide support early-on to people who are vulnerable to developing problems with their AOD use, are likely to see a reduction in rates of engagement with the criminal justice, youth justice and child safety systems. These types of strategies also reduce the demand for AOD treatment and relieve pressure from the entire health system.
While there are significant reforms currently being implemented across Queensland, this review suggests there is further room for system reform. Of the 155 recommendations which fell within the domain of improving pathways and programs to reduce AOD-related harms, 23% were accepted in full, 1% were accepted in part, 2% were accepted in principle and 4.5% were not accepted. For 62% of recommendations, acceptance status could not be determined or was not applicable. Among those accepted in full, just over half (51%) were subsequently also implemented in full. Together, these findings suggest a need for increased transparency with regard to acceptance and implementation of recommendations, as well as improved processes around consultation and development of recommendations. This will likely result in greater implementation of evidence-based interventions and strategies to improve health and social outcomes.
———————–
[1] Health, C. o. S. D. o. (2008). Closing the gap in a generation: health equity through action on the social determinants of health: final report of the commission on social determinants of health: World Health Organization.