You are here: Cabinet Papers Review of the Interface between Mental Health and Alcohol and Other Drug Services and the Criminal Justice System Paper One: Overview

Paper 23: Effective Interventions: Review of the Interface between Mental Health and Alcohol and Other Drug Services and the Criminal Justice System Paper One: Overview

PURPOSE

The purpose of this paper is to provide Cabinet with background information, an overview of the key issues, and the rationale for the Review of the Interface between Mental Health and Alcohol and Other Drug Services and the Criminal Justice System.

This paper also seeks Cabinet's agreement to the recommendations listed in this paper. These recommendations cover all the proposals discussed in this paper and the attached suite of Cabinet papers relating to the Police, Courts, and Corrections settings, and the following population groups: Māori, Pacific peoples, women and youth offenders.

EXECUTIVE SUMMARY

This is the first of five papers proposing initiatives that aim to improve the way in which the mental health and alcohol and other drug (AOD) treatment needs of offenders in the criminal justice system are met.

This paper is divided into two parts. Part One provides background details of the review, its objectives, its processes, the information sources used to complete it, and other related work. It also provides an overview of the attached Cabinet papers including a summary of proposals relating to the three key settings in the criminal justice sector (Police, Courts and Corrections) and the population groups (Māori, Pacific peoples, women and youth). The paper identifies four priority proposals.

Part Two outlines the rationale for the review. Briefly, that enhanced mental health and/or AOD treatment may assist offenders in reducing their re-offending, and thereby reducing the future demand for prison beds. The overarching issues are those that affect all points of the interface between mental health/AOD services and the criminal justice sector, i.e. in the Police, Courts, and Corrections settings. The overarching issues include: the influence of the different perspectives, goals and priorities of the Health and Justice sectors; issues surrounding the mental health and AOD workforce in New Zealand which lead to difficulties for offenders getting the treatment they need; and the lack of useful data and information for the purposes of this review and any future policy developments in this area.

PART ONE - BACKGROUND TO THE REVIEW AND TO THIS SUITE OF CABINET PAPERS

The Review of the Interface between Mental Health and Alcohol and Other Drug Services and the Criminal Justice System

Since October 2006 the Ministries of Health and Justice have jointly led a review of the interface between mental health, alcohol and other drug (AOD) services and the criminal justice system. The New Zealand Police and the Department of Corrections have contributed to this work.

The review examined the mental health and AOD issues for the general offender population, and for Māori, Pacific peoples, women, and youth, at all the points of contact between offenders and the criminal justice system, that is in the Police, Courts and Corrections settings. This review is part of the Government's 'Effective Interventions' programme of work.

The objective of the review was to develop proposals to improve the way in which the mental health and AOD treatment needs of people in the criminal justice system are met. The specific aims of the review were to:

enhance the social functioning and mental health of offenders

assist in reducing their rate of AOD addiction and addiction-related harm

assist in reducing their re-offending.

On 2 October 2006, the Cabinet Business Committee approved the terms of reference for the review [CBC Min (06) 17/13]. On 22 November 2006, the Cabinet Policy Committee brought forward the final Cabinet report-back date for the review from 30 August 2007 to 31 May 2007, and incorporated consideration of any expansion of judicial monitoring as it relates to AOD treatment into the review project [POL Min (06) 26/6].[1]

The new report-back date has meant that, in lieu of the previously planned public consultation on a discussion document,[2] the Ministries of Health and Justice consulted with key informants to gauge support on draft proposals for improving the way in which the mental health and AOD needs of people in the criminal justice system are met.

In accordance with the review's terms of reference, officials reported to the Ministers of Justice and Health on 28 February 2007 on the findings of a literature review; a review and analysis of available documentation and quantitative data; and a review of qualitative data, including discussions with key people in the relevant sectors.

Sources of Information for the Cabinet Papers on the Interface Review

The content of the Cabinet papers on the review was developed from the following sources:

the literature review on the interface between mental health/AOD services and the criminal justice system

interviews with over 50 key stakeholders

feedback from 150 responses to a survey sent to around 1,000 key informants interested in mental health and AOD interventions in the criminal justice system

a review and analysis of available documentation and quantitative data

the paper Effective Interventions: Access to Alcohol and Other Drug Services (see paragraph 13 below).

Related work

Another Effective Interventions project relevant to the interface between AOD services and the criminal justice system is the investigation of the access to AOD services for offenders serving community-based sentences. On
9 October 2006, Cabinet requested officials to investigate and report to the Ministers of Health and Corrections by 30 March 2007 on investment in intensive AOD treatment services for offenders in the community, including an increase in further residential service capacity. Cabinet also requested a similar report on the gap between need and availability of services (insofar as it is possible from available data), and feasible options for expanding the following aspects of AOD treatment services for all offenders in the community [CAB Min (06) 37/5]:

assessment and referral;

non-residential AOD services, including case management; and

withdrawal management (medical and social).

On 30 March 2007 the Ministry of Health and the Department of Corrections reported to the Minister of Health, and the Minister of Corrections on the findings of the investigation. Details from the officials' report have been incorporated into Cabinet Paper Four: The Corrections Setting.

Currently, officials are also considering different models of funding and delivery of primary healthcare for convicted offenders. A report will be referred to the Ministers of Health, Corrections and Justice by 31 October 2007.

An overview of the attached Cabinet Papers

As noted above there are five Cabinet papers. This paper is Cabinet Paper One: Overview. Part One of this paper provides the background to the review and an overview of the attached cabinet papers. Part Two discusses the rationale, the overarching issues and some proposals.

Cabinet Paper One highlights that the shortage of a skilled workforce poses the greatest barrier to securing more and better treatment for offenders xxxx
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Cabinet Paper One proposes accelerating the further development of an AOD workforce with the competency to work with offenders with AOD issues, and most particularly offenders from the vulnerable population groups. The proposal to strengthen the number in the workforce and its competency constitutes a priority project. The paper also proposes a project on improving the quantity and quality of data at the interface between the health and justice sectors.

Cabinet Paper Two: the Police Setting provides a description of what happens in the watch-house and the problems the Police have with people who are mentally ill or addicted, and who are being held largely to be processed for a later court hearing. While most of these people are arrestees, others are people who are being detained by the Police under the provisions of the Alcohol and Drug Addiction Act 1966; the Mental Health (Compulsory Assessment and Treatment) Act 2003; or the Crimes Act 1961. Cabinet Paper Two states that many of the mental health and AOD issues confronting the Police could be alleviated by placing mental health nurses with AOD training in Police stations. The nurses would ensure that those people being held in the watch-houses with mental health and/or AOD problems will be managed appropriately, and be referred and linked to agencies for the treatment they need.

Cabinet Paper Two proposes piloting a mental health nurse with AOD experience in two Police watch-houses for three years. We note that as the Police setting reaches by far the greatest number of offenders, is at the front end of the criminal justice system, and provides the greatest opportunity to divert people away from the criminal justice system into more appropriate services. It is our view that this is also a priority project.

Cabinet Paper Three: the Courts Setting provides a description of the processes for dealing with people who are being processed in the criminal courts, and who have either AOD or mental health problems. It notes that without advice from an AOD clinician it can be difficult for Judges to ascertain whether an offender needs an AOD assessment; and that currently there is no national framework or standard for court-ordered AOD assessments. An inter-agency working group has nearly completed the work to provide a framework and standards. This will ensure the assessments will be more aligned to the needs of Judges.

Importantly, Cabinet Paper Three highlights that timely access to effective AOD and mental health treatment for offenders is not always available. The demand for treatment outstrips supply. Moreover, proposed provisions of the Criminal Justice Reform Bill relating to the new sentences of intensive supervision and home detention, and the process of judicial monitoring will place more pressure on community-based service providers. The effectiveness of these new sentences or processes to achieve the aims of reducing future offending and prison beds will be seriously inhibited if treatment cannot be made more available and accessible. Clearly the workforce proposal will directly assist in addressing this situation.

Cabinet Paper Three proposes:

placing up to two AOD clinicians in metropolitan courts to provide better information to Judges on alcohol and drug needs that have relevance to the sentencing of the offenders

reviewing the effectiveness of judicial monitoring three years after the enactment of the Criminal Justice Reform Bill

examining mental health courts and overseas Court diversion programmes for offenders with mental health problems, to see if adopting these mechanisms, or aspects of them, could benefit these offenders and/or the court in New Zealand.

We note that the ability for Judges to make good use of the new community-based sentences contained in the Criminal Justice Reform Bill is dependent on identifying the people whose offending could be reduced if they receive treatment. As this is a central aim of the review, we recommend that placing AOD clinicians in Courts is a priority project.

Cabinet Paper Four: the Corrections Setting provides a description of how people with AOD and mental health problems have their needs met in the Corrections setting. It states that there are insufficient treatment programmes in prison and in the community. Where services exist there are long waiting lists for treatment.

However, only a few District Health Boards, Community Alcohol and Drug Services (CADS), and non-government AOD service providers operate AOD programmes in prisons. Some CADS and non-government AOD providers find it difficult to provide treatment in the prison setting largely due to necessary security procedures.

Cabinet Paper Four proposes that the Ministry of Health, with support from the Department of Corrections, will fund the following initiatives as the "First steps" in this package:

15 additional AOD intensive residential beds to address gaps in existing services in Auckland/Northland, and the southern South Island in the 07/08 financial year s xxxxxxxxxxxxxx 9(2)(f)(iv) xxxxxxxxxxxxxx

investigate the feasibility of establishing similar services in the lower North Island

fund two additional medical detoxification beds

improve offenders' access to treatment by creating a specialist AOD offender team in the Auckland region to provide services in prisons and in the community, and to ensure continuity of care for those transitioning between the prison and the community

The paper also notes that it would be more appropriate if specific treatment programmes were established to address offenders' needs, rather than prioritising offenders over members of the general public.

We note that the additional intensive residential and medical detoxification beds are urgently required. We also consider the development of a specialist AOD offender team would significantly enhance both the effectiveness and efficiency of delivering AOD treatment to offenders in the Auckland region. We consider these priority projects.

Finally, Cabinet Paper Five: Population Groups outlines the background, issues and proposals relating to the specific population groups: Māori, Pacific peoples, youth and women. The proposals in the other four papers apply equally to these population groups. The specific proposals in Cabinet Paper Five largely relate to improving the access to treatment and its effectiveness to these population groups, and to supporting further workforce development.

Implementation considerations

We note that some of the proposals, especially the various pilots, do not have a specific commencement date. After Cabinet approval, officials will seek the agreement of health and justice sector agencies to provide for the pilots, and then engage the necessary personnel. This must be before the respective pilots can commence. Officials will provide an implementation plan to the Ministers of Health, Justice, Corrections and Police by 31 July 2007.

We also recommend that some of the pilots are reviewed rather than evaluated. This is because the small size of the pilots and the time limitations. As a result the pilots can not provide sufficient information to demonstrate that the specific measures will reduce offending over the medium term. Evidence of reduced offending would require a larger number of pilots and a greater length of time to gauge the extent of recidivism. However, if the reviews indicate that they are successful in providing better access to treatment and better health outcomes for the offenders, then the pilots could be extended to further sites and evaluations of their impacts on recidivism could be undertaken.

PART TWO - THE RATIONALE FOR THE REVIEW AND OVERARCHING ISSUES

Rationale

In Cabinet Paper 9: Preventing Re-Offending tabled in July 2006 (CAB Min (06) 27/3A) it was noted that "well designed interventions have demonstrable effects on reducing re-offending and imprisonment." It is considered that providing AOD or mental health treatment to offenders who need it will assist in improving their health status, reducing their re-offending and the pressure on prison beds. This rationale underpins the proposals for these Cabinet papers.

The higher prevalence of mental illness in offender populations than in the general community is documented in New Zealand[3] and overseas. Major mental disorders, for example, occur at a rate of two to four times more among offenders, compared to the general population. Research has also found a correlation between certain types of mental illness and offending, for example, schizophrenia, alcohol dependence and cannabis dependence. This suggests that there would be benefits to the criminal justice sector and the health sector from treating offenders with mental health problems.

With regard to AOD misuse (as opposed to addiction), research suggests that individuals who use illicit drugs are more likely to commit crimes. Moreover, many crimes, including violent crimes, are committed by individuals who have used drugs or alcohol prior to the offence or who were under the influence at of these drugs at the time of the offence. However, like mental illness and offending, while crime and AOD use are linked, there is not a direct and simple causal connection.

Nevertheless, international literature supports the view that providing treatment to offenders is an effective approach to breaking the drug abuse/criminal justice cycle for offenders with substance abuse problems. This approach has been demonstrated by research that showed that involvement in substance abuse treatment programmes reduces recidivism for offenders who use drugs.[4] AOD programmes (drug treatment units) within New Zealand prisons have been found to be effective. The Department of Corrections have reported that:

an initial evaluation of the Units demonstrated a 13% reduction in the rate participants were returned to prison in the 24 months after completing the programme between April 2002 and March 2004

more in-depth, follow-up research also demonstrated an up to 16% reduction in the re-offending rate of participants compared to similar prisoners who did not undertake the programmes.

Moreover, international studies consistently find that providing effective AOD treatment to offenders brings significant cost benefits from reduced criminal activity. In the United Kingdom, the National Treatment Outcome Research Study calculated that for every £1 spent on drug treatment, £3 was saved in costs to the criminal justice system and victims of crime. In the United States, estimates suggest that for every $1 invested in AOD programmes, approximately $4 - $7 in future costs will be saved in reduced drug-related crime and criminal justice costs, as well as theft. There are also additional benefits to drug-addicted individuals and their families, their potential victims, and society as a whole.

On the basis of both New Zealand and international evidence, we believe that addressing the mental health and AOD needs of offenders in prison and in the community will assist in reducing offending and reduce the need for prison beds in New Zealand.

Overarching Issues

Differences Between the Health and Justice Sectors

The health and justice sectors deliver services based on differing perspectives, operational requirements, and priorities. The criminal justice system has a responsibility to ensure public safety by working to prevent crime, responding to and investigating criminal behaviour, prosecuting and sentencing defendants, and by enforcing and administering sentences. The health system has a responsibility to improve people's health status and overall wellbeing. These responsibilities and operational requirements create different views of, and relationships with, clients, and have led to tensions, and poor communication and collaboration between agencies in addressing offenders' mental health and AOD needs.

For example, the Police are required to detain intoxicated or mentally ill people who present a danger to themselves or to others, or who have been arrested for acting in a criminal manner. Some of these people present medical symptoms that are beyond Police expertise to manage. However, mental health Crisis Assessment and Treatment teams often do not have the capacity to assist the Police manage people with mental health issues. This exposes people with mental health problems to an increased risk of harm whilst in Police custody.

Judges can impose special conditions on an offender's sentence, such as attending AOD treatment. Ordering treatment at the sentencing stage is ideal because attendance can be monitored by Probation Officers and non-compliance can be met with immediate consequences. However, AOD services providers' responsibility is to assist clients to recover. They are either unwilling or unable to accommodate the requirements of the justice system to report to the Probation Officers on the client/offender compliance with their treatment plans. As a result, if an offender fails to attend a treatment session, AOD providers will not always inform the offender's Probation Officer in a timely manner or at all.

In prisons, the difference in priorities for service delivery can lead to tensions when community health services try to provide treatment to prisoners. It is Corrections' responsibility to safely and humanely contain prisoners and to deliver rehabilitation programmes and reintegration initiatives. Prison security is an important component of Corrections' aim to maintain public safety by preventing prisoner escapes and contraband entering the prisons, and by ensuring prisoner, visitor and staff safety. During the review several Health providers noted that they had at some time or another had difficulties with working in an environment in which security seemed to be prioritised over prisoners' health, and felt that the success of programmes was jeopardised as a result. Corrections is now aware of the access issues experienced by some AOD providers at particular prisons and is working to improve planning and communication between providers and prison management.

In the past, service drivers of the sectors have resulted in different ways of prioritising clients. For example, in prisons the most intensive AOD services have been provided to those offenders for whom substance abuse is a high risk factor in their offending and likelihood of re-offending. Most community substance abuse programmes, however, operate on the health model of delivering treatment services based solely on clinical need. As a result, offenders whose AOD problems are not related to their offending have not received a high priority while they are in prison, unless their health related AOD needs were acute. Corrections, with the support of the Ministry of Health, is in the process of moving to routine screening of offenders for AOD addiction, and will soon be in a position to make referrals to health sector providers for specialist AOD assessment and treatment. However, successful assessment and treatment will be dependent on the availability of treatment services in prisons and in the community.

Comment

The proposals of these Cabinet papers will require the agencies of the Justice and Health sectors to work together, especially the proposals for a mental health nurse in the Police Station, the AOD Clinicians in the Courts, and the specialist AOD offender team in Auckland. By working together on projects that combine the aims of both sectors, require exchanges between sectors, and a shared understanding of both the individual health benefits and the wider social public benefits to be gained by treating offenders, the collaboration between the sectors will continually improve. However, successful collaboration requires an investment in a shared outcome.

The proposals in these papers will clearly benefit offenders and both the health and justice sector outcomes also benefit.

Another project will review the effectiveness of funding and delivering healthcare to offenders (in prison and in the community). This project will scope alternative models of prisoner health service delivery, and focus on improved outcomes for offenders. A report on this issue will be referred to the Ministers of Health, Corrections and Justice by 31 October 2007.

The Mental Health and AOD Workforce

A qualified and stable workforce is at the heart of mental health and AOD services. The goal of more and better mental health and AOD services for offenders, and generally, requires an investment in developing the quality and expanding the number of people who deliver those services.

The mental health and AOD workforce in New Zealand presently does not have the capacity in terms of the total number of clinically and culturally competent providers to respond to nationwide service expansion and funding increases across all population groups and offenders. Offenders often have many other issues such as behavioural and personality disorders which means that they are a reasonably complex population to treat.

Nevertheless, the workforce issue compromises the extent to which Judges will be able to sentence offenders to treatment, and the extent to which offenders can be assisted in reducing their offending by being given the treatment they need. It is also partly the reason why these Cabinet papers propose pilots to be reviewed, rather than nation-wide roll-outs of new initiatives. It is anticipated that, by the time the pilots have been completed and reviewed, the mental health and AOD workforce will be better placed to put in place evidence-based service expansion in the areas where the mental health and AOD sector interacts with the criminal justice system.

The Ministry of Health is implementing a workforce development plan that will help to ensure that New Zealand has a well-supported, skilled, culturally and clinically competent, recovery and wellness focused workforce to drive the provision of high-quality services to all New Zealanders, including those in the criminal justice system.

Proposal

The Ministry of Health considers that it should develop further options to accelerate development of the AOD workforce with the competency to work with offenders with AOD issues, and most particularly to work with those from the vulnerable population groups.

If approved, the Ministry of Health will immediately commence expansion of existing programmes that have already proven successful in increasing mental health and addiction workforce numbers. The programmes where expansion will occur will include, the bursar programme, psychiatric registrar training, back-filling of staff into high quality addiction services to acquire best practice training, and mentorship and support programmes. Expansion will also occur for current internship programmes but will specifically focus on addiction services, and training to advance participation or recovering service users in the provision of services.

Additional initiatives will be introduced to increase the competency of staff and services in both DHB and NGO settings through the establishment of mobile training teams who will go into the services to provide essential addiction training. This training will also include increased competency on assessment, including brief intervention support.

The Ministry of Health will prepare a detailed briefing on these proposals for the Minister of Health by 30 June 2007. This briefing will also focus on the proposal in Cabinet Paper Five: Population Groups relating to Pacific peoples.

Availability of Data in the Mental Health/AOD Sector and the Justice Sector

The lack of quantitative data on offenders' AOD and mental health needs has limited officials' ability to provide further evidence to support the substantial amount of qualitative and anecdotal information sourced during the review. There are either negligible or out-dated statistics on how many people in all the various population groups in the Police, Courts, or Corrections settings have mental health problems, or AOD issues; and on how many offenders with an identified need have received specialist assessment and secondary and tertiary treatment. Most initiatives that have been piloted have either not collected any data, or not collected data that would be useful for the review project.

Proposal

We propose that, the Ministry of Health (lead), the Department of Corrections, the New Zealand Police and the Ministry of Justice investigate ways to increase data collection on all offenders with mental health and/or AOD problems including those offenders from the population groups discussed in Cabinet Paper Five: Population Groups. Proposals have to be scrutinised by the Office of the Privacy Commissioner. A data development workplan will be referred to the Ministers of Health, Corrections, Police and Justice by 31 October 2007.

Consultation

The following agencies have been consulted on this paper: Department of Corrections, New Zealand Police, Treasury, Department of Prime Minister & Cabinet, Ministry of Social Development, Te Puni Kōkiri, Ministry of Pacific Island Affairs, and the Ministry of Women's Affairs. Their comments have been incorporated. In addition, the Law Commission, and DHB representatives have been informed.

Financial Implications

If approved by Cabinet, the Minister of Health will fund the proposals in 2007/08 financial year by reprioritising funding within Vote: Health., i.e. a "First Steps" package that will fund:

the full range of pilot initiatives discussed in the Cabinet papers. This includes interventions in Police cells, the Courts setting and a specialist offender team in the Auckland region to provide services to prisoners and offenders in the community

a wide range of workforce development initiatives, given that workforce is the primary constraint on developing AOD services

a limited package of AOD treatment services for offenders serving sentences in the community (see Paper Four: The Corrections Setting). This will give the Courts more scope with sentencing options to refer to community drug and alcohol services

Departmental Expenses of xx s9(2)(j)xx to address the ongoing costs in the Ministry of Health for implementing the full range of decisions in the suite of papers (including setting up and monitoring the pilots, contracting for the evaluation proposals and feasibility studies, and contracting for and monitoring additional AOD services).

The cost of the package outlined above is detailed in the Appendix. In summary, cost fall across Votes as follows:

First Steps PACKAGE:	2007/08	2008/09	2009/10	2010/11	Ongoing
Source of Funding	$[000]	$[000]	$[000]	$[000]	$[000]

Vote: Police - within baseline	x	x	x	x	x

Vote: Justice
- within baseline	x	x	x	x	x
- prospective Budget Bid	x	x	x	x	x
Sub-total Vote: Justice	x	x	x	x	x

Vote: Health - new funding required for 2008/09 and subsequent periods			s9(2)(f)(iv) s(9)(2)(j)
Health Services Funding NDE	x	x	x	x	x
Operating Costs - DE	x	x	x	x	x
Sub-total Health	x	x	x	x	x

TOTAL	x	x	x	x	x

Implications for Vote: Health

The cost of the "First Steps" package to Vote Health in 2007/08, of x s9(2)(j) x million, is to be funded from an allocation from the risk reserve in the Health Services Funding NDE within Vote: Health. The necessary transfers within Vote: Health will be managed via the 2007 October Baseline Update.

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Legislative Implications

This Cabinet paper has no legislative implications.

Regulatory Impact and Business Compliance Cost Statement

A regulatory impact and business compliance cost statement is not necessary.

Human Rights Implications

It is possible that the proposal to seek to increase and improve data may result in proposals that breach privacy principles. However, consultation with the Office of the Privacy Commissioner should assist in avoiding this risk.

Gender Implications

The proposals of this paper do not pose gender implications.

Disability Perspective

The proposals will benefit people with disabilities who are also affected by mental illness.

Publicity

Cabinet decisions will be supported by a communications strategy.

RECOMMENDATIONS

The following lists the recommendations relating to all the Cabinet papers.

CABINET PAPER ONE: Overview

note that Cabinet Paper One (this paper) states that since October 2006 the Ministries of Health and Justice have jointly led a review of the interface between mental health and alcohol and other drug (AOD) services and the criminal justice system, and the issues it poses for the general offender population, Māori, Pacific peoples, women and youth with the support of the Department of Corrections and the New Zealand Police

note the rationale for the review is that meeting the mental health and AOD needs of offenders will assist in improving their health status, reduce their offending, and reduce the pressure on prison beds

note there are three overarching issues that affect the interfaces with the Police, Courts, and Corrections, they are: the different perspectives, goals and priorities of the health and justice sectors; the capacity of the mental health and AOD workforce to meet the demand for treatment; and the availability of relevant data

agree to the Ministry of Health accelerating the development of the AOD workforce with the competency to work with offenders with AOD issues, most particularly those from the vulnerable population groups

agree that the Ministry of Health will prepare a detailed briefing on accelerating workforce initiatives, for the Minister of Health, by 30 June 2007

note that a project reviewing the effectiveness of funding and delivering healthcare to offenders (in prison and in the community) is underway and a report on this issue will be referred to the Ministers of Health, Corrections and Justice by 31 October 2007

agree that the Ministry of Health (lead), Department of Corrections, the New Zealand Police, and the Ministry of Justice investigate ways to improve data in the health and justice sectors about offenders with mental health and/or AOD problems

agree that a data development workplan be prepared for the Ministers of Health, Corrections and Justice by 31 October 2007

agree that the Ministries of Health and Justice in consultation with the Department of Corrections and New Zealand Police develop an implementation plan that will include details relating to the locations and timing of approved pilots, and associated reviews/evaluations, and refer it to the Ministers of Health, Justice, Corrections and Police by 31 July 2007

CABINET PAPER TWO: Police setting

note that Cabinet Paper Two outlines two proposals that will assist in improving the way in which the mental health and alcohol and other drug treatment needs of offenders in the Police watch-houses are met

agree that the New Zealand Police complete a review of the mental health initiative currently operating in the Rotorua Police Station, and report back to the Ministers of Police, Health and Justice by 31 December 2007

agree that the New Zealand Police, with support from the Ministries of Justice and Health, pilot up to two (three year) initiatives that place a mental health nurse with AOD training in Police stations

agree that after the first year of the pilots, the New Zealand Police will complete a review of the pilots within six months, and report back to the Ministers of Police, Justice and Health

CABINET PAPER THREE: Courts Setting

note that Cabinet Paper Three outlines three proposals that aim to:

assist in improving the information to Judges so that they can better identify the AOD needs of offenders, and impose sentences, sentence conditions, or judicial monitoring requirements that will assist offenders in addressing their AOD needs; and

examine overseas measures to better deal with offenders with mental health problems

agree that the Ministry of Health pilot an initiative to place up to two AOD clinicians to assist Judges in the sentencing process in metropolitan District Courts for three years, and complete a review of the pilot six months after the first twelve months have been completed, and report back to the Ministers of Health and Justice

agree that the Ministry of Justice evaluate the implementation and outcomes of judicial monitoring three years after the enactment of the Criminal Justice Reform Bill

agree that the Ministries of Justice (lead) and Health will examine overseas Court diversion programmes for offenders with mental health problems, and mental health courts to ascertain whether these mechanisms or aspects of them could be beneficial to New Zealand, and report back to the Ministers of Justice, Health and Police by 31 December 2007

CABINET PAPER FOUR: Corrections Setting

note that Cabinet Paper Four outlines proposals that will assist in improving how the AOD treatment needs of prisoners and offenders on community-based sentences are met

agree that the Ministry of Health, in consultation with the Department of Corrections, will pilot a 'Specialist AOD Offender Team' in Auckland to increase AOD services for prisoners and offenders in the community and to ensure continuity of treatment when offenders transition from the prison to the community

agree that the pilot will operate for three years and will be evaluated by the Ministry of Health in consultation with the Department of Corrections and the Ministry of Justice

agree that a progress report will be completed by officials before the pilot commences in consultation with Auckland CADs that canvasses the proposal further and outlines the next steps (including the need for an evaluation) by 31 August 2007 to the Ministers of Health and Corrections

agree that the Ministry of Health will, in the 2007/08 financial year, invest in

15 new intensive residential beds and/or intensive AOD day programmes for offenders

investigating the feasibility of establishing similar services in the lower North Island

funding two additional medical detoxification beds

CABINET PAPER FIVE: Population Groups

note that Cabinet Paper Five outlines four proposals that will address the unique treatment needs of the Māori, Pacific peoples, women and youth sections of the offender population

agree that the Ministry of Health evaluate a kaupapa Māori intensive residential treatment programme with a focus on offenders and a mainstream programme in order to assess their effectiveness in treating the AOD needs of Māori. This will also include examining their effectiveness in changing the negative behaviours that may lead to offending by Māori by 31 December 2007

note that the workforce proposal under Recommendation 4 will include specific internship proposals relating to Pacific peoples, including Pacific offenders

agree that the Ministry of Health and the Department of Corrections in consultation with the Ministry of Justice complete a feasibility study aimed at implementing a new dual-diagnosis treatment programme in the Auckland region to help address the needs of female offenders by 31 October 2007

agree that the Ministries of Health, Justice (joint lead) and Social Development should review the existing health services support in those Youth Courts that have these services provided to them by the Auckland, Wellington and Waikato DHBs as a precursor to implementing a pilot, and to consider other improvements may be needed to existing mental health / AOD screening and assessment processes for young offenders

agree, in regard to Recommendation 27, officials should report back to the Ministers of Health, Justice and Social Development by 30 September 2007.

FINANCIAL IMPLICATIONS

note with the exception of costs to be met from Justice and Police baselines, the Minister of Health will fund the proposals outlined in these Cabinet papers from funding within Vote: Health in the 2007/08 financial year

agree the cost of the First Steps package of initiatives (outlined in paragraph 57) in 2007/08, amounting to xx s9(2)(j)xx, will be funded from an allocation from the risk reserve in Health Services Funding NDE

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agree that the the necessary transfers between appropriations in Vote: Health, including the transfer of xx s9(2)(j) xx for Ministry of Health operational purposes from the Health Services funding NDE to Departmental Expenditure appropriations, are to be addressed in the 2007 October baseline update

Hon Pete Hodgson
Minister of Health

Hon Mark Burton
Minister of Justice

Appendix

EFFECTIVE INTERVENTIONS: COMPONENTS OF FIRST STEPS PACKAGE

First Steps PACKAGE:	2007/08	2008/09	2009/10	2010/11	Ongoing
Health/CJS Interface Initiatives	$[000]	$[000]	$[000]	$[000]	$[000]

*Police settings*
2x 36 Month pilots of AOD workers in Police Cells (2 Shifts) Starting in mid-'07/08	x	x	x	x	x
- Police operational costs for pilots	x	x	x	x	x
Review of Rotorua Pilot (Police)	x	x	x	x	x
*Court settings*
Pilot AOD clinicians in two Courts to support Judges (start mid-'07/08) - 36 months	x	x	x	x	x
- Review of clinicians in Courts pilot	x	x	x	x	x
Investigate Mental Health Diversions/Drug Court (Justice)	x	x	x	x	x
Review of Judicial Monitoring of Offenders' Treatment	x	x	x	x	x
*Population groups*
Research Pacific Services	x	x	x	x	x
Research Moana House outcomes (a kaupapa Māori service)	x	x	x	x	x
Feasibility study for a womens intensive treatment service	x	x	x	x	x
Pilot mental health workers in youth courts	x	x	x	x	x
*Workforce Development*	x	x	x	x	x
Sub-total Interface Initiatives	x	x	x	x	x
			s9(2)(j)
AOD: Offenders on Community Sentences
Pilot CADS team focussed on offenders	x	x	x	x	x
- Review of CADS team pilot	x	x	x	x	x
Expansion of AOD services for offenders serving sentences in the community	x	x	x	x	x
- Review of AOD service package	x	x	x	x	x
Feasibility study/establishment of new service (southern North Island)	x	x	x	x	x
Sub-total AOD	x	x	x	x	x

Departmental expenditure (Ministry of Health implementation of First Steps)	x	x	x	x	x

TOTAL	x	x	x	x	x

EFFECTIVE INTERVENTIONS: SOURCES OF FUNDING FOR FIRST STEPS PACKAGE

First Steps PACKAGE:	2007/08	2008/09	2009/10	2010/11	Ongoing
Source of Funding	$[000]	$[000]	$[000]	$[000]	$[000]

Vote: Police
- within baseline	x	x	x	x	x

Vote: Justice
- within baseline	x	x	x	x	x
- prospective Budget Bid	x	x	x	x	x
Sub-total Vote: Justice	x	x	x	x	x
			s9(2)(f)(iv)	s9(2)(j)
Vote: Health - new funding required for 2008/09 and subsequent periods	x	x	x	x	x
Health Services Funding NDE	x	x	x	x	x
Operating Costs - DE	x	x	x	x	x
Sub-total Health	x	x	x	x	x

TOTAL	x	x	x	x	x

Footnotes

1 NB the discussion on judicial monitoring is in Paper Three: The Courts Setting

2 The terms of reference for the review project indicated that a discussion document would be developed and distributed for public consultation by 10 May 2007.

3 For example, The National Study of Psychiatric Morbidity in New Zealand Prisons (1999) indicated that 50% of prisoners have a diagnosable mental disorder

4 In 1999, the United States National Institute on Drug Abuse concluded that drug treatment can reduce drug use by 50 to 60% and decrease criminal activity by as much as 40%.