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How mandatory treatment for public drunkenness is failing Aboriginal people

The Northern Territory’s Alcohol Mandatory Treatment Act is disproportionately applied to Aboriginal people. Terry Trewin/AAP

How mandatory treatment for public drunkenness is failing Aboriginal people

A Commonwealth body has called for the Northern Territory government to roll back its mandatory treatment program for “problem drinkers”.

Investigating the harmful effects of alcohol in Aboriginal and Torres Strait Islander communities, the House of Representatives Standing Committee on Indigenous Affairs’ June report said the NT government’s practice of criminalising alcohol abuse had no basis in evidence.

Among other things, the Committee highlighted the Territory’s contentious Alcohol Mandatory Treatment Act – introduced in July 2013 – which allows for people caught for public drunkenness three times in two months to be referred to a tribunal that decides whether they should undergo “mandatory rehabilitation”. This is treatment in an alcohol rehabilitation facility, or community-based treatment, for up to three months and without the person’s consent.

The Committee expressed doubts about the Act’s effectiveness as well as the adequacy of legal safeguards. Others have had similar concerns since the scheme’s introduction, saying it lacks transparency and is disproportionally applied to Aboriginal people.

Detention for non-criminal acts

Residents of the Northern Territory consistently drink more than the average Australian. Alcohol consumption for each person is about 50% higher than everywhere else in the country, and alcohol-related deaths are more than three times the national average.

The NT government’s mandatory treatment law, in response to this issue, is not unique. Laws allowing for “civil commitment” (detention of a person who has not committed a crime) have existed in Australia for decades.

New South Wales previously allowed detention of problem drinkers for up to 12 months, under its Inebriates Act of 1912. And Victoria had similar laws permitting detention for up to three years. But both states have reviewed their laws in recent years, replacing them with up-to-date statutes that reduce detention periods and better protect individual rights.

New South Wales now only permits detention for 28 days, with an option to extend detention for up to three months - but only in circumstances where the patient is suffering from drug or alcohol-related brain injury.

The Victorian Act has also been updated; only 14 days’ detention is permitted, and patients may obtain a second opinion during the commitment process.

These changes are more in line with international best practice, as recommended by bodies such as the World Health Organization, and the UN Office on Drugs and Crime. But as we argue in the Medical Journal of Australia, the Northern Territory is bucking this trend by moving towards lengthier periods of detention, for which there is little evidence of effectiveness, either in the Territory itself or internationally.

Mandatory treatment

The Territory’s mandatory treatment program is expensive - costing taxpayers around A$27 million a year - and very few people are treated through it.

Each quarter, the NT Department of Health releases a report stating how many people have been referred for assessment under the scheme. On average, around 100 people are referred each quarter but only around 40 to 50 of these people wind up in residential treatment.

But the reports contain no information on effective treatment or relapse rates, and it is not clear whether this kind of evaluation data is even being collected. The number of people who have absconded from care (left rehab without permission) are also not reported, although media outlets claim that absconding is frequent among patients.

There is no data on the effectiveness of mandatory treatment or relapse rates. Dean Lewins/AAP

The only information regarding the success of the scheme comes in the form of government-released “case studies” – a small handful of de-identified success stories.

Controversy around the Act

The Act was reviewed by the government six months into its operation. At that point, a number of professional bodies raised legitimate concerns about the way the scheme operates; for instance, around the lack of transparency and fairness in the operations of the Tribunal.

These concerns seem to have been borne out. One patient successfully appealed a Tribunal decision on the basis that she was not given access to an interpreter during her hearing, and was placed at a disadvantage for that reason.

Another criticism is that the scheme seems to disproportionately target Aboriginal people. Government reports do not contain information on the racial profile of referred people, but it is reported that around 99% of those assessed so far are Aboriginal.

This is not surprising, given the scheme is designed to pick up people who are drunk in public, and Aboriginal people experience much higher rates of homelessness than the rest of the NT population. The homeless are clearly more likely to drink in public.

Alarmingly, we know that at least one woman has died while undergoing treatment. The fact that there’s been no public explanation for the death further highlights the lack of transparency around the scheme.

A social problem

For these reasons and more, the scheme seems designed to deal more with a “social problem” — public drunkenness — than with chronic alcohol misuse.

In its report, the House of Representatives Standing Committee on Indigenous Affairs was:

concerned by evidence that legal safeguards under the Northern Territory’s AMT scheme are inadequate, that [it] does not represent evidence-based best practice, and that it is criminalising alcohol problems, which it views as a public health issue.

The Committee suggested a number of other much less individually restrictive options to curb “problem drinking”, including restrictions on the sale of alcohol, and better pricing controls. More funding could also be provided for general practitioners to treat patients with alcohol problems, a strategy that has been shown to be cost-effective in rural Australia.

Any of these approaches would be an improvement on the current Act, which is simply ineffective in dealing with the genuine problem of alcohol misuse in the Northern Territory, despite its enormous cost.