Estimates: Health (Drug and Alcohol Service SA)

Mr GARDNER: I think this is Budget Paper 4, Volume 3, page 44, DASSA. I want to tease out the figures in the activity indicators a little bit to gain a better understanding, and perhaps that is useful to have on the public record. For the record, perhaps we can start with the fact that there are two activity indicators: the number of inpatient separations, non-hospital; and the number of outpatient attendances. There are estimated results for the end of the 2013-14 financial year in both indicators. Now that we have past the end of the financial year, I am wondering whether we have the actuals for the 2013-14 financial year to the 30 June. I am very happy if it needs to be taken on notice.

The Hon. J.J. SNELLING: Outpatients will exceed target. With regard to inpatients, because there has been some redevelopment work going on, that will be a little bit lower. We have had 10 beds unavailable for the last couple of months. So, we expect the inpatient number to be down a little, but outpatients certainly exceeded targets.

Mr GARDNER: I appreciate that. Will you be able to get us the numbers when they are available?

The Hon. J.J. SNELLING: Yes, sure. They will be made available in the annual report when they table that.

Mr GARDNER: I do appreciate that. I suspect that it is possible that the estimates responses might come in before the annual report, so we will be glad—

The Hon. J.J. SNELLING: We will do our best.

Mr GARDNER: Thank you, sir; I appreciate it. With respect to the outpatient attendances, there were 38,443 last year, and the estimated result for this year is 38,000. It describes the outpatient counselling for medication-assisted treatment for opioid dependence, and it includes attendances across metropolitan and country services. I am wondering whether this includes any of the diversion programs that are run as a result of substance abuse offences.

The Hon. J.J. SNELLING: It is not included in our numbers. We pay for it but on a contract with the non-government sector.

Mr GARDNER: So the non-government agencies deliver it. Does DASSA have any contracts with Justice, or does DASSA deliver any services for Justice in drug programs?

The Hon. J.J. SNELLING: I will ask Marina Bowshall to take the question.

Ms BOWSHALL: If we get referrals to do court assessments, yes, they are included in our outpatient figures, but it is a case of a court diverting them through for an assessment under relevant acts. It may well be that it is a direct court referral, and we may get a mandated assessment through Families SA or another agency, and they would be included in our outpatient numbers.

Mr GARDNER: So there are a number of police diversion programs—I think they are the highest number—and they go to the NGOs. A magistrate could potentially require, as part of somebody's sentencing or release, that they participate in one of your services, or presumably the Parole Board might do that as well, and you are saying that Families SA can refer people to DASSA services. Can I ask then—and I suspect you might not have the numbers at your fingertips so 'on notice' is again welcome if you wish—can we get numbers for how many people have used DASSA services as a result of each of those categories in the last financial year? Is that able to be established?

Ms BOWSHALL: I believe it is, but I would need to take that away and have a look at it for you.

Mr GARDNER: Are you happy with that minister?

The Hon. J.J. SNELLING: Yes.

Mr GARDNER: I would be very grateful for that. Has there been any submission by Drug and Alcohol Services South Australia over the last two years, in regard to those police diversion programs, for DASSA to be given the opportunity to deliver those services? DASSA is a part of government with a significant reputation, and some of its staff have a worldwide reputation, as I understand. I am interested to know—or I will ask elsewhere—why it has not had such an involvement. Has DASSA made a submission to have some of that work?

The Hon. J.J. SNELLING: I will ask Ms Bowshall to take that question.

Ms BOWSHALL: Up until 1 July 2012 DASSA did provide police drug diversion assessments and appointments. As a result of the tender, the non-government sector was able to bid for that work and was able to provide those services and the right number of appointments that we required across the state, with the exception of Kangaroo Island, where there were some services commissioned through Country Health SA to provide those assessments within SA Health.

In addition, we oversee the program so we make sure that we provide accreditation for all the clinicians who deliver those diversion initiatives. We provide training to every new clinician in that area, and there is a standardised manual that they are required to adhere to, to make sure there is a certain quality of assessment undertaken and an appropriate health intervention. In the last couple of years we have also implemented and trained all the non-government sector clinicians working in that area to develop and implement a standardised assessment tool and brief intervention which they all issue now as part of the standard assessment for all police drug diversions in this state.

Mr GARDNER: I trust the non-government agency that won that tender is doing an excellent job and I look forward to learning some more about their work. You have agreed you will get some information about how many of the 38,000 or so outpatient attendances are in each of the justice or other government agencies. I assume that the vast majority of those are people who self-identify and seek help; is that correct?

The Hon. J.J. SNELLING: I will ask Ms Bowshall to take it.

Ms BOWSHALL: Yes, that is correct. People can obviously be referred through a self-referral process or it may well be that they have engaged with a GP or another service provider within the health or human services sector, and they certainly refer them into DASSA. But it is a voluntary appointment and the person determines whether they would like to attend and participate in the treatment program.

Mr GARDNER: What proportion of those are people who are presenting on multiple occasions and what is the entry point? Is it the GP who is the main entry point and somebody presents, or do people then get back in touch with DASSA because they may have had a connection before, or is it done through the website?

Ms BOWSHALL: People come through all of those pathways. Our alcohol and drug information service offers a triage service for members of the public who would like to call and find out what services are available. They can match that particular caller to the most appropriate service for them both within a geographic context, but also in the context of the treatment service that they are seeking and requiring based on the assessment over the phone.

In addition, we do have people who come directly back to DASSA who have obviously worked with DASSA in the past and have built that therapeutic relationship with the agency, GPs, and non-government sector organisations. There is quite a clear focus on multidisciplinary teams, and our focus on the non-government private sector and the government sector, working collaboratively on case managing some clients.

Mr GARDNER: Are there any specific programs (and this could be a broader question) dealing with comorbidity issues between people with substance abuse and mental health disorders looking to assist those people who do not present neatly as one or the other, as so many people do?

The Hon. J.J. SNELLING: Primarily, those people will be dealt with in our mental health system. Mental health has a fair bit of experience in dealing with people with drug addictions. In fact, I will perhaps just ask Dr Tyllis to answer that.

Dr TYLLIS: The comorbidity rate is fairly high when we look at the clinical samples. In mental health services, it is over 70 per cent, and in drug and alcohol services the comorbidity for mental disorders is relatively high as well, up as high as that. The idea is not that those services actually work separately, but that the services and the care services are delivered from the same service, which is the mental health sector.