Friday, November 4, 2011

So what is the Australian Alcohol and Other Drug Treatment Sector?

I had the interesting experience this week of attempting to explain the Alcohol and Other Drug (AOD) treatment sector to a mental health nurse from Hong Kong who was visiting the clinic I work in on an observational placement... for the record I think I failed.

The general gist of the explanation (not verbatim; my memory isn't that good) was as follows:

Well, you see, there are 2 levels of government that control our treatment delivery in various ways. The federal government and the state/territory governments each have separate sets of legislation as well as bureaucratic and funding structures that regulate AOD treatment. And the regulations and service delivery structures in each of the states differs. The type of treatment and how it is funded and structured depends on which of either the state or federal programs is providing the service.

No, not all the treatment services are provided by government. Many of the treatment services are run by non government organisations (NGOs). Some of the NGOs are charities, other are not for profit organisations. Yes there is some private work, but it's not really a profitable area. So which services tend to be provided by NGOs and which ones are provided by government? Well that actually depends on what state or territory you happen to be in. For example here in Victoria the government has actually opted out of a lot of the service provision in AOD treatment - they still provide some funding but as a service purchaser not a service provider. A lot of the AOD treatment is tendered out to various NGOs. No there isn't really any over-arching governance over the service provision, so really there are a lot of different organisations all doing their own thing. Duplication? Well, I guess so. There would have to be wouldn't there?

Of course the set up is different across the border in New South Wales. They tend to have more treatment services embedded within their area health services and directly provided by state government run health organisations. It's kind of different again in Western Australia and different again in Tasmania, and so on.

The funding for different treatment programs can depend on the type of drug treatment too. Opiate replacement pharmacotherapy is delivered in quite a complex manner (yes, even more complex that what I was talking about before). You see, the medication is provided by the federal government. No-one actually pays for methadone and buprenorphine as such. However, people may have to pay to be on the opiate replacement program but that depends on the state government. The delivery on the opiate replacement is the responsibility of state government, and the approach varies state to state. Here in Victoria the state government funds the training and accreditation of doctors and pharmacists to provide treatment but they don't fund the delivery of treatment much at all. This means that GPs will bill either the federal government through Medicare or bill the patient, and the pharmacies charge a dispensing fee (yes they set their own fees so it can vary greatly). In New South Wales there is a mix of public clinics where opiate replacement is provided by doctors and nurses and pharmacists employed by government and private doctors and pharmacists who charge for their service... etc

I wish I could say that I was observant enough to notice that the poor fellow's eyes were well and truly glazed over at this point, but I have to admit that I kept going for a bit longer and actually started exploring the differences between the AOD sector and the mental health treatment sector. I'm worried that I may have actually committed a crime against humanity.