Methamphetamine (meth) use can have serious implications for users, their families and the community. A stimulant, meth is often used continuously over several days in what is known as a ‘binge’, disrupting the patterns of everyday life and work. Continued use can lead to aggressive and violent behaviour, threatening the wellbeing of family, friends and the public and impacting parenting and mental health. It can also lead to police, ambulance and health providers being involved.

This audit assessed the availability, accessibility and effectiveness of treatment services for people with meth dependency by considering if:

• the Mental Health Commission (MHC) ensures the right meth treatment services are in the right places
• all people who require treatments get them, and are they effective.

Background

A 2016 Australian Institute of Health and Welfare (AIHW) national survey found that more than 65,000 Western Australians, 2.7% of the population, had used meth in the last 12 months. This compared with 3.8% in 2013 but was still nearly twice the national rate in 2016 of 1.4%.

The survey also showed meth had become the drug of greatest public concern, named by 39.8% of respondents in 2016 compared to 16.1% in 2013. To put this in perspective, the survey showed a decline in concern about excessive drinking from 42% to 28%.

There is a suite of WA government activities dealing with substance dependency in general, including meth. They include:

• criminalisation and other legislative approaches
• police and other enforcement and corrective services
• broad public health initiatives
• targeted educational programs
• targeted treatment services.

The Government has had 3 key plans or strategies relating to meth in recent years:

• The 2015 Better Choices. Better Lives: Western Australian Mental Health, Alcohol and other Drug Services Plan 2015-25 (Better Choices. Better Lives). This plan forecasts the alcohol and other drug (AOD) treatment and support services that will be needed in WA to 2025. While this plan provides baseline forecasts of need and capacity for AOD services, its full implementation was not funded.
• The 2016 WA Methamphetamine Strategy to address growing concern about the impact of meth dependency. Alongside education and awareness, legal and law enforcement changes, the WA Methamphetamine Strategy aimed ‘to expand withdrawal, residential rehabilitation, and community based treatment services’ across the state.
• The 2017 Methamphetamine Action Plan that updated how the strategy and plan would be implemented, but the key aspects were unchanged.

Our audit focused on the implementation of the Strategy which committed $14.9 million across 2016-17 and 2017-18 to:

• establish a further 52 residential rehabilitation (rehab) and 8 withdrawal beds. This was intended to provide a 9% increase in instances of treatment
• add 13 staff, full-time equivalent, to Community Alcohol and Drug Services (CADS) across the state. Expanding the capacity of these counselling and referral services was expected to provide a 6% increase in episodes of care
• fund a dedicated WA Meth Helpline for 2 years to provide support and advice. In its first 6 months of operation, counsellors and volunteers answered more than 3,000 meth-related calls, mainly from users and their families
• provide 2 years of funding for a specialist outpatient clinic for people with complex methamphetamine withdrawal needs
• fund frontline drug support nurses in hospital emergency departments for 2 years.

The extra beds and CADS staff are an expansion of existing services for people dealing with alcohol and other drug dependencies and are not restricted to clients with meth problems. The 2018-19 State budget funded all these services until 2021-22 except CADS, which is funded until 2020-21.

Residential rehab beds are for services that are all variations of the Therapeutic Community model which is a model for residential drug treatment supported by evidence and accepted by the alcohol and other drug (AOD) sector. This is where the residential community itself, through self-help and mutual support, is the main means of treatment. It is not specific to meth, and is used for treating all drug dependency. There are no pharmacological treatments for meth dependency.

Withdrawal beds are for medically supported detoxification with healthy meals, a clean living space, a supervised environment and daily counselling. Withdrawal usually takes around 7 days. ‘Low medical’ withdrawal beds offer limited sedative and pain medication to people as they withdraw. ‘High medical’ withdrawal beds are for people with a higher risk of complications and include additional medical supervision by specialist medical staff.

CADS deliver AOD counselling and referral services. These use variations of Cognitive Behavioural Therapy, often referred to as CBT, one of the most common evidence-based treatments used for drug dependency worldwide.

Although there are many treatment providers, Government funding is primarily through the MHC. The MHC was established in 2010. In 2015 it amalgamated with the Drug and Alcohol Office, which had managed this area since its inception in 1974.

The MHC funds AOD treatment services from 23 non-government providers. It also provides services itself, and contracts some services from the Western Australian Country Health Service (WACHS). While emergency departments deal with many people under the influence of meth and other drugs, the public hospital system is not a key treatment provider.

All services funded by the MHC have to demonstrate that their treatment model is evidence-based and show how it will meet local and individual needs. They must also detail staff qualifications, training and supervision levels.