6 Dec 2018

Considering the Mental Health Inquiry recommendations on drugs and alcohol

5:13 pm on 6 December 2018

How other countries adopted health-based approaches to drug use was one issue considered by the Inquiry into Mental Health and Addiction report released this week.

A male smoking using a homemade bong.

Photo: RNZ / Cole Eastham-Farrelly

One of those was Portugal, which in 2001, decriminalised the purchase, possession and consumption of all drugs for personal use. Despite concerns, the initiative has been a success.

Approaches such as Portugal's "appear to be generating great success, are widely advocated for across New Zealand, and show great promise for transforming our current approach," according to the inquiry's report.

The inquiry panel suggested the government decriminalise personal drug use and instead introduce civil fines and treatment options.

But Sally Casswell, a Professor of Public Health and Social Research at Massey University, doesn't agree that Portugal is a good example for Aotearoa.

"I think it's clear we have to do something and I'm not necessarily arguing against decriminalisation but I think we need to be a bit more sophisticated in the way we are talking about it," she told Morning Report.

"I think we need to recognise that Portugal in 2001 - when the change happened - is very different from what New Zealand is now. We're a country which is suffering the consequences of colonisation we've got indigenous people that are really very vulnerable to drug use.

"They [Portugal] had much lower levels of drug use at the time they decriminalised, for example, I think seven percent of their population had ever used cannabis whereas we're more in the 40s - 42 percent range."

Portugal's drug issue was different - a heroin epidemic, compared to New Zealand's methamphetamine problem, she said.

In focusing on decriminalisation and Portugal, people weren't focusing on the supply of drugs.

"We have a supply of methamphetamine coming in from Asia in large quantities and I think we can't just talk about decriminalisation and ignore the issue of supply and increasing availability."

Ross Bell, executive director of the New Zealand Drug Foundation, said there was beauty in a Portugal-style approach.

"I've described [the inquiry's recommendations] as a public health approach and the beauty of a Portugal-type model, whether it's for heroin or drugs like methamphetamine, is essentially a health referral model, it's intervening early and making sure there are services available in the community.

"There's a goal in the [inquiry] to not just address the three percent of that real high-need in terms of mental health and addiction but to expand that out to the 20 percent of New Zealanders who have mild and moderate mental health and problematic drug use and providing interventions early.

The Drug Foundation's executive director Ross Bell speaks to the Health Committee about changing cannabis law.

New Zealand Drug Foundation executive director Ross Bell says Portugal-style approaches to swap criminal sanctions for health interventions. Photo: VNP / Phil Smith

"So the beauty of a Portugal-type model or something like that is you are removing the criminal sanctions for drug use but you are swapping it out for something else. You are swapping it out for health interventions."

Similar approaches were already being implemented in Aotearoa, Mr Bell said.

"When it comes to meth, New Zealand is actually beginning to do that. There's a brilliant project up in Northland which is run between the police and the DHB where you have a Portugal-style model where police, when they arrest people for possession of meth, they actually refer them straight away to the DHB services and then the DHB services can provide whatever range of health or social interventions that person needs."

Alcohol recommendations

The inquiry panel also suggested introducing a higher minimum age for buying alcohol and increasing the price of alcohol through more taxes.

Prof Casswell thinks the recommendations will improve mental health and reduce suicide rates.

"I think they would really work and go beyond mental health to solving a lot of other issues connected with alcohol. But I think certainly in relation to mental health it's a step that needs to happen and we've been waiting a long time," she said.

"It won't solve all of the problems. I mean ... we are going to continue to have those alcohol-related mental health problems. But I think the recommendations that the Law Commission made in 2010 are well overdue to be put in place."

Mr Bell said the inquiry's approach, informed by the Law Commission's 2010 recommendations, was "about pulling [issues relating to alcohol] back from an extreme [of] over-commercialisation and wide-spread availability".

"But if you take what that chapter around alcohol and drugs says, combine it with all the others that they say, which is around more resources into the health sector, not just at that high need, but community based services, peer support services and then also addressing a lot of the underlying issues around homelessness and poverty and so on, then it does paint quite a beautiful picture of how New Zealand could better address the problematic and mental health and drug issues that we have."

The inquiry

The panel, led by former Health and Disability Commissioner Ron Paterson, spent roughly 10 months consulting people around the country, holding more than 400 meetings and considering about 5000 submissions.

It delivered a 200-page report and 40 recommendations to Health Minister David Clark, who released it on Tuesday.

Dr Clark said the government would consider the recommendations carefully.

"The inquiry panel has delivered a set of strong and coherent recommendations covering everything from the social determinants of health and wellbeing, to expanding access to treatment services and taking strong action on alcohol and drugs.

"We are working our way through the 40 recommendations and will formally respond in March.

"I want to be upfront with the public, however, that many of the issues we're facing, such as workforce shortages, will take years to fix."

Get the RNZ app

for ad-free news and current affairs