BILL: Youth Treatment Orders

Today Mark outlined the Greens' concerns and strong opposition to the Government's deeply flawed proposal for mandatory treatment measures for young people grappling with drug issues.


I have added myself fairly late in the piece to the speaking list for this bill, because it is such an important matter that this parliament does need to seriously consider the direction in which it is heading. I note that the portfolio holder for the Greens in relation to this matter is my colleague the Hon. Tammy Franks. She spoke at the second reading on 15 November, and I associate myself fully with her remarks. However, since then there have been a number of developments, and I wanted to take the opportunity to put them on the record.

Let me say at the outset that this is one of the most flawed and ill-conceived pieces of legislation that I have ever come across. If you are looking for an indication as to why that might be, you only have to look at the fact that every single professional body even vaguely associated with this subject matter has written to us telling us to oppose it. All of them have written to us saying that the bill is the wrong way to go, it will not achieve what it intends to achieve and it will have consequences that result in negative impacts on young people. In fact, I have not seen one submission that suggests that this bill has any redeeming features whatsoever.

The position of the Greens has always been that our preference would be to knock this bill off at the second reading and then we can get back, as a parliament, to debating sensible measures that do advance the welfare of the people of South Australia. It looks as if the bill has enough support to get through the second reading stage but that does not mean that we should then quickly proceed into committee and pass this bill before Christmas.

It is so flawed and there is so much more work to do that the Greens believe that a more sensible option is to pause for breath, and that means not proceeding through all the stages today, sending it off to a committee where it can be properly scrutinised and where different stakeholder groups, whether they be medical groups, the Youth Affairs Council, the Law Society or the charity sector through SACOSS—that we get all of these people to come in and explain to MPs in detail what is wrong with this bill and whether in fact it is at all redeemable.

I am just getting some advice on how such a process might work but in the meantime I think it is important for me to put on the record some of the most recent correspondence that has been received. I think all members would have just this morning received an email from the Australian Medical Association (South Australia) Incorporated. It is a letter addressed to all members of parliament. It is a page and a half in length but I think I need to put it on the record because it certainly sums up the concerns that the Greens have had since this bill was introduced. The letter is under the hand of Joe Hooper, Chief Executive, Australian Medical Association (South Australia). It states:

Dear Members of Parliament,

The AMA(SA) asks all Members of Parliament to reject the government's deeply flawed proposal for mandatory treatment measures for young people grappling with drug issues.

The Controlled Substances (Youth treatment Orders) Bill is not only fundamentally flawed, it is potentially dangerous. It is based on a flawed premise; lacks important protections; has no medical substance; it is legally and morally questionable; and confuses medicine and social issues in its approach. Multiple groups have raised major issues with what the government has proposed and the Bill itself.

Setting aside the thoroughly problematic premise of the Bill, major questions remain unanswered. Members of Parliament may wish to attempt to improve the Bill with amendments. With respect this will not and cannot have a satisfactory outcome.

Simply rushing through unsuitable legislation and attempting to work out a model of care after the event is not an acceptable process. The Government has not addressed major questions and concerns raised about the Bill.

Models of care and the facilities for detention (outside of the juvenile justice system) are simply non-existent or undeveloped. This is legislation before treatment models, which is not defensible. We are perplexed by the approach of tasking stakeholders with helping to develop a model of care established under poor legislation. If these very parties do not support the Bill, and in fact have deep concerns about it, how are they to be tasked with making flawed legislation work, contrary to medical evidence?

If the government is seeking a 'clinically robust Model of Care' we can advise that we are aware of no such model for such a proposal as this. Mandatory measures altogether are not supported by evidence. The lack of evidence for mandatory measures, in general, was explicitly indicated in the consultation paper produced by SA Health in January 2018 in relation to a previous, much less restrictive proposal for a trial of mandatory measures, for adults, for a maximum duration of two weeks.

It has been said that full implementation of the Bill will not be achieved until the model of care and resources are developed. If this is the case, why are Members of Parliament being asked to make the Bill law? It is under-developed, not evidence based, and has no resources or budget information attached.

The diversion of resources into making this flawed Bill operational (and it won't yield results in a value for investment analysis) will only add further pressure to the funding of existing voluntary services. On the issue of 'voluntary services', our state is significantly under-resourced for drug and alcohol services and treatment centres.

So why is the government willing to detain young people with drug issues whilst not providing clear access and multiple services for those wanting voluntary treatment? We are also concerned about the lifelong impact on a young person having been detained. Also, what happens if they do not cooperate? Concerningly, this Bill is also not consistent with the recommendations of the major state inquiries, the Nyland Report, Mullighan Report and the Layton Review.

The patient group envisaged would be very complex, characterised by high rates of psychiatric co-morbidity. There would be a high number of young people in this group who have had exposure to significant adverse childhood events that would be unmasked and require a therapeutic response. Without the person's active cooperation there is unlikely to be an accurate assessment, engagement and effective treatment. The Bill also has concerning ramifications for the doctor-patient relationship, trust, and the stigmatizing of people with mental health and drug-related conditions.

The harms from this proposal have simply not been thought through. These include from combining users together, some of whom would be extremely vulnerable; stigma creation; the opportunity cost of driving people away from seeking treatment themselves voluntarily; re-traumatisation of those with trauma backgrounds forced to do things against their will; and others we can discuss.

Developing state of the art interventions for young people grappling with drug related issues is a welcome and worthy proposal if approached scientifically and with an evidence-informed approach, evaluation and published outcomes. Rushing into involuntary or custodial treatment when we do not know what benefits there will be, and what potential harms can be caused, is unacceptable, and for the above reasons the AMA(SA) strongly opposes this Bill.

I do not think I have read a more scathing assessment of a piece of legislation by a recognised medical body as that letter that I have just put on the Hansard record. It is not exaggerating to say that the bill has no redeeming features according to the AMA, and they are not alone in their criticism. When my colleague the Hon. Tammy Franks spoke on 11 October, she put on the record the concerns of some other organisations. The Youth Affairs Council and other groups had weighed in.

In the time since my colleague made her contribution, we have received other communications from stakeholder groups. I do not propose to read all those onto the record, but I think it is important that all members of parliament know how universally criticised this legislation is. For example, this Monday 3 December, the South Australian Council of Social Service wrote to the Premier. They cc'd the Minister for Health and made copies available to other members of parliament.

SACOSS was not writing just on their own behalf: they were writing as part of a coalition that had formed around opposition to this bill. The letter is co-signed by Ross Womersley, South Australian Council of Social Service; Penny Wright, the Guardian for Children and Young People; Michael White, the South Australian Network of Drug and Alcohol Services; Simon Schrapel, Uniting Communities; and Melissa Clarke, Aboriginal Legal Rights Movement. In very similar terms, although less focused on the medical side, the submission urges the government:

…to withdraw the Bill and bring on a proper consultation to ensure we get an effective model for young people who need treatment. The government must consult with the treatment sector and our colleagues with expertise in youth mental health, family relationships, child welfare and wellbeing, and education, to design a system that meets the needs of young people, families and communities this legislation is intended to help.

The letter concludes:

We and the wider drug treatment services and other stakeholders, including families and users of current treatment services, are ready to help in designing a fit-for-purpose and more effective response to the issues faced by young people and their families.

The ideal response to these submissions being received as recently as this week is for the government to withdraw the bill and say, 'We have listened to what the stakeholders are saying. We will pause for breath, reconsider and come back with something else next year after we have consulted with the people in the sector.'

I have had no indication that the government is interested in doing that, so the next best thing is for this council to do the job that the government should have done over the last several months. If the only way that we are going to get that proper consultation is for this bill to be sent off to a committee, where all of the stakeholders can be called in to give direct evidence, then that is, I think, what we need to do.

There is support for that approach. Again, as I have said, there was a flurry of activity in the last week, and another piece of correspondence from yesterday, from Michael White, the executive officer of the South Australian Network of Drug and Alcohol Services, or SANDAS, basically supports the idea of a proper investigation and that a parliamentary committee might be the way to do that. I do not think any of these groups are pulling their punches. Their preference is for the bill to be scrapped and for the government to go back to the drawing board. But if we are not going to be able to achieve that, then we do need to make sure that we properly scrutinise the legislation.

In some ways, this is yet another example of something that I have been banging on about for many years; that is, that the way this parliament deals with complex social legislation with multiple stakeholders is very poor. If all we do—and in most cases this is all we do—is read, as I have done, lengthy submissions onto the Hansard, and the committee of the whole is basically a bit of a question and answer session with the minister, who takes advice, that is a flawed way of processing complex legislation.

A far better approach would be for many more of these bills to go to committees, where the stakeholders can be called into the room, they can be quizzed directly, and we can ask them not only what they like or do not like about a piece of legislation but what alternative measures they think might be appropriate. I guess that is what makes this so disappointing—that the health department did undertake some consultation at the start of this year on a related provision, and apparently all of the learnings from that process have been lost.

With those brief words, the Greens' position is that we do not support the second reading of the bill, but we do support the idea of a committee. I will say that I know colleagues can be nervous about committees. Certainly, the Greens' intention would be that this would not be a committee that languished. July of next year would appear to be a very reasonable time frame for any committee to report. We showed that we could do it with the ICAC legislation. A very strict time line was imposed, and I will acknowledge the Hon. Dennis Hood; he cracked the whip and made sure that that committee did not languish and that it reported very quickly. There is no reason why a committee looking at this bill could not do exactly the same.