1. Guidelines for the Rehabilitation of Persons with Substance Dependencies 18 October 2006

2. 2 Outline of the presentation Nature & extent of the drug problem Background Minimum norms and standards for inpatient treatment centers Implementation process of the minimum norms & standards Model for the treatment of substance dependant youth in residential facilities

3. 3 Outline of the presentation cont… Centre based rehabilitation Registration of treatment centres Treatment of youth in residential facilities Community based intervention Challenges in accessing treatment & rehabilitation services Conclusion

4. 4 Nature and Extent of the Drug Problem Alcohol is the dominant substance of abuse (for example 37% of the men in the Northern Cape are alcoholics) The use of cannabis and mandrax (methaqualone) alone or in combination (“white pipe”) are very high. Up to 45% of patients admitted to treatment centres in KwaZulu-Natal during 2005, had cannabis as primary or secondary drug of abuse and up to 16% for Mandrax.

5. 5 Nature and Extent of the Drug Problem cont… Between 13% and 20% of patients in treatment in 2005, have cocaine as a primary or secondary drug of abuse. Overtime, there has been a large increase in treatment demand for heroin as a primary drug of abuse. Between 11% and 16% of patients have heroin as a primary or secondary drug of abuse. Most heroin is smoked, but between 8 and 39% of patients report injection use.

6. 6 Nature and extent of the drug problem cont… Club drugs and methamphetamine (MA) such as Ecstasy and LSD as primary drug is low. Over- the-counter and prescribed medicines are reported as primary or secondary drug of abuse by between 4 and 6 percent at treatment centres in 2005.

7. 7 Background The department has developed the following policy and legislative framework to incorporate rehabilitation and treatment : A policy on the management of substance abuse Minimum norms and standards for inpatient treatment centres Model for the treatment of substance dependent youth in residential facilities

8. 8 Background cont… National Drug Master Plan 2006-2011 Prevention and Treatment of Substance Abuse Bill The policies promote uniformity in managing rehabilitation and treatment in the country

9. 9 Background cont… Treatment and rehabilitation is not that accessible in the country due to the expensive nature of the programme, limited facilities and programmes and the present admission process more especially to state facilities

10. 10 Minimum Norms and Standards for Inpatient Treatment Centres These Minimum Norms and Standards were developed and approved during February 2005 They were piloted in five government facilities The purpose of the Minimum Norms and Standards is to ensure monitoring and quality assurance of all treatment facilities in SA

11. 11 Minimum Norms and Standards cont…. What will the Minimum Norms and Standards try to achieve: Ensure that transformation is phased in a specific, planned and effective manner Will ensure compliance before registration is granted

12. 12 Minimum Norms and Standards cont…. Will provide guidelines for the review of funding criteria/policy and procedure related to inpatient treatment facilities Provide basis for monitoring of facilities

13. 13 Minimum Norms and Standards cont…. The document includes amongst others the following elements in its structure: Applicable legislation Principles Purpose Rights and responsibilities

14. 14 Minimum Norms and Standards cont…. Categories of service delivery Target groups Procedure for treatment centre management

15. 15 Minimum Norms and Standards cont…. Rights and responsibilities (standard): Patient’s rights (health rights) Children’s rights Constitutional rights Discrimination

16. 16 Minimum Norms and Standards cont…. Category of services-(standards): Prevention  Program practice for awareness and outreach programs  Management actions for the above Early intervention  Program practices and management actions for admission criteria, pre admission screening, policy and procedures for admission

17. 17 Minimum Norms and Standards cont…. Category of services-(standards) Statutory services  Program practices and management actions for statutory services leading to admission, release, leave and discharge Treatment services  Program practices and management actions for assessment, IDP’s, pharmacotherapy and medical care, multi disciplinary team, detoxification, daily activities, treatment rehabilitation program and finally release, re- admission and aftercare

18. 18 Minimum Norms and Standards cont…. Treatment centre management (standard): Staff training and support Environment and amenities Individual case records

19. 19 Minimum Norms and Standards cont…. Target groups (children and adolescents, and people living with HIV and AIDS, women Procedure for treatment centre management (incident reporting, faith based practices, visits, abuse, behavior management, privacy and confidentiality, financial management and planning and human resource management)

20. 20 Implementation process of the Minimum Norms and Standards Implementation plan has been drafted and implemented which includes the following: Piloting in the five state facilities from the 1 st April 2005 to 31 st March 2006

21. 21 Implementation Process of the Minimum Norms and Standards Progress: Guidelines for assessment and registration of treatment centres (based on minimum standards) Training of provinces and service providers on assessment technique Need analysis conducted to identify training needs After training, standardized assessment tool developed and piloted Four policy guidelines were developed (admission, expulsion, transfers, readmission)

22. 22 Implementation Process of the Minimum Norms and Standards Cont… Progress: The above mentioned policy guidelines were also piloted for the period of three months All five facilities submitted the annual progress reports on the pilot Provinces requested to submit rollout plans The external evaluator will be appointed soon to determine the extent to which the implementation process has been effective.

23. 23 Centre Based Rehabilitation There are 72 operational treatment centres and only 35 are registered ( as per our records) including five state facilities Only 16 of these centres cater for adolescents including the four state facilities Distribution per province Kwazulu-Natal- 21 treatment centres Western Cape-16 treatment centres Eastern Cape - 8 treatment centres

24. 24 Centre Based Rehabilitation cont… Distribution per province Mpumalanga-2 treatment centres Northwest- 1 treatment centre Northern Cape-3 treatment centres Free State-1 treatment centre Limpopo-1 treatment centre Gauteng- 19 treatment centres

25. 25 Registration of Treatment Centres The national Department of Social Development is responsible for the administration of the Prevention and Treatment of Drug Dependency Act, No 20 of 1992 (the Act). The Department is in process of delegating this responsibility to the provincial Departments of Social Development. The final date for the delegation of these powers and the provinces that would be affected, is still to be finalised.

26. 26 Registration of Treatment Centres cont… The department in collaboration with the provincial departments of Health and Social Development is responsible for the registration of treatment centres, as prescribed in the Act The minimum norms and standards for the in-patient treatment centres, are used as a guideline in the registration of treatment centres.

27. 27 Model for the Treatment of Youth in Residential Facilities This document was developed based on the minimum norms and standards It aims to ensure that the therapeutic program offered responds to the treatment needs for young people within a developmental context which ensures respect for young person’s individuality It proposes essential elements, strategies, processes and methods to be applied when dealing with young people It provides guidance on the implementation of the model

28. 28 Treatment of Youth in Residential Facilities Essential elements of the model:  Model promotes developmental approach  Medical model applied in terms of describing the substance dependent behaviour  Ecological perspective is incorporated with family/significant recognized as crucial to young person’s recovery  Model embodies outreach and networking

29. 29 Treatment of Youth in Residential Facilities cont…  Model recognizes an eclectic approach drawing on a range of existing models (medical model, systems theory, Minnesota model circle of courage model, adolescent development program model).  Training of personnel working with young people  Multi-disciplinary team required  Availability of aftercare services for the young person's recovery

30. 30 Treatment of Youth in Residential Facilities Strategies, processes and methods:  Pre- admission regarded as a vital process  Medical assessment of young people  Developmental assessment of young people within three weeks of admission  Therapeutic program should be inclusive (education on substance abuse, behaviour management, relapse prevention, aftercare, self –awareness & personal growth, health and hygiene, communication skills, spirituality, sexuality, HIV and AIDS, diversity etc).

31. 31 Treatment of Youth in Residential Facilities cont…  Ongoing training and supervision of all team members  Involvement of volunteers  Application of restorative approach in conflict situations  Provision of educational component  Structured activity program (sports, music, art  Skills development

32. 32 Community Based Intervention Community based model for prevention and treatment/rehabilitation developed and consulted with stakeholders The model will guide successful interventions for outpatient and community based services The model is regarded as an alternative intervention for centre based services to the previously disadvantaged areas and vulnerable groups The community based approached has been outlined in the Bill, the NDMP and the policy on the management of substance abuse

33. 33 Elements of community based intervention Prevention: the awareness and education Early intervention: which could involve education to community, families, parents about management of substance abuse Treatment: which would involve day care treatment intervention based on amongst others diversion programmes After care and support: establishment of support groups for users, etc

34. 34 Challenges in Accessing Treatment and Rehabilitation Services Treatment is expensive and not accessible to all citizens Limited financial and human resources to provide effective services at national and provincial levels Admission process as stipulated in the present legislation is not user friendly

35. 35 Challenges in Accessing Treatment and Rehabilitation Services cont… Mushrooming of unregistered treatment centres and non-compliance with minimum norms and standards Slow response on the process of delegating the present Act 20 of 1992 Period of treatment not clearly determined, the period varies from centre to centre

36. 36 Proposed measures to address challenges The minimum norms and standards and the youth model be rolled out to all provinces to promote uniformity and ensure compliance Expansion of treatment and rehabilitation services in all provinces Period of treatment and rehabilitation be explored and benchmarked with other countries for effective results

37. 37 Proposed measures to address challenges conti… Measures be put in place to measure success rate of treatment and rehabilitation services in the country Provinces have made provisions for more beds in the subsidised centres for previously disadvantaged groups.

38. 38 Conclusion All the documents referred to in this presentation were approved by the Minister of Social Development The NDMP 2006-2011 was approved by Cabinet on the 04 th of October 2006.

39. 39 “ Lets promote a society free of drugs” Thank you for your attention!!!