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7. Alcohol measures

The alcohol measures introduced as part of the NTER were not based, as they should have been, on available evidence of what works and on the need to coordinate with existing alcohol arrangements in the NT. In the NT, many Aboriginal communities, particularly remote communities, had already voluntarily put in place alcohol bans, although the effectiveness of these bans has been undermined by a lack of support from governments in providing sufficient policing resources and restricting alcohol supply. A small number of communities also had regulated access to alcohol via alcohol purchase cards and permits or regulated clubs and ‘wet' canteens. There were also a number of in-place alcohol management plans negotiated with the communities and relevant stakeholders, and a successful trial of alcohol restrictions in Alice Springs.

Improvements in the rates of alcohol consumption and related harms have occurred as a result of these measures largely through the restriction of take-away sales, effective price-based supply reduction and increased preventative policing. For example, although not yet independently evaluated, the Alice Springs trial appears to be associated with improved statistics: a reduction in overall consumption by 10%; a 50% reduction in the combined murder/manslaughter rate, admissions for stabbings at Alice Springs Hospital and the suicide rate; and a reduction of admissions for alcohol-related conditions.

The blanket bans on alcohol in prescribed communities introduced under the NTER ran over the top of existing arrangements without consideration of the impact on them and did so in a manner that was racially discriminatory. The NTER measures precluded community participation or consent and introduced extraordinary police powers allowing, for example, entry to any house in a prescribed community without a warrant if police suspect alcohol is being consumed.

The Aboriginal and Torres Strait Islander Social Justice Commissioner was highly critical of the NTER alcohol measures, commenting that

"...the approach adopted by the federal government...is misconceived and has threatened undoing more than two decades of achievements in Territory communities in dealing with alcohol."30

In addition to the alcohol bans applied to prescribed communities, the NTER alcohol measures included a totally ineffective and administratively burdensome system of registering alcohol purchases across the NT.

The most significant failure of the alcohol measures, however, was the failure to recognise that the most severe alcohol-related harms are occurring in the regional centres and it is from these centres that the supply of alcohol is occurring. While additional police has resulted in a welcome crackdown on grog running, there has been no NTER measures aimed at reducing the supply of alcohol in regional centres even though this is what we know works.

Negative impacts of the NTER alcohol measures

From the above it is clear that one of the key negative impacts of the NTER alcohol measures has been the disruption of existing alcohol control arrangements in the NT and the lost opportunity to build on the existing hard-won successes. Other negative impacts include:

In addition there was an irrational over-emphasis on the need for detoxification services and hospital beds and the beds that were funded were hardly used. This is because the measure was based on an incorrect analysis of the major treatment and rehabilitation needs of Aboriginal people, which can be addressed through the implementation of the service model that AMSANT has been advocating (see Attachment 5).

Addressing the impacts of the NTER alcohol measures

To fully assess the impacts of the NTER alcohol measures the Review Panel will need to establish:

AMSANT strongly advocates that a comprehensive, evidence-based approach to alcohol requires measures that address supply reduction, demand reduction and harm minimisation, including

AMSANT has developed a policy paper, Options for Alcohol Control in the Northern Territory, which is provided as Attachment 6 of this submission. AMSANT urges the Review Panel to recommend the coordinated reform of the NTER alcohol measures and NT alcohol policy to achieve a coordinated, evidenced-based alcohol policy framework in the NT [See Recommendation 9].

Alcohol and Other Drug (AOD) initiatives

During 2008, several alcohol and other drugs (AOD) initiatives were introduced using NTER funding. The most significant of these was the establishment of functioning AOD workforces within regional Aboriginal health services (all of which are AMSANT members). Around 20 additional AOD staff have been employed.31

The Interim Report on the AOD initiatives noted that:

"...these services have been remarkably successful within a short timeframe. They have certainly exceeded my expectations and those of many other observers. This view is based on both formal feedback mechanisms (ie interim service reports, fortnightly worker reports) and on informal and anecdotal feedback from numerous sources, including local people."32

The Interim Report notes that successful aspects of these projects included a flexible funding model which allowed the health services to decide how to incorporate the project into their existing service structures based on local priorities; the quality of the people engaged in the projects; and the quality of community engagement that was achieved, particularly through the use of local cultural brokers.

The project also sought to conform to AMSANT's recent policy document, A model for integrating alcohol and other drug, community mental health and primary health care in Aboriginal medical services in the Northern Territory, that addresses the lack of integration between AOD and mental health. (See Attachment 5).

It should also be noted that establishing this successful program within such a short timeframe also relied on the immediate availability of funds and the fast-tracking of the project through bureaucratic processes. It is an example of where the "emergency" aspect of the NTER proved a positive when matched with receptive community-based organisations (the ACCHSs) and an agreed evidence-based model.

Over time, the services need to extend to other more remote locations which did not get short term Phase 2 AOD funding. Services that are currently provided on an outreach basis by larger ACCHSs need to be devolved to remote ACCHSs as they develop the capacity to manage these services. The extension of AOD and mental health services within PHC in more remote locations will require considerable planning and consultation. However, the development of larger regional services through the EHSDI should enable service coverage to increase in an Aboriginal community controlled PHC framework.

The NTER AOD initiative has been welcomed and has introduced services that have been desperately needed. However, as the Interim Report notes, the challenge is to ensure that these new AOD services in PHC become sustainable through long-term funding. This will require the transfer of significant COAG mental health and AOD funds into the Phase 3 primary health care pool. Currently there are no arrangements in place to enable this to occur.

AMSANT urges the Review Panel to recommend that ongoing funding be provided for AOD services in PHC and that these services be expanded to cover all Aboriginal PHC services in the NT after suitable consultation and evaluation of the existing services. AMSANT also recommends that these services should broaden in scope so that they have the capacity to treat both AOD and mental health problems as outlined in AMSANT's policy paper on integrating AOD, mental health and PHC services. [See Recommendation 10]

30. Social Justice Report 2007, p286

31. Northern Territory Emergency Response (NTER) Alcohol and Other Drugs (AOD) Clinical Director's Interim Report (Draft Report) July 2008.

32. Ibid. p 4

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8. Child Protection

6. Comprehensive PHC reform (Phase 3)