Public Health Model

Overview

Over the period since 1900 a number of approaches have been adopted to manage and provide treatment to problematic users of alcohol in Western Australia (WA). The term ‘treatment’ is used loosely to refer to the broad conceptual approaches for managing problematic users in WA over the period.

However, our contemporary understanding of the term ‘treatment’ is an inaccurate characterisation of punitive practices accepted in the earlier part of the period, even though these were referred to as ‘treatment’ in official accounts of that time.

Public health (ADA) model (1975 – mid 1990s)

The public health model was designed to avoid the stigma associated with treatment within the mental health system, which had equated problematic use of alcohol with mental illness. The public health model was implemented by the Alcohol and Drug Authority (ADA) and operated from 1975 to the mid 1990s. This approach involved developing a limited number of places for detoxification in special purpose short-stay hospital settings and longer term residential rehabilitation programs.

Compared to the preceding mental health model based on civil commitment that operated to the mid 1970s, this approach was largely developed around the concept of outpatient services to facilitate early intervention and to provide support for post-detoxification recovery.

Key features of the ADA service model included reliance on a single agency to establish and operate services, voluntary admission to all stages of treatment, expansion of outpatient-based services in both the metropolitan area and regional cities, early stage intervention as the primary mode of treatment, and support of community-level health campaigns to change attitudes and behaviours about the harms of alcohol and its moderate use. 

The ADA was an independent entity, in theory, even though it reported directly to the Minister for Health, as it was established as a separate statutory body under the Alcohol and Drug Authority Act 1974, developed a range of both outpatient and inpatient detoxification treatment facilities over a number of years after commencement in 1975. However, as all members of the Board were appointed by the Minister, it operated as a quasi specialist sub-agency within the Department of Health (DOH) portfolio. 

These iterations in the diminution in the role of publicly operated programs to a primary focus preventive programs, meant the statutory arrangement that underpinned the ADA remained unchanged for some 40 years, until absorption into the Mental Health Commission (MHC) in 2015.

Although the ADA’s detoxification hospital was located in Perth and operated as an adjunct to the ADA’s service at the Carelllis Centre, the ADA expanded and established a number of metropolitan sub-regional offices, as well as regional offices. As the ADA had its own board it reported directly to the Minister for Health and did not operate as a Division within the DOH.

In February 2015 the Alcohol and Drug Authority Act 1974 was renamed the Alcohol and Other Drugs Act 1974.

In the mid 1990s there were policy reforms by both Labor and Liberal (ie conservative) governments which reshaped the role of the ADA. These included a number of changes in organisational name (ie WA Drug Abuse Strategy Office, Next Step Drug and Alcohol Services, Drug and Alcohol Office) and administrative arrangements, culminating in the absorption on 30 June 2015 of the DAO and its functions by the MHC.

The 2015 reform stemmed from the Alcohol and Drug Authority Amendment Act 2015, the statutory framework of the ADA was replaced by the Alcohol and Other Drugs Ministerial Body and the Alcohol and Other Drugs Advisory Board, under provisions in the Alcohol and Other Drugs Act 1974.

However, the WA Government has recently announced an intention to obtain legislative powers to compel alcohol and drug users, in particular methamphetamine users, to undertake residential-based detoxification and rehabilitation services.

This approach may indicate a return to a commitment model of treatment, potentially along the lines that had occurred under the Convicted Inebriates Rehabilitation Act 1963, which had operated a prison-based unit for the ‘treatment’ of problematic users of alcohol, until the closure of the Karnet Prison Inebriates Unit as a consequence of the opening of the ADA.

Sources of data: Annual reports

Official publicly available detailed statistical information about operation of services to manage problematic users of alcohol can be found in a number of different sources, the primary source until the 1970s being in annual departmental reports of the Mental Health Services (MHS). These can be found at the Civil commitment model page.

Annual reports: Alcohol and Drug Authority (1975/1976 – 1997/1998) 

Annual reports of the ADA were published up to the 1997/1998 year.

However, later annual reports were published were published in a fragmented manner by three agencies – the Health Department’s Mental Health Division up to 2001/2002, Next Step up to 2001/2002 and WADASO up to 2000/2001. From 2002/2003 publication of a consolidated annual report was restored and published by DAO, up to 2014/2015.

Annual reports (excerpts): Health Department of WA (1997/1998 – 2001/2002)

A specialist area was created within the Mental Health Division of the Department of Health. This was created by the transfer of some functions to the SHPA previously undertaken by the ADA.

Over the period 1997/1998 to 2001/2002 this area was named variously the Drug and Alcohol Policy and Planning Unit (DAPPU), the Alcohol and Drug Policy and Planning Section (ADPPS) and the Alcohol and Drug Policy Branch (ADPB).

There was also the Alcohol and Other Drug Program (AODP) within the Population Health Division of the Department of Health. Details of activities of the DAPPU, the ADPPS and the AODP are contained in the excerpts from DOH annual reports for the years 1997/1998 to 2001/2002 – 

  • 1997/1998 excerpt DAPPU [624k]
  • 1998/1999 excerpt ADPPS [776k]
  • 1999/2000 excerpt AODP [142k]
  • 2000/2001 excerpt AODP [469k
  • 2001/2002 excerpt AODP [311k]

Annual reports: Next Step Specialist Drug and Alcohol Services (1998/1999 – 2001/2002)

Note: The first annual report of the DAO, for the year 2001/2002, was published under the title of Next Step.

Annual reports: WA Drug Abuse Strategy Office (1997/1998 – 2000/2001)

As the WADASO was transferred to a new Minister Responsible for Drug Strategy, it was administered as part of FCS portfolio and accordingly its activities were included in a section of the FCS annual reports for the years 1997/1998, 1998/1999 and 1999/2000. The relevant sections of these annual reports have been excerpted.

  • 1997/1998 excerpt FCS [302k]
  • 1998/1999 excerpt FCS [187k]
  • 1999/2000 excerpt FCS [1.1Mb]
  • 2000/2001 [571k]

In July 2000 WADASO was removed from the FCS administrative structure and became a stand alone agency under the Financial Administration and Audit Act 1985. It submitted its only annual report for the 2001/2002 year, as it ceased to exist as a separate agency after 30 June 2002, when the Drug and Alcohol Office (DAO) was established.

Annual reports: Drug and Alcohol Office (2002/2003 – 2014/2015)

The DAO commenced on 1 July 2002 by consolidating a number of functions formerly undertaken by the WADASO, the Alcohol and Other Drug Program in the Population Health Division and the Alcohol and Drug Policy Branch in the Mental Health Division.

Note: The first annual report of the DAO, for the year 2001/2002, was published under the title of Next Step.

Annual reports of the ADA from 2002/2003 were published under the title of DAO. Note: The ‘Drug and Alcohol Office’ is the ‘business name’ of ADA whereas the Next Step Drug and Alcohol Services is the ‘trading name’ of DAO.)

Annual reports: Mental Health Commission (2015/2016 +)

The absorption of the ADA into the MHC at 30 June 2015 means formerly separate reporting data has been aggregated into the MHC reporting format, resulting in the loss of more detailed breakdowns previously available in annual reports.

Copies of annual reports may be available on the Mental Health Commission’s website.