This page introduces the Substance Addiction (Compulsory Assessment and Treatment) Act - SA(CAT) - 2017, the difference between this Act and the Alcoholism and Drug Addiction Act - ADA - 1966, details the people involved in implementing it with their roles, and concludes with the sections relevant for GPs.
The SA(CAT) 2017 Act replaced the ADA 1966 Act and came into effect on 21 February 2018.
The purpose of the Act is to enable people to receive compulsory treatment if they have a severe substance addiction and their capacity to make decisions about treatment for that addiction is severely impaired - so that the compulsory treatment may:
Compulsory treatment is the option of last resort and the criteria for this are: (a) the person has a severe substance addiction; and (b) the person's capacity to make informed decisions about treatment for that addiction is severely impaired; and (c) compulsory treatment of the person is necessary; and (d) appropriate treatment for the person is available.
The compulsory status lasts for a maximum of eight weeks, but that period may be extended for a further eight weeks in the case of patients appearing to suffer from a brain injury. It is not anticipated children or young people (under 18 years) will generally be subject to the Act.
The ADA 1966 required two medical certificates, neither of whom were specialist drug or alcohol practitioners. The SA(CAT) 2017 requires an early assessment from a specialist practitioner.
ADA 1966 has a statutory period of two years whereas the period for SA(CAT) 2017 is eight weeks.
SA(CAT) 2017 also creates offences relating to the ill-treatment or neglect of patients undergoing compulsory treatment, or for the staff at a treatment centre assisting or allowing a patient to be absent without leave.
Principal caregiver: friend or family member.
Nominated person: a person nominated by the patient, but has no authority over the patient's interests outside the scope of the Act (eg. the patient's financial affairs or relationships).
Approved specialist: a health professional who is designated as an "approved specialist" by the Director of Addiction Services. The compulsory treatment certificates are completed by approved specialists, and compulsory status starts immediately after an approved specialist certifies the criteria for compulsory treatment are met.
Area director: notified by the approved specialist of the identity of the patient to whom the compulsory treatment certificate relates.
Responsible clinician: Area director must assign a responsible clinician to every patient for whom a compulsory treatment certificate has been signed.
Authorised officer: designated by the Area director and be appropriately trained and have appropriate competence in dealing with persons who have severe substance addiction.
Responsible district inspector: is involved with upholding the patient's rights and may apply to the Court for an urgent review.
If a GP is assigned as a "responsible clinician", the following sections are applicable from the first meeting to the patient's release from compulsory status.
Section 29: within a period no longer than seven days after the patient's compulsory treatment certificate is dated and signed, the GP, as a responsible clinician, prepares a treatment plan for the patient, arranges a place for the patient in a treatment centre, and applies to the Court for a review of the compulsory status of the patient.
Section 30 requires a responsible clinician to direct that a patient be detained and treated in a treatment centre. The responsible clinician must obtain the agreement of the manager of the treatment centre and must consider the wishes and preferences of the patient and the views of the patient's principal caregiver, welfare guardian and nominated person.
Section 37 authorises the responsible clinician to give or authorise any treatment, including medication (if in their scope of practice) that they think fit. The responsible clinician is required to give or authorise the minimum medication, consistent with proper care, to ensure the patient is not prevented from communicating adequately with any person engaged in proceedings to represent the patient.
Section 39 allows the responsible clinician to grant a patient leave of absence from a treatment centre.
Section 41 authorises the transfer of a patient from one treatment centre to another at the direction of the responsible clinician and with the agreement of the manager of the new treatment centre, and after consultation with the patient and the patient's principal caregiver, welfare guardian and nominated person.
Section 42: best practice expectations are that responsible clinicians should conduct regular reviews of the patient's condition and capacity at least every two weeks or on request of the treatment centre manager.
Section 43 requires the responsible clinician to order the release of a patient if the responsible clinician is satisfied the criteria for compulsory treatment are no longer met or no useful purpose would be served by the further compulsory treatment of the patient.
Section 44: the patient's responsible clinician must prepare a treatment plan for the patient. The treatment plan should include a focus on future treatment and care, and can be expected to change as the patient progresses through treatment. It also requires the plan be shared with any agency involved in providing relevant services to the patient; this would include the patient's usual health practitioner.
Sections 45, 46 and 48 clarifies the responsibilities for the responsible clinician if the court extends the patient's compulsory treatment order in the event of a brain injury.
Section 72 clarifies the responsibilities for the responsible clinician in serving the application on the patient, the district inspector and other relevant people.
More notes can be found in the Ministry of Health Introductory Guideline.
A free e-learning module is available to help develop a familiarity with the scope and intent of the Act.
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