The alcohol and drug treatment sector says its annual Government funding needs to be at least doubled and funding provided to successful initiatives such as Alcohol and Drug Treatment courts and the Northland meth programme Te Ara Oranga.
The sector has been shrouded in uncertainty since the mental health and addiction inquiry reported back in December last year.
The Government response to its 40 recommendations - expected to establish a Mental Health and Wellbeing Commission - has been pushed back from March to April and now until Wednesday, with fiscal announcments due on Thursday when the Wellbing Budget will be unveiled.
The Government is treating mental health and addiction together; Corrections estimates that 70 per cent of people getting addiction treatment also have mental health problems.
In the meantime waiting lists for residential addiction treatment have lengthened, a fraction of repeat drink-drivers are accessing services, and treatment programmes have been forced to push forward despite future funding being up in the air.
A new report this week showed a 23 per cent increase from December 2017 to October 2018 in the number of people waiting eight hours or more for urgent mental health help at hospital emergency rooms.
Cost pressures are already expected across the health sector, with Health Minister David Clark announcing a review last year to "future-proof our health and disability services". He appointed Heather Simpson, former chief of staff to Helen Clark, to chair the review and report back next year.
Funding for the mental health and addiction treatment sector has not kept pace with demand. A 2018 report from the Mental Health Commissioner said that the number of people checking in for those services had increased by 73 per cent in the last three years, while funding had only gone up 40 per cent.
Drug Foundation executive director Ross Bell said the Government's $150 million a year spend on alcohol and drug treatment services helped about 51,000 people.
Police estimate that there are a further 50,000 alcohol and drug users every year who want treatment but do not access it. On this basis, the foundation wants funding to be doubled to $300 million a year.
"There's huge expectations on the Wellbeing Budget later this month that the Government will prioritise mental health and addictions, but I'm really nervous they won't meet our expectations," Bell said.
That need is further amplified by the Misuse of Drugs Amendment bill, which could deepen demand for treatment services. The bill would see a health-based approach to drug users that could send them to therapeutic services instead of police cells.
"There has been a dismal underinvestment in addiction services for more than a decade which verges on being unethical," residential treatment centre Odyssey House said in its submission on the bill.
"The disproportionate funding of mental health versus addictions (addictions receives 11 per cent of the mental health funding) needs urgent attention."
Odyssey chief executive Fiona Trevelyan said referrals had increased 34 per cent from 2017 to 2018.
"This is impacting the length of time people have to wait for admission. The median length of time for 2017 and 2018 was 2.5 to 3 months. The first four months of 2019 the median has increased to 104 days."
Drug and Alcohol Practitioners' Association executive director Sue Patton also supported a doubling of the annual budget - but sees it as the bare minimum.
"Specialist treatment needs a serious boost. If we invest in treatment and support for people recovering from addiction, we will reduce our prison population, we will reduce harm to significant others and to community.
"The knock on effect will be huge."
She noted the mental health and addition inquiry's estimate that specialist services should cater to 20 per cent of the population who are estimated to have a mental health disorder each year.
This is more than five times the current system, which caters to 3.7 per cent of the population.
Patton said the current model could only look at those with acute needs, leaving those with moderate needs to miss out.
"We do that really poorly in this country for people at the moderate end. There is a bigger group that certainly use substances in a risky fashion, and would benefit from intervention.
"Another thing we need to be investing in is peer workers (who have lived experience with addiction). They help a person to integrate back in to the community in a way that practitioners can't. That part of the workforce is currently missing."
Patton would also like to see the expansion of the Alcohol and Drug Courts in Auckland and Waitakere, which were piloted in 2012 and have only had their budgets extended to mid-2020.
A preliminary evaluation showed that the courts have reduced the likelihood of reoffending by 15 per cent more than those who go through the
standard court process.
"These have led to incredibly transformed lives, some of our most antisocial citizens becoming some of our most pro-social citizens," Patton said.
Justice Minister Andrew Little has indicated that the first step is to increase drug treatment programmes, and the 2020 Budget could address whether to further fund the courts.
Meth programme up in the air
Te Ara Oranga only has funding until December, even though its collaborative police and health approach has been widely lauded.
Since it started in October 2017 to March 2019, 305 people have been referred to treatment such as counselling or a residential programme. The health board referred an additional 500 users after screening in the emergency department.
"We do a lot of work to engage them in treatment and support them to make changes," project manager Jewel Reti said.
"They might go to residential treatment rather than go to prison, where they can look at what drives their addiction and what changes they can make sustainably."
The programme was given $3 million from the criminal proceeds fund, and was recently given another $1 million that would last until December. It has put in a bid for sustainable funding, but is still waiting for a response.
Reti is not only hopeful for ongoing funding, but would like to see the programme rolled out to Gisborne and the Bay of Plenty, communities with high per capita meth use.
"For isolated areas where people are not able to engage for whatever reason, this project actually goes to find people to bring them into treatment.
"We don't wait for them. We get a referral, a name, and do our best to find them and offer them treatment."
Reti echoed many in the sector about the need for funding certainty.
"It's not just Northland DHB, but it's NGOs, it's Odyssey House, the Salvation Army, iwi providers. For them, it's imperative to have sustainable funding."
Green Party spokeswoman on mental health and drug law reform Chloe Swarbrick has been pushing to fully fund Te Ara Oranga.
"The most effective way to get outcomes is to ensure those services are delivered by people on the ground through culturally-appropriate and inclusive services."
Swarbrick said the mental health and drug treatment sector was "massively underfunded".
"It's not just the money. The current model is inadequate and needs a complete overhaul."
Alcohol and drug counsellor Roger Brooking said the Government currently provides about $1 million a year to treat repeat drink-drivers.
But he said that only treated about 1500 drink-drivers a year, a fraction of the total number which he estimated as between 20,000 and 30,000.
"Only 5 to 10 per cent of drink drivers are getting into a treatment programme. Offending often starts with drink-driving. There's just a huge shortage for that in the community."
Finance Minister Grant Robertson has already talked up a whole-of-government approach to health issues in the Wellbeing Budget.
"This is about stepping out of the silos of agencies and working together to assess, develop and implement initiatives to improve wellbeing."
National today claimed Thursday's budget would include funding for a Mental Health and Wellbeing Commission.
The announcement was one of many by National who claimed to have acquired details of the Government's highly anticipated Wellbeing Budget.
National leader Simon Bridges said a Mental Health and Wellbeing Bill would be introduced very soon as a category two piece of legislation, meaning it must be passed this year.
When the Government announced $200 million to spend on homelessness earlier this month, Prime Minister Jacinda Ardern said housing was an important part of the mental health and substance abuse equation.
"Chronic homelessness is often a result of multiple complex and often compounding issues," she said in a pre-Budget speech on Friday.
"To suggest for instance that someone who is homeless needs to be free from alcohol or drug addiction, or medicated for mental health issues, ignores the impact that one can have on the other. Rather than take part in a merry dance on what issue comes first, we should instead house first."
Last year the Government announced $10.49 million for a free counselling pilot for 18 to 25 year olds.
Patton was sympathetic to the Government for taking time to respond to the mental health and addictions inquiry.
"I sort of understand that the Government wants to get it right. On the other hand, everybody is a little bit up in the air.
"We need to know where we are going."