An evaluation of the Northern Territory's contentious program of forcing alcoholics into treatment has found that for a program with no apparent long-term health impacts, the $18 million spent running it every year "seems high".
The review, due to be released today, also found that blockages in the system, including a lack of beds and staff at assessment centres, meant that up to half the people who could potentially benefit from the treatment were excluded from the process.
Under the mandatory treatment program, anyone picked up by police for being drunk in public three times in two months can be forced into rehabilitation in Alice Springs or Darwin for up to 12 weeks.
The controversial scheme was introduced by the former NT Country Liberals government in July 2013, in spite of fierce opposition from health, legal, and Indigenous groups, who argued that the program targeted homeless Indigenous people and criminalised a health issue.
"[AMT] was a costly program that delivered minimal long term gains for the relatively few people who participated," Health Minister Natasha Fyles said.
The evaluation of the program, by PwC's Indigenous Consulting and the Menzies School of Health Research, was commissioned by the former CLP government and was handed to the NT Health Department in January.
But the reviewers found there were limitations to what they could say about the effectiveness of the scheme that costs at least $18 million a year to run.
The report said the evaluation was difficult because of a lack of a "sound program logic" that clearly stated what the government was trying to achieve with Alcohol Mandatory Treatment (AMT) and how it would try to achieve it.
"The program was implemented without a program logic or theory of change model and without an evaluation framework," the report stated.
No significant drop in hospital presentations
The review team analysed data for people who were eligible for AMT between July 1, 2014 and the June 30, 2015, and also examined a number of individual case studies.
It found 97 per cent of people who entered AMT were Indigenous and typically faced a number of difficulties including poor physical or mental health, cognitive impairment, homelessness, past trauma and disconnection from families.
According to the report, in 2015/16 the government allocated at least $18 million to deliver forced rehab to 339 people at an average cost per person of $53,915.
The report stated in the short-term there were benefits of mandatory treatment because people were placed in better living conditions, had clinical support to withdraw from alcohol, and received medical attention for any health conditions.
But when compared with a control group, over the longer term there was no significant difference in the number of emergency department presentations and hospital admissions for people who had been through AMT.
"When considering the findings from the client outcomes section, which showed that there had been no discernible decrease in emergency department presentations or hospital admissions for people who had been through mandatory treatment, and that many of the people had received more than one episode of mandatory treatment in that period, this cost per client seems high," the report said.
"The chronic nature of the drinking and associated health problems identified among those eligible for AMT indicate that people are likely to need multiple and ongoing treatment and care in order to receive sustained benefit."
Patients ended up homeless again after treatment
While people in mandatory treatment were given practical help to get their finances organised or to find accommodation, the report stated problems such as a lack of public housing or difficulties returning to remote communities meant people often ended up homeless again once finished the mandatory treatment.
"The current treatment models and period of three months is not long enough to address contributing factors such as housing stress, deep trauma and cognitive impairment," the report said.
The review also found problems with the implementation of the scheme meant that each year 31 to 54 per cent of the people eligible for AMT were not assessed for treatment because of a range of "system blockages", such as assessment centres not being able to take any more people.
"This means a number of people who could potentially benefit from treatment were excluded from the process," the report said.
The Labor Government, elected last August, has already decided to scrap the program and re-introduce its own alcohol policy — the Banned Drinker Register (BDR), which is a list of problem drinkers banned from buying take-away alcohol.
The BDR has never been evaluated.
"The Territory Labor Government believes that every Territorian has the right to control over their lives and access to high quality services," Ms Fyles said.
"To deliver this we have to invest in the types of therapeutic interventions that work … We've listened to concerns from experts and community that rehabilitation has to be offered on a voluntary basis."
She said the Health Department had "broadly accepted" all 28 recommendations in the report,
which warned that better data collection would be "essential" for measuring the long-term impacts of any alcohol interventions.