Up to 90% of prison inmates have problems with substance abuse and addiction. But Corrections does not require the counsellors who provide rehabilitation programmes for them to have a graduate degree in the assessment and treatment of addictive disorders. In fact, they don't even need a degree - just a qualification.

In April last year, Radio New Zealand reported that the Corrections Department was paying for non-existent alcohol and drug counsellors. The story omitted the fact that most of the AOD counsellors who do work in the prisons are not actually qualified -- at least not in addiction treatment.

The qualifications required to work as an AOD counsellor in prison are described in tender documents issued by Corrections recently. The documents refer to Drug Treatment Units (DTUs), the prison programme that inmates with addictions are required to attend. The tender states:

"DTU programme clinical staff and the DTU clinical manager will have a relevant qualification in psychology, counselling, psychotherapy or similar.

Remarkably, the document does not specify that the ‘relevant qualification’ has to be a graduate degree. Nor does it state that clinicians require a qualification in the assessment and treatment of addictive disorders.

Currently an AOD agency called CareNZ has contracts with Corrections to run eight of the nine DTUs. CareNZ also has contracts with a number of DHBs up and down the country to provide addiction treatment to the public in community clinics. The DHB contracts are a great more specific. For example, CareNZ’s contract with the Waikato DHB says:

“Clinicians employed to deliver these services must have a level VII (graduate) AOD (alcohol & other drug) specific qualification.”

Clearly, the DHB’s want value for money; they want professional clinicians to treat addicts – ones who are specifically qualified in the treatment of addictive disorders. But Corrections doesn’t seem to care. Perhaps that’s because their clients are only prisoners – so any old counsellor with any old qualification will do. If that’s their attitude, no wonder drug treatment in prison doesn’t work.

Review of DTU’s under CareNZ

And it doesn’t work. Hundreds of inmates are put through these DTU programmes each year and they reduce reoffending by less than 5%. Mind you, 11 of the 12 rehabilitation programmes in prison don't work. Corrections management are concerned about this because in 2011, government set the department a goal to reduce reoffending by 25% by June this year.

The department seems to think the poor performance of the DTUs is CareNZ’s fault. They even initiated an evaluation of CareNZ’s performance by an independent consulting company, Julian King & Associates. Amazingly, the independent review reported that CareNZ was doing fine. See Corrections pays consultant to whitewash failure of rehabilitation programme.

So when RNZ reported that Corrections was paying for non-existent counsellors, Corrections' Southern Regional Commissioner, Ben Clark, spun the story like this. He said:

"If we had cause for concern that Care NZ weren't delivering an effective service to our offenders, and weren't giving the taxpayer good value for money, then absolutely we would look to put that money elsewhere, but so far we have no evidence of that being the case."

Less than 12 months later, Corrections has decided to put the taxpayers’ money elsewhere. They’ve put the DTU contracts up for tender.

The tender process is nearly complete and my sources tell me that six of CareNZ’s eight contracts have now been offered to other AOD treatment agencies. But as described above, neither CareNZ nor any of the new treatment agencies will be required to use qualified or experienced clinicians.

Prison inmates have extra needs

This makes no sense whatsoever. There are now over 10,000 people in prison in New Zealand and up to 90% of them have problems with substance abuse. At least 45% of inmates also have underlying personality disorders, mental health problems, and learning disabilities. They often use alcohol and drugs to alleviate the symptoms associated with these disorders.

Not forgetting that addictions are hard to treat at the best of times; treating inmates with coexisting disorders is even tougher. The counsellors who work in prison therefore need to be as qualified, if not more qualified and more experienced, than AOD clinicians in the community. At the very least, they need to have a graduate degree in the assessment and treatment of addictive disorders; and they need at least five years’ experience working with addicts in the community before starting work in a prison.

So what’s happened is that Corrections has used CareNZ as a scapegoat.

That particular agency's role in the prison system has been cut, but nothing will change if the clinicians doing the counselling can’t cut the mustard.  To use another analogy, changing agencies is akin to re-arranging the deck chairs on the Titanic; unless the right people are sitting in the right chairs, the ship is still going to sink.

Comments (11)

by Antoine on February 18, 2017
Antoine

Guess a good outcome would be if one or more of the treatment agencies puts in the tender that they will use qualified experienced clinicians, and they won the tender on merit... The tender evaluation process must put some weight on the quality of the offering?

A.

by Dennis Horne on February 18, 2017
Dennis Horne

Do paper qualifictions make any statistically significant difference to outcomes?

 

 

by Roger Brooking on February 19, 2017
Roger Brooking

@Antoine: Good idea but not going to happen. I have just come accross an ad on Seek for AOD clinicians to work in the DTUs. A graduate degree in addiction is not required.

@ Dennis: If you had a serious health problem would you go to a 'doctor' that didn't have a medical degree...? If you had a legal problem, would you go to a 'lawyer' that wasn't qualified...? 

by Chuck Bird on February 19, 2017
Chuck Bird

Roger Brooking, a degree is certainly no guarantee that a person knows what they are doing.  See example below.

Struck-off prison psychologist's secret marriage to Australian gang rapist

I know a judge who obviouly has a law degree who is thick as two short planks.  I will not name her as I would be in contempt but anyone who knows anything about law would guess who I am talking about.

 

 
by Dennis Horne on February 19, 2017
Dennis Horne

@Roger Brooking. You made a specific claim. I asked a specific question. If you don't know the answer then say so. Then at least we might assume we're not talking about anything that has been measured.

Do paper qualifictions make any statistically significant difference to outcomes?

by Roger Brooking on February 20, 2017
Roger Brooking

@Chuck the fact that there are bad apples in every barrel does not alter the need for professionals to be qualified. If you need advice from an apple, you don't want to be talking to a cabbage.

 

by Roger Brooking on February 20, 2017
Roger Brooking

@Dennis. The answer depends on what you are asking. Does addiction treatment work when done by professionals with appropriate qualifications? Yes it does. But the outcome depends on what you measure - which could be reduced substance use, better relationships, increased employment, improved qualifty of life, reduced reoffending etc. But relapse rates are still quite high. See How effective is drug addiction treatment?

Does addiction treatment delivered by professionals with appropriate qualifications produce better outcomes than treatment delivered by amateurs without qualifications in addiction treatment? It would be unethical to conduct such research. Anyone with a health problem deserves treatment by professionals with relevant qualifications.

by Dennis Horne on February 20, 2017
Dennis Horne

@Roger Brooking. We don't seem to be getting to the nub of the issue:  what is the appropriate qualification.

Unless we see some data measuring outcomes it seems to me to be a matter of personal opinion.

If some counselling is being offered by those you deem insufficiently qualified then we don't need to run an experiment with "amateurs". Do we.

by Roger Brooking on February 20, 2017
Roger Brooking

@Dennis. The appropriate qualification is a degree in the assessment and treatment of addictive disorders. That's what the article says.

Here are the outcomes of the DTU's run by counsellors that don't have the necessary qualifications. The  DTU programmes reduce reoffending by less than 5% in the first 12 months after release from prison.

by Dennis Horne on February 22, 2017
Dennis Horne

@Roger Brooking. Is there any data that show a statistically significant difference, or suggest a difference, between the outcomes for counsellors who do have the qualifications you deem necessary and counsellors with qualifications the department considers sufficient?  YES/NO

by Roger Brooking on February 22, 2017
Roger Brooking

Its not that simple. The point is its unethical to use unqualified, inexperienced clinicans to provide 'treatment' to prisoners with addictions, mental health problems and personality disorders. Not only is it unethical, its also highly irresponsible, not to mention a total waste of taxpayers money - because clearly it doesn't work. We won't really know how well it could, or should, work until the Department wakes up and employs professionals.

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