Private alcohol and drug rehab needs tighter regulation

Many facilities are doing their best with a complex problem but lack evidence-based care from AHPRA-registered professionals.

---

Private rehabilitation facilities play a crucial role in supporting individuals with substance-related disorders who require timely and efficient treatment.

Alcohol and other drug (AOD) treatment is vast, and can include aspects of withdrawal management, counselling, pharmacotherapy, case management, education and, perhaps most well-known, rehabilitation. While assistance for individuals with AOD dependencies is available at government-funded facilities, there are often long wait times and too few places available. Given the complex nature of AOD rehabilitation specifically, which often necessitates long-term support and complex, multidisciplinary care, there needs to be additional capacity made available.

According to independent investigations, there are over 32,000 requests for residential rehabilitation placements annually, far exceeding the 1500 publicly available beds across the country. This growing demand is driving the expansion of the private rehabilitation sector. We know that wait times can exacerbate the condition of those seeking treatment, or sadly, dissuade them from seeking treatment altogether. That’s why sector capacity building is crucial.

However, while publicly funded rehabilitation centres and private hospital based AOD treatment are required to remain compliant with government standards, such as the National Safety and Quality Health Service (NSQHS) Standards, private rehabilitation centres do not have the same standards applied and operate under self-regulatory models.

The Sana Health Group, of which I am the founder, has recently acquired NSQHS accreditations across our three practices, and we are passionate to drive forward conversations in this space and lead the way to quality and robust healthcare for Australians living with AOD dependencies.

While private facilities have the option to achieve NSQHS accreditation (that which all hospitals, dental surgeries and day procedure surgeries are required to work within) it is exactly that – an option – meaning that very, very few private facilities do seek these out.

We do not know of any other private facilities which have these accreditations apart from those that form our network.

AOD dependencies are complex in nature, often rooted in underlying mental health issues, physical health and genetic factors and social and environmental impacts. Robust and high-quality services which facilitate multidisciplinary, holistic care, ongoing support and case management are important to ensuring positive patient outcomes and reducing the risk of relapse. We know that every patient is different, and we believe that people should be able to find the treatment they want, when they want it.

However, with a lack of regulation in the sector, individuals seeking treatment have to navigate a complex, confusing and unregulated sector which can place their recovery journey at risk. 

Operating outside of the public health and private hospital system, community-based private rehabilitation facilities have a lack of oversight which can give rise to underinformed and unexperienced providers who may be operating from the best of intentions, but with a lack of professional evidence-based care. The lack of accreditation and regulation means that centres can operate without clinically trained staff and AHPRA-registered health professionals.

We acknowledge that there are many sincere and qualified people who practise as psychotherapists and counsellors, and who operate at a high professional standard. Unfortunately, unlike protected titles such as psychologist and registered nurse, the title of psychotherapist is unprotected and can be claimed by anyone, including those who may not have relevant experience, certification or education, and operate with little scientific evidence or clinical governance guiding their practice.

While there are, undoubtedly, plenty of private rehabilitation facilities across the country which provide effective, safe and quality care with a team of registered health care professionals, the lack of accreditation requirements can make it difficult to identify these. For example, in 2017, the Health Complaints Commissioner of Victoria received 26 complaints relating to private drug and alcohol rehabilitation services in the span of 10 months, raising concerns about the safety and efficacy of treatments, cleanliness of facilities and the discharge conditions of patients. This led to the recognition of the growing need for tighter regulations for these facilities.

Authoritative bodies in the AOD sector, including the National Drug Strategy Committee, Ministerial Drug and Alcohol Forum and the Australian Network of State and Territory Alcohol and Other Drug Peaks, have previously advocated for national frameworks to be put in place to regulate the sector.

There is, of course, a National Quality Framework for Drug and Alcohol Treatment Services, which sets a nationally consistent quality benchmark for providers of drug and alcohol treatment services. It includes strong clinical governance requirements and a list of accreditation standards that drug and alcohol specialist treatment service providers must meet. However, providers who do not receive government funding fall in between Commonwealth and state bodies and are not monitored or regulated against these standards.

This is the great gap.

Echoing the sentiment of these bodies, and the National Quality Framework for Drug and Alcohol Treatment Services, it would be my recommendation that a regulatory or licensing framework is developed for private facilities. Such a framework would ensure that a minimum standard of quality, clinical governance and policy was maintained across all operators in the sector, to ensure that patients are receiving a consistent, best-practice level of care, regardless of their modality of treatment or their provider. Complimenting this framework would be an ongoing system of accreditations which drive continuous quality improvement for systems and processes within an organisation.

Such dramatic interventions to the private system necessarily require time, collaboration and conversation to facilitate, but this is not a reason to avoid a change. In the interim, while a licensing or regulatory framework was being developed I would call on federal and state governments to work in tandem to support the rollout of NSQHS accreditations across the sector, to ensure patients receive a minimum standard of quality and clinical governance. In particular, I’d suggest additional support be provided to non-profit facilities that may lack resources to achieve these accreditations.

I have spoken to countless clients and patients over the years who are very uncertain about what sort of treatment they should be seeking and where. The lack of clarity makes an already difficult time even more challenging. This would be somewhat relieved through consistent regulatory and accreditation requirements.

My last recommendation would be for health practitioners to be aware of the current issues facing the private rehabilitation sector, so that they can support patients to make informed decisions. AOD rehabilitation can be high-quality, life-changing care; however, it is critical to remain aware of the challenges in the sector and collaborate on how we can shape a more robust, safe and quality system for everyone.

Ruth Limkin is founder of The Banyans Healthcare and Sana Health Group.