TRANSFORMATION JOURNEY OF TREATMENT AND REHABILITATION
PROGRAMS IN MALAYSIA:COMPULSORY OPEN ACCESS SERVICES
CURE & CAREDR. SANGEETH KAUR
NATIONAL ANTI DRUGS AGENCYMINISTRY OF HOME AFFAIRS
MALAYSIA
- Drug Treatment and Rehabilitation Act 1983- Drug was issued as a security threat Ministry of Home Affairs- Facility – Pusat Serenti (One Stop Centre)
- National Antidrugs Agency Act- Fasiliti – Pusat Serenti (rebranded as PUSPEN [Pusat Pemulihan Penagihan Narkotik] in 2009)-Enforcement Division was established in 2007
- Transformation of Treatment and Rehabilitation at AADK- Drug Dependency treated as a chronic relapsing disease (Patient)
1983
2004
-Drugs as a social problem-- Department of Social Welfare - Facility – Pusat Insaf Diri
1975
2010 onwards
2
Evolving government policies towards Treatment and Rehabilitation of Drug Dependency
Category of Drug Dependents 2011 2012 DECREASE (%)
New Drug Dependents 6,956 5,270 -24.24
Repeat Drug Dependents 4,238 3,745 -11.63
Total 11,194 9015 -19.50
Total no of registered drug dependents since 1988 till 2012 are 345,234 individuals
COMPARISON STATISTICS OF DRUG DEPENDENTS 2011 AND 2012
PROFILE OF DRUG DEPENDENTS 2012
0
1,500
3,000
4,500 4,354
2,820
3 3 5689
311,090
6 13 1
Type of Drug
Num
ber
78%Malay
9%
12%
0%0% 1% MELAYUCINAINDIAPRIBUMI SABAHPRIBUMI SARAWAKLAIN-LAIN
< 13 TAHUN13-15 TAHUN16-18 TAHUN19-24 TAHUN25-29 TAHUN30-34 TAHUN35-39 TAHUN40-44 TAHUN45-49 TAHUN≥ 50 TAHUN
0 200 400 600 800 1,000 1,200 1,400 1,600 1,800
024
2711,506
1,5771,611
1,317964
744974
No of drug dependents
Age
whe
n de
tect
ed
Adults, 29.85%
Youth,
66.88%
Teenagers, 3.29%
98 % DRUG DEPENDENTS ARE MALE
77.4% BETWEEN THE AGES OF 18-44
91.6% USE TRADITIONAL DRUGS LIKE HEROIN/ MORPHINE/ MARIJUANA
/ 48.3%
/ 31.3%
/ 12%
Treatment Scenario in Malaysia
Compulsory Treatment
• Provided for drug dependants since 1983
• Drug Rehabilitation Centers (DRC) & Supervision in the Community
• 22 DRCs – capacity of 7,000 residents• Supervision - 55,000 estimated in the community
How can N.A.D.A take care of the massive numbers in the community?
Success Rate 75% ?50% ?20% ?10% ?
Compulsory Treatment
Reluctant & Resistant Clients Problems in the
DRCs
Treatment Services
Programs in DRCs and those
undergoing Supervision
Parents, Families
StigmatizedResidents – criminalized
(records)
Changes Impact of New
drugs on ClientsNeed for Clinical
Approach
Why NADA needs to Transform?
Stakeholders
GTP & NKRAConcept of 1Malaysia
Success Rate 75% ?50% ?20% ?10% ?
Compulsory Treatment
Reluctant & Resistant Clients Problems in the
DRCs
Treatment Services
Programs in DRCs and those
undergoing Supervision
Parents, Families
StigmatizedResidents – criminalized
(records)
Changes Impact of New
drugs on ClientsNeed for Clinical
Approach
OBJECTIVE
2
In response to the growing drug problem and its complexity and realizing that the existing strategies are not achieving the intended effects / targets, NADA has shifted its approach from INSTITUTIONALISED rehabilitation to an open approach, OPEN ACCESS SERVICES, by setting up THE CURE AND CARE 1 MALAYSIA CLINIC or better known as C&C 1MALAYSIA CLINIC.
This is a paradigm shift for NADA to transform its treatment and rehabilitation services to all its clients in the country.
NADA MALAYSIA
Major Developments since 2010 in terms of the extension of voluntary community based treatment
COMPULSORY REHABILITATION
OPEN ACCESS AMBULATORY VOLUNTARY
CENTRES
19 CURE & CARE REHABILITATION
CENTRES
11 CURE & CARE 1MALAYSIA
CLINICS
AADKDAERAH
9
AKTA PENAGIH DADAH (RAWATAN DAN PEMULIHAN)
1983
INSTITUTION BASED COMMUNITY BASED
Return of clients as socially funcional
individuals
Provide a holistic approach in treatment and rehabilitation
Treat Drug Dependents as patients
10
Treatment and Rehabilitation Strategy
TRANSFORMASI
Treatment Wards
Registration Office– Sg. Besi
Psychiatrist/ Medical Officers
CONCEPTOPEN ACCESS SERVICES
Voluntarism or Walk-in Support from parents or
family Referral Outreach / Motivate
No Legal Implications No Pre-conditions
No stigma Private and Confidential Options for clients Community-based
Program Clients as patients
• Medical Detoxification• MAT with
Methadone/Suboxone• Psychiatric
Management• HIV/HEP/TB/STI
Management• Inhalan Management• Alcohol and Nikotin
Management• Immunisation• Infectious Disease
Screening • INH Prophylaxis
CLINICAL SERVICES2 VOCATIONAL
TRAINING AND JOB PLACEMENT 3
• Skill Training• Business• Job Placement
• Early Recovery• Relapse Prevention• Sosial Support• Family Development• Spiritual and
Religious programmes
• Counseling • Self Management• Outing/Excursion• Sports and
Recreational Activities
PSYCHOSOCIAL1
13
PROGRAMME PROVIDED
Bkt. Mertajam 15/10/10
Kota Bharu15/10/10 Papar
01/11/10
Tampin 04/04/11
Sg. Besi 01/07/10
Kuching 15/10/10
Tampoi 15/10/10
Jerantut 01/07/11
Karangan01/05/12
Bachok 1/8/12
TOTAL NO OF CURE & CARE
CLINICS- 11 CLINICS
TOTAL NO OF MINI C&C : 4 CLINICS (BESUT, KINTA, MIRI & KENINGAU) : INPATIENT – 479 CLIENTS
: OUTPATIENT – 525 CLIENTS : OPERATIONAL SINCE – 15 NOV 2011
Tampin 04/04/11
Dengkil07/01/13
(TILL April 2013)
Distribution
C&C CLINIC CAPACITYCLIENT REFERRAL
& ADVOCACY
TOTALINPATIENT OUTPATIENT
SG.BESI 150 135 74 7 216KOTA BHARU 50 50 42 13 105
BKT MERTAJAM 40 35 51 8 94TAMPOI 100 61 2 1 64
KUCHING 30 19 7 0 26PAPAR 40 20 3 2 25TAMPIN 75 54 92 111 257
JERANTUT 100 77 4 5 86KARANGAN 100 100 59 0 159
BACHOK 20 15 16 0 31DENGKIL 100 25 14 0 39
CURRENT NO ( 30 Apr 2013) 591 364 147 1102ACCUMULATIVE JAN - APR 2013 1449 1278 2248 4975
ACCUMULATIVE 2012 5043 3854 3869 12766ACCUMULATIVE 2011 3028 2259 4080 9367ACCUMULATIVE 2010 666 772 117 1555
ACCUMULATIVE 2010-2013 10186 8163 10314 28663
PERCENTAGE OF INCREASE OF CLIENTS FROM 2011 TO 2012 } INPATIENT : 66% OUTPATIENT : 71 %
15
STATISTIC OF CLIENTS
DRC VS. C&C CLINIC
DRUG REHAB. CENTERS
C&C CLINIC
Compulsory Treatment & Admission through the Law; Criminal Records; Stigma
Open Access Services – Voluntary Admission; Considered as Patients
Focus on medical, psychiatric & clinical treatment
Treatment-based services only
Treatment for opiate-based addicts; all males and separate for women
Treatment for all substance abusers (opiate, ATS, inhalant) – males, females & adolescent are separated
Treatment Duration – 2 years Treatment duration – 1-3 months (inpatient), 4-6 months (outpatient)
Capacity for residents in DRCs – 7,350 Number of clients that accessed services at 8 C&C Clinics – 9,041
Cost of food – RM8.00 x 30 days x 12 months /person = RM 2,880
Cost of food – RM8.00 x 30 x 3 months = RM720.00
Loss of Property caused by violence, arson No incidence of violence or arson
FUN, EFFECTIVE & EASY TO IMPLEMENT APPROACH
YEAR TYPE OF SERVICE
TOTAL NO OF
CLIENTS DISCHARGED
CLIENT STATUS
ENTRY TO COMPULSOR
Y CENTRE
UNDERGO REHABILITATI
ON IN COMMUNITY
PRISON COMPLIANT NOT ABLE TO BE TRACED*
2010Inpatient 560 3 0.54% 15 2.68% 3 0.54% 455 81.25% 81 14.46%
Outpatient 294 0 0.00% 5 1.70% 1 0.34% 278 94.56% 10 3.40%
2011Inpatient 2590 36 1.39% 203 7.84% 27 1.04% 1819 70.23% 455 17.57%
Outpatient 1600 11 0.69% 129 8.06% 8 0.50% 959 59.94% 504 31.50%
2012Inpatient 3230 49 1.52% 271 8.39% 49 1.52% 2153 66.66% 885 27.40%
Outpatient 2527 24 0.95% 507 20.06% 5 0.20% 1367 54.10% 632 25.01%
TOTAL 10,801 123 1.14% 1130 10.46% 93 0.86% 7031 65.10% 2567 23.77%
OUTCOME RESULTS OF CLIENTS DISCHARGED FROM CURE & CARE CLINICS (2010-2012)
• 94.4%
• 90%
• 61%• Reduced by 37.1%
Injecting drug use 46% to 8.9%
Confident of not using drugs in the near future
Clients satisfied with servicesReady to
recommend the clinic to family and friends
OUTCOME STUDY AT C&C CLINIC
Drug use history
Substance30 days
BEFORE first visit to C&C
Past 30 days
Heroin 67.1% 4.8%
Benzos; Dormi, Clona, Valium, Xanax
12% 2.0%
Syabu, Meth, Ice 13.9% 2.1%
Pil Kuda 3.3% 2.2%
3 or more substances in the same day
10.8% 1.7%
OUTCOME STUDY AT C&C CLINIC
• In general, how satisfied are you with the medical attention you receive for your health problems (other than drug addiction) at the Cure and Care Clinic?
Satisfied 69.3%Very satisfied 23.9%
Not very satisfied 5.6%
Health status, needs and accessOUTCOME STUDY AT C&C CLINIC
Qualitative analysis: Opinions and feedback on C&C program and services.
• Overall, happy with the C&C concept• C&C encourages voluntary and ambulatory care and
rehabilitation • MMT is seen as a stabilizer giving 2nd chance • Programs offered by C&C were well received • Good support from C&C staff, Counselors and Medical Team
OUTCOME STUDY AT C&C CLINIC
20112010
Example text
METHADONE MAINTENANCE PROGRAMME
CCSC 1024
CCRC 0
Klinik C&C
0
Jumlah 1024
CCSC 1380
CCRC 21
Klinik C&C
351
Jumlah 1647
2012
CCSC 1530
CCRC 40
Klinik C&C
1735
Jumlah 3305
936 (67.8%) clients employed in 2012 compared to 543 (53%)
clients in 2011.
OUTCOME STUDY AT C&C CLINIC
56.3% •Helped maintain jobs
42.7% •Helped get into government support services
54.3% •Continued education
77.6% •Improved family relations
72.1% •Obtained permanent homes
75.9% •Prevented arrest into prisonsOUTCOME STUDY AT C&C CLINIC
73.8% •Prevented admission into Compulsory DRCs
78.3%% •Helped family or friends to get treatment and rehabilitation
76.7% •Access to medical care
94.9% •Very satisfied with the methadone maintenance programme
94.4% •Reduced drug cravings
65.4% •Obtained skill trainingKAJIAN KEBERKESANAN PROGRAM KLINIK
C&C OLEH UNIVERSITI MALAYAOUTCOME STUDY AT C&C CLINIC
CRIME HISTORY
Institution BEFORE C&C Since coming to the C&C
Lock-up 3.50 0.57
Prison 1.06 0
PUSPEN 0.61 0
Average number of times inpatients and outpatients have been sent to prison, lock up, or PUSPEN
KAJIAN KEBERKESANAN PROGRAM KLINIK C&C KOTA BHARU OUTCOME STUDY AT C&C CLINIC
Mental Health
Experienced serious depression, sadness, hoplessness, or loss of in-terest
Experienced serious anxiety/tension-uptight, unreasonably worried, inability to feel relaxed?
0
5
10
15
20
25
30
26
22
11 11
30 days before coming to C&C
In the Previous 30 Days
KAJIAN KEBERKESANAN PROGRAM KLINIK C&C KOTA BHARU OUTCOME STUDY AT C&C CLINIC
1. UNODC (United Nation Office of Drug And Crime)
2. UNAIDS3. WHO4. IDPC (International Drug Policy
Consortium)5. Pengiktirafan daripada Negara Luar
PENGIKTIRAFAN ANTARABANGSA
28
Drug Issues and Priorities for Southeast Asia
24th IFNGO Conference, Kuala Lumpur
Gary LewisRegional Representative, UNODC
8 November 2011
Positive example: Malaysia’s Cure and Care 1 Malaysia Clinics
(Gary Lewis. Regional Representative, UNODC)
Commendation by Mr. Andrew Marshall, Journalist from Al-Jazeera
AFTERCARE SERVICES
AFTERCAREOptions for Aftercare Services after discharge from C&C Clinic :
as outpatient with the same C&C Clinic or other facility; or
CCSC (Cure & Care Service Centres); or
CCH (Community Caring House)
CCVC (Cure & Care Vocational Centre) – vocational skills training
TransCC – Transitional Cure&Care facility
OutpatientCCSC
CCH
CCVC
TransCC
NADA District Offices
NADA
VISIONS AND TARGETS
People TargetsCapacity Building – Training for officers, partners, volunteers
Process TargetsEngaging Strategic Partners and Smart Partners
Strategy TargetsScaling up of Community-based services /programs
Outcome TargetsBetter outcome and success rate in treatment & rehabilitation
Nation’s TargetsHealthier people, drug-free country
By 2015
STRATEGIC PLANNING FOR COMMUNITY-BASED SERVICES / PROGRAMS
CCH / MOBILE UNITSC&C
1MALAYSIA CLINIC
CCSC
What are N.A.D.A’s
Future Plans?
By 2015
STRATEGIC PLAN (2011 – 2015)
No. of Compulsory Rehab. Centers
(CCRC) (4)
No. of CCSC – 98
No. of CCH – 96
2015
CCSC
2015
CCH
2015
C&C 1Malaysia
Clinic
No. of C&C 1Malaysia Clinics
(18)
THANK YOUTERIMA KASIH
We Care, We Serve