DCD II WP Treatment Challenges Second Group Meeting, Vienna 5 June, 2009.

Transcription

1 DCD II WP Treatment Challenges Second Group Meeting, Vienna 5 June, Participants: Thomas Legl, euro-tc, Vienna Hans Gros, Stadt Stuttgart Sylke Lein, Drogenprävention, Leipzig Ewald Lochner, Drug coordinator, Vienna Manon Reynders, Plan de prévention, Liège Julia Kalchhauser, euro-tc, Vienna t.legl@knappenhof.at hans.gros@stuttgart.de sylke.lein@leipzig.de ewald.lochner@sd-wien.at prevention.drogues@liege.be info@euro-tc.org Minutes The work package coordinator, Thomas Legl welcomes the participants and briefly reports about the day s aims of developing guidelines according to the proposed topics on the agenda (see list of working topics). Any changes, requests, amendments are very welcome. Everyone agrees on the proposal of differentiating between general and local problems. First topic: Accessibility to treatment Thomas Legl introduces the points reflecting the situation and different realities in practice highlighting the question of waiting lists and acceptability of waiting times before admission to treatment. Hans Gros generally states that the work on the guidelines has to cover overall treatment situations pointing out, that he runs so many different programs in Stuttgart, which all have their individual needs. Discussing the issue there is general agreement that: everyone should have access to treatment Ewald Lochner agrees principally but he suggests that there should be certain standards to make clear who needs what kind of treatment; criteria have to be developed to filter out the correct treatment method for each patient.

2 Manon Reynders agrees since she states that individuals with addiction programs and their situations are very different and in need of differentiation in treatment planning and strategies. Hans Gros suggests that it would be important for the cities executives to be involved and provided with knowledge about the criteria, so everyone would work in one line. Ewald Lochner proposes the development of a standardized diagnosis (with the exception of emergency cases, of course) and on the base of the diagnosis professionals will decide what kind of treatment the patient needs. Question of financing: Thomas Legl brings up the topic of financial participation and responsibility for part of the costs from the side of the patients. Sylke Lein explains that in Germany, if patients cannot afford the hospital costs for treatment, then the social welfare takes over the costs. She states that there are quite different regulations, different countries use different systems, but confirms that at least the system within one country should be homogenous. Ewald Lochner is of the opinion that treatment should be paid according to the national rules of the country, but many patients who are unemployed cannot even afford the smallest amount of money. Sylke Lein argues that treatment has to be financially regulated, that it should not be for free but that either the insurance or the social service has to pay for it in the end, featuring that also the insurance companies have to fulfil their responsibilities. Ewald Lochner agrees with Sylke and adds that treatment should be financed according to the country s insurance system, which is not the case at the moment since in many countries health insurance does not pay for many kinds of addiction treatment. Hans Gros asks for at least marginal financial contribution by the patients in order to make them feel more responsible and increase their perception of reality. Thomas Legl subsumes: for addiction treatment there should be the same regulations for health insurance as are for other treatments. There is general agreement on this issue.

3 Ewald Lochner points out the essential objectives which he experienced as an outcome of a local as well as international discussion process. Evaluation should bring result for the crucial issues: how long should the patient be treated? - What aims should be reached? - Who needs what kind of treatment? - Can patients who relapsed after therapy claim treatment again? Thomas Legl reinforces that it makes sense to have criteria, bringing up the topic of interests of the treatment providers, need of regulations but also of the right to decide on treatment from side of the client. Ewald Lochner suggests that patients who do not want to follow the standardized criteria and undergo treatment in another way should be financed at least partly by themselves. Hans Gros explains that in Stuttgart there are basically 4 pillars when it comes to financing treatment: clients treatment is paid for by - the city of Stuttgart - the social insurance - the health insurance - a private organization Ewald Lochner says that guidelines with standards that would apply to all the different parts of financing are even more important and preferential efforts in order to unify these are needed. Hans Gros further explains that many of these systems cooperate; that there are many overlapping areas and that he thinks it not necessary to define one big standard for all these parts. Thomas Legl subsumes that an intense cooperation between health insurance and the social system is necessary, common aims have to be analyzed. The local drug coordination should then host some kind of system where a first contact, counselling and the provision of information should be available to patients. Hans Gros remarks that if standards exist they are generally based on political decisions made on a higher level and possibilities of the drug coordination to

4 influence decision making are generally quite limited. But main task of the drug coordination has to be to evaluate, guarantee and distribute services according to the existing standards from the national drug plan. Sylke Lein mentions that in Leipzig exist discussion platforms where working standards are mutually developed. Ewald Lochner explains that in Austria there are no standards for addiction treatment, no standards for health insurance, each of the 9 counties decide with the insurance how a situation will be dealt with. In order to develop guidelines it should be an aim to have one set of standards that applies to patients from all over the country. There is a multi-level system within the EU, there should be some standards that should be the same within one country! Thomas Legl points out and subsumes that within the European Union, where first steps for common drug strategies are taken a common framework for financing and guaranteeing services should be set up and accessibility be secured. Following the discussion the group agreed on the following items: - a cooperation between the welfare and insurance system is necessary and has to clearly define financing criteria - insurance system / welfare system and drug coordination have to cooperate in an ongoing process of cinsultation - treatment has to be paid according to national rules, according to the health insurance system - everybody should have access to the treatment system - for addiction treatment the same regulations as for all other treatment of diseases and health problems should apply - European guidelines have to be developed adapted to the national level by the member countries with the possibility to adapt to local specialties - European law should regulate financing, the same level of treatment should be financed within all countries of the EU Second topic: Treatment for criminal offenders instead of prison

5 Sylke Lein lines out that for drug-inflicted crimes there should always be the possibility to receive treatment instead of imprisonment, which is already the case in many EU countries. In general treatment has to be successful in order to avoid a prison sentence. If there are new criminal offences during the time of treatment the measure for health intervention has to be stopped and the original sentence will be enforced. Thomas Legl interposes that often the personal decision and views of the judges are still quite essential. The issue is widely discussed. Following the discussion the group agreed on the following items: - treatment instead of prison should be available for drug addicts whose crime is directly drug-related in the sense of necessity to guarantee their addiction needs. - treatment has to be successful, the patient has to be stable for the whole period to keep up the treatment and avoid punishment in terms of the original sentence. - the timeframe of the treatment has to be defined according to therapeutic success and not to the actual time of the criminal sentence - all types of treatment should be possible Third topic: Treatment for criminal offenders in prison The topic is introduced and widely discussed. Following the discussion the group agreed on the following items: - all possible treatment including substitution treatment should be available - drug-free compartments to improve treatment motivation should be installed - counselling through professionally trained staff should be provided - useful rehabilitation programs including school and job education for the motivated individuals should be provided - participation in therapeutic measures should result in better living conditions during detainment

6 At the end of the round table, Thomas Legl thanks all participants for the very productive and professional working climate which is also confirmed and pointed out by the feedback of the participants. The proposal to continue the process until the next meeting through internet contact is welcomed, the participants are kindly asked to react on other topics from the list before the next meeting to move forward the working process and ease the discussion at the next meeting. It is commonly agreed upon the 4 th of December 2009 as a date for the next meeting which will take place in Leipzig. The following meeting is preliminary set for June (11 th ) 2010 in Liège. The round table is followed by an impressive visit to the headquarters and different projects of the Vienna drug coordination which takes place under outstanding hospitality of Ewald Lochner and his colleagues and provides a high professional level of demonstration and possibilities for discussion pointing out the benefits of integrative strategies. The field visits are followed by a working dinner and an excellent presentation by Ewald Lochner, which is attached to the minutes, as well as the presentation by the ISD (Institut für Suchtdiagnostik).

7 DCD II WP Treatment Challenges, Meeting Vienna, June 5th 2009 LIST OF TOPICS Accessibility to Treatment Types of Treatment -> Residential/Outpatient Substitution Treatment Criteria Treatment and Gender Treatment and families/parents with children Treatment and school/job education Treatment and Integration into the labour market Treatment and Ethnicity Treatment and types of consumption Treatment for criminal offenders -> Treatment instead of prison -> Treatment in prison Treatment evaluation and research Treatment cooperation with other stakeholders Prevention /Harm reduction facilities/local political authorities