August 2022

The waiting game: Australia’s capacity crunch for residential treatment

People seeking treatment for problematic drug use at residential facilities are facing significant backlogs in several states and territories across Australia, leading to worries about how delayed treatment affects people’s lives and calls for more funding.

The issue has been well publicised in Victoria, where the Victorian Alcohol and Drug Association (VAADA) has registered rising waitlists for all types of treatment, with the residential treatment backlog spiking from 230 people in September 2020 to 452 in December 2021.

Other states have not produced similarly dramatic headlines – due in part to spotty data – but expressions of concern are common. In the ACT, for example, there is no centralised waitlist, but according to Dr Devon Bowles, CEO of the Alcohol Tobacco and Other Drug Association ACT (ATODA), ‘demand for drug services in the ACT is probably around double the availability of places.’

demand for drug services in the ACT is probably around double the availability of places

Dr Devon Bowles

Michael White, executive director of the South Australian Network of Drug and Alcohol Services, notes that in his state ‘it’s very hard to compute [the data]; people disengage at the initial contact point when told there will be a week or a month’s wait. This means that there is likely to be a degree of unmet and unmeasured need.’

Although the issue precedes the Covid-19 pandemic, the implementation of social distancing guidelines led to services operating with significantly reduced staff, which worsened capacity shortfalls – just as demand for treatment spiked. According to analysis by the Australian Institute for Health and Welfare, treatment episodes at residential treatment facilities declined markedly, a shift that, in most states, was attributable to reduced capacity. This crunch occurred just as lockdown pressures led to increases in demand for residential treatment. Clinics in New South Wales reported growing waitlists for alcohol and substance abuse treatment programs, while the Alcohol, Tobacco and other Drugs Council Tasmania (ATDC) reported increasing harm from alcohol use, alongside 11-week waits for residential rehabilitation.

Even after the easing of restrictions, extended waitlists for residential treatment persist, in part because the after-effects of lockdown are still reverberating throughout the sector. In a May 2022 media release, VAADA noted ‘unprecedented increases in demand since the pandemic, with average wait times blowing out for some treatment types by over 25 per cent. This means extra weeks for those in desperate need of help in a queue, which for many dangerously increases the rate of attrition.’

The intention of getting treatment isn’t always enduring. Some may feel ready to enter treatment for a number of days but may then experience a traumatic event or a relapse, causing them to move themselves off the waiting list.

David Taylor

For clients, such delays can jeopardise potential progress – or worse. If treatment is not accessible, clients run the risk of falling through the cracks. According to VAADA’s David Taylor, ‘the intention of getting treatment isn’t always enduring. Some may feel ready to enter treatment for a number of days but may then experience a traumatic event or a relapse, causing them to move themselves off the waiting list.’ As another Lived Experience Advocate put it: ‘By the time people reach out to seek admission to a residential rehabilitation centre they are often at crisis point in their substance use. Long delays to enter rehabilitation result not only in continued use, but in some cases have been the difference between life and death.’

What can be done? It is clear that more funding for dedicated detox and residential treatment is necessary in many states and territories. In Victoria, the state government has opened several new residential rehabilitation facilities, and in May officials announced funding for a 30-bed facility in Mildura.

While improving infrastructure is crucial, the extent of waitlists only partly reflects the number of available beds. According to data compiled by VAADA, Victoria currently has 0.74 residential beds per 10,000 residents, ahead only of South Australia. On the other hand, Tasmania has 1.86 beds per 10,000 residents, and several dozen residential rehabilitation beds have been added, but the ATDC has noted that a lack of community-based withdrawal beds is acting as a bottleneck, prompting a December 2021 call for $4.9 million across 3 years to add beds.

Staffing is another potential obstacle. VAADA identified funding cuts of $39 million in overall support for the AOD sector in Victoria’s 2022/2023 state budget, which it says will lead to job cuts and delay training for the workers necessary to fill positions – thereby potentially creating new barriers for clients seeking treatment. In a similar vein, although the NT has the highest number of residential treatment beds per capita, Katie Flynn of the Association of Alcohol and other Drug Agencies noted that ‘the main issues we have are appropriately funded staffing levels for each service and those staff being adequately trained and qualified.’

Finally, states must also be aware of the intersection between residential rehabilitation backlogs and other challenges, particularly access to housing. Devon at ATODA notes that ‘many AOD clients struggle to obtain stable housing, and, anecdotally, there is some suggestion that some people who are in residential treatment could benefit equally from a less intensive form of treatment if they had access to housing.’’ A Lived Experience Advocate based in Tasmania likewise emphasised the housing crisis’s impact on available beds, observing that ‘clients stay in treatment longer than necessary due to lack of housing options and aftercare,’ adding that ‘clients have nowhere to go and so are holding up space in beds that might otherwise be available.’

In the short term, some organisations have attempted forms of waitlist harm reduction. The Bridge Program in Hobart has implemented a process to check in on people waiting for treatment more often. ‘They provide one-on-one and regular support once someone’s made contact,’ a Tasmanian Lived Experience Advocate said. ‘Also, they have a triage system to determine who needs the beds most urgently and are able to successfully treat far more people now that they are running more day programs for outpatients and outreach-type services.’

That said, increased contact support is no silver bullet. As David at VAADA points out: ‘While [contact support] goes some way to diminish the harms, it simply doesn’t provide the same level of in-depth support.’ When asked about the long-term effects of extended wait times for residential treatment, VAADA Executive Officer Sam Biondo is clear: ‘It will be incredibly devastating for many,’ he said. ‘Lots of individuals will find themselves in dire circumstances; while some clients will end up in the health system, others will end up in the justice system, and some may not survive at all.’