Complex Needs at the Boundaries of Mental Health, Justice and Welfare: Gatekeeping Issues in Managing Chronic Alcoholism Treatment?

Abstract:     
In the 19th century, addictions and mental health were managed in institutional 'retreats', with admission lightly governed by legislation until civil commitment laws developed, which separated management of addiction and mental health. At the beginning of the 21st century, some jurisdictions are re-visiting debates about how best to handle co-morbid or complex needs - whether as a criminal justice, civil, or service-coordination issue - and how to design gatekeeping mechanisms which match responses with needs. This paper reviews recent Australian experiences in re-casting one of the world's oldest 'Inebriates Acts' (1912 NSW), and the choices between renovated 'detoxification/place of safety' legislation, a broadened Mental Health Act, enactment of 'modern' addictions civil commitment laws, or adoption of Victoria's recent 'Complex Needs Act'. It is argued that philosophical and practical considerations favour limited service coordination models, just as is the case in managing involuntary anorexia treatment.

Number of Pages in PDF File: 22

Keywords: Comorbid conditions, addictions, models of intervention

JEL Classification: K39, J78, I38

Accepted Paper Series