Special Commission of Inquiry into the Drug ' Ice'

STATEMENT OF [INSERT NAME]

Insert Date

Name Leone Crayden

Address C/o The Buttery

346 Lismore Road Binna Surra NSW 2479

Occupation; Chief Executive Officer

On & May 2019, I , Leone Crayden, state:

1. This statement made by me accurately sets out the evidence that I would be prepared,

if necessary, to give in court as a witness. The statement is true to the best of my

knowledge and belief and I make it knowing that, if it tendered in evidence, I will be

liable to prosecution if I have wilfully stated in it anything that I know to be false, or

do not believe to be true.

I am currently the CEO of The Buttery a not-for-profit, charitable drug and alcohol

rehabilitation, addiction and mental health services organisation located near

Bangalow in Northern NSW, Australia. I possess a background in community

development and peer worker models. Previously to the Buttery I served from 2015-

2018 Executive Director of Q Shelter, a peak housing and homeless organisation, and

CEO of On Track Community Programs between 2007-2015.

I currently Co-chair of the Mental Health Network for the Agency for Clinical Innovation

(ACI), I have served as the Chairperson of the Mental Health Coordinating Council

NSW for six years, a Board member of the Northern NSW Local Health District 2007-

2015, Director of the Lady Musgrave Trust, current member of the Lismore City Council

Social Justice and Crime Prevention Committee. I have a background in nursing, social

science, leadership and governance and presented several papers on housing and

homelessness, especially on mental health, housing and support services and

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importance of the interface between clinical, psychosocial support and tenancy

sustainment.

2. Current Chief Executive Officer of the Buttery Ltd and have been since October 2018

3. The Buttery has been operating drug and alcohol treatment services since 1973 and

expanded its programs to include mental health services and co-existing mental health

and alcohol and other drug programs in 1999.

Our reputation, experience and positive outcomes have long been held in high esteem.

Many thousands of people have participated successfully in harm minimisation and/or

abstinence programs conducted by The Buttery, through both residential and

community outreach services.

In 2018, the Buttery supported over 1,240 teenagers and adults in their recovery

journey, with greater numbers now entering and completing community outreach

programs. These include day rehabilitation (''dayhab''), individual counselling, group

therapy sessions, youth in- school early intervention programs and wellness education

programs.

4. a) In the North Coast - yes 2018-24% of people entering our services report

Methamphetamine as drug of concern compared to 12% in 2014.

b) The Buttery has 63 people currently on our waiting list with a six (6) month wait for

men and four ( 4) month wait for women for our residential rehabilitation service.

c) More people report poly substance use alcohol and methamphetamine and people

enter our services with complex financial, health and mental health issues. Often are

homeless and have been for long periods of time. 19% in 2018 compared to 10% in

2014

d) Data collected on entry to our services both outreach and residential

5. The Buttery has two residential addiction rehab programs and a separate psychological

wellbeing program, which operates as a social enterprise. Surplus funds from the social

enterprise are applied to The Buttery's charitable work. The Buttery also operates

community outreach programs across Mid and Far North Coast NSW. In recent years

it has significantly increased its Regional footprint with the roll out of new outreach

services. In the 2017-18 financial year it had 1,240 participants, up 20 per cent on the

previous year.

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The Residential Treatment Programs we provide:

• Maintenance to Abstinence Program (3 months)

• Therapeutic Community Residentia l Rehabilitation Program (3 to 9 months)

• The social enterprise, The Buttery Private Wellbeing Program (28 days plus

three-month follow-up)

The Buttery's community outreach se.rvices cover a wide area from Port Macquarie to Tweed Heads and west to Kyogle. The Buttery has operated some of the outreach services since 2006

These services can be accessed by NPS participants where appropriate/eligible and include:

• INTRA for adults with alcohol and other drug misuse problems- individual and group counselling sessions

• INTRA for young people aged 12-24 with AOD misuse problems. Family/carer support is also available

• CORE - a 6-week, five days per week community based, day stay AOD rehab program for people who cannot access residential rehab e.g. sole parents of young children

• b.well is a community outreach service for people aged 12 years and older whose mental health and drug and alcohol use affect their desired way of life and well-being. Through b.well, participants can access a range of support services including:

• Psycho education

• Peer support groups

• Individual support

• Activities programs

• Life skills programs

• Early intervention

• Living healthily program

• Partners in Recovery - for people with long-term mental illness (PIR). PIR supports people with severe and persistent mental illness with complex needs and their carers and families, by getting multiple sectors, services and support to work in a more collaborative, coordinated, integrated way. The b.well PIR program is in partnership with Mission Australia. The Buttery programs are linked with mental health and AOD services provided by Northern NSW Local Health District, thus providing an easy step up or step-down approach for participants. Cross referral between programs is also likely.

• RPAS/AODCCC - Relapse Prevention Aftercare Service/AOD Continuing Coordinated Care both support people 18-65 years of age who have complex unmet psychosocial needs

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and are receiving, or have recently received, AOD treatment through the Mid North Coast Local Health District (MNCLHD) or NNSWLHD or a Community Managed Organisation (CMO).

• Northern Rivers Gambling Counselling Service (NRGCS) for those affected by problem gambling, including family members

• Financial Counselling Service - this service is solely funded through philanthropic grants and donations, it has proved positive for people both within the residential and community outreach programs. People who are using methamphetamine and poly substances often come to The Buttery with huge debts from outstanding fines and same day loans used to pay for drug use. The Financial Counselling services assists people access Work Development Orders to repay outstanding fines. It also acts as an advocacy service to assist people negotiate debt waivers or realistic repayment plans. The service works across all Buttery programs as is an essential part of the intake assessment when people enter into treatment, individuals can be supported with budget preparation whilst in Community Outreach or when exiting the Buttery residential Programs.

• Family Program - Family counselling service is not funded through any government grants it is solely funded through philanthropy. Due to this, it is tenuous in nature, it survives year to year by foundation grants or donations from generous donors.

6. The Buttery collects Client Reportable Experience measures and utilises psychco­

metric results to evaluate our effectiveness. The Australian Treatment Outcomes

Profile (ATOP's) as well as the Kessler Psychological Distress Scale (Kl0).

We have also partnered with Southern Cross University to evaluate the Maintenance

to Abstinence program

Measures:

Retrospective analysis of routinely collected data (2013-2017) from surveys completed

by 100 clients. Outcome measures were: Depression, Anxiety, Stress Score (DASS-42),

World Health Organisation Quality of Life 8 questions (WHOQOL-8) and Kessler

Psychological Distress Scale (K10). Other variables included demographics, drug use,

other addictions, aggression, self-harm, suicidal ideation/attempts, and risk taking

behaviours. Statistical methods included Chi-square, Fisher's exact, t-tests, repeated

measures analysis of variance and the Reliable Change Index.

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Results:

All mean DASS-42, WHOQOL-8 and KlO scores improved significantly in all participants

from entry to exit (p < 0.001). The majority of participants demonstrated reliable

improvement across all psychometric measures. Completion rates for the MTA program

were 51 %. Depression (p =0.023), anxiety (p =0.010) and stress (p = 0.015) DASS-

42 scores decreased significantly more in completers compared to non-completers.

The rate of improvement in mean WHOQOL-8 scores and psychological distress scores

(KlO) was not statistically significantly different between completers and non­

completers over time. There was no significant difference between completers and

non-completers on socio-demographics, self-reported drug addiction or risk taking

behaviour on program entry, except for suicidal thoughts while intoxicated (p =0.033).

Completers were more satisfied with their relationships (p =0.044) and living place (p

=0.040) on program entry.

We have further evaluated the Factors influencing early withdrawal from a drug and

alcohol treatment program and client perceptions of successful recovery and

employment: a qualitative study.

7. No we do not have specific programs for ATS use as we are funded for all substance

use disorders. However, we do see a need especially for a long term residential facility

with long term employment goals would be useful.

8. Dependent on the program, however, in most instances we prefer self-referral, yet

we receive a number of referral sources via both internet inquiry and telephone. The

majority still be phone. We have inquiries from GP's psychiatrists, families, detox units,

private and public hospitals, other rehabilitation units or outreach programs.

9. Residential -Waiting lists, in most cases, not enough residential places - Increase the

number of beds. Need for specific programs for women and their children also

pregnant women;

Community Outreach- In the case of outreach and counselling services barriers are

more varied, lack of transport, significant responsibility to report job seeking outcomes,

family commitments, children, dual disorder and lack of clinical care; day rehabilitation

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only operates in areas on a rotating basis, people have to wait until it comes back into

their area.

10. Yes, planning, funding and contract management of our services are greatly impacted.

No increase in funding for over ten years means demand is outstripping supply for all

treatment services. Cannot employ the clinical staff necessary for the complexity of

need. Very little strategic planning done in conjunction with funders on trend analysis

and how to plan to address growing trends identified by our data. No comparative data

analysis between LHD and our service. Contract management and reporting duplicated

between the Ministry and the LHD. Ministry Key Performance Indictors differ from LHD

Key Performance Indicators. The Drug and Alcohol Service Planning Model (DASPM) is

not used to determine funding or bed numbers in our area, impacting on the number

of residential beds we are funded for.

11. a) The Buttery is moving to centralised intake and assessment system to ensure people

can be referred to community programs whilst waiting for treatment in residential

services

b) Training is expensive and so is supervision for workers; the Buttery provides clinical

supervision to its staff, however with funding less then optimum it will cease. Funding

needs to recognise the need for AOD workers to have access to clinical supervision to

retain a healthy workforce.

c) Co-locate detox facilities collocated with residential services would assist in the

coordination of services. The Buttery collocates many of its Community Outreach

services within LHD's this is an extremely effective method to ensure timely and

effective services.

d) Funding for both community outreach programs and residential rehabilitation is

inadequate to retain trained staff, to provide quality accredited programs and to cover

the costs of infrastructure necessary to maintain residential sites.

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