For information by
LegCo Panel on Security
on 11 February 1999
LEGCO PANEL ON SECURITY
Registration Scheme for
Drug Treatment and Rehabilitation Centres
This paper informs Members of the progress of the registration scheme for drug treatment and rehabilitation centres and the way forward.
2. At present, the Government adopts a multi-modality approach to drug treatment and rehabilitation services in order to cater for the different needs of drug abusers. The Correctional Services Department (CSD) operates a compulsory placement programme for drug addicts who have been convicted of minor offences; the Department of Health provides voluntary out-patient methadone treatment and maintenance programme for heroin addicts; the Hospital Authority (HA) operates, as part of its hospital establishment, six Substance Abuse Clinics (SACs) providing out-patient service for abusers of psychotropic substances, and the Society for the Aids and Rehabilitation of Drug Abusers (SARDA), a subvented body, provides voluntary medical detoxification and live-in rehabilitation service for detoxified addicts. At the same time, there are a number of other non-governmental organizations (NGOs), including Christian therapeutic agencies, which provide voluntary non-medical residential treatment and rehabilitation service based on the Christian faith. A number of these organisations also receive Government subvention.
3. In 1997, the Government established an inter-departmental working group to review the existing treatment and rehabilitation policy and the relevant ordinance which provides statutory underpinning for that policy. The key findings were as follows:-
- Obsolescence of the Drug Addicts Treatment and Rehabilitation Ordinance (Cap 326)
Enacted in 1960, Cap 326 "establishes centres for the treatment and rehabilitation of addicts of drugs and of intoxicants and for purposes connected therewith". The provisions in Cap 326 reflect the drug treatment and rehabilitation philosophy at the time which was based on detention of addicts in treatment centres and restriction of personal freedom of the addicts for up to six months to ensure that they could not get hold of drugs before they were completely cured. So far, two treatment centres of SARDA (one in Shek Kwu Chau and one in Shatin) have been declared as "Addiction Treatment Centres" in the Declaration of Addiction Treatment Centre (Consolidation) Order under Cap 326. Given that SARDA now operates as a "voluntary" treatment and rehabilitation centre, the "detention" requirement has become obsolete and Cap 326 is no longer applicable.
- Lack of Uniform Control for Centres Providing Voluntary Residential Treatment and Rehabilitation Services
Under the Hospitals, Nursing Homes and Maternity Homes Registration Ordinance (Cap 165), the Director of Health requires that an establishment for the sick, injured or infirm or those who need medical treatment is to be registered as a hospital or nursing home. In line with this statutory provision, SARDA's centres in Shek Kwu Chau, Shatin, Sheung Shui and Yuen Long as well as a Caritas' centre in Sai Kung (which will be opened in March 1999) need to be registered as nursing homes because of the medical approach they adopt. These centres are subject to statutory controls on accommodation, staffing, equipment used, keeping of patients' records, inspection by the licensing authority, etc. As regards drug treatment and rehabilitation centres which do not use medical treatment, they are not subject to any registration or regulatory controls. This has been an area of criticism as many of these centres are also receiving Government subsidies such as subvention, land, Comprehensive Social Security Assistance and education allowances for the rehabilitating addicts, etc. Except for those being subvented, there is no requirement to keep records or statistics on the operation of these centres.
- Physical Conditions and Conduct of Non-medical Drug Treatment and Rehabilitation Centres
As far as we are aware, there are about eleven non-medical drug treatment and rehabilitation centres operating in Hong Kong. Most of these centres are accommodated in stone or wooden structures in remote areas with minimum building and fire safety installations. Some of them are not fitted with proper electricity and water supplies. They are therefore highly susceptible to building safety, fire safety and environmental health hazards. Besides, the management and operation of such centres vary. Concerns have been expressed about drug patients not having been given proper medical care when they experience withdrawal symptoms during the course of treatment or suffer from other illnesses during the course of the programme.
4. In the light of the above, the Government proposed in a consultation document issued in May 1998 (Annex) that a registration scheme should be introduced for drug treatment and rehabilitation centres, in order to :-
- ensure drug patients undergo treatment and rehabilitation in a properly managed and secure physical environment to safeguard their well-being;
- protect the rights of drug patients who may be subject to psychological stress and physical health problems when undergoing treatment and rehabilitation. The staff working in these centres should, therefore, be competent or relevant in providing the necessary service; and
- enable the Government to keep a register including patients' records of the drug treatment and rehabilitation centres and to impose requirements and standards for their operations as necessary.
5. It was also proposed in the document that Cap 326 should be repealed and replaced by a new legislation providing for the registration scheme.
6. On the requests of drug treatment and rehabilitation centres, the public consultation on the registration scheme was extended to six months until 31 October 1998. A total of 24 submissions had been received. Views had also been collected through meetings with the Action Committee Against Narcotics (ACAN) and its Sub-committees, the Drug Liaison Committee comprising representatives of drug treatment and rehabilitation centres, five Provisional District Boards whose constituencies include drug treatment and rehabilitation agencies and ad hoc meetings with the management of drug treatment and rehabilitation centres. The majority of the views expressed were in support of the basic principles of the registration scheme. The key points of concern are as follows:-
- some respondents were worried about the apparent dichotomy of medical and non-medical addiction treatment and rehabilitation centres. Some cast doubt on whether the dichotomy should be upheld, since a drug abuser undergoing detoxification may need both medical and non-medical services. Some considered that there should only be one licensing authority for all drug treatment and rehabilitation centres, and the control should be provided under a single piece of legislation;
- the proposed building and fire services requirements were generally agreed, but the majority of the drug treatment and rehabilitation centres reckoned that some centres would not meet such requirements unless their premises were rebuilt or substantially improved. They considered that the Government should assist by giving the necessary funds and land for the relocation or improvement works;
- the requirement that a licensee should be a "fit" person is too stringent. They considered that drug addicts who have rehabilitated or who have remained "clean" for, say, 10 years prior to registration should be eligible for becoming the licensees;
- a few centres were concerned that the registration scheme may overly control the services they provide and their staffing arrangement. They were of the view that the future registration scheme should ensure that such centres would continue to enjoy autonomy in deciding their own mode of operation and staff employment;
- the majority of the respondents considered the proposed grace period of four years acceptable;
- to ensure a drug-free environment in the centres, the centre management commented that they should be given the statutory powers to restrict unauthorised entry, conduct bodily search on inmates, clothing search, screening of letters, parcels and visitors, etc., similar to those currently conferred under Cap 326; and
- some of them were not clear whether half-way house for rehabilitated drug addicts should be included under the proposed registration scheme.
7. The Government had collated and analysed all views received and consulted ACAN in December 1998 and the affected agencies again in January 1999. The registration proposal is being finalised along the following lines having regard to the views received:-
- to avoid double standards and to impose uniform controls on the drug treatment and rehabilitation centres providing voluntary residential service, there will be a single licensing authority, i.e. the Director of Social Welfare, for all these centres under the new legislation. Centres which provide medical treatment as part of their services are however required to obtain one more licence under Cap 165, as is presently the case;
- to assist centres with financial difficulties in conducting the upgrading or improvement works as a result of the registration scheme, the Narcotics Division has been liaising with the management of various charitable funds such as the Lotteries Fund, Beat Drugs Fund, etc. and alerted them of the possible demand for financial assistance from these centres. The Division is also liaising with the Lands Department and the Government Property Agency with a view to securing their commitment for assisting centres which will need to relocate their premises as a result of the registration scheme;
to ensure that the licensee is reasonably credible in providing drug treatment and rehabilitation services, and to provide an opportunity for rehabilitated addicts or ex-drug offenders to contribute to the community, the eligibility criteria of the licensee under the registration scheme will be revised by incorporating a timeframe of 10 years prior to registration during which the applicant must stay "clean", i.e. not having undertaken any drug treatment and having no record of offences in the manufacture, trafficking and possession of dangerous drugs in Hong Kong or elsewhere, and/or any other serious crimes;
- the registration scheme does not set out to impose an overly stringent control on the services currently provided by drug treatment and rehabilitation centres. The Director of Social Welfare, i.e. the future licensing authority, will ensure that the centres will continue to enjoy the autonomy of staff employment within the limits of current guidelines applicable to them, though for the purpose of registration, they must demonstrate to the licensing authority that the staff they employ are capable of or suitable for discharging the functions and services of the centres. The Director of Social Welfare will also provide the centres with general guidelines and a code of practice covering areas such as the building and fire safety requirements under the scheme, and other operational aspects e.g. seeking clients' consent to abide by house rules before admission, etc. Under the registration scheme, there will not be any stringent requirements for centres to employ professionals such as psychologists, social workers or medical practitioners. When a centre comes forth for registration, the licensing authority will solicit the relevant information and statistics (e.g. details with regard to patient intake, service utilization, addicts' demography, types of drugs abused, etc) for the purpose of keeping a central registry and effective monitoring;
- since some centres may need to be substantially upgraded to meet the registration requirements, sufficient time must be allowed for such works to be carried out. Implementation of the registration scheme will take a two-phase approach (i.e. first phase catering for centres which are under Government subvention, and the second phase, centres which are not under current subvention) with a grace period of four years in the first phase, having regard to the time required to secure funding and in some cases, sites for relocation and consultation with locals;
- with regard to the statutory powers (i.e. the power to refuse visitors and telephone calls, to censor letters and parcels, to confiscate any articles not authorised by the centre superintendent and to prohibit entry to the centre's premises), it is noted that at present, all drug treatment and rehabilitation centres except SARDA do not have such powers as they have not been gazetted under Cap 326. The Secretary for Justice has advised that many of such powers, especially those relating to censorship of letters and parcels, might be challenged under the International Covenant on Civil and Political Rights and the Basic Law. Thus, instead of conferring statutory powers to the centres in the new legislation, the licensing authority will issue guidelines to centres advising them of possible approaches in this regard; and
as half-way houses for rehabilitated addicts offer residential and, in most cases, counseling services similar to those offered in drug addiction treatment and rehabilitation centres, they will be required to be registered.
8. The Narcotics Division had further consulted the drug treatment and rehabilitation centres on the above directions for fine-tuning the registration scheme and the centres agreed to such modifications. The Administration is now finalising the registration proposals, and will proceed with the drafting of the legislation, with a view to introducing it to the Legislative Council in the next session. Meanwhile, the Director of Social Welfare will be drafting the guidelines and code of practice mentioned in paragraphs 7 (d) and 7 (f). The drug treatment and rehabilitation centres will be consulted on such guidelines and code of practice in due course.
|Narcotics Division||Ref. NDJ/3/12 (97)
|Security Bureau||February 1999