Problematisation and centralised assessment in drug treatment sector reform

Abstract

In the construction of drug use as a 'social problem' (Bacchi, 2015), ease of access to drug treatment aims to enable an immediate response when people seek help. However, as treatment demand exceeds supply, establishing qualifications with regards to efficiency and effectiveness of access, it has been argued, will improve treatment pathways for those most in need. In 2014, drug sector reform in Victoria, Australia introduced policies that supported centralised intake and assessment (CI&A). In 2016, a significant change of policy saw assessment being disaggregated to treatment services. This paper explores the problematisations at these two points to clarify the processes impacting drug treatment governance. Policies, reviews, and allied documents have been explored using an application of Bacchi's (2009) 'what's the problem represented to be' analytical approach. This application aims to stage an encounter between day-to-day policy as a socio-material practice (Bacchi, 2012) and problematisation in the development of contrasting 'realities' at each point. At Time 1, problematisation was about access and navigating treatment. CI&A were introduced as part of sector reform, however an independent review documented disruption to client flow and stakeholder concerns. At Time 2, the policy focus was on quickly establishing a therapeutic relationship with clients. Across these two policy events, the problem representation of uncertainty regarding service effectiveness and efficiency was maintained. This may reflect a deeper characterisation whereby 'drug problems' are accepted and understood as value neutral, and government and services are obliged to take responsibility for their amelioration. The power differential in so called 'collaborative' approaches to policy development may have contributed to silences regarding the salience of organisational factors, such as funds redistribution and recommissioning, and the limited involvement of clients in policy making processes. The shift in emphasis from system design to clinical practice across the two policy events appeared to elevate the status of treatment providers and affirm government's legitimacy in governing.

Keywords: Australia; Bacchi; Centralised intake; Drug policy; Problematisation.