Alternatives to Criminalizing Public Intoxication: Case Study of a Sobering Centre in Calgary, AB

Western society has for centuries treated public intoxication as a crime, based on the idea that those found drunk in public can be harmful — to themselves, to the people around them, and to the social values of the community. To this day, public intoxication is in many places still a criminal offence, including in Canada. But what happens when, instead of approaching public drunkenness as a crime, we think of it as a symptom of larger problems? And what if, instead of routinely arresting those found drunk in public, we gave them a place to sober up, where they also have the opportunity to get help for other issues that may be contributing to the situation that put them there in the first place? As it turns out, this approach may provide a greater reduction in possible harm to the individual, others around him or her, and the broader community. In Calgary, Alpha House’s sobering centre facility takes this approach, welcoming clients who are not eligible for shelter in other, ‘dry’ facilities. Through its Downtown Outreach Addiction Partnership (DOAP), Alpha House actively works to divert publicly intoxicated people from law-enforcement responses by bringing them into the shelter, or finding other alternatives to incarceration. Once clients have been taken into Alpha House, workers are available and motivated to help clients address any addiction or mental-health issues they might be struggling with and, if appropriate, to assist them in finding secure housing. During a twelve-month assessment period, the results of Alpha House’s approach appears to be having a dramatic effect in helping those who have turned up publicly intoxicated, with apparent benefits for the community. During the period measured, there was a 50.1 per cent annualized decrease in the average number of days that clients were hospitalized, compared to the 12-month average prior to their intake into facility programs. There was a 62.6 per cent decrease in the number of times clients were hospitalized, a 50 per cent decrease in the use of emergency medical services, and a 42.4 per cent decrease in the number of times using an emergency room. Most dramatically the study observed a 92.7 per cent decrease in the average number of days clients spent in jail compared to the year prior, and a 70.8 per cent decrease in the number of interactions with police. The number of times clients went to jail actually increased by 26.6 per cent, but that may have to do with Alpha House’s staff encouraging clients to address outstanding warrants and charges during their program participation. Calgary Police Services, meanwhile, reports notable decreases in people being processed for public intoxication in its downtown unit facilitated by partnership with community-based organizations, such as Alpha House. This is the crux of the harm-reduction approach: that holding cells should be a last resort for those publicly intoxicated people who cannot safely or effectively be helped through a sobering centre. But for those who are suitable for Alpha House’s program, the effects appear to be highly encouraging, providing an option to divert people facing the difficult personal circumstances that might cause them to be publicly intoxicated, into a program where they can access medical support, addiction and recovery programs. We may never eliminate public intoxication, but if our goal in criminalizing it has been to reduce harm to the individual and those around him or her, the sobering-centre approach appears to provide a much more effective response. Sobering centres will not and should not replace the need for medical intervention in some cases. They cannot replace the need for police custody as some clients cannot be safely assisted in such facilities. This means that the triage into sobering centres, health system and police custody will continue to be needed. Ultimately, a comprehensive approach to intoxication is necessary, one including sobering facilities along with a continuum of housing, health, and corrections responses that challenges the criminalization of addiction

Accountability by Design: Moving Primary Care Reform Ahead in Alberta

Health-care reform is perennially popular in Alberta, but reality doesn’t match the rhetoric. Government has invested more than $700 million in Primary Care Networks — with little beyond anecdotal evidence of the value achieved with this investment. As the province redirects primary care to Family Care Clinics, the authors assert that simply tinkering with one part of the system is not the answer: health care must change on a system-wide basis. Drawing on the experiences of frontline staff and a rich body of literature, the authors present their vision for integrated team-based primary care, designed to be accountable to meet the needs of populations. This will require governance that makes primary care the hub of the system, and brings together government and health-services leadership to support the integration of primary and specialty care. There are shared accountabilities for achieving primary care that exhibits the attributes of high performing primary care systems, and these exist at multiple levels, from individuals seeking primary care, up to and including government. The authors make these accountabilities explicit, and outline strategies to secure their achievement that include system redesign, service delivery redesign and payment reform. All of this demands whole-system reform focused on primary care, and it won’t be easy. There are plenty of vested interests at stake, and a truly transformative vision requires buy-in at every level. However, Alberta’s rapidly growing and aging population makes it more urgent than ever to realize such a vision. This paper offers guidelines to spark the fresh thinking required

International Profiles of Health Care Systems, 2011

This publication presents overviews of the health care systems of Australia, Canada, Denmark, England, France, Germany, Japan, Italy, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United States. Each overview covers health insurance, public and private financing, health system organization, quality of care, health disparities, efficiency and integration, use of health information technology, use of evidence-based practice, cost containment, and recent reforms and innovations. In addition, summary tables provide data on a number of key health system characteristics and performance indicators, including overall health care spending, hospital spending and utilization, health care access, patient safety, care coordination, chronic care management, disease prevention, capacity for quality improvement, and public views

Competition in Canadian Health Care Service Provision: Good, Bad or Indifferent?

Most provincial health care systems in Canada combine public, private non-profit, and private for-profit delivery. In Alberta, the Health Care Protection Act , known as Bill 11, allows the public to purchase certain insured surgical services from private providers. This legislation sparked a heated and ongoing debate in Canada about the role of competition in health care service delivery. The key question asked is what can be gained from introducing competition among hospital and physician services while maintaining a public payment system. This paper evaluates what has been learned from the recent literature on competition in health care markets in the context of expanding the role of the private sector in Alberta. The evidence does not provide a definitive answer. Competition introduced by an expanded private sector is likely to be beneficial on some measures, indifferent on others, but not likely bad

International Profiles of Health Care Systems

Compares the healthcare systems of Australia, Canada, Denmark, England, France, Germany, Italy, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United States, including spending, use of health information technology, and coverage

Telehealth Handbook

The Centre for Telehealth (CT@M) Handbook is a resource for the growing number of people working in the field of telehealth, with a particular focus on applications in the area of mental health and addictions. It is intended to provide Site Coordinators and others with practical information, guidelines, and forms for clinical and evaluation purposes

International Profiles of Health Care Systems, 2012

This publication presents overviews of the health care systems of Australia, Canada, Denmark, England, France, Germany, Japan, Iceland, Italy, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United States. Each overview covers health insurance, public and private financing, health system organization, quality of care, health disparities, efficiency and integration, care coordination, use of health information technology, use of evidence-based practice, cost containment, and recent reforms and innovations. In addition, summary tables provide data on a number of key health system characteristics and performance indicators, including overall health care spending, hospital spending and utilization, health care access, patient safety, care coordination, chronic care management, disease prevention, capacity for quality improvement, and public views

Access to Civil & Family Justice: A Roadmap for Change

There is a serious access to justice problem in Canada. The civil and family justice system is too complex, too slow and too expensive. It is too often incapable of producing just outcomes that are proportional to the problems brought to it or reflective of the needs of the people it is meant to serve. While there are many dedicated people trying hard to make it work and there have been many reform efforts, the system continues to lack coherent leadership, institutional structures that can design and implement change, and appropriate coordination to ensure consistent and cost effective reform. Major change is needed

The Alberta Legal Services Mapping Project: Report for the Edmonton Judicial District

Edmonton is the sixth of eleven Alberta Judicial Districts to be mapped as part of the Alberta Legal Services Mapping Project (ALSMP). The ALSMP is a large-scale, multiyear endeavor, designed to gain an understanding of the legal needs of Albertans and of the legal services available in Alberta