**Aboriginal and Torres Strait Islander readers are advised this article mentions someone who has passed**
Introduction by Croakey: On 7 November, 2023, Victoria implemented an historic and long overdue legal reform, to decriminalise public intoxication and take a health-based approach when people are drunk in public places.
The reform has been decades in the making, with all other jurisdictions – except Queensland – having decriminalised public intoxication between 1974 and 1990, according to the Alcohol and Drug Foundation.
However, the Victorian response is providing national leadership in a number of ways, as Marie McInerney reports below.
This article is published in collaboration with cohealth, a not-for-profit community health organisation, as part of its Health Equity Champion membership of the Croakey Health Media funding consortium.
Marie McInerney writes:
The call comes in from the police, paramedics, or licensed venues, alerting health services that someone in a public space is at risk from their level of alcohol intoxication.
If the person identifies as Aboriginal and/or Torres Strait Islander, the Victorian Aboriginal Health Service (VAHS) — acting as a triage service — makes an initial assessment on level of need before referring the call to one of five dedicated Aboriginal and Torres Strait Islander community controlled organisations across Melbourne and regional Victoria.
Otherwise, for Melbourne callouts, VAHS will refer the case to community health provider cohealth’s Public Intoxication Response Service, with a nurse and harm reduction worker dispatched to support the intoxicated person to get home safely or bring them to a sobering up centre in the inner city.
It’s a significant advance from what might have happened until very recently, when people who were drunk in public in Victoria risked ending up in a police cell under criminal or civil police powers and, too often, in grave danger due to absence of health support.
“This new service represents a fundamental shift in the way that we as a community respond to public drunkenness, and will save lives, improve people’s health and reduce the burden on police and other emergency services,” said Chris Turner, cohealth’s Deputy Chief Executive.
“A health-based response to public intoxication keeps people safe, avoids unnecessary contact with police, and creates a safer and more supportive environment for vulnerable members of our community,” he said.
Long-urged change
According to the Alcohol and Drug Foundation (ADF), those most likely to benefit from the new approach include Aboriginal and Torres Strait Islander communities, people who are homeless, and culturally diverse communities – the groups who were most impacted by public intoxication laws.
Aboriginal communities and health and legal groups had been urging the move in Victoria for decades – decriminalisation of public intoxication was a key recommendation of the 1991 Royal Commission into Aboriginal Deaths in Custody.
Finally the Victorian Government acted, partly in response to powerful advocacy by the family and supporters of Aunty Tanya Day, a much-loved Yorta Yorta mother, sister, grandmother, and community advocate.
Aunty Tanya fell asleep on a train in December 2017 and, despite causing no disturbance, was arrested for being drunk in a public place in circumstances where the Coroner found that the police should have taken her to hospital or sought urgent medical advice.
While locked in a concrete police cell at the Castlemaine police station, Aunty Tanya hit her head on the wall and subsequently died.
Leading the way
While belated, Victoria’s public intoxication response is ahead of other states and territories on a number of fronts.
Firstly, said the Human Rights Law Centre, Victoria is “the first state to meaningfully transition away from a legal response to a public health response to public intoxication, finally treating it as the public health issue it has always been”.
“In every other state and territory where public intoxication has been decriminalised, civil ‘protective custody’ laws still allow for police to detain intoxicated people in police cells.”
That’s resulted in continued over-representation of Aboriginal and Torres Strait Islander people and risk of people dying in custody, Human Rights Law Centre lawyer Monique Hurley told Croakey.
The ADF has estimated that, from 1989-2021, there have been 129 deaths in police custody where the person was arrested for things like public drunkenness, protective custody for intoxication, disorderly conduct, or offensive behaviour.
Another important innovation in Victoria’s response puts Aboriginal community controlled health organisations “front and centre” of the new response, said Victorian Aboriginal Community Controlled Health Organisation (VACCHO) CEO Jill Gallagher, who has hailed the “historic and long overdue reform”.
Five Aboriginal community controlled organisations are now providing eight metropolitan and regional services — Wathaurong Aboriginal cooperative (Geelong), Ballarat and Districts Aboriginal cooperative (Ballarat), Bendigo and District Aboriginal cooperative (Bendigo), Rumbalara Aboriginal cooperative (Shepparton), and Ngwala Willumbong Aboriginal corporation (Mildura, Swan Hill, Latrobe, and East Gippsland as well as Melbourne and a First Nations sobering centre in St Kilda).
Gallagher said the design of the Victorian services “champions Aboriginal culture and Aboriginal ways of knowing, being, and doing to deliver positive health and wellbeing outcomes for Aboriginal and Torres Strait Islander communities”.
“For the same behaviour, Aboriginal and Torres Strait islander people in Victoria have faced inordinately higher rates of incarceration for public drunkenness than non-Aboriginal Victorians face,” she said.
“In some instances, this can lead to devastating outcomes with some Aboriginal and Torres Strait Islander people subjected to far harsher and inhumane treatment whilst in custody.”
Alcohol harms
The scale of alcohol harm in Victoria and more broadly in Australia is, of course, huge.
In Victoria alone, there were 59,216 alcohol-related hospital admissions in 2021–22, and 45,759 alcohol-related ambulance attendances in 2022, according to addiction research group Turning Point.
Given Australia’s complicated relationship with alcohol and the many vested interests involved, it’s not surprising there has been some resistance to the reforms.
In the lead-up to the decriminalisation date, ambulance and police unions raised concerns that health services would be overwhelmed by demand, but to date it’s been “steady and manageable”, according to Danny Jeffcote, who is cohealth’s Operations Manager for Public Intoxication Response.
cohealth is not yet making public the number of callouts, but he says that, despite some public concerns that Melbourne Cup Day was coincidentally the first day of decriminalisation, “the sky didn’t fall in”.
cohealth said the start date was never a major concern, given that in 2022 on Cup Day only five Victorians were arrested for public drunkenness (a decrease on the daily average of eight public drunkenness arrests according to police data).
“Yes, we had a number of people who were given beds, but we were quite able to cope,” Jeffcote said.
The cohealth public intoxication response service, which employs 40 people across three daily shifts seven days a week, has been built on the work of a 12-month trial in the City of Yarra in Melbourne’s inner east, which was delivered in partnership with the Salvation Army.
The trial allowed cohealth to test the model of care and develop operational protocols, with many of those learnings carried over to the expanded metro service.
“What we learned was that most people our outreach teams have contact with have a plan to get home, and often just need some help to get there, or to be re-connected with friends and family who can look after them,” said Jeffcote.
On 29 November, a new 20-bed sobering centre started 24/7 operation, replacing a smaller six-bed trial site. The new facility – owned by the State Government and managed by cohealth – offers a safe place to sober up under the care of health professionals as well as a range of wraparound health and social support services and referrals to family violence, homelessness and mental health supports.
Outreach matters
The third way that Victoria’s response is providing national leadership, Jeffcote says, is its outreach element.
As well as responding to callouts – which can come in from emergency services, local government authorities, liquor licensees, and transport operators from across Melbourne – cohealth’s public intoxication response teams ramp up their outreach to proactively visit known hot spots around town at night and on weekends.
From intoxicated young people who’ve been separated from friends, to people who have had too many after-work drinks, and people experiencing homelessness, cohealth says that their teams will support anyone in need.
Outreach teams, who carry a medical kit, breathalyser, water, snacks and mobile chargers, move proactively around the metro area between 8 pm–4 am on Thursday, Friday, Saturday and Sunday nights, as well as being available for callout 24/7.
Regardless of how they are connected to the service, people are taken to the sobering centre as a last option, Jeffcote said. If they refuse assistance, they are left in place if assessed as safe. Intoxicated people who commit crimes, are identified as a safety risk, or need serious medical support continue to be managed by emergency services.
Those who are brought to the sobering up centre are given a health assessment as well as a bed, with frequent checks by a nurse to ensure they are recovering well.
Jeffcote says the whole journey depends on consent – consent to engage initially, to get into the vehicle, to be admitted and then for referral to specialist services. “By far” the majority of people brought into contact with the service are helped to get home or to safety with friends.
“It’s only a minority of people that are brought back to the sobering centre, typically those who are a little bit more vulnerable for whatever reason or more intoxicated,” he said, observing that “alcohol is a very powerful drug” that can put people’s health and safety at serious risk.
“I would much rather someone sobered up in a health service, which is going to respond from a health perspective, not a law and order perspective,” he said.
“They get care and support until they are safe to leave and then we offer to link them into other health services, depending on their needs, instead of leaving with a fine and a court date or a fine and conviction. It’s a stark difference.”
Tanya Day’s family has urged other Australian states to follow Victoria’s lead, saying “police cells are dangerous places for intoxicated people”, especially for Aboriginal and Torres Strait Islander people who are further at risk due to systemic racism and bias.
“Our family is yet to receive a public apology or acknowledgement of the role that police played in our mother’s death and we continue to fight for independent oversight and accountability of police to ensure that what happened to our mum doesn’t happen again,” the family said in a statement.
“The burden of driving all this work should not be left to families who have had their loved ones die at the hands of the state. Governments must be more proactive in getting the job done, so our families don’t feel the pressure of having to pick up the slack while also grieving the death of our family members.”
Further reading
- The coronial findings in the inquest into Aunty Tanya Day’s death here.
- A copy of the Expert Reference Group’s report – Seeing the Clear Light of Day – here.
Declaration: This article is published in collaboration with cohealth as part of their Health Equity Champion membership of the Croakey Health Media funding consortium. cohealth had input into the selection of the topic of the article, interviewees and the editing process.
See Croakey’s extensive archive of articles on primary healthcare
