Procedure and data colletion

What is diversion?

Diversion is a legal construct: alternative to imprisonment for drug-related offences. Taking the possibility of diversion – if legal conditions are fulfilled – leads to a quasi-compulsory treatment.

What are the legal conditions to be fulfilled if choosing diversion?

 The conditions for choosing diversion are determined by the Act XIX of 1998 on Criminal Procedure. According to it choosing diversion is a possible legal act, it has no connection with the severity of addiction of the client. Those arrested citizens have the chance to choose diversion:

  • that possessed small amount of illicit drug,
  • the person did not take part in diversion in the previous two years,
  • the offender was not trafficking the drug but “consumed” it (typically demand-side offences),
  • and in certain cases for other minor offences (e.g. shoplifting, if the total punishment is under 2 years in prison, minor non-violent crimes exclusively to addict offenders).

 How does diversion work?

The process of entering treatment as diversion: 1) As a first step (if the legal conditions fulfilled – see above), the offender will be sent to a preliminary status assessment (registered in OSAP) which takes place at a health service provider/hospital. As a result of this preliminary status assessment the health service provider determines the addiction/psychiatric status of the offender. It is recommended for the doctor to use ASI (Addiction Severity Index), but there may be individual practises different from that. 2) According to the gravity of the offender’s addiction the person will be sent to the proper type of diversion out of the three possibilities. 3) The diversion, that lasts 6 months, 2 hours in every two weeks in average, for all the three types. None of the types of diversion has a written standard therefore there is no available information on the content of treatment at individual service providers.

What are the types of diversion?

Diversion has 3 different types:

  • preventive-consulting service: typically provided in a NGO setting, which has the professional content more or less similar to indicated preventive interventions with psycho-therapeutic components (no medicalisation, psychosocial intervention), which is somewhere between treatment and preventive interventions, but for historical causes we collect the information on these interventions (preventive-consulting service) in the TDI-database.
  • Ttreatment for dug-addiction: treatment takes place in health service setting, therefore it is registered in OSAP (possible double-counting due to the previous preliminary status assessment)
  • treatment of other conditions with drug use: (e.g. psychiatric conditions with accompanying drug use). treatment takes place in health service setting, therefore it is registered in OSAP (possible double-counting due to the previous preliminary status assessment)

 

Where do these cases appear in data collection?

The preliminary status assessments are optimally not counted neither in TDI nor in OSAP. In OSAP, however, since the assessment takes place at health service providers, these one-meeting assessments are likely to be reported separately from the following treatment. This may lead to double-counting. People in diversion who are referred to health care (the two latter types: treatment for drug-addiction, and treatment of other conditions with drug use see 2)/a.) are counted in the OSAP and also in the yearly TDI data collection. People in diversion in preventive-consulting service are optimally not counted in OSAP, but counted in TDI data collection.   When analysing TDI data it is important to make a distinction between patients participating in diversion programmes and patients in treatment outside diversion. In the course of describing characteristics of patients, those participating in diversion programmes are always described in a separate sub-chapter due to their special characteristics and due to their big proportion within the total treated cases.

Summary on data collection systems – collecting data on drug-related treatment in Hungary

OSAP (National Statistical Data Collection Programme)

TDI (Treatment Demand Indicator)
coordinated by
Ministry of Health

National Centre for Addiction

(programme exists from 2005)
relevant collected data
OSAP is an obligatory data collection system for health service providers. NFP receives the data from OSAP on treatments provided for drug-users –on specifically drug use-related problems. Treatments provided by NGO settings are not reported in OSAP.
TDI an obligatory data collection system for service providers on treatment provided for drug users (as described in TDI protocol) either by health care or NGO settings. Data provision is not obligatory for low threshold services.
estimated coverage
100 % of health service providers, 0% of NGO service providers.
90 % of health service providers, and vast majority of NGOs.
type of data collection
Aggregated by the service provider, yearly provided.
Client-based, quarterly provided.
treatment episode
OSAP is not only for new but all treatment episodes (prevalence data), it also records long-time continuous (mainly opiate substitution) cases, that are not reported in the TDI.
Only new treatment episodes (described by EMCDDA’s TDI protocol) are reported in TDI (incidence data).
compatibility with EMCDDA TDI standards
OSAP is not compatible with TDI-treatment criteria (e.g. overdose treatment in emergency care, for historical reasons) and the services provided by NGO settings are not covered by it.
Hungarian TDI system is fully compatible with EMCDDA TDI standards (e.g. treatment definition, reporting sites definition) and refers for both health care and NGO setting.
diversion
Preliminary status assessment takes place in outpatient health care setting, and mostly reported in the OSAP system (unfortunately, because this single event should not be considered as treatment and we permanently make efforts to clean these “redundancy” from the OSAP system). This means, if a client is preliminary surveyed and then referred to health system, it is likely to be double-counted. In theory cases in preventive-consulting service are not reported in OSAP.
Not so severe cases (a lot of cannabis cases in diversion) mostly turn to NGO setting after the preliminary status assessment, their number may be a bit lower in the health-based OSAP and higher in the psychosocial-focusing TDI. All types of diversion are reported in TDI.
overdose
Non-fatal overdoses (eg. opiate and sedative cases etc.) are also recorded in OSAP, which means, that the detoxification treatment is also reported as drug case, and later we cannot distinguish it from treatment cases aiming drug use/dependency.
Overdose cases are not registered.
bias
Possible multiple registering for different treatment modes: handling overdose, preliminary status assessment, treatment, rehabilitation.
Output status and length of stay not documented, such as: programme aborted vs. completed or continued at another service provider.