NACCHO #healthelection16 : Vulnerable Aboriginal communities must lead their own recovery

Tom 2

“In fact, to those calling for another stolen generation – well, we already have one. Thousands of our children are today involved in child protection services; at a rate eight times higher than non-Indigenous children.

And despite the care and commitment of services and those involved in fostering, there are risks for all children, black or white, involved. This includes “broken placements” and institutionalisation, and increased rates of mental health issues, contact with the criminal justice system, substance use and abuse, and homelessness later in life.

For our children in particular, risks associated with compromising strong Aboriginal identity-formation and the breaking of cultural transmission are well-documented.”

Dr Tom Calma AO and Professor Pat Dudgeon

As originally published in the NACCHO Aboriginal Health Newspaper April

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The recent terrible news that a 10-year-old Aboriginal girl had taken her own life shook many Australians. Yet there would be few Aboriginal families who have not already been affected by the suicide or attempted suicide of their young people. This includes our own extended families and kin.

Our families have suffered the losses of a loved 14-year-old girl and two equally loved young men who were employed and content. All tragic and unexplained losses that have left those grieving feeling hollow and bewildered.

The deaths by suicide of our young people then are not isolated events. The latest statistics show that our 15- 24 year olds are dying by suicide at four times the non-Indigenous rate; and our 1 – 14 year olds at nine times the non-Indigenous rate.

Colonisation still impacts upon us. Our young people and children are not immune from the “deep and persistent disadvantage”, or poverty and social exclusion, that the Productivity Commission reports still characterises about one in 10 Indigenous Australians.

What this means is stressful life events impact on our mental health – be they violence, racism, long term unemployment or poor health. High levels of psychological distress are reported in over one in four of us three times higher than the non-Indigenous rate. Another contributing factor is the use and abuse of drugs and alcohol. Ice is just the latest community and family-destroying scourge.

Trauma, including intergenerational trauma, is also a major issue particularly (but not only) for stolen generations survivors and their descendants. This group report higher rates of mental illness and alcohol and other drug problems than Aboriginal people who weren’t removed from their families, communities and cultures.

This belies the knee jerk response of removing children from families in crisis, rather than working with their families. While removal is necessary in extreme cases, it should always be seen as a last resort. We need to break the intergenerational cycles of despair and dysfunction, not accelerate them.

And removing a child can also exacerbate existing factors, or itself be a suicide risk, and as was reported in the case of the girl who died last week.

What we have then is a concentration of suicide risk factors in many of our communities, with our children and young people in the front line. Yet for some, the response is to close these communities down: put them in the “too hard” basket. But this is lazy policy that will cause as much harm as it might prevent.

So we are all asking: what can be done?

More forced social engineering is not the answer

Aboriginal people have already experienced the trauma of communities being closed down. Historically, peoples with different cultures and languages were forced to live together under the control of missionaries and governments. This is one of the roots of the crises in many communities today.

And where will the people from the closed down communities go? Is it better that they end up homeless in towns that shun them, and live in camps where violence, sexual abuse and alcohol and drug use are just as problematic?

More forced social engineering is the last thing the members of these communities need. People advocating community closures need to ask themselves: what will be the effects be of removing them from sustaining and well being-supporting contact with kin, culture and country? Yes, there are challenges in many communities, but let’s also acknowledge that there are cultural and other strengths that can be built on, and that could be lost in closures.

Stop seeing Indigenous communities as a drain on the public purse

And instead of responding after the event to crisis after crisis, let’s be proactive and preventative in our focus. Let’s think about investing in these communities, rather than seeing them as a drain on the public purse.

In particular, where are the services, including mental health and drug and alcohol services, to meet the needs of these communities? As the National Mental Health Commission reported in its 2015 review, despite much good work in recent decades, on a needs basis there are still significant mental health and other service gaps. This includes services to support our families and communities in crisis situations, and to support them before they get into such situations.

The National Mental Health Commission recommended to Government that there was a Closing the Gap target for improved Indigenous mental health, and a national target to reduce suicide by 50% in a decade – including a 50% reduction in suicide among Indigenous Australians. Further, that an Indigenous mental health action plan be developed. However, there has been no take-up at this time.

Vulnerable communities must lead their own recovery

There are alternative ways to respond to child suicide in our communities without removing children from families or closing communities down, but it requires resources and placing communities in the driver’s seat.

Most broadly, “upstream” activity to mitigate the impact of disadvantage and the associated suicide risk factors is required. Here vulnerable communities must take the lead in identifying their needs and priorities, be it addressing community safety, unemployment or alcohol and drug use. And yes, it might include whole-of-community responses to preventing child sexual abuse.

Developmental factors and culturally-informed norms are crucial

It might also include building on protective culturally-informed norms (including familial norms) and other cultural reclamation work that has been shown to be protective against youth suicide in indigenous Canadian communities, and that we believe has an important role to play here.

In particular, addressing the developmental factors that can pre-dispose our children and young people to suicide is critical. Protecting them from sexual abuse is important, but sexual abuse is not the only cause of suicide among our children and young people. Among some, impulsiveness and overwrought responses to the end of a relationship have been reported as being enough to lead to suicide.

In fact, a comprehensive response might include addressing healthy cognitive development from conception onwards, providing age and culturally appropriate school programs about relationship issues and how to handle break-ups, and promoting cannabis and other drug use reduction. It should involve strategies to reduce the contact of our young people with the criminal justice system including by addressing boredom and increasing employment opportunities.

Communities themselves are also best placed to develop situational analyses to support more focused universal suicide prevention activity, including by identifying specifically suicidal behaviours and suicide risk factors among their members – and appropriate responses.

Access to the same support as all Australians at risk

Our communities must also have access to the same high quality clinical standards, treatments and support available to all Australians at risk of suicide. Critical in this is access to culturally safe mental health service environments, and culturally competent staff (who are able to work effectively, cross-culturally with us).

We should also have access to cultural healers as needed. Effective transitions from community-based primary mental health settings to specialist treatment and then back again to community primary mental health care settings are also important.

After a suicide, postvention is critical

Because many of our communities are small and close knit, a death by suicide can have a significant destabilising impact and may influence other community members to attempt suicide or self harm. As such, when culturally appropriate and with social support as required, postvention is an important suicide prevention measure in our communities. Programs that respond to suicide, such as the one currently piloted in WA by the Australian Government, are a welcome example of this.

And with many responsibilities for suicide prevention being devolved to the primary health networks, it is critical that these bodies partner with our communities in suicide prevention activity. This is particularly so in relation to the implementation of the National Aboriginal and Torres Strait Islander Suicide Prevention Strategy against which $17.8m has been pledged by the Australian government, and that has been entrusted to them.

Sustainable outcomes in the longer term require empowering and meaningfully engaging with Indigenous families and communities including those in crisis situations.

But this is best done long before they reach the terrible point of losing yet another child to suicide.

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