NACCHO Aboriginal Community Control and #Justice Health : @NACCHOChair Donnella Mills full speech at the @_PHAA_   #JusticeHealth2019 Conference #ClosingtheGap #justicereinvestment

” Given ACCHOs commitment to providing services based on community identified needs, it is not surprising, then, to learn that we are starting to address justice inequities by developing innovative partnerships with legal services.

Health justice partnerships are similar to justice reinvestment in that they target disadvantaged population groups and are community led. They differ in that funding is not explicitly linked to correctional budgets and secondly, the primary population groups targeted through these partnerships are those people at risk of poor health.[i]

Health justice partnerships in the ACCHO context address people’s fears and distrust about the justice system, by providing a culturally safe setting in which to have conversations about legal matters.

I believe that the development of collaborative, integrated service models such as Law Yarn can provide innovative and effective solutions for addressing not only the overrepresentation of Aboriginal and Torres Strait Islander peoples in the justice system, but also the health gaps between Indigenous and non-Indigenous Australians.

Selected extracts from Donnella Mills Acting Chair of NACCHO keynote speaker 9 April 

See PHAA #JusticeHealth2019 Website

Aboriginal community control and justice health

A justice target has been proposed to focus government efforts towards closing the gap on Aboriginal and Torres Strait Islander peoples’ overrepresentation in the justice system.

Discussion of the role of community leadership to address this serious issue must begin with a commitment to self-determination, community control, cultural safety and a holistic response. Aboriginal community controlled health services understand the interplays between intergenerational trauma, the social determinants of health, family violence, institutional racism and contact with the justice system.

As trusted providers within their communities, they deliver services based on community identified needs.

The presentation explores how the principles, values and beliefs underpinning the Aboriginal community controlled health service model provide the foundations for preventing and reducing Aboriginal and Torres Strait Islander peoples’ exposure to the justice system

I would like to acknowledge that the land we meet on today is the traditional lands for the Gadigal people of the Eora Nation, and that we respect their spiritual relationship with their Country.

I also acknowledge the Gadigal people as the traditional custodians of this place we now call Sydney. Their cultural and heritage beliefs are still as important to the living Gadigal people today.

This is also true for all Aboriginal and Torres Strait Islander peoples that are here this morning. We draw on the strength of our lands, our Elders past and on the lived experience of our community members.

For those who don’t know me, I am a proud Torres Strait Islander woman with ancestral and family links to Masig and Nagir.

I thank the Public Health Association of Australia for welcoming me here so warmly. I am delighted to be here today to share ideas with you on a topic that I care so deeply about.

Scene setting

Some of you may be aware that, late last month, a Partnership Agreement on Closing the Gap was signed between the Council of Australian Governments and the Coalition of Aboriginal and Torres Strait Islander Peak Bodies.

The agreement sets out how governments and Aboriginal and Torres Strait Islander representatives will work together on targets, implementation and monitoring arrangements for the Close the Gap strategy.

NACCHO and almost 40 other peak Aboriginal and Torres Strait Islander bodies negotiated the terms and conditions of this historic agreement on the understanding that when Aboriginal and Torres Strait Islander peoples are included and have a real say in the design and delivery of services that impact on them, the outcomes are far better. This understanding informs the premise of my presentation.

I am here to talk to you about how the principles, values and beliefs underpinning the Aboriginal community controlled service model provide the foundations for preventing and reducing Aboriginal and Torres Strait Islander peoples’ exposure to the justice system.

But first, a little bit about NACCHO, for those of you who are unfamiliar with our work.

NACCHO, which stands for the National Aboriginal Community Controlled Health Organisation, is the national peak body representing 145 Aboriginal Community Controlled Health Organisations – ACCHOs – across the country, on Aboriginal health and wellbeing issues.

Our members provide about three million episodes of holistic primary health care per year for about 350,000 people.

In very remote areas, our services provide about one million episodes of care in a twelve-month period. Collectively, we employ about 6,000 staff (56 per cent whom are Indigenous), which makes us the single largest employer of Indigenous people in the country.

SLIDE 2: Rates of representation in prisons and youth detention facilities

It is timely to come together and consider justice health issues in Aboriginal and Torres Strait Islander communities. It is likely that, for the first time, a justice target may be included in the Close the Gap Refresh strategy.

I am heartened to know that, for the first time, Aboriginal and Torres Strait Islander peak bodies will guide the finalisation of targets and oversee the strategy’s implementation, monitoring and evaluation. I am hopeful that, for the first time, we can begin to address the issues and see some improvements.

All of you hear today will have read and heard the shocking statistics, the increasing rates of incarceration among Indigenous Australians.

Last month it was reported that Aboriginal and Torres Strait Islander men are imprisoned at a rate 14.7 times greater than non-Indigenous men, and for women the rate is even higher, 21.2 times higher than non-Indigenous women.[ii]

Our women represent the fastest growing population group in prisons; their imprisonment rate is up 148% since 1991.[iii]

Imprisoning women affects the whole community. Children may be removed and placed in out-of-home care. Research has found there are links between detainees’ children being placed into out-of-home care and their subsequent progression into youth detention centres and adult correctional facilities.[iv] Communities suffer, and the cycle of intergenerational trauma and disadvantage is perpetuated.

Figures on the incarceration of Aboriginal and Torres Strait Islander children and young people in detention facilities reveal alarmingly high trends of overrepresentation:

  • On an average night in the June quarter 2018, nearly 59% of young people aged 10–17 in detention were Aboriginal and Torres Strait Islander, despite Aboriginal and Torres Strait Islander young people making up only 5% of the general population aged 10–17.
  • Indigenous young people aged 10–17 were 26 times as likely as non-Indigenous young people to be in detention on an average night.[v]

A concerning factor is the link between disability and imprisonment. A Senate Inquiry found that about 98% of Aboriginal and Torres Strait Islander prisoners also have a cognitive disability.[vi]

People living with physical disabilities such as hearing loss, and people with undiagnosed cognitive or psycho-social disabilities may struggle to negotiate the justice system and their symptoms are likely to be correlated with their offending behaviours, and receive punitive responses rather than treatment and care.

SLIDE 3: Overrepresentation – causal factors

Our experiences of incarceration are not only dehumanising. They contribute to our ongoing disempowerment, intergenerational trauma, social disadvantage, and burden of disease at an individual as well as community level. Indeed, ‘imprisonment compounds individual and community disadvantage.’[vii]

The question – why Aboriginal and Torres Strait Islander peoples are overrepresented in prisons – is complex. It can partly be explained by exploring how structural, geographic, historic, social and cultural factors intersect and impact individuals’ lives.

While people have some agency in how they respond to the circumstances they are born into, they are also constrained by many generations’ experiences of marginalisation, discrimination, poverty and disadvantage. This is particularly relevant and disturbing when one considers Aboriginal and Torres Strait Islander peoples’ experiences in navigating the justice system.[viii]

Issues of access and equity also disadvantage Aboriginal and Torres Strait Islander peoples in their dealings with the justice system. Some of these may relate to their geographical location – remote and very remote regions have limited legal services. Given the limited service infrastructure available in remote settings, geography also determines people’s access to community based options.

Some of the other barriers faced by our people relate to the lack of language interpreters and inappropriate modes and technologies of communication. People have different levels of English language literacy and IT capacities. These factors can result in peoples’ experiences of structural discrimination in the justice system and result in miscarriages of justice.[ix]

We have heard of the over-policing of Indigenous Australians and how this impacts on their exposure to the justice system. In his submission to the Senate Inquiry into Aboriginal and Torres Strait Islander experiences of law enforcement and justice services, Chief Justice Martin referred to ‘systemic discrimination’ through over-policing:

Aboriginal people are much more likely to be questioned by police than non-Aboriginal people. When questioned they are more likely to be arrested rather than proceeded against by summons. If they are arrested, Aboriginal people are much more likely to be remanded in custody than given bail. Aboriginal people are much more likely to plead guilty than go to trial, and if they go to trial, they are much more likely to be convicted. If Aboriginal people are convicted, they are much more likely to be imprisoned … and at the end of their term of imprisonment they are much less likely to get parole … So at every single step in the criminal justice process, Aboriginal people fare worse than non-Aboriginal people.[x]

There are other contributing factors that explain the overrepresentation of Aboriginal and Torres Strait Islander people in the justice system. The inadequate resourcing of Aboriginal community controlled legal services plays a major role in the growing level of unmet need in communities.[xi] As noted by the National Aboriginal and Torres Strait Islander Services:

Aboriginal and Torres Strait Islander people don’t just need access to more legal services; they need greater access to culturally appropriate legal services. … Cultural competency is essential for effective engagement, communication, delivery of services and the attainment of successful outcomes.[xii]

Aboriginal and Torres Strait Islander peoples’ experiences of institutional racism and discrimination, the trauma caused to members of the Stolen Generations and entire families and communities, which continues today with increasing numbers of children being placed in out-of-home care, contribute to the distrust, fear and unwillingness of many people to engage with legal services.

The Senate Inquiry into Aboriginal and Torres Strait Islander experiences of law enforcement and justice services heard that ‘for Aboriginal people in particular, there is this historical fear of about walking into a legal centre’.[xiii]

Governments’ inertia and lack of commitment to genuinely addressing the issues have contributed to a worsening situation. The National Indigenous Law and Justice Framework 2009-2015 was never funded, attracted no buy in from state and territory governments, and the review findings of the Framework were never made public.

SLIDE 4: Justice reinvestment

Increasing funding for the corrective service sector will not and does not address the issue of Aboriginal and Torres Strait Islander peoples’ exposure to the justice system. As Allison and Cunneen note, ‘the solutions to offending are found within communities, not prisons.’[xiv] They are referring to justice reinvestment, a strategy and an approach, whereby correctional funds – a portion of money for prisons – are diverted back into disadvantaged communities.

The concept of justice reinvestment centres on the belief that imprisoning people does not address the causal factors that give rise to their exposure to the justice system. Ignoring the causal factors leads not only to recidivism and repeat incarceration, it also reproduces intergenerational cycles of disadvantage and exposure to the justice system.

Reinvesting the money into community identified and led solutions not only addresses causation; it also strengthens communities. Depending on the project, justice reinvestment may not only help to reduce people’s exposure to the justice system; it may also improve education, health, and employment outcomes for Aboriginal and Torres Strait Islander peoples.

Allison and Cunneen’s analysis of justice reinvestment projects in Northern Australia shows how the underpinning principles of this approach reaffirm self-determination and strengthen cultural authority and identity. Justice reinvestment projects address the driving factors of many Aboriginal and Torres Strait Islander peoples’ interactions with the justice system: their historical experiences of colonisation, discrimination, dispossession and disempowerment.[xv]

It is encouraging to note that in its 2016 report of the inquiry into Aboriginal and Torres Strait Islander experience of law enforcement and justice services, the Finance and Public Administration References Committee recommended that the Commonwealth Government support Aboriginal led justice reinvestment projects.[xvi] In December 2017, the Australian Law Reform Commission recommended that Commonwealth, state and territory governments should provide support for:

  • the establishment of an independent justice reinvestment body; and
  • justice reinvestment trials initiated in partnership with Aboriginal and Torres Strait Islander communities.[xvii]

SLIDE 5: Closing the gap on justice outcomes: best practice approach

Emerging out of these inquiries is a growing understanding that closing the gap on justice outcomes must begin with a commitment to self-determination, community control, cultural safety and a holistic response.

Appropriately resourced, culturally safe, community controlled services are essential for addressing these barriers. Best practice approaches for developing solutions to preventable problems of Aboriginal and Torres Strait Islander peoples’ exposure to the justice system must begin with enabling their access to trusted services that are governed by principles and practices of self-determination, community control, cultural safety and a holistic response.[xviii]

NACCHO’s member services – the ACCHOs – embody these principles. The cultural safety in which ACCHOs’ services are delivered is a key factor in their success. They provide comprehensive primary care consistent with clients’ needs.

This includes home and site visits; provision of medical, public health and health promotion services; allied health, nursing services; assistance with making appointments and transport; help accessing child care or dealing with the justice system; drug and alcohol services; and providing help with income support.

The Aboriginal Community Controlled Health model of care recognises that Aboriginal and Torres Strait Islander peoples require a greater level of holistic care due to the trauma and dispossession of colonisation, dispossession and discrimination, which are linked to our poor health outcomes and over-representation in prisons.

ACCHOs understand the interplays between intergenerational trauma, the social determinants of health, family violence, and institutional racism, and the risks these contributing factors carry in increasing Aboriginal and Torres Strait Islander peoples’ exposure to the criminal justice system. We understand the importance of comprehensive health services that are trauma informed; and providing at risk families with early support. Within the principles, values and beliefs of the Aboriginal community controlled service model lie the groundwork for our communities’ better health outcomes.

SLIDE 6: Health justice partnerships

Given ACCHOs commitment to providing services based on community identified needs, it is not surprising, then, to learn that we are starting to address justice inequities by developing innovative partnerships with legal services.

Health justice partnerships are similar to justice reinvestment in that they target disadvantaged population groups and are community led. They differ in that funding is not explicitly linked to correctional budgets and secondly, the primary population groups targeted through these partnerships are those people at risk of poor health.[xix]

Health justice partnerships in the ACCHO context address people’s fears and distrust about the justice system, by providing a culturally safe setting in which to have conversations about legal matters.

In testimony given to a Senate Inquiry, an ACCHO representative describes how:

We form relationships with the health services and actually provide a legal service, for example, within the Aboriginal medical service. We have a lawyer embedded in the Aboriginal medical service in Mount Druitt so that when the doctor sees the person and they mention they have a housing issue – ‘I’m about to get kicked out of my place’ – they can say, ‘Go and see the lawyer that is in the office next door.’[xx]

ACCHOs are increasingly recognising the benefits of working with legal services to develop options that enable services to be delivered seamlessly, safely, and appropriately for their communities. Lawyers may be trained to work as part of a health care team or alternatively, health care workers may be upskilled to start a non-threatening, informal conversation about legal matters with the clients, which results in referrals to pro bono legal services.

 Case study: Law Yarn

As a lawyer and Chair of the Cairns-based Wuchopperen Health Service, I was aware of the need to provide better legal supports for my community. In conversations with local Elders and LawRight, Wuchopperen entered into a justice health partnership in 2016. LawRight is an independent, not-for-profit, community-based legal organisation which coordinates the provision of pro bono legal services for individuals and community groups.

The aim of the partnership was to improve health outcomes by enhancing access to legal rights and early intervention. Initially, it was decided that, as community member and lawyer employed by LawRight, I would provide the free legal services at Wuchopperen’s premises.

One of the challenges of justice health partnerships is ongoing funding, and in 2017 we were forced to close our doors for several months. We knew the partnership was addressing a real need in our community, so we submitted a funding proposal to the Queensland Government, and received funding of $55,000 to trial ‘Law Yarn’.

Law Yarn is a unique resource that supports good health outcomes in Aboriginal and Torres Strait Islander communities. It helps health workers to yarn with members of remote and urban communities about their legal problems and connect them to legal help. A handy how-to guide includes conversation prompts and advice on how to capture the person’s family, financial, tenancy or criminal law legal needs as well as discussing and recording their progress.

Representatives from LawRight, Wuchopperen Health Service, Queensland Indigenous Family Violence Legal Service and the Aboriginal Torres Strait Islander Legal Services came together and created a range of culturally safe resources based on LawRight’s successful Legal Health Check resources.

SLIDE 8: Law Yarn – your law story

SLIDE 9: Four aspects of Law

These symbols have been created to help identify and represent the four aspects of law that have been identified as the most concerning for individuals when presenting with any legal issues. If these four aspects can be discussed, both the Health worker and Lawyer can establish what the individual concerns are and effectively action a response.

Each symbol is surrounded by a series of 10 dots; these dots can be coloured in on both the artwork and the referral form by the Health worker to help establish what areas of law their clients have concerns with.

SLIDE 11: Launch of Law Yarn

Law Yarn was officially launched at Wuchopperen Health Service, Cairns, on 30 May 2018 by the Queensland Attorney General as a Reconciliation Week Event.

The trial has been funded to 30 June 2019 and will be comprehensively evaluated by independent academic researchers who specialise in this field.

Legal and health services throughout Australia have expressed interest in this holistic approach to the health and wellbeing of Aboriginal and Torres Strait Islander peoples. And we are hopeful that the evaluation findings will support the rollout of our model to ACCHOs across Australia.

In conclusion, I believe that the development of collaborative, integrated service models such as Law Yarn can provide innovative and effective solutions for addressing not only the overrepresentation of Aboriginal and Torres Strait Islander peoples in the justice system, but also the health gaps between Indigenous and non-Indigenous Australians.

Address the legal problems, and you will have better health outcomes. Justice health partnerships provide a model of integrated service delivery that go to the heart of the social determinants of health, key causal factors contributing to Aboriginal and Torres Strait Islander peoples’ over-exposure to the justice system.[xxi] With Aboriginal community control at the front and centre of service design, these partnerships are able to deliver both preventive law and preventive health for Aboriginal and Torres Strait Islander peoples.

SLIDE 12: Thank you

[i] Health Justice Australia. 2017. Integrating services; partnering with community. Submission to national consultation on Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan 2013-2023.

[ii] https://www.lawcouncil.asn.au/media/media-releases/recommendations-to-reduce-disproportionate-indigenous-incarceration-must-not-be-ignored

[iii] Law Council of Australia. 2018. The Justice Project, Final Report – Part 1. Aboriginal and Torres Strait Islander People.

[iv]. Law Council of Australia. 2018. The Justice Project, Final Report – Part 1. Aboriginal and Torres Strait Islander People.

[v] Australian Institute of Health and Welfare. 2018. Youth detention population in Australia. AIHW Bulletin 145.

[vi] Ibid., 2010 Senate Inquiry into hearing health in Australia.

[vii] Australian Human Rights Commission. 2009. Social Justice Report, pp. 53-54, cited in Finance and Public Administration References Committee. 2016. Aboriginal and Torres Strait Islander experience of law enforcement and justice services. The Senate: Australian Parliament House.

[viii] Law Council of Australia. 2018. The Justice Project, Final Report – Part 1. Aboriginal and Torres Strait Islander People.

[ix] Finance and Public Administration References Committee. 2016. Aboriginal and Torres Strait Islander experience of law enforcement and justice services. The Senate: Australian Parliament House; Law Council of Australia. 2018.

[x] Finance and Public Administration References Committee. 2016. Aboriginal and Torres Strait Islander experience of law enforcement and justice services. The Senate: Australian Parliament House. Testimony from Chief Justice Martin.

[xi] Finance and Public Administration References Committee. 2016. Aboriginal and Torres Strait Islander experience of law enforcement and justice services. The Senate: Australian Parliament House; Law Council of Australia. 2018. The Justice Project, Final Report – Part 1. Aboriginal and Torres Strait Islander People.

[xii] National Aboriginal and Torres Strait Islander Legal Service, Submission No. 109 to ALRC, 60, cited in Law Council of Australia. 2018. The Justice Project, Final Report – Part 1. Aboriginal and Torres Strait Islander People.

[xiii] Finance and Public Administration References Committee. 2016. Aboriginal and Torres Strait Islander experience of law enforcement and justice services. The Senate: Australian Parliament House, p. 31. Testimony from Ms Porteous, NACLC, Committee Hansard, 23 September 2015, p. 28.

[xiv] Allison, Fiona and Chris Cunneen. 2018. Justice Reinvestment in Northern Australia. The Cairns Institute Policy Paper Series, p. 5.

[xv] Allison, Fiona and Chris Cunneen. 2018. Justice Reinvestment in Northern Australia. The Cairns Institute Policy Paper Series, p. 8.

[xvi] Finance and Public Administration References Committee. 2016. Aboriginal and Torres Strait Islander experience of law enforcement and justice services. The Senate: Australian Parliament House.

[xvii] Australian Law Reform Commission. 2017. Pathways to Justice—An Inquiry into the Incarceration Rate of Aboriginal and Torres Strait Islander Peoples, Final Report No 133, p. 17.

[xviii] Thorburn, Kathryn and Melissa Marshall. 2017. The Yiriman Project in the West Kimberley: an example of justice reinvestment? Indigenous Justice Clearinghouse, Current Initiatives Paper 5; McCausland, Ruth, Elizabeth McEntyre, Eileen Baldry. 2017. Indigenous People, Mental Health, Cognitive Disability and the Criminal Justice System. Indigenous Justice Clearinghouse. Brief 22; AMA Report Card on Indigenous Health 2015. Treating the high rates of imprisonment of Aboriginal and Torres Strait Islander peoples as a symptom of the health gap: an integrated approach to both; Richards, Kelly, Lisa Rosevear and Robyn Gilbert. 2011. Promising interventions for reducing Indigenous juvenile offending Ibid. Indigenous Justice Clearinghouse, Brief 10.

[xix] Health Justice Australia. 2017. Integrating services; partnering with community. Submission to national consultation on Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan 2013-2023.

[xx] Finance and Public Administration References Committee. 2016. Aboriginal and Torres Strait Islander experience of law enforcement and justice services. The Senate: Australian Parliament House, p. 31. Testimony from Ms Hitter, Legal Aid NSW, Committee Hansard, 23 September 2015, p.28

[xxi] Ibid., p. 4; Chris Speldewinde and Ian Parsons. 2015. Medical-legal partnerships: connecting services for people living with mental health concerns. 13th National Rural Health Conference, Darwin; Barry Zuckerman, Megan Sandel, Ellen Lawton, Samantha Morton. Medical-legal partnerships: transforming health care. 2008. The Lancet, Vol 372.

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