” 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.
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 Aboriginal and non-Aboriginal 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.[i]
With Aboriginal community control at the front and centre of service design, these partnerships can deliver both preventive law and preventive health for Aboriginal and Torres Strait Islander peoples.”
Acting NACCHO Chair Donnella Mills speaking at the Indigenous Health Justice Darwin August 13
Picture above : Barb Shaw Chair AMSANT , Donnella , Priscilla Atkins and MC Christine Ross
I would like to acknowledge that the land on which we are meeting today is the traditional land of the Larrakia Nation. I wish to acknowledge and respect the continuing culture of the Larrakia people and the contribution they make to the life of this important region.
I thank the convenors of the Indigenous Health Justice Conference for welcoming me so warmly. I am delighted to be here to share ideas with you on a topic that is close to my heart. For those who don’t know me, I am a Torres Strait Islander woman with ancestral and family links to Masig and Nagir. I am the Acting Chair of NACCHO, which stands for the National Aboriginal Community Controlled Health Organisation.
It was tempting to focus today on the problem rather than a solution. I could have talked about the unconscionably high rates of incarceration for our people and their over-representation in the gaols and institutions across the country. I could have asked why nothing has changed since the Royal Commission into Aboriginal Deaths in Custody was initiated in 1988. But most of you are already very familiar with these topics and frustrations.
What I would like to focus on instead is the Aboriginal community-controlled model of health care, how it started, how it evolved over time and where it is going. Why? Because I think that the model of community control is the future, not just in health, but in justice and other areas.
It gives us control. It gives us a way forward in which we assume control of our own health and justice outcomes and develop our own solutions and genuine partnerships.
I want to talk to you about how the principles, values and beliefs underpinning the Aboriginal community-controlled model provide a sensible foundation for preventing and reducing Aboriginal and Torres Strait Islander peoples’ exposure to the justice system.
But before we look forward, let’s look backwards for a moment, so that we can appreciate the context in which this model was forged.
Aboriginal Community Controlled Health since 1971
The first Aboriginal medical service was established at Redfern in 1971 as a response to the urgent need to provide decent, accessible health services for the largely medically uninsured Aboriginal population of Redfern. The mainstream was not working. So it was, that forty-eight years ago, Aboriginal people took control and designed and delivered their own model of health care.
Similar Aboriginal medical services quickly sprung up around the country. In 1974, NAIHO (the National Aboriginal and Islander Health Organisation) was formed to represent them at the national level. All this predated Medibank in 1975. NAIHO became NACCHO in 1992 and the ACCHO sector has been growing bigger and stronger every year.
We now represent 144 ACCHOs across the country. Our members provide about three million episodes of care per year for about 350,000 people. Collectively, we employ about 6,000 staff (56 per cent whom are Aboriginal or Torres Strait Islanders), which makes us the single largest employer of Aboriginal or Torres Strait people in the country.
The primary health care approach developed by Redfern and other early ACCHOs was innovative. It mirrored international aspirations at the time for accessible, effective and comprehensive health care with a focus on prevention and social justice. It even foreshadowed the WHO Alma-Ata Declaration on Primary Health Care in 1978.
NACCHO has often played a leadership role in the Aboriginal and Torres Strait Islander community. Some of you may be aware that, recently, NACCHO and almost 40 other peak Aboriginal and Torres Strait Islander bodies have worked hard to force the nine Australian governments to get the Closing the Gap process back on track.
Closing the Gap
As the ‘refreshed’ strategy was being prepared for sign off by the Australian Governments, our frustration with the process galvanised a small group of community-controlled organisations to come together to write to the Prime Minister, Premiers and Chief Ministers asking that it not be agreed. NACCHO led the bringing together of organisations for this purpose.
Along with NACCHO, APONT, Central Land Council, and Northern Land Council here in the Northern Territory were four of the first fourteen organisations that signed up to this letter to the Prime Minister. I would like to acknowledge the great work that John Paterson and other Territorians have done in this respect.
Governments could see that we weren’t going away. There were three important messages that we wanted them to hear. These were:
- Include us in the design and delivery of services that impact on us and the outcomes will be far better.
- We need to be at the centre of Closing the Gap policy as the gap won’t close without our full involvement.
- COAG cannot expect us to work constructively with them to improve outcomes if we are excluded from the decision making.
By staying strong and unified, our voice could not be ignored. On 6 December 2018, the Prime Minister met with us and acknowledged that the current targets were ‘government targets’ not ‘shared targets’, and that for Closing the Gap to be realised we had to be able to take formal responsibility for the outcomes through shared-decision making.
Six days later, the nine Australian Governments publicly committed to developing a genuine partnership with us through which a new Closing the Gap policy would be agreed.
The initial fourteen organisations have since grown to almost forty, as we brought together Aboriginal and Torres Strait Islander Peaks bodies across the country to form a Coalition of Peaks to negotiate a new Closing the Gap framework with Australian Governments.
This is community control at the national level. It is the first time that Aboriginal and Torres Strait Islander Peaks have come together in this way, to work collectively and as full partners with Australian Governments. It’s also the first time that there has been formal decision making with our peoples and the Australian Governments in this way.
We need this sort of radical shift to the way governments work with Aboriginal and Torres Strait Islander people at all levels of policy design and implementation. We need a seat at the table and responsibility for making decisions about what governments do in our communities. Another priority reform area is placing Aboriginal community-controlled services in all sectors – not just health – at the heart of delivering programs and services to our people. When we are in control and lead services for our communities the outcomes are so much better.
Throughout our negotiations with government, we learned the importance of staying strong and presenting a unified voice. Our membership may be large and reflective of very diverse organisations. But this diversity is also a strength, as long as we are willing to stay true to our common cause.
Let me now focus more closely on health and justice.
All of you here today know the shocking statistics. Earlier this year it was reported that Aboriginal and Torres Strait Islander men are imprisoned at a rate almost 15-times greater than non-Aboriginal men, and for women the rate is even higher, 21-times worse than non-Aboriginal women.[1]
Our women represent the fastest growing population group in prisons; their imprisonment rate is up 148% since 1991.[2] Locking up our 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.[3] Communities suffer, and the cycle of intergenerational trauma and disadvantage is perpetuated.
Figures on the incarceration of our children and young people in detention facilities also reveal alarmingly high trends of overrepresentation. Our young people aged 10–17 are 26-times as likely as non-Aboriginal young people to be in detention on any given night.[4] How can this be justified?
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. We need to come together – like we have done in the Closing the Gap process – to force governments to work with us to fix this.
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, and cultural safety. These are three of the most critical elements of the community-controlled model itself.
Appropriately resourced community controlled services are essential for addressing these barriers. Best practice solutions to preventable problems of our peoples’ exposure to the justice system must begin with enabling their access to trusted services that are governed by the principles and practices of self-determination, community control, and cultural safety.[5]
Increasing funding for the corrective service sector will not (and does not) address the issue of our peoples’ exposure to the justice system. As Allison and Cunneen note, ‘the solutions to offending are found within communities, not prisons.’[6] Their research is referring to what we call ‘justice reinvestment’, a strategy and an approach, whereby a portion of correctional funds – a portion of money for prisons – are diverted back into disadvantaged communities.
Reinvesting the money into community-identified and community-led solutions not only addresses causation; it also strengthens communities. Depending on the project itself, 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 people. 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.[7]
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 Senate committee recommended that the Commonwealth Government support Aboriginal led justice reinvestment projects.[8] 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.[9]
Health justice partnerships on the ground
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.[10]
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, a NSW ACCHO representative described 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.’[11]
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 myself and the ex-Chair of the Cairns-based Wuchopperen Health Service, I have become 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 health justice 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, regional and urban communities about their legal problems and connect them to legal help.
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.
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.
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.
Building trust and relationship
Questions for engaging with clients about legal problems.
Launch of Law Yarn
Law Yarn was officially launched at Wuchopperen Health Service, Cairns, in May 2018 by the Queensland Attorney General as a Reconciliation Week Event.
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 Aboriginal and non-Aboriginal 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.[12]
With Aboriginal community control at the front and centre of service design, these partnerships can deliver both preventive law and preventive health for Aboriginal and Torres Strait Islander peoples.
[1] https://www.lawcouncil.asn.au/media/media-releases/recommendations-to-reduce-disproportionate-indigenous-incarceration-must-not-be-ignored
[2] Law Council of Australia. 2018. The Justice Project, Final Report – Part 1. Aboriginal and Torres Strait Islander People.
[3]. Law Council of Australia. 2018. The Justice Project, Final Report – Part 1. Aboriginal and Torres Strait Islander People.
[4] Australian Institute of Health and Welfare. 2018. Youth detention population in Australia. AIHW Bulletin 145.
[5] 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.
[6] Allison, Fiona and Chris Cunneen. 2018. Justice Reinvestment in Northern Australia. The Cairns Institute Policy Paper Series, p. 5.
[7] Allison, Fiona and Chris Cunneen. 2018. Justice Reinvestment in Northern Australia. The Cairns Institute Policy Paper Series, p. 8.
[8] Finance and Public Administration References Committee. 2016. Aboriginal and Torres Strait Islander experience of law enforcement and justice services. The Senate: Australian Parliament House.
[9] 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.
[10] 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.
[11] 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
[12] 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.