NACCHO Aboriginal Health : #NTIntervention: Ten years on and what has been achieved?

 

” The intervention was a “debacle” and a new attempt with Indigenous involvement “couldn’t do any worse .

I suggest a “mark two of what was attempted under the intervention”: a 10-year “Marshall plan” between federal and territory governments but with Aboriginal people as expert advisers on a planning, oversight and implementation committee.

It’s not enough to pay us the cursory privilege of being consulted, where our voices are not listened to and where we have no role in decision-making,” she said. “We couldn’t do any worse than what’s being done today, surely.”

Olga Havnen, the chief executive of the Danila Dilba Aboriginal health service see Part 2 story below

 “I  describe the intervention as “a complete violation of the human rights of Aboriginal people in the Northern Territory.

The legacy is that Aboriginal people were completely disempowered.

They had the Army going into communities in their uniforms. They had no idea why the Army was there. People were terrified that they’d come to take the kids away.”

National Aboriginal Community Controlled Health Organisation chief executive Pat Turner see story part 3 NT Intervention: Australia’s most costly ‘political stunt’

As the national representative body for Aboriginal and Torres Strait Islander peoples, the National Congress of Australia’s First Peoples calls for a fundamental reset of government and community relations with us, beginning with the implementation of the Uluru Statement resolutions for constitutional reform. Congress stands ready to fill the role of the advisory body to parliament.”

“We also call for the immediate implementation of the Redfern Statement, which provides a roadmap for how governments can work collaboratively with us to develop efficient and effective programs”

Congress press release Part 1 Below

Part 1 The Northern Territory Intervention: Ten years on and what has been achieved?

As a federal election loomed a decade ago, facing disappointing polls the government of the day was scandalized by sexual abuse in Northern Territory Aboriginal communities and proposed an intervention to improve the life chances of Aboriginal children.

The program won bipartisan support and continued under a new name, Stronger Futures, when the government changed. Closing the Gap targets were announced and hundreds of millions of dollars have been spent to improve the health, education, housing and employment status of Aboriginal and Torres Strait Islander people around the country, and especially those living in remote communities.

A decade on, it is timely to consider results:

  • The annual Closing the Gap report shows that six of the seven targets are not on track.
  •  We understand that there has not been a single prosecution for child sexual abuse as a result of these programs.
  •  Aboriginal men have been stigmatized as drunken, irresponsible pedophiles.
  •  Provisions of the Racial Discrimination Act have been ignored to allow the Intervention to proceed.
  •  Communities have been weakened by the downgrading of local self-government. Those who presume to know what is best for Aboriginal and Torres Strait Islander peoples have had their way.
  •  Tax payers are askance at the shocking waste of public monies on ineffective programs, for which many blame Aboriginal people.
  •  Most notably in the Northern Territory, but in the states as well, shocking abuses of Aboriginal and Torres Strait Islander juveniles have been uncovered.
  •  Incarceration rates of Aboriginal and Torres Strait Islander men, women and children have sky rocketed.
  •  United Nations representatives have issued reports critical of the Intervention and of government relations with Aboriginal and Torres Strait Islander peoples.
  • The 97 recommendations of the 2007 Ampe Akelyernemane Meke Mekarle (Little Children are Sacred) report have been ignored.

A longer list would add to the inevitable conclusion that there is a crisis in Indigenous Affairs.

“The rationale for the Intervention was to protect Aboriginal children and to provide them with a better future. Health, education and well-being statistics demonstrate failure of the Intervention. There have been very few positive outcomes to show for the hundreds of millions of dollars that have been spent on the Intervention and related programs,” he said.

Part 2 NT intervention a ‘debacle’ and second attempt should be made, commission told

from Helen Davidson The Guardian

A 10-year Northern Territory intervention “mark two” could address the failings of the first one, which has seen most of the money “squandered”, the Northern Territory royal commission has heard.

Olga Havnen, the chief executive of the Danila Dilba Aboriginal health service, said the intervention was a “debacle” and a new attempt with Indigenous involvement “couldn’t do any worse”.

Havnen, who is also a former coordinator general for remote services in the NT, made the comments before the royal commission into the protection and detention of children on Thursday.

The hearing has coincided with the 10-year anniversary of the federal government’s emergency intervention into the region, which has been criticised as draconian and removing self-determination from Indigenous communities while failing to address Indigenous inequality.

Havnen told the hearing the NT was still reliant on federal funds and still failing to involve Indigenous people and organisations properly.

This week the commission heard the rates of child protection cases and notifications has more than doubled in the 10 years since the intervention. Separately, NT budget estimates revealed the number of children in out of home care had tripled, while the proportion in had dropped 20%.

Havnen said many government contracts were still procured without proper assessment of whether the organisation had the capability to work with Indigenous communities.

“These arrangements are absolutely stunning and I think are largely a legacy of the intervention supposedly committed to improving Aboriginal communities,” she said.

“By any measure the vast majority of that money has been squandered, and the people who made those decisions need to be held to account in my view.

“Just on the very cursory amount of information we have access to, you have to go: what the hell is actually really going on here and why does this continue to happen?”

Earlier this week the commission heard evidence a private business, Safe Pathways, had charged the Northern Territory government $85,000 a month to run a residential home for a maximum of four children.

A former Safe Pathways manager, Tracey Hancock, told the commission the amount would include staff wages but she didn’t have any further information on what the money was for.

Safe Pathways reportedly told the ABC the charges had been approved and accepted by the NT government.

“We get held up to be accountable as Aboriginal service providers and our level of accountability and transparency – every dollar we spend and commit, including performance outcomes, is well and truly documented,” Havnen said on Thursday.

“But you go and look at these websites for a lot of these NGOs running out-of-home services, there’s no detail about their governance arrangement, there’s no annual report, there’s no financial transparency or accountability. How is this good for anybody?”

Havnen earlier told the commission governments treated large non-Indigenous organisations as equal partners more than they did Indigenous organisations. She also said there were Indigenous organisations across the NT that were “well placed” to provide services currently contracted to non-Indigenous NGOs.

Aboriginal health services across the NT would be asked by the department to provide client medical records when there was an investigation “and yet we seem to be completely invisible to them as a capable partner and potential resource” to assist the department and vulnerable families, she said.

She said it seemed ironic and suggested the commission look at where remote Aboriginal health services were located. “Many of them are in those communities where we know large numbers of Aboriginal children are being removed from.”

Story 3 NT Intervention: Australia’s most costly ‘political stunt’

THE Federal Government’s radical plan to forcibly intervene in Aboriginal communities and impose restrictions on individuals was a billion dollar “political stunt”, a former political head has said.

WATCH SKYNEWS COVERAGE

The Northern Territory Emergency Response, known as “the Intervention”, was launched unilaterally by the Howard Government 10 years ago today.

It saw widespread alcohol bans and other restrictions imposed on 73 remote indigenous communities, as well as forced land leases, and changes to welfare under the Northern Territory Response Act 2007. The Racial Discrimination Act was suspended by the Commonwealth so thousands of indigenous people could have their welfare payments put onto “basics cards” for essential items. The Army, federal police and medical professionals were deployed to the communities for logistical support and health checks. The community development employment projects (CDEP) scheme was disbanded which limited job prospects for locals and an already limited support of bilingual education was cut off.

Communities that boasted distinctive ways of life as the oldest living culture in the world were suddenly referred to as “prescribed areas”, then “towns”, with individuals in need of reform.

Mr Howard said the Commonwealth had “responded” because the NT government of the day had failed to take action as recommended by the Little Children are Sacred report on child sexual abuse in NT indigenous communities.

The Intervention has cost Australian taxpayers more than one billion dollars but has largely proved ineffective in making a positive impact on the lives of those it denigrated.

NT’s first Labor chief minister Clare Martin said it was nothing more than a “political stunt” that was rolled out without her consultation when she was in power.

“(Then Prime Minister John Howard) didn’t ring me to say ‘can we talk about a possible intervention’, he rang me and said ‘there is an intervention taking place, I’m not going to talk to you about it, and it’s a done deal’,’ she told Sky News earlier today.

“I was stunned. I had no idea it was going to happen. I don’t think most people in the Territory — Aboriginal people who were the subject of it — they didn’t know it was going to happen, and very quickly you worked out it was mostly a political stunt.”

Ms Martin told the program she offered to fly to Canberra to discuss the plan but Mr Howard told her he was ‘too busy’ to meet.

“I thought for six years I had worked reasonably well with John Howard,” she said.

“I wasn’t in the same party as John Howard, but we always seemed to manage to sort things out, and then to be used as a political strategy like it obviously was, I just felt really deflated.

“My first thought when Howard rang me was to say expletives and resign and then I thought ‘well that’s just not mature’, but I did after that plan when I would leave.”

Ms Martin kept her position in the 2007 federal election then resigned as chief minister in November of the same year.

But she wasn’t the only one critical of the Intervention with the full scale of the blunder quickly revealing itself. It has widely been criticised for not directly involving Aboriginal people and instead giving rise to a remarkable spurt of government-funded activity that went on around them.

Twenty thousand Territorians are now on income management, despite the scheme not meeting its aims, according to a report.

Earlier this week, royal commissioners were told child protection notifications, substantiations and out-of-home placements had all more than doubled since 2007.

About 50 per cent of indigenous children in the NT now come to the attention of the child protection system by the age of 10, the Royal Commission into the Protection and Detention of Children in the Northern Territory heard on Monday.

Aboriginal women from the remote Central Australian community of Ampilatwatja performing at a public ceremony in 2010 to protest against the Northern Territory intervention. Picture: Chris Graham.

Aboriginal women from the remote Central Australian community of Ampilatwatja performing at a public ceremony in 2010 to protest against the Northern Territory intervention. Picture: Chris Graham.Source:Supplied

Signs — like this one outside Alice Springs — were erected in many Aboriginal communities following the rollout of the NT Intervention.

Signs — like this one outside Alice Springs — were erected in many Aboriginal communities following the rollout of the NT Intervention.Source:News Limited

New figures by the Menzies School of Health research that were presented to the Royal Commission indicated the intervention has not made a difference.

“The data that we have shows that since the intervention rates of child protection notifications, substantiations and out of home care have all doubled and so if that’s an outcome we’re looking at, the intervention has really failed to make a difference for that particular outcome,” school spokesperson Sven Silburn said.

Professor Silburn said the lack of proper community engagement, which he said might have given the Intervention a better chance of success, was a “great mistake”.

Footage of children detained at Don Dale recently sparked a royal commission into the maltreatment of youths in detention. It came as the Territory’s incarceration rate hit a 15-year high — the highest per capita rate in Australia — with one per cent of the population behind bars and more than 85 per cent of inmates indigenous.

Federal indigenous Affairs Minister Nigel Scullion recently said the Intervention was flawed.

“I think it would have been far better to do some of the same things with the full compliance of the community rather than the community having the sense that it was imposed on us, so yes of course we could have done it better,” Mr Scullion said during a recent visit to the central Australian community of Mutitjulu, which was at the front line of the Intervention.

“Aboriginal and Torres Strait Islander people, community, families have to be at the centre of the decisions, if we’re going to make substantive and sustainable change.”

Central Australian Aboriginal leader Bess Price has been vocal about the high level of violence in central Australian indigenous communities and supported the Northern Territory intervention.

Central Australian Aboriginal leader Bess Price has been vocal about the high level of violence in central Australian indigenous communities and supported the Northern Territory intervention.Source:Supplied

 

Some high profile indigenous politicians and community members have expressed support for the Intervention.

Former Chair of the Northern Territory’s indigenous Affairs Advisory Council, Bess Price previously said the Intervention has “had an impact on the grog, the alcohol, and it’s made life a bit better for the children”.

“It’s gonna take years to fix not everything, but right now, it’s done a huge amount of, you know, change in the way people have thought about children as well in regards to their health and wellbeing,” Ms Price told the ABC in 2011.

Ms Price later came under attack for her comments from indigenous lawyer Larissa Behrendt who used her Twitter account to describe watching bestiality on TV as “less offensive than Bess Price”.

News.com.au has contacted Ms Price for comment.

megan.palin@news.com.au

NACCHO Aboriginal Health :@IPAAACT After 50 years of #Indigenous affairs, ‘We need to do better’

 

” 50 years on from the referendum that made Indigenous affairs a Commonwealth concern, the Department of the Prime Minister and Cabinet’s new deputy secretary, Professor Ian Anderson, sets out a clear and comprehensive vision of a better way forward.

The 50th anniversary of the referendum that made Indigenous affairs a federal policy concern has prompted a lot of reflection on what governments have done with that role and, more importantly, consideration of how policymakers and public servants can do better.”

From Stephen Easton journalist at The Mandarin 

In the view of Australian Public Service head Martin Parkinson, the 90.77% affirmative vote both “provided opportunities for us to begin to right the wrongs” caused by British colonisation and assured the prime minister that nearly every citizen wanted the national government to try and do so.

“We may have created the opportunity in ’67 but we haven’t actually delivered on it,” Parkinson added on Friday, opening a public administration seminar at Old Parliament House marking half a century of Indigenous policy.

The keynote address came from his new deputy secretary for Indigenous affairs, Ian Anderson, an Aboriginal University of Melbourne professor who became an Officer of the Order of Australia (AO) last week for “distinguished service to the Indigenous community” as a doctor, health researcher and role model.

Ian Anderson

Anderson was brought in to the Department of the Prime Minister and Cabinet in February to lead a “root and branch” review of Closing the Gap targets, replacing Richard Eccles, who quietly moved across to the Department of Communications and the Arts.

“There is a shared sense among Indigenous leaders, governments and the wider community that despite the significant progress in some areas, we need to do better,” said Anderson.

He sees enough progress to prove solutions do exist, but also consistent themes behind the failures: too many “one size fits all” approaches, “chopping and changing” goals, and governments “overreaching” in terms of what is realistic, while failing to “significantly” engage with Indigenous communities.

The highly regarded professor is seen as a brilliant quiet achiever who has led by example rather than taking to the barricades. He acknowledged “the activist generation” who fought for their rights and built a robust Indigenous-led community sector “from the ground up” but also pointed out Aboriginal society had changed.

“We now have an Indigenous middle class, working at all levels of government, the private sector, universities, and of course continuing to lead in the community sector,” said Anderson, who thinks this group will play a key role in the future of their people.

He also sees a role for new joined-up approaches to public administration, but believes “wicked problems” like Indigenous disadvantage can’t be solved by government alone; they require “the active participation of citizens” as well.

“We, as the Australian Public Service, have to do a damn sight better than we’re doing now.”

“We, as the Australian Public Service, have to do a damn sight better than we’re doing now.”

“The key to Indigenous disadvantage is not just what governments do, but what Indigenous people and communities do,” Anderson said, arguing public servants must create “an environment that helps solutions be found by a much wider range of actors”.

Regional planning in healthcare and the Empowered Communities initiative supported by PM&C were both good examples, he said. Government agencies would need to keep working collaboratively with Indigenous Australia “at a scale and depth we haven’t seen before” — and learn to share leadership and accountability in new ways that might be uncomfortable at first.

A new joined-up vision

Invoking the principle of subsidiarity, Anderson displayed his deep knowledge of the challenges of Indigenous affairs and set out a clear and comprehensive vision for how the federal and state governments could improve outcomes.

“The current approach to building the public sector Indigenous workforce is well past its use-by date,” he added later.

“It’s focusing only on entry-level programs and assumes a sort of trickle-up model that looks increasingly constrained, given the growing numbers of skilled and experienced Indigenous professionals working across … many sectors outside government.”

Martin Parkinson

The newly recruited deputy secretary, who will have a hand in a $10 million per year evaluation program, also spoke for the importance of rigorous evidence-based policy, using “high quality, granular data” to empower better regional and governmental decision-making.

“In the past, we have tended to rely too heavily on gut-feel and ideas that sound good but don’t have anything to back them up beyond their ability to generate enthusiasm,” said Anderson.

He thinks Australia has “one of the best Indigenous data collection systems in the world” but said data quality issues were common, especially for areas where Indigenous people are a tiny minority. Much of this is “not collated transparently, burying important information about Indigenous outcomes in population-wide trends and averages”.

In his admittedly “ambitious” vision for the future, the operating model is a “collaborative partnership” with Indigenous Australia, “founded on robust, accountable and professional working relationships” that feature shared decision-making and mutual accountability as core principles.

“At the same time, higher quality and more transparent data platforms will give us better tools for understanding the problems in our communities and Indigenous cohorts, measuring our successes and our failures and keeping ourselves accountable,” Anderson said.

“And on these foundations and the new capabilities and insight that will give, we will build an Indigenous policy system that is much more dynamic, much more responsive to diversity and innovation, and much better able to negotiate a place-based context, and create solutions with authority and with buy-in.”

‘Fire in the belly’

Anderson was followed by National Aboriginal Controlled Community Health Organisation CEO Patricia Turner, who in some ways represented the activist generation.

Pat Turner

Having worked in senior APS roles herself, she believes Aboriginal public servants still need a bit of “fire in the belly” and should constantly advocate for their people within the administration — because support for Closing the Gap within mainstream Australia is not guaranteed.

Indigenous affairs is not a top-order political issue among the general population, judging by its absence from recent debates. Turner reminded the audience that the Redfern Statement she helped launch during the last election was a direct response to this.

Turner argued for more targeted public service recruitment and mentoring to increase Indigenous representation at senior level, better engagement with Indigenous-led groups like NACCHO, and more collaboration between departments. She criticised the lack of progress towards Closing the Gap targets, questioning why they are not an explicit concern of every cabinet submission and calling on individual public servants to think about how they personally could contribute to achieving them.

Turner was followed by the architect of the Close the Gap targets, University of Canberra professor Tom Calma, who spent 45 years in the APS. Calma said the media often obscured the role of governments in Indigenous policy failures and suggested they were the fault of communities themselves.

Tom Calma

“Now this is not the case, and we need a better understanding of the role and effectiveness of the APS in Australian Indigenous affairs, and their consistent contribution to failure,” he said.

Calma also pointed to the financial and opportunity costs of machinery of government changes, pointing out there have been 21 different ministers for the portfolio in the past 50 years and 10 different administrative structures — nine of those within the past 30 years.

This had led to the same old ideas being recycled with little learning from the mistakes of the past, he said, fuelling a destructive cynicism and lethargy among those who had watched the government spin its bureaucratic wheels through several policy and MOG changes.

The full speeches — and the panel’s responses to pre-written questions asked by Department of Human Services secretary Kathryn Campbell, ACT Public Service head Kathy Leigh and Threatened Species Commissioner Gregory Andrews — are all worth listening to in the full video of the two-hour event.

A flurry of discussion, but where will it lead?

Held in partnership with the Institute of Public Administration Australia (ACT Division), the event was just one of many ways PM&C, as the current home of Indigenous affairs, is actively encouraging a discussion about the way forward. The department’s Indigenous affairs group has also partnered with the Australia New Zealand School of Government (ANZSOG) to deliver several more academic forums and publications this year.

The first, a discussion paper that also came out on Friday, considers “two constant underlying problems” that have persisted ever since the Commonwealth first set up an Indigenous affairs bureaucracy in 1967.

“They had to ask what government structure or instrument would be best suited to this effort,” Parkinson explained. “And they had to ask how best to bring Aboriginal and Torres Strait Islander people into the national decision-making process.”

“They” were the original Council for Aboriginal Affairs set up shortly after the referendum, comprising inaugural Reserve Bank governor Herbert Cole “Nugget” Coombs, senior diplomat Barrie Dexter and the famous anthropologist William Stanner.

“50 years after Coombs’ original questions, I think those questions are as salient today as they were then,” said the PM&C secretary.

The event was also a moment to admit that in many ways, federal policymakers have struggled to work out what to do and where to stand with regard to Indigenous Australians for most of that 50 years.

“We, as PM&C, have to do better. But we, as the Australian Public Service, have to do a damn sight better than we’re doing now,” said Parkinson.

While the IA group in his department plays a leading a role, he said it only spends about 7% of funding for services directed to Indigenous Australians.

“The vast bulk of monies spent in this country actually rest in your hands and the hands of states and territories,” Parkinson said, with a line of federal secretaries seated front and centre.

“And ask yourself a question: do you pay enough attention to the impact of the policies that you design and you implement and you deliver on Indigenous Australians?

“And I think if you ask that question and you’re honest with yourself, the answer is pretty clear.”

Going back to first principles

Much of the progress that has occurred has come through protest, grass-roots activism and community organisations built by Indigenous people, as Turner reminded the audience. The years before the referendum were much darker times for Aborigines and, she recalled, the outcome of the vote was a joyous occasion.

“However, we have always had to fight for our basic rights as Aboriginal people, the original owners and occupiers of this land for some 60,000 years,” she added.

Turner had high praise for some of the past “giants of the APS” whose frank, impartial advice led to big nation-building projects and successful responses to national crises — and for the “bold vision of the future” set out by Coombs, Dexter and Stanner.

“Those three wise, white men did so much for my people in a short space of time,” she said, suggesting there might be value in revisiting some of the CAA”s “seminal” report.

“Today we can bear witness to the fact that very few professional public servants seek an entire career at the coal-face of Indigenous policy advice.”

It is up to all public servants, she said, to make sure their ministers hear “frank and fearless” advice on the “political hot potato” of Indigenous affairs that reflects the views of Aboriginal people “about the decisions made in government for them” and comes through their own representative organisations.

“In the past, we have tended to rely too heavily on gut-feel.”

“In the past, we have tended to rely too heavily on gut-feel.”

Turner believes in Indigenous self-determination and public servants using their positions to advocate for their people, in line with cultural expectations. She said doing this made her an “unusual” public servant who often challenged her superiors — but encouraged current public servants with an Indigenous background to do more or less the same.

Current policy targets a certain level of Indigenous representation in the APS generally, as a sign of fairness and diversity reflecting the population, while initiatives like special mentoring networks are being revived, but it’s not clear if or how public service leaders expect this to translate into more consideration of Indigenous perspectives, in a practical sense.

Meanwhile, the PM&C discussion paper reminds us that conservative views remain and, across the whole population, not everyone agrees that there should even be Indigenous-specific arms of government — or affirmative action to reverse “the lack of Aboriginal and Torres Strait Islander voices in the government executive and administration” for that matter.

Going all the way back to the questions Coombs wrestled with in 1967, the paper explains the other view is that governments should demand better outcomes for Indigenous Australians from all mainstream agencies as part of their normal work — not cast Indigenous people as a special class of citizens with special policies and special public servants to administer them.

“We may have created the opportunity in ’67 but we haven’t actually delivered on it.”

“We may have created the opportunity in ’67 but we haven’t actually delivered on it.”

As wise as those white men of the CAA were, it was also their view that Indigenous people should call the tune through their own organisations as soon as practical. 50 years later, it is still up to APS to figure out “the structural challenge that Nugget Coombs outlined” decades ago, according to Parkinson.

“One thing I am absolutely sure of is that setting the agenda for how we approach the second 50 years of Commonwealth public administration in Indigenous affairs is going to test our values,” he added.

“It’s going to test our technical expertise, and it’s going to test, importantly, our leadership — both our capacity to lead but more importantly, our willingness to lead. There’s no question; we have to do things differently.”

Parkinson’s closing comments reflect the current policy mantra to do things “with” Aboriginal people, not “to” them. But it is much easier to put this principle into words than into practice, although in Anderson, the department seems to have found someone who truly understands the challenges and can plot a realistic path forward.

“We will be asking Indigenous communities to step up, to take on leadership and to hold themselves accountable, but we, as public servants, also then have to let go,” Parkinson said.

Top image: Department of the Environment and Energy secretary and IPAA ACT president Gordon De Brouwer with the panellists and Martin Parkinson. All images by RLDI.

NACCHO Aboriginal Health News : $20 million Streamlined Support for Aboriginal Community Health Services

This is fundamental to the Turnbull Government’s policy of partnership, our commitment to doing things with, not to, the Indigenous community

Under the agreement, NACCHO will receive the funding and will form a collaborative network with its State and Territory counterpart organisations to finance and support local health services.

The agreement provides the network with funding certainty, allowing organisations to plan for the future and improve their effectiveness.”

Federal Indigenous Health Minister Ken Wyatt

Download

NACCHO Ken Wyatt Press Release June 20 2017

Minister Wyatt says a new Network Funding Agreement will streamline the provision of $20 million a year in health service support through the National Aboriginal Controlled Community Health Organisation (NACCHO).

The unified funding arrangements, signed on Friday, will allow the Commonwealth to work better with Australia’s peak indigenous community health organisation.

Minister Wyatt said the agreement was focussed on outcomes, allowing service funding to be administered through an Aboriginal-controlled agency.

“I have been hearing from Aboriginal and Torres Strait Islander people about the kind of care they want, and this agreement will help deliver it,” he said.

“We know that strong, Aboriginal-administered care plays a pivotal role in improving health outcomes, but it can face challenges supplying services on the ground.

“‘This new approach will allow service providers to access the assistance they need to enable them to deliver crucial, quality care to their clients.”

Minister Wyatt said the new network would also ensure that Aboriginal and Torres Strait Islander voices were heard clearly at all levels of health administration.

“The aim is to streamline funding and communication, to continue our shared commitment to Closing The Gap,” he said.

NACCHO Aboriginal Health : The #NTIntervention 10 years on – history and evaluations

 ” And when the government announced the Intervention and commenced it, they sent in what they called ‘government business managers’ who were, in effect, the old, you know, ‘protectors’ of Aboriginals, the, you know, the old superintendents, the mission managers.

I mean, this is 10 years ago, this is not a hundred years ago, and Aboriginal people were being treated like this. It was almost a violation of every possible human right you could think of.”

Pat Turner AM CEO NACCHO speaking to Nick Grimm ABC (see full Interview Below

 

 Picture above : Powerhouse panel at UTS Sydney last night talking about the 10th anniversary of the #NTIntervention: @KylieSambo @Bunbajee Pat Turner & @LarissaBehrendt #IndigenousX

  ” In August 2007 the Howard Liberal Government enacted the Northern Territory National Emergency Response Act, or, “the Intervention”. Liberal politicians marketed it as a solution to problems within Indigenous communities in the Northern Territory.

These problems include health, housing, employment and justice.  When Labor was in power it continued the Intervention’s major initiatives.

See 10 Years history of the NT Intervention Below Part 2 after the Interview

 Major General David Chalmers, of the Inter-Agency Northern Territory Emergency Response Task Force, and Mal Brough, indigenous affairs minister, are greeted by David Wongway, a member of the Imanpa Local Community Council

 ” In 2008, following the change of government after the 2007 Federal Election, the Rudd Labor Government re-framed the intervention through a new national policy focus on “Closing the Gap”. Rudds’ intention to re-work the Intervention to focus more closely on reforming the welfare system linked closely with the already existing targets of the Close the Gap Campaign.

The aims of the campaign are set out in the 2012 National Indigenous Reform Agreement ”

 The Intervention and the Closing the Gap Campaign see part 3

 ” Evaluating the Intervention is not an easy task. Impartial data is difficult to find and there is a mass of complex and conflicting information. However, by looking at the Closing the Gap targets that were set by the Government and considering human rights concerns, we have provided our assessment. Below we give major features of the Intervention a score out of 10.  We also score it for compliance with human rights.”

Issues with Evaluating the Interventionhow did we work out our grades? Part 4

NT Intervention – nothing has changed for the better: Pat Turner

Hear Interview HERE

NICK GRIMM: Ten years ago this week, one of the defining moments in Australian national life began unfolding in remote communities in the outback.

The Northern Territory intervention was launched by the then Howard government in response to reports of social dysfunction and allegations of endemic abuse of women and children in remote communities.

Since then, the policy has continued under governments of both persuasions.

But 10 years on critics of the Intervention say it’s fixed nothing.

Pat Turner is currently CEO of the National Aboriginal Community Controlled Health Organisation.

She was previously a CEO of the Aboriginal and Torres Strait Islander Commission, ATSIC, and had a long career as a senior Commonwealth public servant.

I spoke to Pat Turner a little earlier.

Pat Turner, can I start by asking you this: Ten years on, what’s the best thing you have to say about the Northern Territory Intervention?

PAT TURNER: (Laughs) Nothing, really, I’m afraid.

It was a complete violation of the human rights of Aboriginal people in the Northern Territory.

It came out of the blue, following the Commonwealth Government’s reading and response to The Little Children Are Sacred report.

NICK GRIMM: So how would you describe the legacy of the process that began 10 years ago?

PAT TURNER: Well, I think it’s still a shambles.

You know, both sides of politics were responsible.

While it was introduced by the Liberal government, the Coalition under John Howard and Mal Brough, it was carried on also by Jenny Macklin and Kevin Rudd and Gillard and so on.

So the legacy is that Aboriginal people were completely disempowered.

They had the Army going into communities in their uniforms. They had no idea why the Army was there.

You know, to send the Army in at a time like that was just totally confusing. People were terrified that they’d come to take the kids away. There would be no explanation as to why they were going in.

And it wasn’t their fault; it was the way the Government handled it.

The government also, at the time, insisted that every child under 16 have a full medical check. Now, actually what they were looking for, I think, was whether a child had been sexually abused.

And we said, at the time, those of us who were opposed to the way the Government was handling this, “You cannot do that without parental permission. You must have parental permission. You would not do a medical check on any other child in Australia and you should not do that with our children without their parents’ say-so”.

And what’s more, fine, go ahead, do a full medical check, but what are you going to do when you find the otitis media, when you find the trachoma, when you find the upper respiratory diseases, when you find rheumatic heart disease? Where…

NICK GRIMM: All those common medical conditions in those areas.

PAT TURNER: Absolutely, absolutely. And what are you going to do to treat these people?

Because you don’t have the health services that Aboriginal people should have. You don’t have those in place.

And they were paying doctors a phenomenal salary.

They also, of course, introduced the infamous cashless welfare card, called it ‘income management’, where 60 per cent of the income was quarantined for food and clothes and so on.

People weren’t allowed to get access to video, so that was a… and that was fine for X-rated videos and adult videos, but certainly not for entertainment, which a lot of families relied on in outlying communities.

And it had ramifications. I mean, there was a young Aboriginal businesswoman in Tennant Creek whose business went bust because she couldn’t hire out videos.

NICK GRIMM: Well, in your view, can we say that anything has changed for the better in those remote communities?

PAT TURNER: No.

Look, the other thing that happened at the time, Nick, was there was a reform in local government.

So, from the hundreds of Aboriginal community councils that were in place, they all became part of these super shires, nine super shires, so all the decision making at the local community level had evaporated.

And when the government announced the Intervention and commenced it, they sent in what they called ‘government business managers’ who were, in effect, the old, you know, ‘protectors’ of Aboriginals, the, you know, the old superintendents, the mission managers.

I mean, this is 10 years ago, this is not a hundred years ago, and Aboriginal people were being treated like this. It was almost a violation of every possible human right you could think of.

And what’s more, I called it at the time the Trojan Horse to get the land that our people have under freehold inalienable title in the Northern Territory.

And I thought it was a land grab, and I still believe that, you know, the Commonwealth certainly wanted to have a greater say over Aboriginal land in the Northern Territory – as did the Northern Territory Government, by the way.

NICK GRIMM: Yeah, well we’ve talked about the situation on the ground there in the Northern Territory.

What then would you say have been the national implications of the Intervention?

PAT TURNER: Well, I think without the evidence they’ve adopted – you know, Alan Tudge is very keen on the cashless welfare card, as is Twiggy Forrest, who promoted it.

While I see that, you know, there may be, you know, some opportunity for women to buy more food, it’s fine if you have access to fresh produce at a reasonable price that you could expect to pay in a major regional centre like Alice Springs.

You go out to the communities, the prices are at least double if not tripled, and they’re stale, rotten, old vegetables and meats and so on.

So, you know, that’s where government services need to step up through their outback stores and make sure that people are getting really fresh produce all the time, and healthy produce.

NICK GRIMM: Alright, Pat Turner, thanks very much for talking to us.

PAT TURNER: You’re most welcome. Thank you.

NICK GRIMM: Pat Turner is CEO of the National Aboriginal Community Controlled Health Organisation.

Part 2

” In August 2007 the Howard Liberal Government enacted the Northern Territory National Emergency Response Act, or, “the Intervention”. Liberal politicians marketed it as a solution to problems within Indigenous communities in the Northern Territory.

These problems include health, housing, employment and justice.  When Labor was in power it continued the Intervention’s major initiatives. “

See 10 Years history of the NT Intervention

Intervention was directed at addressing the disproportionate levels of violence in Indigenous communities in the Northern Territory, as well as the endemic disadvantage suffered in terms of health, housing, employment and justice.

It was also a direct response to the Ampe Akelyernemane Meke Mekarle Report (‘Little Children are Sacred Report’) into sexual abuse of Indigenous children. This report was commissioned by the then Northern Territory Chief Minister Clare Martin following an interview on the ABC’s Lateline program, in which Alice Springs Senior Crown Prosecutor Dr Nanette Rogers SC commented that the violence and sexual abuse of children that was entrenched in Indigenous society was ‘beyond most people’s comprehension and range of human experience’. The then Commonwealth Minister for Families, Community Services and Indigenous Affairs, Mal Brough, indicated in his second reading speech introducing the NTNERA that “[t]his bill… and the other bills introduced in the same package are all about the safety and wellbeing of children.”

The Little Children are Sacred Report was the result of in-depth research, investigation and community consultation over a period of over eight months by members of the Northern Territory Board of Inquiry. The focus of their inquiry was instances of sexual abuse, especially of children, in Northern Territory Indigenous communities. The findings were presented to Chief Minister Martin in April 2007 and released to the public in June. The striking facts, graphic imagery and ardent plea for action contained in this report saw this issue gain widespread attention both in the media and in the political agenda, inciting divisive debate and discussion.

The NTNERA was enacted by the Howard Government just two months after the report was released to the public, allowing little time for consultation with Indigenous communities. It was framed as a ‘national emergency’ with army troops being deployed to Indigenous communities in the Northern Territory. This took place in the lead up to the 2007 Federal Election, in which the Labor Party under Kevin Rudd defeated the Howard Government after four terms of Liberal government.

The Intervention in 2007

The Intervention was a $587 million package of legislation that made a number of changes affecting specified Indigenous communities in the Northern Territory. It included restrictions on alcohol, changes to welfare payments, acquisition of parcels of land, education, employment and health initiatives, restrictions on pornography and other measures.

The package of legislation introduced included:

  • NorthernTerritory National Emergency Response Act 2007.
  • Social Security and Other Legislation Amendment (Welfare Payment Reform) Bill 2007.
  • Families, Community Services and Indigenous Affairs and Other Legislation Amendment. (Northern Territory National Emergency Response and Other Measures) Act 2007.
  • Appropriation (NorthernTerritory National Emergency Response) Bill (No. 1) 2007-2008.
  • Appropriation (NorthernTerritory National Emergency Response) Bill (No. 2) 2007-2008.

In order to enact this package of legislation, several existing laws were affected or partially suspended, including:

  •  Racial Discrimination Act 1975.
  •  Aboriginal Land Rights (Northern Territory) Act 1976.
  • Native Title Act 1993(Cth).
  • Northern Territory Self-Government Act and related legislation.
  • Social Security Act 1991.
  • IncomeTax Assessment Act 1993.

A raft of reforms and regulations were introduced by this package of legislation, including:

  • Restricting the sale, consumption and purchase of alcohol in prescribed areas. This included the prohibition of alcohol in certain areas prescribed by the legislation, making collection of information compulsory for purchases over a certain amount and the introduction of new penalty provisions.
  • ‘Quarantining’ 50% of welfare payments from individuals living in designated communities and from beneficiaries who were judged to have neglected their children.
  • Compulsorily acquiring townships held under title provisions of the Native Title Act 1993 with the introduction of five year leases in order to give the government unconditional access. Sixty-five Aboriginal communities were compulsorily acquired.
  • Linking income support payments to school attendance for all people living on Aboriginal land, and providing mandatory meals for children at school at parents’ cost.
  • Introducing compulsory health checks for all Aboriginal children.
  • Introducing pornography filters on publicly funded computers, and bans on pornography in designated areas.
  • Abolishing the permit system under the Aboriginal Land Rights Act 1976 for common areas, road corridors and airstrips for prescribed communities,.
  • Increasing policing levels in prescribed communities. Secondments were requested from other jurisdictions to supplement NT resources.
  • Marshalling local workforces through the work-for-the-dole program to clean-up and repair communities.
  • Reforming living arrangements in prescribed communities through introducing market based rents and normal tenancy arrangements.
  • Commonwealth funding for the provision of community services.
  • Removing customary law and cultural practice considerations from bail applications and sentencing in criminal trials.
  • Abolishing the Community Development Employment Projects (CDEP).

Changes under successive governments

After an initial focus on preventing child sexual abuse, successive federal governments re-designed and re-framed the Intervention. This involved linking the Intervention with the broader ‘Closing the Gap’ campaign, introducing new measures such as the BasicsCard and tougher penalties for the possession of alcohol and pornography. Changes were also made to the operation of the Racial Discrimination Act (see section on Human Rights). The current package of legislation retains the support of the Liberal Government and is due to expire in 2022.

2008 Changes

The Intervention was introduced in 2007 by the Howard Government, but a change of government in September of that year saw the Labor Government under Kevin Rudd gain power. After some consultation and minor changes, the NTNERA and associated legislation were initially maintained.

In 2008 Rudd apologised to the members of the Stolen Generations on behalf of the nation. In 2009, Rudd also declared support for the most substantive framework for the rights of Indigenous peoples, the UN Declaration on the Rights of Indigenous Peoples. The previous Howard government had voted against the ratification of this treaty. Article 3 of the Declaration states that:

‘Indigenous peoples have the right of self-determination. By virtue of that right they freely determine their political status and freely pursue their economic, social and cultural development’.

The failure to recognise this right to self-determination would become one of the major points of criticism for the Intervention.

In 2009 Rudd implemented the BasicsCard.  The card is used to manage income in certain areas of the Northern Territory. It cannot be used to purchase alcohol, tobacco, tobacco-products, pornography, gambling products or services, home-brew kits or home-brew concentrate.

During the period 2009-2010 the Rudd Government committed itself to a re-design of the Intervention, with a focus on reinstating the suspended provisions of the Racial Discrimination Act (RDA). The Social Security and Other Legislation Amendment (Welfare Reform and Reinstatement of Racial Discrimination Act) Act 2010 (Cth) repealed the ‘special measures’ that had been created under the original Intervention to suspend the operation of the RDA. However, this new legislation still did not comply with the RDA as it continued to discriminate against Indigenous Australians through land acquisition and compulsory income management.These measures overwhelmingly  affect Indigenous people.

The focus of the government then shifted slightly, concentrating more closely on the need to ‘tackle the destructive, intergenerational cycle of passive welfare’ (see then Minister for Families, Community Services and Indigenous Affairs Jenny Macklin’s second reading speech). The Rudd government explicitly linked the Intervention to the ‘Closing the Gap’ targets, changing the focus of the Intervention from the protection of children from sexual abuse to the reform of the welfare system.

2012 changes

The legislative basis for the Intervention was due to expire in 2012.  Decisions regarding its future had to be made. Under the Gillard Government, the StrongerFuturesin the Northern Territory Act 2012 (Stronger Futures) replaced the NTNERA and extended the Intervention for a further ten years to 2022.  The StrongerFutureslegislation comprises three principal Acts (the Stronger Futures package), plus associated delegated legislation. The three Acts are:

  • Stronger Futures in the Northern Territory Act 2012;
  • Stronger Futures in the Northern Territory (Consequential and Transitional Provisions) Act 2012; and
  • Social Security Legislation Amendment Act 2012.

In 2013, the  Parliamentary Joint Committee on Human Rights examined Stronger Futures and the related legislation in their 11th Report. They noted that although the StrongerFutureslegislative package repealed the Northern Territory Emergency Response (‘NTER’) legislation, it retained three key policy elements:

  • The tackling alcohol abuse measure: the purpose of this measure was ‘to enable special measures to be taken to reduce alcohol-related harm to Aboriginal people in the Northern Territory.
  • The land reform measure: the land reform measure enabled the Commonwealth to amend Northern Territory legislation relating to community living areas and town
  • camps to enable opportunities for private home ownership in town camps and more flexible long-term leases.
  • The food security measure: the purpose of this measure was ‘to enable special measures to be taken for the purpose of promoting food security for Aboriginal communities in the Northern Territory’; modifying the legislation involves a 10 year timeframe with most provisions other than the alcohol measures being reviewed after 7 years.

The key changes imposed under the 2012 Stronger Futures legislation package consist of:

  • Expansion of income management through the BasicsCard and the increase of ‘quarantined’ payments to 70%.
  • Increased penalties related to alcohol and pornography, with as much as 6-months jail time for a single can of beer.
  • Expansion of policy that links school attendance with continued welfare payments.
  • Introduction of licences for ‘community stores’ to ensure the provisions of healthy, quality food.
  • Commonwealth given power to make regulations regarding the use of town camps.

{Sources: SBS Factbox, Stronger Futures in the NT, Listening but not Hearing Report}

Although consultation with Indigenous communities did take place, there was much criticism of the nature of the consultative process and the extent to which it was acted upon. The ‘Listening butnot Hearing’ report by the Jumbunna Indigenous House of Learning concluded that “the Government’s consultation process has fallen short of Australia’s obligation to consult with Indigenous peoples in relation to initiatives that affect them”.

The Australian Council of Human Rights Agencies has also stated that it was ‘invasive and limiting of individual freedoms and human rights, and require[s] rigorous monitoring’. Amnesty International commented that the new package of legislation was the same as the original ‘Intervention, but with the pretence of being non-discriminatory.’

2014 changes

The current Intervention legislation is not due to expire until 2022. During his time as Opposition Leader, Tony Abbott supported extending the intervention into the future.

In a speech in February of 2014, then Prime Minister Abbott identified the importance of closing the gap through investment in indigenous programs, with a specific focus on school attendance. However, this speech was followed by massive budget cuts to Aboriginal legal and health services, early childhood education and childcare, and the consolidation of 150 Indigenous programs into 5 core programs. While the 2015 Budget reinstated funding to Family Violence legal services, these ongoing cuts are expected to detrimentally affect attempts to Close the Gap of Indigenous disadvantage.

The 2015 Budget modified the  Stronger Futures NPA, redirecting $988.2 million in funds to the new National Partnership Agreement on Northern Territory Remote Aboriginal Investment  (NPA) over eight years. This new NPA prioritises schooling, community safety and employment. This funding also aims to help the Northern Territory Government take full responsibility for the delivery of services in remote Indigenous communities. Additional funding will also be made available to extend the income management scheme until 2017. However, the new NPA has halved the spending allocated to health measures, and means that the Federal Government will have less control over target outcomes.

Government administered funding of $1.4 billion, previously available under Stronger Futures, will not be transferred to the new NPA, but will be delivered by the departments of Prime Minister and Cabinet and Social Services, outside the NPA framework. The new NPA will be complemented by a Remote Indigenous Housing Strategy that will receive $1.1 billion nationally.

Part 3 The Intervention and the Closing the Gap Campaign

The Council of Australian Governments (COAG) had identified six areas of Indigenous disadvantage to target as the basis for the Closing the Gap Campaign. These were:

  1. Early childhood;
  2. Schooling;
  3. Health;
  4. Economic Participation;
  5. Safe Communities; and
  6. Governance and Leadership (see Right to Self Determination below).

The Closing the Gap in the Northern Territory National Partnership Agreement (2009) ceased on the 30 June 2012. The Stronger Futures in the Northern Territory package which started on 1 July 2012 continued to support the Closing the Gap reforms.

The 6th Annual Progress Report on Closing the Gap was tabled in Parliament by then Prime Minister Tony Abbott on 12 February 2014. It outlined the commitments made by the Coalition government, including:

  • Consolidating the administration of Indigenous programs from eight government departments into the Department of the Prime Minister and Cabinet.
  • Establishing the Prime Minister’s Indigenous Advisory Council.
  • Increasing indigenous school  attendance  through  providing  $28.4 million funding for a remote school attendance program.
  • Improving indigenous  access to employment by commissioning a review and funding employment initiatives.
  • Supporting a referendum for the recognition of the First Australians in the Australian Constitution.

However, in the seventh annual progress report of 11 February 2015, then PM Tony Abbott labelled progress as ‘profoundly disappointing‘. The report concluded that 4 out of 7 targets were not on track to be met by their deadlines, with little progress in literacy and numeracy standards and a decline in employment outcomes since 2008.

Link to 2012 National Indigenous Reform agreement here.

Part 4 Issues with Evaluating the Intervention – how did we work out our grades? Part 4

Quantity of Evaluation:

The controversial nature of the Intervention and the need for expenditure to be accounted for has meant that there have been a large number of evaluations undertaken regarding various aspects of the Intervention. Within five years of the establishment of the Intervention, by December 2012, 98 reports, seven parliamentary inquiries and hundreds of submissions had been completed. However, the sheer quantity of these reports actually hinders the evaluation process, as it obstructs proper evaluation of effectiveness.

Impartiality of Evaluation:

The majority of evaluations of the Intervention have been undertaken by government departments and paid consultants. Australian National University researchers Jon Altman and Susie Russell suggest that the evaluation of the Intervention, instead of being an independent objective process, has been merged into the policy process and, in many cases, is performed by the policy-makers themselves. This means there is a real risk of evidence being ignored or hidden to suit an agenda.

Independent reports and government commissioned reports have often contradicted each other, with the government seeking to discredit independent reports rather than gathering additional data. This includes independent reports by researchers at Jumbunna Indigenous House of Learning at the University of Technology Sydney, Concerned Australians and the Equality Rights Alliance, all of which have often come to different conclusions than government reports.

Quality and Consistency of Evaluation:

The ‘final evaluation’ of the Intervention under the NTNER occurred in November 2011 with the publication of the Northern Territory Emergency Response Evaluation ReportHowever, the Stronger Futures legislation did not come into effect until August 2012. This left eight months unaccounted for.

Closingthe Gap in the Northern Territory Monitoring Reports are conducted every six months. A significant criticism is that they focus on bureaucratic ‘outputs’ rather than outcomes. Income management studies, for example, have reported on ‘outputs’ such as the number of recipients of the Basics Card or the total amount of income quarantined, rather than focusing on the card’s effectiveness for health and child protection outcomes.

Much of the data collected has also relied on self-assessment in the form of surveys, such as asking individuals to rate their own health rather than collecting and analysing data on disease. Another issue is the ad hoc nature of some reports. For example, the review of the Alcohol Management Plan in Tennant Creek was only conducted once. This makes it difficult to make comparisons over the life of the policy and evaluate the effectiveness of particular measures.

Independent statistical data can be hard to find, since information compiled by the Australian Bureau of Statistics is national in scope and cannot be translated directly into the context of the individual Indigenous communities in the Northern Territory. Indigenous Australians also have a lower median age than other Australians, meaning data on employment rates or incarceration rates can be statistically skewed.

Benchmarks for Evaluation:

ANU researchers Jon Altman and Susie Russell have noted that the “absence of an overarching evaluation strategy has resulted in a fragmented and confused approach”. They found that the 2007 Intervention did not have any documentation articulating the basis of the policy, nor how it should be evaluated. The first document to address this was the unpublished Program Logic Options Report which was developed in 2010; three years after the Intervention began. This means that there are no original benchmarks for evaluation, and that the decision to extend the program in 2012 was made without clear evidence as to its effectiveness. Furthermore, there is a limited connection between the benchmarks proposed in the 2010 Report and those used in later evaluations.

NACCHO Aboriginal Health #Disability #NDIS : ACCHO Submissions to #NDIS close 12 July 2017

 ” This position paper outlines the Productivity Commission’s early thinking on NDIS costs. The purpose of this position paper is to seek feedback on the Commission’s preliminary conclusions, and on any additional issues that should be considered before the public release of the final study report.

This position paper was released on 14 June 2017. You are invited to examine the paper and to make a written submission or comment by Wednesday 12 July 2017.”

People who want to comment or make a submission for the final report, due to be released in September, can do so at pc.gov.au

Download the PC Overview and Position paper here

ndis-costs-position-overview

ndis-costs-position

or Download MS Word copies here

‘The National Disability Insurance Scheme (NDIS) is a major, complex national reform — the largest social reform in Australia since the introduction of Medicare,’

Social Policy Commissioner Richard Spencer

 ” For Aboriginal and/or Torres Strait Islander people living with disability and their carers, this is a much-needed conversation.

FPDN estimates 60,000 Aboriginal and/or Torres Strait Islander people will potentially be eligible for NDIS. Whilst there might be new opportunities for First Peoples through the NDIS, such as a growth in Aboriginal and/or Torres Strait Islander health and disability services workforce, valid concerns are being raised.

Some of these include how effective NDIS rollout will be in rural and remote Aboriginal and Torres Strait Islander communities, and concerns of eligibility criteria not being inclusive or culturally relevant for First Peoples living with disabilities ”

See all NACCHO posts Disability NDIS

OR

NACCHO Aboriginal Health #disability and @NDIS : Your Top 10 Questions answered about the National Disability Insurance Scheme

 ” For many, language barriers can prevent meaningful engagement with planning processes. Neami National (sub. 63, p. 6) said that ‘consumers without English as their first language describe difficulties in participating in planning and in getting plans that they can fully implement on account of their language needs’.

This is an issue which disproportionately affects Aboriginal and Torres Strait Islander communities: English is a second language for many Indigenous people in remote communities. The majority of participants in Barkly identify as being Aboriginal or Torres Strait Islander and for 67% English is not their first language. Many have limited capacity to understand or read it.

This has a significant impact on their ability to have genuine input into the formulation of their plans and also impacts on decision making and choice. (Brain Injury SA, sub. 116, p. 3) “

From Page 172 Submission

.

In 2020, when the NDIS is fully rolled out, around 475 000 people with disability are expected to receive individualised supports, at an estimated cost of $22 billion per year.

In a position paper released today, the Commission finds that while it is early days in the transition to full scheme, the NDIS is on track in terms of costs.

KEY POINTS

  • The National Disability Insurance Scheme (NDIS) is a complex and highly valued national reform. The scale, pace and nature of the changes it is driving are unprecedented in Australia. If implemented well, it will substantially improve the wellbeing of people with disability and Australians more generally.
  • The level of commitment to the success and sustainability of the NDIS is extraordinary. This is important because ‘making it work’ is not only the responsibility of the National Disability Insurance Agency (NDIA), but also that of governments, participants, families and carers, providers, and the community.
  • Based on trial and transition data, NDIS costs are broadly on track with the NDIA’s long-term modelling. While there are some emerging cost pressures (such as higher numbers of children entering the scheme), the NDIA has put in place initiatives to address them. The benefits of the NDIS are also becoming apparent. Early evidence suggests that many (but not all) NDIS participants are receiving more disability supports than previously, and they have more choice and control.
  • Nevertheless, the speed of the NDIS rollout, as specified in Bilateral Agreements between governments, has put the scheme’s success and financial sustainability at risk. It has resulted in the NDIA focusing too much on meeting participant intake estimates and not enough on planning processes, supporting infrastructure and market development.
    • This focus is manifest in poor outcomes such as confusion for many participants about planning processes; rushed phone planning conversations; inadequate pre-planning support for participants; problems for providers with registering, pricing and receiving payment; and a lack of effective communication with both participants and providers.
  • For the scheme to achieve its objectives, the NDIA must find a better balance between participant intake, the quality of plans, participant outcomes, and financial sustainability. Steps are now being taken by the NDIA to better balance these aspects. Greater emphasis is needed on pre-planning, in-depth planning conversations, plan quality reporting, and more specialised training for planners. The Commission is unable to form a judgment on whether such a refocus can be achieved while also meeting the rollout timetable.
  • The interface between the NDIS and other disability and mainstream services is also critical for participant outcomes and the financial sustainability of the scheme. Some disability supports are not being provided because of unclear boundaries about the responsibilities of the different levels of government. Governments must set clearer boundaries at the operational level around ‘who supplies what’ to people with disability, and only withdraw when continuity of service is assured.
  • A significant challenge is growing the disability care workforce required to deliver the scheme — it is estimated that 1 in 5 new jobs created in Australia over the next few years will need to be in the disability care sector. Present policy settings are unlikely to see enough providers and workers as the scheme rolls out. Some emerging shortages need to be mitigated by better price monitoring and regulation; better tailored responses to thin markets; formal and informal carers allowed to provide more paid care; and a targeted approach to skilled migration.
  • NDIS funding arrangements could better reflect the insurance principles of the scheme, including by allowing more flexibility around the NDIA’s operational budget and providing a pool of reserves. Funding contributions made ‘in-kind’ must be phased out.

 

‘While there are some emerging cost pressures, such as higher than expected numbers of children entering the scheme, the National Disability Insurance Agency (NDIA) has put in place initiatives to address these cost pressures,’ Commissioner Angela MacRae said.

‘Given the extraordinary scale, pace and nature of the changes the scheme is driving, we are seeing some big challenges. A key concern is the speed of the rollout and its impact on the experience of participants and providers through the planning process, plan quality and market development,’ Mr Spencer said.

‘A real challenge is growing the disability care workforce needed to deliver the scheme. As many as one in five new jobs created in Australia over the next few years will need to be in the disability sector. There are unlikely to be enough providers and workers as the scheme rolls out under current policy settings,’ Mrs MacRae said.

The paper finds that the NDIA must place greater emphasis on pre-planning, in-depth planning conversations, plan quality reporting, and more specialised training for planners. And governments must set clearer boundaries around who supplies what, so that people with a disability are assured of continuity of service.

‘Everyone wants the NDIS to work, but there are challenges to be overcome and work is needed by all governments. Putting the enormous goodwill behind the NDIS into action is needed now more than ever,’ Mr Spencer said.

The Productivity Commission’s position paper is National Disability Insurance Scheme (NDIS) Costs.

People who want to comment or make a submission for the final report, due to be released in September, can do so at pc.gov.au

Aboriginal Health and #prevention : New report : @Prevention1stAU health : How much does Australia spend and is it enough?

 ” The verdict is in: Prevention is better than cure when it comes to tackling Australia’s chronic disease burden, but is Australia pulling its weight when it comes to tackling the nation’s greatest public health challenge?

A new economic report looking at what Australia invests in preventive health has found Australia ranks poorly on the world stage and has determined that governments must spend more wisely to contain the burgeoning healthcare budget.

Treating chronic disease costs the Australian community an estimated $27 billion annually, accounting for more than a third of our national health budget.

Yet Australia currently spends just over $2 billion on preventive health each year, or around $89 per person.

One in two Australians suffer from chronic disease, which is responsible for 83 per cent of all premature deaths in Australia, and accounts for 66 per cent of the burden of disease.”

The report, Preventive health: How much does Australia spend and is it enough? was co-funded by the Heart Foundation, Kidney Australia, Alzheimer’s Australia, the Australia Health Promotion Association and the Foundation for Alcohol Research and Education.

Download the report HERE

Preventive-health-How-much-does-Australia-spend-and-is-it-enough_FINAL

Produced by La Trobe University’s Department of Public Health, the report examines trends in preventive health spending, comparing Australia’s spending on preventive health, as well as the funding models used, against selected Organisation for Economic Co-operation and Development (OECD) countries.

The report also explores the question: ‘how much should Australia be spending on preventive health?’

Treating chronic disease costs the Australian community an estimated $27 billion annually, accounting for more than a third of our national health budget.

Yet Australia currently spends just over $2 billion on preventive health each year, or around $89 per person. At just 1.34 per cent of Australian healthcare expenditure, the amount is considerably less than OECD countries Canada, New Zealand and the United Kingdom, with Australia ranked 16th out of 31 OECD countries by per capita expenditure.

Michael Thorn, Chief Executive of the Foundation for Alcohol Research and Education (FARE), a founding member organisation of the Prevention 1st campaign, says that when looking at Australia’s spend on prevention, it should be remembered that one third of all chronic diseases are preventable and can be traced to four lifestyle risk factors: alcohol and tobacco use, physical inactivity and poor nutrition.

“We know that by positively addressing and influencing lifestyle factors such as physical activity, diet, tobacco and   alcohol consumption, we will significantly reduce the level of heart disease, stroke, heart failure, chronic kidney disease, lung disease and type 2 diabetes; conditions that are preventable, all too common, and placing great pressure on Australian families and on Australia’s healthcare systems,” Mr Thorn said.

Report co-author, Professor Alan Shiell says we should not simply conclude that Australia should spend more on preventive health simply because we spend less than equivalent nations, and instead argues that Australia could and should spend more on preventive health measures based on the evidence of the cost effectiveness of preventive health intervention.

“The key to determining the appropriate prevention spend is to compare the added value of an increase in spending on preventive health against the opportunity cost of doing so.

“If the value of the increased spending on preventive health is greater than the opportunity cost, then there is a strong case to do so,” Professor Shiell said.

Professor Shiell says there is clear evidence that many existing preventive health initiatives are cost-effective.

“Studies suggest Australia’s health could be improved and spending potentially even reduced if government was to act on existing policy recommendations and increase spending on activities already considered cost-effective.

“We also suspect that the choice of funding mechanism, or how money is allocated to whom for prevention – is an important factor for the overall efficiency of health prevention expenditure,” Professor Shiell said.

The report highlights England’s efforts in evaluating and monitoring the cost effectiveness and success of its public health interventions and Mr Thorn believes Australia would do well to follow their lead.

“In the United Kingdom we have a conservative government no less, showing tremendous leadership to tackle chronic disease, with bold policy measures like the recently introduced sugar tax and broad-based physical activity programs, all of which are underpinned by robust institutional structures,” Mr Thorn said.

The report will be launched at a Forum at Parliament House in Canberra today, where public health experts, including the World Health Organization’s Dr Alessandro Demaio will explain how they would invest in preventive health if given $100 million to spend.

 

 

 

NACCHO #Aboriginal Health and #Immunisation @AIHW reports Aboriginal children aged 5 national immunisation rate of 94.6%

 ” Aboriginal and Torres Strait Islander people suffer a disproportionate burden from communicable diseases (diseases that can be transmitted from person to person), with rates of hospitalisation and illness due to these conditions many times higher than other Australians.1

Part 2  below presents results for children who were identified as Aboriginal and/or Torres Strait Islander on the AIR. “

 In 2015–16, Aboriginal and Torres Strait Islander children aged 5 had an even higher national immunisation rate of 94.6%. However, there was wider variation across PHN areas, ranging from 98.8% in the Gold Coast (Qld) to 89.4% in Western Victoria.”

Download Healthy Communities:

AIHW_HC_Report_Imm_Rates_June_2017

See Previous NACCHO Aboriginal Health and #WorldImmunisationWeek : @healthgovau Vaccination for our Mob

Part 1 Overview MORE INFO HERE

Immunisation is a safe and effective way to protect children from harmful infectious diseases and at the population level, prevent the spread of these diseases amongst the community.

Australia has generally high immunisation rates which have increased steadily over time, but rates continue to lag in some local areas.

This report focuses on local area immunisation rates for children aged 5 and shows changes in immunisation rates over time. It also presents 2015–16 immunisation rates for all children and Aboriginal and Torres Strait Islander children aged 1, 2 and 5.

Results are presented for the 31 Primary Health Network (PHN) areas. Where possible they are broken down into smaller geographic areas, including for more than 300 smaller areas and across Australian postcodes.

Further detailed rates are available in the downloadable Excel sheet and a new interactive web tool allows users to compare results over time by geography and age group.

This local-level information assists professionals to use their knowledge and context for their area, to target areas in need and develop effective local strategies for improvement.

The report finds:

  • Since 2011–12, childhood immunisation rates have improved nationally and across smaller areas, for all children and for Aboriginal and Torres Strait Islander children. Variation in rates still exists across local areas, however the gap between those areas with the highest and lowest rates is diminishing
  • Nationally 92.9% of all children aged 5 were immunised in 2015–16. All PHN areas achieved an immunisation rate of 90% or more, ranging from 96.1% in Western NSW to 90.3% in North Coast (NSW).

Summary

In 2015–16, childhood immunisation rates continued to improve nationally and in most local areas. Although rates vary across local areas, the gap in rates between the highest and lowest areas is diminishing.

This report focuses on immunisation rates for 5 year olds and presents results since 2011–12. It also provides the latest information for 1, 2 and 5 year olds for Australia’s 31 Primary Health Network (PHN) areas and smaller local areas.

From 2011–12 to 2015–16, there were notable improvements in rates for fully immunised 5 year olds. National rates increased from 90.0% to 92.9%. Rates increased for PHN areas too, as all areas reached rates above 90% in 2015–16.

Rates in smaller local areas (Statistical Areas Level 3, or SA3s) have also improved. In 2015–16, 282 of the 325 local areas had rates of fully immunised 5 year olds greater than or equal to 90%. This is up from 2011–12 when only 174 areas had rates in this range. Further, the difference in rates between the highest and lowest areas has decreased over time (Figure 1).

In 2015–16, the rate of fully immunised children varied across PHN areas for the three age groups:

  • 1 year olds – 95.0% to 89.8% (national rate 93.0%)
  • 2 year olds – 93.2% to 87.2% (national rate 90.7%)
  • 5 year olds – 96.1% to 90.3% (national rate 92.9%).

Part 2 Aboriginal and Torres Strait Islander children

Aboriginal and Torres Strait Islander people suffer a disproportionate burden from communicable diseases (diseases that can be transmitted from person to person), with rates of hospitalisation and illness due to these conditions many times higher than other Australians.1

This section presents results for children who were identified as Aboriginal and/or Torres Strait Islander on the AIR. These data are based on Medicare enrolment records.

For Aboriginal and Torres Strait Islander children, national immunisation rates in 2015–16 for 1 and 2 year olds were lower than the rates for all children (89.8% compared with 93.0% for 1 year olds, and 87.7% compared with 90.7% for 2 year olds).

In contrast, the national immunisation rate for Aboriginal and Torres Strait Islander children aged 5 years was higher than the rate for all children (94.6% compared with 92.9%).

Primary Health Network areas

In 2015–16, the percentages of fully immunised Aboriginal and Torres Strait Islander children varied across PHN areas for all three age groups as shown in Figure 6. The range in immunisation rates across PHN areas for the three age groups is outlined below.

  • 1 year olds – 94.2% in Tasmania to 76.1% in Perth North (WA)
  • 2 year olds – 93.4% in South Western Sydney (NSW) to 76.0% in Perth South (WA)
  • 5 year olds – 98.8% in Gold Coast (Qld) to 89.4% in Western Victoria.

Statistical Areas Level 4 (SA4s)

For Aboriginal and Torres Strait Islander children, Statistical Areas Level 4 (SA4s) were used instead of SA3s as the smallest geographic areas. There are larger populations in SA4s and this allows more reliable reporting for smaller population groups such as Aboriginal and Torres Strait Islander children.

Across more than 80 SA4s, the percentage of Aboriginal and Torres Strait Islander children fully immunised in 2015–16 varied considerably:

  • 1 year olds – ranged from 95.9% in Central Coast (NSW) to 72.4% in Perth–North West (WA)
  • 2 year olds – ranged from 96.0% in Coffs Harbour–Grafton (NSW) to 71.2% in Perth–South East (WA)
  • 5 year olds – ranged from 100% in Murray (NSW) to 87.6% in Perth–South East (WA).

Figure 6: Percentage of Aboriginal and Torres Strait Islander children fully immunised and numbers not fully immunised, by Primary Health Network area, 2015–16

# Interpret with caution: This area’s eligible population is between 26 and 100 registered children.

Notes

  • Components may not add to totals due to rounding.
  • Data are reported to one decimal place, however for graphical display and ordering they are plotted unrounded.
  • These data reflect results for children recorded as Aboriginal and Torres Strait Islander on the AIR. Levels of recording may vary between local areas.

Source Australian Institute of Health and Welfare analysis of Department of Human Services, Australian Immunisation Register statistics, for the period 1 April 2015 to 31 March 2016, assessed as at 30 June 2016. Data supplied 2 March 2017.

ADDED June14

Influenza Vaccination During Pregnancy

Vaccination remains the best protection pregnant women and their newborn babies have against influenza.

Despite influenza vaccination being available free to pregnant women on the National Immunisation Program, vaccination rates remain low with only 1 in 3 pregnant women receiving the influenza vaccine.

Influenza infection during pregnancy can lead to premature delivery and even death in newborns and very young babies. Pregnant women can have the vaccine at any time during pregnancy and they benefit from it all through the year.

Health professional:

Pregnant women:

 

NACCHO Aboriginal Health #CarersGateway : Free online resources to support #Aboriginal #carers

It’s rewarding work, but without help Dolly finds herself emotionally and physically drained. Dolly reached out and found that she could get services to help her.

Like Dolly, millions of people in Australia care for others who need help with their everyday lives.

A carer may be someone who looks after their husband or wife, partner, grandparent, uncle, aunty, cousin, child, grandchild or any other family member, a neighbour, a friend or someone in their community who needs help.

Everyone’s situation is different. Some carers look after someone who is an older person or who is unwell or has difficulties getting around. Some carers may look after someone who has a disability, a mental illness or dementia, a chronic condition or a long-term illness or drug and alcohol problems.

Many people looking after someone else don’t think of themselves as carers. They just see caring as what they do to help their families or friends or people in their communities.

Carers need help too – someone they can talk to and find out about services that can help. Carer Gateway is a free, Australian Government funded service that provides information for carers and helps people get in touch with their local services. People can ring up and have a private chat or go online and find out about support in their area, free financial and legal help and what to do in emergencies.  They can also get tips on how to look after themselves so they don’t get burnt out while caring for someone else.

Carer Gateway has short videos about real-life carers in the community – showing how they cope and deal with problems – and how they make the most of the time they spend caring for someone in need.

The videos include Dolly’s story. Dolly is a mother and full-time carer for her two adult daughters, who both need support with their everyday needs.

“It’s pretty much 24/7 around the clock. Four years ago, I realised I was doing a care role and I was also a working mum so quite busy. I thought you know what, it’s time for me to step back and start looking after my own,” she said.

There are free online resources to support Aboriginal carers, including a guided relaxation audio recording and information brochures and posters for use by health and community groups  which can also be ordered from the Carer Gateway ordering form and a Carer Gateway Facebook page to keep up to date on services and supports for carers.

To find out more, Carer Gateway can be contacted on 1800 422 737, Monday to Friday between 8am and 6pm,

or by visiting carergateway.gov.au

You can join the Carer Gateway Facebook community by visiting https://www.facebook.com/carergateway/

 

 

 

Aboriginal Health : Second Atlas of Healthcare Variation highlights higher Aboriginal hospitalisation rates for all 18 clinical conditions

 

“The report, compiled by the Australian Commission on Safety and Quality in Health Care, shows us that high hospitalisation rates often point to inadequate primary care in the community, leading to higher rates of potentially preventative hospitalization

The most disturbing example of this  has been the higher hospitalisation rates for all of the 18 clinical conditions surveyed experienced by Aboriginal and Torres Strait Islander Australians, people living in areas of relative socioeconomic disadvantage and those living in remote areas.

 Chairman of Consumers Health Forum, Tony Lawson who is a member of the Atlas Advisory Group.

 “Additional priorities for investigation and action are hospitalisation rates for specific populations with chronic conditions and cardiovascular conditions, particularly:

  • Aboriginal and Torres Strait Islander Australians
  • People living in remote areas
  • People at most socioeconomic disadvantage.

Please note

  • Features of the second Atlas include: Analysis of data by Aboriginal and Torres Strait Islander status

DOWNLOAD Key-findings-and-recommendations

Mr Martin Bowles Secretary Dept of Health  launches the Second Australian Atlas of Healthcare Variation

A new report showing dramatic differences in treatment rates around Australia signals a pressing need for reforms to ensure equitable access to appropriate health care for all Australians, the Consumers Health Forum, says.

“A seven-fold difference in hospitalisation for heart failure and a 15-fold difference for a serious chronic respiratory disease depending on place of residence, are among many findings of substantial variations in treatment rates in Australia revealed in the Second Australian Atlas of Healthcare Variation,” the chairman of Consumers Health Forum, Tony Lawson, said.

“While there are a variety of factors contributing to these differences,  the variation in health and treatment outcomes is, as the report states, an ‘alarm bell’ that should make us stop and investigate whether appropriate care is being delivered.

“These findings show that recommended care for chronic diseases is not always provided.  Even with the significant funding provided through Medicare to better coordinate primary care for people with chronic and complex conditions, fragmented health services contribute to suboptimal management, as the report states.

“We support the report’s recommendation for a stronger primary health system that would provide a clinical ‘home base’ for coordination of patient care and in which patients and carers are activated to develop their knowledge and confidence to manage their health with the aid of a healthcare team.

“The Atlas provides further robust reasons for federal, state and territory governments to act on the demonstrated need for a more effective primary health system that will ensure better and more cost effective care for all Australians.

“The Atlas also examined  variations in women’s health care, and its findings included a seven-fold difference in rates of hysterectomy and  21-fold  difference in rates of endometrial ablation.  The report states that rates of hysterectomy and caesarean sections in Australia are higher than reported rates in other developed nations.  These results highlight the need for continuing support and information on women’s health issues,” Mr Lawson said.

The Second Australian Atlas of Healthcare Variation (second Atlas) paints a picture of marked variation in the use of 18 clinical areas (hospitalisations, surgical procedures and complications) across Australia.

This Atlas, the second to be released by the Commission, illuminates variation by mapping use of health care according to where people live.  As well, this Atlas identifies specific achievable actions for exploration and quality improvement.

The second Atlas includes interventions not covered in the first Atlas, such as hospitalisations for chronic diseases and caesarean section in younger women. It also builds on the findings from the first Atlas – for example, examining hysterectomy and endometrial ablation separately, and examining rates of cataract surgery using a different dataset.

Priority areas for investigation and action arising from the second Atlas include use of:

  • Hysterectomy and endometrial ablation
  • Chronic conditions (COPD, diabetes complications)
  • Knee replacement.

Additional priorities for investigation and action are hospitalisation rates for specific populations with chronic conditions and cardiovascular conditions, particularly:

  • Aboriginal and Torres Strait Islander Australians
  • People living in remote areas
  • People at most socioeconomic disadvantage.

Healthcare Variation – what does it tell us

Some variation is expected and associated with need-related factors such as underlying differences in the health of specific populations, or personal preferences. However, the weight of evidence in Australia and internationally suggests that much of the variation documented in the Atlas is likely to be unwarranted. Understanding this variation is critical to improving the quality, value and appropriateness of health care.

View the second Atlas

The second Atlas, released in June 2017, examined four clinical themes: chronic disease and infection – potentially preventable hospitalisations, cardiovascular, women’s health and maternity, and surgical interventions.

Key findings and recommendations for action are available here.

View the maps and download the data using the interactive platform.

What does the Atlas measure?

The second Atlas shows rates of use of healthcare interventions (hospitalisations, surgical procedures and complications,) in geographical areas across Australia.  The rate is then age and sex standardised to allow comparisons between populations with different age and sex structures. All rates are based on the patient’s place of residence, not the location of the hospital or health service.

The second Atlas uses data from national databases to explore variation across different healthcare settings. These included the National Hospital Morbidity Database and the AIHW National Perinatal Data Collection.

Who has developed the second Atlas?

The Commission worked with the Australian Institute of Health and Welfare (AIHW) on the second Atlas.

The Commission consulted widely with the Australian government, state and territory governments, specialist medical colleges, clinicians and consumer representatives to develop the second Atlas.

Features of the second Atlas include:

  • Greater involvement of clinicians during all stages of development
  • Analysis of data by Aboriginal and Torres Strait Islander status
  • Analysis of data by patient funding status (public or private).

Table of Contents

Chapter 1 Chronic disease and infection: potentially preventable hospitalisations

1.1 Chronic obstructive pulmonary disease (COPD)
1.2 Heart failure
1.3 Cellulitis
1.4 Kidney and urinary tract infections
1.5 Diabetes complications

Chapter 2 Cardiovascular conditions

2.1 Acute myocardial infarction admissions
2.2 Atrial fibrillation

Chapter 3 Women’s health and maternity

3.1 Hysterectomy
3.2 Endometrial ablation
3.3 Cervical loop excision or cervical laser ablation
3.4 Caesarean section, ages 20 to 34 years
3.5 Third- and fourth-degree perineal tear

Chapter 4 Surgical interventions

4.1 Knee replacement
4.2 Lumbar spinal decompression
4.3 Lumbar spinal fusion
4.4 Laparoscopic cholecystectomy
4.5 Appendicectomy
4.6 Cataract surgery
Technical Supplement
About the Atlas
Glossary

Australian Atlas of Healthcare Variation data set specifications are available at http://meteor.aihw.gov.au/content/index.phtml/itemId/674758

 

NACCHO Aboriginal Mental Health : Download report “Mental health in remote and rural communities “

 ” The poorer mental health of remote and rural Indigenous Australians is also impacted by the social determinants of Indigenous health, which are well recognised nationally and internationally.

These relate to the loss of language and connection to the land, environmental deprivation, spiritual, emotional and mental disconnectedness, a lack of cultural respect, lack of opportunities for self-determination, poor educational attainment, reduced opportunities for employment, poor housing, and negative interactions with government systems

The relationship of remoteness to health is particularly important for Indigenous Australians, who are overrepresented in remote and rural Australia (Australian Institute of Health and Welfare, 2014a).

The National Mental Health Commission (2014a, p. 19) identified that “the mental health needs of Aboriginal and Torres Strait Islander people are significantly higher than those of other Australians.”

Photo above

“ The women of Inkawenyerre, a small settlement in the Utopia community four hours by road north of Alice Springs, regularly take part in a different kind of mental health therapy, known as ‘narrative therapy.’

Narrative therapy taps into the centuries-old tradition among Aboriginal people of story-telling and expression through art. At the family Urapuntja Clinic, both women and children take part in narrative therapy.

They recreate what is commonly seen on any given evening in an Aboriginal community—people sitting around the fire, relating to one another and telling stories.

The activity is enjoyable for participants with group members often laughing and supporting one another as they tell stories and work on their painting—all while promoting good mental health living practice,”

Lynne Henderson, former RFDS Central Operations mental health clinician.

“People who live in the country get less access to care. And they become sicker,”

To increase the access to care, the RFDS said it needed a massive increase in funding. Country Australians see mental health professionals at only a fifth the rate of those who live in the city,

So there should be a five-fold increase in access to mental health care for country Australians.”

RFDS CEO Martin Laverty see story Part 2 below

Mental health in remote and rural communities

Mental health disorders are not more common in rural and regional Australia than they are in Australia’s cities, according to a new report from the Royal Flying Doctor Service (RFDS), but they are a lot harder to treat.

The report, Mental Health in Remote and Rural Communities, found about one in five remote and rural Australians — 960,000 people — experience mental illness.

Download the report HERE

RN031_Mental_Health_D5

But a combination of lack of access to facilities, social stigma, and cultural barriers present challenges to getting people the help they need.

AHCRA believes that’s something that everyone should be concerned about, with access to care regardless of location.

 

Part 1  Indigenous mental health and suicide

Data from the 2011 Australian Census demonstrated that 669,881 Australians, or 3% of the population, identified as Indigenous (Australian Bureau of Statistics, 2013b), and that 142,900 Indigenous Australians, or 21% of the Indigenous population, lived in remote and very remote areas (Australian Institute of Aboriginal and Torres Strait Islander Studies, 2014).

Around 45% of people in very remote Australia (91,600 people), and 16% of people in remote Australia (51,300 people) were Indigenous (Australian Bureau of Statistics, 2013b; Australian Institute of Aboriginal and Torres Strait Islander Studies, 2014).

In 2011–2012 around one-third (30%) of Indigenous adults reported high or very high levels of psychological distress—almost three times the rate for non-Indigenous Australians (Australian Bureau of Statistics, 2014).

In 2008–2012, in NSW, Queensland (Qld), WA, SA and the NT, there were 347 Indigenous deaths11 from mental health-related conditions (Australian Institute of Health and Welfare,

2015a). Specifically, age-standardised death data demonstrated that Indigenous Australians (49 per 100,000 population) were 1.2 times as likely as non-Indigenous Australians (40 per 100,000 population) to die from mental and behavioural disorders (Australian Institute of Health and Welfare, 2015a). Age-standardised deaths from mental and behavioural disorders increased with increasing age in both Indigenous and non-Indigenous Australians in 2008–2012.

Very few Indigenous and non-Indigenous Australians under the age of 35 years died as result of mental and behavioural disorders in 2008–2012. However, Indigenous Australians aged 35 years or older were more likely to die from mental and behavioural disorders than non-Indigenous

Australians in 2008–2012. Specifically, Indigenous Australians (7.2 per 100,000 population) aged 35–44 years were 5.7 times as likely as non-Indigenous Australians (1.3 per 1200,000 population) to die from mental and behavioural disorders (Australian Institute of Health and

Welfare, 2015a). In 2008–2012, Indigenous Australians (14.7 per 100,000 population) aged 45–54 years were 4.9 times as likely as non-Indigenous Australians (3.0 per 100,000 population) to die from mental and behavioural disorders (Australian Institute of Health and Welfare, 2015a).

In 2008–2012, Indigenous Australians (18.3 per 100,000 population) aged 55–64 years were 2.7 times as likely as non-Indigenous Australians (6.9 per 100,000 population) to die from mental and behavioural disorders (Australian Institute of Health and Welfare, 2015a). In 2008–2012,

Indigenous Australians (91.2 per 100,000 population) aged 65–74 years were 2.9 times as likely

as non-Indigenous Australians (31.3 per 100,000 population) to die from mental and behavioural disorders (Australian Institute of Health and Welfare, 2015a).

Further exploration of death data from mental and behavioural disorders illustrates the significant impact of psychoactive substance use (ICD-10-AM codes F10–F19) on Indigenous mortality (Australian Institute of Health and Welfare, 2015a). In 2008–2012, 29.1% of Indigenous deaths due to mental and behavioural disorders were the result of psychoactive substance use, such as alcohol, opioids, cannabinoids, sedative hypnotics, cocaine, other stimulants such as caffeine, hallucinogens, tobacco, volatile solvents, or multiple drug use. During this period, Indigenous Australians (7.3 per 100,000 populations) were 4.8 times as likely as non-Indigenous Australians to die as a result of psychoactive substance use (Australian Institute of Health and Welfare, 2015a).

Similarly, in 2006–2010, there were 312 Indigenous deaths from mental health-related conditions (Australian Institute of Health and Welfare, 2013a). Indigenous Australians living in NSW, Qld, WA, SA and the NT were 1.5 times as likely as non-Indigenous Australians to die from mental and behavioural disorders in 2006–2010 (Australian Institute of Health and Welfare, 2013a).

11 Deaths from mental and behavioural disorders do not include deaths from intentional self-harm (suicide). Intentional self-harm is coded under ICD-10-AM Chapter 19—Injury, poisoning and certain other consequences of external causes.

Age-standardised death data demonstrated that Indigenous males (49 per 100,000 population) were 1.7 times as likely as non-Indigenous males to die from mental and behavioural disorders. Indigenous females were 1.3 times as likely as non-Indigenous females to die from mental and behavioural disorders (Australian Institute of Health and Welfare, 2013a).

The greater number of deaths from mental and behavioural disorders with age may also represent the impact of conditions associated with ageing, such as dementia. For example, in 2014, Indigenous Australians (50.7 per 100,000 population) in NSW, Qld, SA, WA and the NT were 1.1 times as likely as non-Indigenous Australians (45.3 per 100,000 population) to die from dementia (including Alzheimer disease) (Australian Bureau of Statistics, 2016a).

In 2014–2015, Indigenous Australians (28.3 per 1,000 population) were 1.7 times as likely as non-Indigenous Australians (16.3 per 1,000 population) to be hospitalised for mental and behavioural disorders (Australian Institute of Health and Welfare, 2016a).

In 2011–2013, 4.2% of Indigenous hospitalisations were for mental and behavioural disorders (Australian Institute of Health and Welfare, 2015a). Age-standardised data demonstrated that Indigenous Australians (27.7 per 1,000 population) were twice as likely as non-Indigenous Australians (14.2 per 1,000 population) to be hospitalised for mental and behavioural disorders in 2011–2013 (Australian Institute of Health and Welfare, 2015a).

In 2008–2009, Indigenous young people aged 12–24 years (2,535 per 100,000 population) were three times as likely to be hospitalised for mental and behavioural disorders than non-Indigenous young people (Australian Institute of Health and Welfare, 2011).

 

The leading causes of hospitalisation for mental and behavioural disorders amongst Indigenous young people were schizophrenia (306 per 100,000 population), alcohol misuse (348 per 100,000 population) and reactions to severe stress (266 per 100,000 population) (Australian Institute of Health and Welfare, 2011).

A preliminary clinical survey of 170 Aboriginal and Torres Strait Islander Australians in Cape York and the Torres Strait, aged 17–65 years, with a diagnosis of a psychotic disorder, was undertaken to describe the prevalence and characteristics of psychotic disorders in this population (Hunter, Gynther, Anderson, Onnis, Groves, & Nelson, 2011).

Researchers found that: 62% of the sample had a diagnosis of schizophrenia, 24% had substance-related psychoses, 8% had affective psychoses, 3% had organic psychoses and 3% had brief reactive psychoses; Indigenous Australians aged 30–39 years were overrepresented in the psychosis sample compared to their representation in the population (37% of sample versus 29% of population) with slightly lower proportions in the 15–29 years and 40 years and older age groups; almost three-quarters (73%) of the sample were male (versus 51% for the Indigenous population as a whole); Aboriginal males (63% in the sample compared to 46% for the region as a whole) were overrepresented; a higher proportion of males (42%) than females (5%), and Aboriginal (44%) than Torres Strait Islander patients (10%) had a lifetime history of incarceration; comorbid intellectual disability was identified for 27% of patients, with a higher proportion for males compared to females (29% versus 20%) and Aboriginal compared to Torres Strait Islander patients (38% versus 7%); and alcohol misuse (47%) and cannabis use (52%) were believed to have had a major role in the onset of psychosis (Hunter et al., 2011).

In 2015, Indigenous Australians (25.5 deaths per 100,000 population) in Qld, SA, NT, NSW and WA were twice as likely as non-Indigenous Australians (12.5 deaths per 100,000 population) to die from suicide (Australian Bureau of Statistics, 2016b). In their spatial analysis of suicide, Cheung et al. (2012) concluded that higher rates of suicide in the NT and in some remote areas could be explained by the large numbers of Indigenous Australians living in these areas, who demonstrate higher levels of suicide compared with the general population.

The poorer mental health of remote and rural Indigenous Australians is also impacted by the social determinants of Indigenous health, which are well recognised nationally and internationally.

These relate to the loss of language and connection to the land, environmental deprivation, spiritual, emotional and mental disconnectedness, a lack of cultural respect, lack of opportunities for self-determination, poor educational attainment, reduced opportunities for employment, poor housing, and negative interactions with government systems

Part 2 Flying Doctors fight barriers to treat mental illness in rural Australia

Source ABC

Like so many in the bush, Brendan Cullen has a lot on his plate.

He manages a 40,000-hectare property south of Broken Hill. There are 8,000 sheep to keep track of. And that’s just a fraction of the number he looked after previously at another station.

A few years ago, the mustering, the maintenance, juggling bills and family — it all caught up to him.

“You just bottle stuff up. And sometimes you can’t find an out,” he said.

“In the bush you have a lot of time by yourself.”

He spent a lot of that time thinking about his problems. But Mr Cullen was lucky.

He heard about a mental health clinic being run by the Royal Flying Doctor Service (RFDS) in a nearby community and decided to go along.

“Catching up with one of the mental health nurses gave me the tools to be able to work out how I go about living a day-to-day life,” he said.

“My life’s a hell of a lot easier now than what it used to be.”

Mental health disorders are not more common in rural and regional Australia than they are in Australia’s cities, according to a new report from the RFDS, but they are a lot harder to treat.

The report, Mental Health in Remote and Rural Communities, found about one in five remote and rural Australians — 960,000 people — experience mental illness.

But a combination of lack of access to facilities, social stigma, and cultural barriers present challenges to getting people the help they need.

“People who live in the country get less access to care. And they become sicker,” RFDS CEO Martin Laverty said.

To increase the access to care, the RFDS said it needed a massive increase in funding.

“Country Australians see mental health professionals at only a fifth the rate of those who live in the city,” Mr Laverty said.

“So there should be a five-fold increase in access to mental health care for country Australians.”

The impact of distance and isolation when it comes to treating mental disorders can be seen in suicide rates. In remote Australia, the rate is nearly twice what it is in major metropolitan areas — 19.6 deaths per 100,000 people.

The suicide rate is even greater in very remote communities.

If you or anyone you know needs help:

The RFDS has responded by increasing its mental health outreach. In communities like Menindee, about an hour’s drive from Broken Hill in the far west of New South Wales, a mental health nurse is on call once a fortnight.

“I have needed them in the past. I got down to rock bottom at one stage. Even now I appreciate that support,” Menindee resident Margot Muscat said.

Ms Muscat plays an active role in the remote community. But she has also felt pressure in the past to manage that role, her work, and family commitments.

Mental health counselling has given her a valuable outlet.

“Just to know that I wasn’t alone. And that you don’t have to take the drastic step of suiciding, so to speak,” Ms Muscat said.

Some the RFDS’s mental health counselling is done over the airwaves. From its regional base in Broken Hill, mental health nurse Glynis Thorp counsels patients over the phone. Often calls are simply people checking in.

“It’s critically important…often there might only be two people on the property. So no one to talk to maybe,” she said.

“We might get out to a clinic every fortnight, but we might have follow up phone calls to check how people are going. For myself it’s probably a ratio of four to one.”

The RFDS report reveals every year hundreds of serious mental illness incidents require airplanes to be dispatched to remote areas to fly patients out for treatment.

Over three years from July 2013 the RFDS conducted 2,567 ‘aeromedical retrievals’.

The leading causes for evacuation flights due to mental disorder are

The RFDS also uses airplanes to carry its mental health nurses to very remote areas. On a typical day in Broken Hill, the medical team takes off just after dawn to head to three communities hundreds of kilometres away: Wilcania, White Cliffs and Tilpa.

In the opal mining town of White Cliffs, the mental health nurse sees patients at the local clinic. One is “Jane”, who doesn’t want her full name used.

“Without them, we would really be lost here,” she said.

Jane has been counselled by the RFDS and was recently directed to mental health treatment in Broken Hill. But she’s still reluctant to talk openly in town about the help she’s getting.

“In a small community it’s not wise to talk to other people in town,” she said. “And mental health, it does carry a stigma.”

Back on his station south of Broken Hill, Mr Cullen believes that stigma over mental health is slowly changing in the bush.

“People get wind that someone’s had a mental health problem, people talk now. As opposed to, let’s go back five years even, 10 years. It was a closed book,” he said.

“With these clinics, once upon a time you might have had a dental nurse, a doctor, and the like.

“But now you have a mental health nurse…And these clinics are close by. So you’re able to go to them. They come to you.”