NACCHO Aboriginal Health : Pat Dudgeon “Closing the Mental Health Gap ” Special Issue : Indigenous Psychology

 
” The available data on Aboriginal and Torres Strait Islander disadvantage has shone a light on the Indigenous mental health and wellbeing gap.

In their commentary in this special issue, Calma, Dudgeon, and Bray (2017) provide details of the challenges in mental health for Aboriginal and Torres Strait Islander peoples and what needs to happen to change the situation.All articles in this issue are concerned with and aimed at contributing to closing the mental health gap.”

Pat Dudgeon Pictured above with NACCHO CEO Pat Turner at the recent launch of the ATSISPEP report

Download all reports HERE

Articles

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    The Australian Psychological Society’s Apology to Aboriginal and Torres Strait Islander People (pages 261–267)Timothy A Carey, Pat Dudgeon, Sabine W Hammond, Tanja Hirvonen, Michael Kyrios, Louise Roufeil and Peter Smith

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We acknowledge the Traditional Owners of the land across Australia and pay our respect to the Elders past, present and future.

We also acknowledge young people as they are our future leaders, the custodians of our stories, cultures, histories and languages.

We as seniors must create opportunities and encourage our youth to realise their full potential (Calma, 2015).This special issue on Indigenous psychology is timely in a changing landscape for Aboriginal and Torres Strait Islander (hereon Indigenous) people and their participation in an Australian nationhood. A range of significant landmark events suggests that both Aboriginal and Torres Strait Islander people and Australians are in a process of decolonisation.

In our first special issue of Australian Psychologist: Indigenous Australian Psychologies (2000), we marked the changes that were taking place and our hopes for a better future. Here our focus was on psychology, Indigenous issues, and reconciliation. Looking back to that time 17 years ago, Aboriginal and Torres Strait Islander affairs have clearly advanced.As a result of the work of Indigenous communities, their leaders, and social justice advocates, there is now a greater public awareness of the social and cultural determinants of Indigenous health and a range of government policies and actions aimed at closing the health and life expectancy gap between the Indigenous peoples of the land and other Australians.In his role as the Aboriginal and Torres Strait Islander Social Justice Commissioner, Professor Tom Calma released a landmark document, the Social Justice Report (2005).This called for the nation to commit to achieving health equality for Indigenous people by 2030, and saw the establishment of the Close the Gap campaign in 2007.Dialogues about the underlying and deeply entrenched socio-economic disadvantage that contributes to this gap are now part of the national dialogue. Government policies and action to close the gap have also now become a national priority that is annually reviewed.This year, the Prime Minster presented the ninth annual report card to Parliament (Closing the Gap Prime Minister’s Report, 2017).Notably, Indigenous mental health and suicide prevention is highlighted as a priority in this report, which is acknowledged by all Australian governments.
Closing the Mental Health Gap

The available data on Aboriginal and Torres Strait Islander disadvantage has shone a light on the Indigenous mental health and wellbeing gap.

In their commentary in this special issue, Calma, Dudgeon, and Bray (2017) provide details of the challenges in mental health for Aboriginal and Torres Strait Islander peoples and what needs to happen to change the situation.
All articles in this issue are concerned with and aimed at contributing to closing the mental health gap.
For example, in Addressing the Mental Health Gap in Working with Indigenous Youth: Some Considerations for non-Indigenous Psychologists Working with Indigenous Youth (Ralph & Ryan, 2017), an overview of therapeutic approaches with Aboriginal and Torres Strait Islander people, particularly youth, is provided.
Ralph and Ryan (2017) stress that an understanding of Indigenous social and emotional wellbeing (SEWB) is necessary for all those who work with youth: “for practitioners working with Indigenous youth and others there is a need to work from within a social and emotional wellbeing framework and a need to adapt the application of any focused psychological strategies to the cultural context of the individual client.” They also express justifiable concerns that “the average number of sessions provided under ATAPS for youth aged 12–25 is only 4.8 sessions.”

The SEWB of Aboriginal and Torres Strait Islander youth is also the focus of Using Culturally Appropriate Approaches to the Development of KidsMatter Resources to Support the Social and Emotional Wellbeing of Aboriginal Children (Smith, O’Grady, Cubillo, & Cavanagh, 2017).

In this article, Smith, O’Grady, Cubillo, and Cavanagh (2017) describe the methodology behind the development of resources in the KidsMatter Aboriginal Children’s Social and Emotional Wellbeing Project. An inclusive process of workshops and consultations with Aboriginal people was informed by participatory action, narrative therapy, and critically reflexive practice. This process enabled researchers and the community to build effective learning tools for children for use by Aboriginal families, schools, and early childhood and health and community services.

Another article in this special issue, Narratives of Twitter as a Platform for Professional Development, Innovation and Advocacy (Geia, Pearson, & Sweet, 2017) offers a compelling argument for the online engagement of psychologists—both Indigenous and non-Indigenous—in raising community awareness of strategies for decolonisation, for circulating empowering, strength-based approaches to Indigenous wellbeing, and supporting and recruiting potential practitioners.

This paper describes the significant success of some transformative Indigenous Twitter movements. Lynore Geia, a Bwgcolman woman from Palm Island in Queensland, discusses #IHMayDay the day long Twitter festival raising awareness of health issues; Luke Pearson, a Gamilaroi man, describes how he set up @IndigenousX and the subsequent global and local impact on healing and knowledge building, and Melissa Sweet discusses the important #JustJustice campaign.

The connections between the criminal justice system and SEWB are also focused on in a significant paper on the urgent need for justice reinvestment, Keeping on Country: Understanding and Responding to Crime and recidivism in Remote Indigenous Communities (Dawes, Davidson, Walden, & Isaacs, 2017). Outcomes from a qualitative study using a multidisciplinary research team that engaged the community through a specific participatory action research process are discussed.

Their findings resonate with the principles of justice reinvestment; Dawes, Davidson, Walden and Isaacs (2017) suggest that with the right methodological approach Indigenous communities themselves can easily identify the underlying factors contributing to crime. With the community, localised strategies to address over-representation in the justice system can be developed. Further, adopting a self-determination approach provides a strength-based position for psychologists working in the area.

Cross-cultural understanding and developing and maintaining local culture in remote communities is the focus of another unique article, The Uti Kulintjaku Project: The Path to Clear Thinking. An Evaluation of an Innovative, Aboriginal-led Approach to Developing Bi-cultural Understanding of Mental Health and Wellbeing (2017).

The results of 3 years of research was an innovative approach to strengthen shared understandings in mental health. The research work undertaken is at the heart of cross-cultural relationships, that is, exploring and articulating deep understandings of language and concepts. Both the community leaders and the non-Indigenous workers in the research team have benefited from this appropriately long-term project.

 

It increased the empowerment and capacity building of the leaders involved, and increased the cultural understanding of non-Indigenous service providers. Togni (2017) demonstrates that the building of stronger bi-cultural wellbeing literacies will “lead to increased help-seeking, strengthened cultural competency within health services and Anangu leadership in strengthening Anangu social and emotional wellbeing (SEWB).”

The importance of recognising the contributions of Indigenous concepts of SEWB is also the focus of Decolonising Psychology: Validating Social and Emotional Wellbeing (Dudgeon, Bray & D’Costa, Walker, 2017) which uses findings from the National Empowerment Project to explore the seven domains of SEWB, namely body, mind and emotions, family, community, culture, Country, and spirituality.

 

In this article, Dudgeon, Bray, D’Costa, and Walker (2017) highlight how SEWB, (an emerging concept within Indigenous psychology), is important in holistically addressing the well being needs of Indigenous people.

The breadth of topics and approaches of the articles in this special issue are a testament to the strong emergence of Australian Indigenous psychology and are just some of the numerous innovations being made in the field across the nation. New methodologies, important findings, strategies for research futures, and guides for practitioners are offered. Each paper makes a significant contribution to both the discipline, the project of Indigenous social justice, and closing the mental health gap.

Indigenous PsychologyIndigenous psychology is emerging as a powerful new discipline and was recognised at a global level with the establishment of the Task Force for Indigenous Psychology in the Society for Humanistic Psychology, Division 32, American Psychological Association in 2010. The Task Force describes Indigenous psychology as:

  1. A reaction against the colonisation/hegemony of Western psychology.
  2. The need for non-Western cultures to solve their local problems—Indigenous practices and applications.
  3. The need for a non-Western culture to recognise itself in the constructs and practices of psychology.
  4. The need to use Indigenous philosophies and concepts to generate theories of global discourse.

We address each of these factors below; however, it is noted that implicit within these is a recognition that the principle of self-determination, confirmed as an underlying principle in the United Nations Declaration of the Rights of Indigenous People (UNDRIP) (2007), is central to wellbeing and the survival of cultural rights. Specifically, there are provisions regarding obligations to respect, recognise, and uphold Indigenous peoples’ individual and collective rights to develop, maintain, and use their own health systems, institutional structures, distinctive customs, spirituality, traditions, procedures, and practices in pursuit of their right to health and mental health and wellbeing. Authors such as Dudgeon and Walker (2015) have examined this relationship in other papers.

  • 1.A reaction against the colonisation/hegemony of Western psychology

The measured and principled response of Australia Indigenous psychology to the colonising impacts of Western psychology has challenged the discipline to re-think foundational assumptions. Since the 1990s Indigenous psychologies across the world have illuminated the ways in which Western therapeutic paradigms have privileged a concept of individual mental health. In short, the normalisation of Western individualism has reduced our understanding of psychological distress and healing. Indigenous therapeutic knowledge about the self as a dynamic flow of connections have until quite recently been silenced, and even pathologised. Yet gains in the discipline over the last few decades have seen a shift from Indigenous people being framed as objects of research to being agents of meaning and transformation. The marginalisation of Indigenous psychological research within the academy is still, however, an issue which requires change.

  • 2.The need for non-Western cultures to solve their local problems—Indigenous practices and applications

There is a broad consensus across Australian Indigenous communities that culturally strong therapeutic knowledge and practices are ones which articulate solutions identified by local communities (Dudgeon et al., 2014). Respect for the cultural knowledge of Elders is also important in the capacity building of on-country healing programs aimed at reducing youth suicide and “highlight the need for continued support for Elders in maintaining and passing on their cultural knowledge to young people” (Solutions That Work: What the Evidence and Our People Tell Us, 2016, p. 22).

  • 3.The need for a non-Western culture to recognise itself in the constructs and practices of psychology

This form of recognition is foundational to the process of decolonisation and for communities to identity their own solutions and articulate their own cultural concepts. However, it is equally important for Western psychology to recognise how the discipline has constructed Indigenous subjectivity and practiced culturally inappropriate therapeutic interventions. In this respect, the Australian Psychological Society has made history by being the first to formally apologise to Indigenous peoples for past oppressive practices and to vow to make systemic changes. The 2016 people was made at the Australian Psychological Society Congress 2016 in Melbourne. This has become a significant event that gained considerable worldwide media attention and has impact not only in Australia but internationally, with the American Psychological Association now developing a similar apology to their Indigenous people. It is fitting that those involved with progressing the APS apology comment in this special edition. Carey et al. provide a brief overview of the APS’s involvement with Aboriginal and Torres Strait Islander people and issues, tracing the history that contextualises the apology. The apology, how it came about and the reaction to it, particularly by APS members, describes a changing discipline. Following the Australian Government’s landmark apology to Aboriginal and Torres Strait Islander people Stolen Generations in 2008, the APS apology speaks to a maturing sense of race relations and nationhood. In my opinion, the apology formally owns and acknowledges the wrongs done, and the denial of the past, the injustice and oppression that was the lot of many Aboriginal and Torres Strait Islander people. In some respects, Aboriginal and Torres Strait Islander people have suffered a double burden—of suffering injustice and also of having that suffering denied. The apology from the nation and the APS is important; they value people and their experiences and give people respect and a genuine presence. A shared journey of healing for us as a nation can progress.

  • 4.The need to use Indigenous philosophies and concepts to generate theories of global discourse

There is a growing recognition of how psychology has been complicit in the processes of colonisation and oppressing Indigenous peoples. Recognising and acknowledging this past is important, hence the importance of the APS apology. Such acknowledgement and apology allows us to move forward, acknowledging colonisation allows decolonisation for both groups and into a more advanced discipline. It allows space for other viewpoints and understandings to emerge that not only benefit Indigenous peoples but all Australians. There is reason for optimism and the potential for empowerment and genuine inclusion of Aboriginal peoples in the discipline. In order to decolonise psychology in Australia, the discipline needs to consider and incorporate Aboriginal culture and beliefs into mental health services and research. We see this happening from the papers in this special edition. There is focus on the development of Aboriginal paradigms, standpoints, and concepts such as social and emotional wellbeing. Further, there is a deep appreciation of cultural difference and a willingness to work to develop mutual understandings. The papers in the special edition show the promise of different approaches and the development of a new phase of Australian psychology.

In 2017 we stand at a new beginning. We are living in a time of continual change. Twenty years ago Ernest Hunter wrote:

Self determination’, ‘quality of life’, ‘wellbeing’: these are terms that have only recently entered the vocabulary of mental health professionals working in indigenous settings. They are unfamiliar and handled with uncertainty and, at times, temerity; they are also unavoidable (1997, p. 821).

This special issue attests to how such terms are now a common part of discussions about Aboriginal and Torres Strait Islander wellbeing, and part of a vanguard movement in psychology.

Such terms have a substantial material force and a political history, as well as being part of the discourse of Indigenous psychology. Globally, the focus on decolonisation has emerged as a new defining movement which is in the process of transforming all disciplines, not only psychology. Decades of complex Indigenous struggles, debates, and victories are driving decolonisation, and it is because of this that terms such as “self-determination” and “wellbeing” resonate with a particular historical dignity.

The Aboriginal and Torres Strait Islander mental health movement is decolonising the discourse of Australian mental health not only within specialised journals but within the public sphere through the opening up of national debates about the relationship between racism and wellbeing. In doing so, the movement has also contributed to the national projects of overcoming racism and de-stigmatising psychological distress by providing insights into the social and cultural determinants of mental health.

TerminologyA range of words are used to describe Aboriginal and Torres Strait Islanders and non-Aboriginal peoples. The term Indigenous is also used by authors, as this includes both Aboriginal and Torres Strait Islander people. While encouraging authors to use terms that best fit the people they write with, I acknowledge that the preferred term is “Aboriginal and Torres Strait Islander peoples.” The Australian Human Rights Commission explains this term in further detail:

Aboriginal and Torres Strait Islander peoples retain distinct cultural identities whether they live in urban, regional or remote areas of Australia. The word ‘peoples’ recognises that Aborigines and Torres Strait Islanders have a collective, rather than purely individual, dimension to their lives. This is affirmed by the United Nations Declaration on the Rights of Indigenous Peoples (2012, p. 6).

NACCHO Aboriginal Health and Smoking : Download Tackling Indigenous Smoking Program prelim. evaluation report

 ” The overall goal of the national Tackling Indigenous Smoking (TIS) program is to improve the health of Aboriginal and Torres Strait Islander people through local population specific efforts to reduce harm from tobacco.

The purpose of this preliminary report is to provide a mid-term evaluation of progress to date in implementing the first year of the three year (2015-2018) TIS program.

The TIS programme with a budget of $116.8 million over 3 years ($35.3 million in 2015-16; $37.5 million in 2016-17 and $44 million in 2017-18) was announced by the Government, on 29 May 2015.”

Download 133 page PDF report Here :

NACCHO Download Dept Health Tackling Indigenous Smoking Evaluation June 2017

The report found the program is operating effectively, using proven approaches to change smoking behaviours, and delivering evidence-based local tobacco health promotion activities. I am pleased the report recommends it continues,

Smoking is the most preventable cause of disease and early death among Aboriginal people and accounts for almost one-quarter of the difference in average health outcomes between indigenous and non-indigenous Australians.

“The program provides grants in 37 urban, rural, regional and remote areas to assist local communities to develop localised anti-smoking campaigns

Minister Ken Wyatt

Read over 100 plus NACCHO articles published in past 5 years

This mid-term evaluation looks at progress to date of the TIS program, particularly in terms of regional grants delivering localised Indigenous tobacco interventions.

Source of intro

See list all 35 Recipients below

It does not look at long-term impact in relation to a reduction of smoking rates at a national level.

Findings focus on (see in full below 1-9)

  • the shift to TIS
  • community engagement and partnerships
  • localised health promotion
  • access to quit support
  • contribution to evidence base
  • National Best Practice Unit and TIS portal
  • governance and communications.

A number of key recommendations emerging from the evaluation are included in the report.(see Below Part 2)

Findings

1. Shift to TIS

Since the implementation of the TIS program, all grant recipients are primarily focused on planning for, and/or delivering, targeted and tailored activities that directly address reduction of smoking prevalence within communities.

For some grant recipients, broader health promotion activities without a clear link to tobacco reduction have dropped off significantly as a result of the shift to TIS, whilst for others the integration of healthy lifestyle and tobacco control strategies has been successful. There are varying degrees of clarity among grant recipients about the extent to which there is flexibility to tap into healthy lifestyle activities under the new guidelines.

2.Community engagement and partnerships

Community engagement and involvement in the design and planning of localised TIS programs is a key priority for grant recipients, and a key indicator of successful TIS activities.

While challenges were identified in terms of handling competing priorities in community, adhering to cultural protocols, and the change in focus of the TIS program and uncertainty about ongoing funding, in the main, grant recipients have demonstrated substantial progress in involving community in design and planning and garnering support for TIS activities.

This is evidenced by the popularity of community events hosted/attended by the TIS team and the proactivity of local community and Elders in advocating for tobacco control.

The success of the TIS program and the capacity for grant recipients to operate as a multi-level population health program in their region is highly dependent upon the quality and reach of partnerships between grant recipients and other agencies/organisations.

Whilst challenges to regional collaborations were reported, overall there has been a noticeable increase in the reporting of grant recipient collaboration and partnerships, representing an important shift to both a wider regional focus and wider community approach to tobacco reduction.

3.Localised health promotion

At the local level, a range of multi-component health promotion activities around tobacco control are being undertaken by grant recipients, in collaboration with external stakeholders. Local partnerships are crucial to the successful implementation of localised health promotion activities through facilitating access to priority populations, supporting capacity-building and enabling a broader population reach to achieve awareness and understanding of the health impacts of smoking and quitting pathways. viii

Increased levels of community support and ownership for local solutions to tackling Indigenous smoking are being seen across the TIS sites.

4.Community education

Community education, is being undertaken by all grant recipients. This manifests in a range of ways, including health promotion activities at community/sporting events, drama shows and comedy and social marketing.

The involvement of local champions and Elders in local education and awareness raising events and activities is recognised as central to tobacco control messages resonating with target audiences.

It has also been recognised that targeting priority groups, such as young people and pregnant women, requires the adaptation of messages so that they resonate with those groups.

Grant recipients are partnering with key local organisations (e.g. schools, other AMS etc.) to overcome some of the challenges around access to these priority groups.

Many grant recipients have established or showed progress in establishing social marketing campaigns to supplement other health promotion activities. Campaigns are developed largely through a strength-based approach, with ‘local faces and local places’ taking precedence. Grant recipients have acknowledged the challenges in measuring the impact of social marketing campaigns although some are demonstrating a commitment to collecting data on awareness, and influences on motivations and attempts to quit.

5.Smoke-free environments

An area that has been recognised by grant recipients as requiring attention is the promotion and establishment of smoke-free environments, particularly in rural and remote locations. Modelling smoke-free environments within the grant recipients’ own workplace is one way in which this issue is being addressed, with some evidence of success.

Challenges to the implementation of smoke-free workplaces include getting support from senior leaders or Board members who smoke, and organisations where tobacco control is not the main priority. Monitoring the compliance of smoke-free environments presented an additional challenge to grant recipients. Some external organisations have requested support to become smoke-free, and successful examples of smoke-free environments including smoke-free community events are evident.

Shifting attitudes around second-hand smoke (e.g. smoking indoors and in cars) and some evidence of behaviour change were reported by grant recipients and community members.

6.Access to quit support

TIS funded organisations are encouraged to take a systems approach to activity planning. The TIS program is part of a larger preventive health care system, all connected in different ways such as through referral pathways, and client appointments.

A key component of the TIS program is therefore enhancement of referral pathways and promoting access to quit support. Grant recipients have developed a range of opportunities for community members to achieve smoking cessation, with referral pathways having been established in two key areas: clinic-based referrals within their organisation and referrals made during localised TIS health promotion activities.

For some, successful referral pathways are dependent upon grant recipients partnering with external organisations.

Improving access to culturally appropriate support to quit has been a key focus of the grant recipients over the past 12 months.

Quitline enhancements are a component of the TIS program and data suggests that referrals to Quitline are higher in urban and some rural areas. Continuing to build strong partnerships between grant recipients and Quitline will be key to increasing referrals from local TIS programs into Quitline where appropriate.

Another key focus for grant recipients has been in increasing the skills of TIS workers and other professionals in contact with Aboriginal and Torres Strait Islander people to provide smoking cessation education and brief interventions. Quits kills training, and other smoking cessation education programs, have been accessed to support this goal.

7.Contributions to evidence base

The shift to delivering activities based in evidence and focusing more on outcomes than outputs has been welcomed by grant recipients, in the main, and has provided greater direction for activities and a goal to work towards.

A range of activities were undertaken by grant recipients to develop or strengthen their evidence base and work towards measurable outcomes. Collecting data remained challenging for some remote grant recipients operating in contexts with low literacy levels and where English is not the first language. Health service grant recipients wanting to collect population level data was also challenging when services are operating on different databases within a region and where there was an unwillingness to share data.

Overall, grant recipients expressed a willingness to focus on outcomes, and the confidence and capability to obtain data, although interpreting and reporting on data was presented as a challenge.

8.National Best Practice Unit and TIS portal

Advice and guidance around monitoring, measuring and further improving local TIS programs is provided to grant recipients through the NBPU TIS. Grant recipients have indicated that they value the support and advice provided through the NBPU TIS and this has aided in building their confidence and capacity to undertake monitoring and evaluation activities.

Some grant recipients reported that an additional level of support from NBPU TIS was needed. Resistance to change is common in any business when new processes are set in place. NBPU TIS therefore expected, and has witnessed, some resistance to this change. However, it continues to engage with grant recipients and support significant processes of change, not just reporting and compliance.

Another component of the work of the NBPU TIS is the development and ongoing maintenance and improvement of the Tackling Indigenous Smoking Resource and Information Centre (TISRIC) and its home, the TIS Portal (hosted by Australian Indigenous HealthInfoNet).

Information and resources to support grant recipients in planning, monitoring, and evaluating activities, as well as information on workforce development is provided through the TIS Portal.

In addition, the Portal hosts an online forum (TIS Yarning Place) that enables grant recipients from across the country to share information and ask questions. Evaluation findings suggest that, whilst grant recipients are utilising the TIS Portal, some grant recipients have identified opportunities to enhance the useability of the TIS Portal.

9.Governance and communications

Various components of support are provided to grant recipients by the department and the NBPU TIS regarding the new focus and priorities and expectations of the TIS program.

To ensure consistent program messaging, and to enhance performance reporting, a range of initiatives were undertaken in the latter half of 2016 to clarify the roles and responsibilities of the various ‘players’ in the national TIS program.

The loss of experienced staff due to funding uncertainty has represented a significant challenge for several grant recipients in their planning and implementing activities.

Particularly in remote areas, recruitment has been an issue for many grant recipients due to the mix of skills demanded of TIS staff. Grant recipients report continued issues attracting and retaining staff with only short term contracts under the new TIS program.

Despite these concerns, indications are that providing grant recipients are given sufficient time and support to execute their Action Plans, they are on track for achieving stated tobacco reduction outcomes. The key risk to this is workforce stability, which would be mitigated by timely advice about the outcome of ongoing funding arrangements.

A number of key recommendations have emerged out of the evaluation findings:

Overall recommendations

1. Department: The TIS program in its current form should be continued, with a move away from short-term funding cycles.

2. Department: Provide immediate advice about the funding of TIS from June 2017 to end of current funding cycle.

Shift to TIS

3. Department: Provide clarity around what is allowable in relation to healthy lifestyle activities within the current iteration of the TIS program  Community engagement and partnerships

4. Grant recipients: Continue to broker partnerships and leverage relationships.

5. NBPU TIS: Continue to build capability of grant recipients to broker partnerships and leverage relationships through the distribution and promotion of relevant resources.

Community education and awareness

6. Grant recipients: Continue to identify and prioritise key groups, especially pregnant women.

7. Grant recipients: Ensure evidence-based best practice community education models (including monitoring and evaluation approaches) are sought and adopted where appropriate.

8. NBPU TIS: Ensure the evidence-based best practice community education models (including monitoring and evaluation approaches) are available, particularly for priority target groups such as pregnant women and activities around social marketing.

Smoke-free environments

9. Grant recipients: Continue to explore implementing smoke-free workplaces and enhance support for smoke-free public spaces.

10. National Coordinator: Lead a dialogue between regional leaders, including CEOs, Board members of TIS and non-TIS funded organisations around establishing smoke-free environments.

Access to quitting support

11. Grant recipients: Continue to strengthen partnerships with Quitline and other quit support structures where appropriate.  Contribution to larger evidence base

12. Grant recipients: Build on routine and existing data sources to reduce data collection burden.

National support

13. Grant recipients: Continue to seek feedback from NBPU TIS regarding M&E activities where required.

14. NBPU TIS: Continue to respond to feedback from GRs around M&E needs and TIS portal content and use ability.

15. Department: Articulate the role of the National coordinator  in the context that the program has evolved and as such his role has evolved. Governance and communication

16. Department: Provide greater clarification of TIS funding parameters, especially in terms of incorporation of healthy lifestyle activities and one-on-one smoking cessation support.

The Tackling Indigenous Smoking (TIS) regional tobacco control grants aim to improve the wellbeing of Aboriginal and Torres Strait Islander people through population health activities to reduce tobacco use. It is an initiative of the Australian Government Department of Health (DoH).

At the end of 2015, a number of organisations were notified of their success in gaining a TIS grant for culturally appropriate tobacco cessation programs. The grants were awarded to a variety of service providers across the nation.

The 35 organisations that have commenced their programs are:

With the program funding provided until 2018, the successful organisations will work towards the intended outcomes of the TIS programme, including:

  • encouraging community involvement in and support for local tobacco control activities
  • increasing community understanding of the dangers of smoking and chewing tobacco
  • improving knowledge, skills and a better understanding of the health impacts of smoking.

NACCHO Aboriginal Mental Health News : Dr Mark Wenitong appointed to Federal Government mental health advisory panel

The Turnbull Government has established a new mental health advisory panel to support their commitment to improve services.On that panel (see all members below) is Dr Mark Wenitong advising on Indigenous and remote health

The Primary Health Network Advisory Panel on Mental Health will work closely with the Government on its plan to deliver more frontline mental health services.

BIO Dr Mark Wenitong – Indigenous and Remote Health

The choices for me to come back and work with communities and with my own mob up this way was kind of an easy one really,”

“I wasn’t particularly interested in a career in medicine or specialising.

“It was more getting the paper (qualifications) behind me and being able to have a voice in Aboriginal health and to be able to do something practical to help our mob.”

Dr Mark Wenitong Former Aboriginal Public Health Medical Officer, at NACCHO. Now Senior Medical Officer at Apunipima Cape York Health Council where he remains focused on his community’s health needs and inspiring the next generation of young Aboriginal students to be doctors.

See NACCHO TV interview with DR Mark for ” Aboriginal Health In Aboriginal Hands Series “

And Australian Story

Read here : Dr Mark Wenitong, reggae musician and Indigenous health leader

Primary Health Networks (PHNs) have substantial responsibilities in mental health:

  • They plan and commission primary mental health care services at the regional level;
  • They plan and coordinate the clinical service needs of people with severe and complex mental illness who are managed in primary care;
  • They implement evidence-based stepped care; and
  • They integrate services in partnership with state and territory governments, general practitioners, non-government organisations, National Disability Insurance Scheme providers and other related services, organisations and providers.

The Minister for Health, Greg Hunt, has now established a PHN advisory panel with specific Terms of Reference:

  1. To consider and provide advice regarding the guidelines for mental health commissioning issued to the 31 PHNs and oversee the development of a Framework for PHM mental health commissioning, noting that commissioning is a cyclical process of local consultation, design and solutions.
  2. To oversee an analysis of the 2016/17 Department of Health-approved needs assessment and mental health plans developed by the 31 PHNs.
  3. Following the analysis, provide advice to the Minister for Health on strategies to support the 31 PHNs to efficiently and effectively carry out their commissioning responsibilities in mental health.
  4. Provide recommendations to the Minister for Health about the optimal system architecture and arrangements for supporting the role of PHNs in ongoing mental health reform.
  5. Provide guidance for peak bodies and Colleges on how their members can engage with the PHN commissioning process.

Panel Membership:

  • Dr Peggy Brown – National Mental Health Commission
  • Vahid Saberi – NSW North Coast PHN
  • Learne Durrington – WA Primary Health Alliance
  • Abbe Anderson – Brisbane North PHN
  • Amanda Bresnan – Community Mental Health Australia
  • Professor Lyn Littlefield – Australian Psychological Society
  • Associate Prof Kim Ryan – College of Mental Health Nurses
  • Dr Kym Jenkins – RANZCP
  • Professor Pat McGorry – National Centre of Excellence in Youth Mental Health
  • Jackie Crowe – National Mental Health Commission Advisory Board
  • Frank Quinlan – Mental Health Australia
  • Lucy Brogden – National Mental Health Commission Advisory Board
  • Dr Morten Rawlin (RACGP)
  • Dr Mark Wenitong – Indigenous and Remote Health
  • Samuel Hockey – Youth lived experience
  • a nominee from Mental Health Consumer and Carer Forum

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.”

Aboriginal Health and #Justjustice : @UNHumanrights finds Australia’s Aboriginal peoples face “tsunami” of imprisonment.

“It is alarming that, while the country has adopted numerous policies to address the socio-economic disadvantage of Aboriginal peoples and those from the Torres Strait Islands, it has failed to respect their rights to self-determination and to full and effective participation in society.

Government policies have failed to deliver on targets in the areas of health, education and employment and have led to a growing number of people being jailed, and have resulted in an increasing number of children being removed from their homes in Aboriginal and Torres Strait Islander communities.  

High rates of incarceration were described to me as a tsunami affecting indigenous peoples. It is a major human rights concern.

The figures are simply astounding. While Aboriginal and Torres Strait Islanders make up only 3% of the total population, they constitute 27% of the prison population, and much more in some prisons,”

United Nations human rights expert the Special Rapporteur on the rights of indigenous people, Victoria Tauli-Corpuz pictured above meeting the Opposition Aboriginal parliamentarians and below meeting the NT APO lead by John Paterson CEO of NACCHO Affiliate AMSANT

Australia must reduce the “astounding” rates of imprisonment for indigenous peoples and step up the fight against racism, a United Nations human rights expert has concluded, at the end of an official visit.

“The rate of incarceration of Aboriginal and Torres Strait Islander youth is alarming,” Ms. Tauli-Corpuz said. “I visited Cleveland Youth Detention Centre in Townsville, Queensland, where Aboriginal and Torres Strait Islander children constitute 95% of the children detained.

Many have been going from out-of-home care into detention. “Aboriginal children are seven times more likely than non-Indigenous children to be in contact with the child protection system or to be subject to abuse or neglect, Ms. Tauli-Corpuz noted.

“As already recommended by the UN Committee on the Rights of the Child, I urge Australia to increase the age of criminal responsibility. Children should be detained only as a last resort.

“These children are essentially being punished for being poor and in most cases, prison will only aggravate the cycle of violence, poverty and crime. I found meeting young children, some only 12 years old, in detention the most disturbing element of my visit.

The UN expert expressed criticism of the Government programme known as the Indigenous Advancement Strategy which was initiated by the Government in 2014 and involved a large budget cut in funding for support programmes.

She said: “The implementation of the strategy has been bureaucratic, rigid and has wasted considerable resources on administration. Travelling across the country, I have repeatedly been told about its dire consequences.”

However, Ms. Tauli-Corpuz said: “I want to emphasise that during my visit I have been particularly impressed and inspired by the strength of spirit and commitment of Aboriginal and Torres Strait Islanders to develop innovative measures to support their own communities.”

She pointed to the number of peak organisations across a range of areas led by indigenous people. “The Government could achieve significant progress in realising the rights of indigenous peoples if it consulted and worked much more closely with these organisations,” she said.

“I have also observed effective community-led initiatives in a range of areas including public health, housing, education, child-protection, conservation and administration of justice, which all have the potential of making immediate significant positive changes in the lives of Aboriginal and Torres Strait Islanders.”

She called on the government to forge a new relationship with the national representative body for indigenous peoples, the National Congress of Australia’s First Peoples, and restore their funding.

She expressed concern that the Government would not meet targets to close the gap in areas such as life expectancy, infant mortality, education and employment. She called for a comprehensive approach including specific targets for the reduction of detention rates, child removal and violence against women.

“I call on the Government to adopt a participatory approach based on consultation with indigenous peoples and take into account the ‘Redfern statement’, launched by peak Aboriginal and Torres Strait organisations in 2016, as it sets out priority areas for action and recommendations on issues ranging from health, justice, violence prevention, disability, children and families,” the expert concluded.

Ms. Tauli-Corpuz ended her two-week visit to Australia with a press conference in Barton in the Australian Capital Territory where she presented her initial findings and recommendations. She will present a comprehensive report to the UN Human Rights Council in September 2017.

The Special Rapporteur on the rights of indigenous peoples, Ms. Victoria Tauli-Corpuz (Philippines), is a human rights activist working on indigenous peoples’ rights

. Her work for more than three decades has been focused on movement building among indigenous peoples and also among women, and she has worked as an educator-trainer on human rights, development and indigenous peoples in various contexts. She is a member of the Kankana-ey, Igorot indigenous peoples in the Cordillera Region in the Philippines.

The Special Rapporteurs are part of what is known as the Special Procedures of the Human Rights Council. Special Procedures, the largest body of independent experts in the UN Human Rights system, is the general name of the Council’s independent fact-finding and monitoring mechanisms that address either specific country situations or thematic issues in all parts of the world.

Special Procedures’ experts work on a voluntary basis; they are not UN staff and do not receive a salary for their work. They are independent from any government or organization and serve in their individual capacity.

See the UN Declaration on the Rights of Indigenous Peoples UN Human Rights, country page: Australia

 

NACCHO Aboriginal #WorldHealthDay : #LetsTalk about Depression and #mentalhealth

 ” The theme of our 2017 World Health Day campaign is depression

The Gayaa Dhuwi (Proud Spirit) Declaration[4] was developed and launched by the National Aboriginal and Torres Strait Islander Leadership in Mental Health in 2015.

It provides a platform for governments to work collaboratively to embed culturally competent and safe services within the mental health system that are adaptable and accountable to Aboriginal and Torres Strait people.

Nearly one-third of Aboriginal and Torres Strait Islander people aged over 15 years reported having high to very high levels of psychological distress. This was more than twice the levels reported for other Australians.

Aboriginal and Torres Strait Islander women reported these levels of stress more than men.

It is often hard to know how common depression is in the Aboriginal and Torres Strait Islander population, however, because of the way people understand depression and their cultural understanding of mental illness.”

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  ” Depression needs to be seen within the wider scope of the social and emotional wellbeing of Aboriginal and Torres Strait Islander people; this means looking more holistically at health.

The warning signs for depression in Aboriginal and Torres Strait Islander people may vary between communities, so it is vital that the people working in the area of social and emotional wellbeing are aware of the different languages and understandings used by individual communities when talking about depression.

From Healthinfonet :Does the understanding of depression differ between Aboriginal and Torres Strait Islander communities?

World Health Day, celebrated on 7 April every year to mark the anniversary of the founding of the World Health Organization, provides us with a unique opportunity to mobilize action around a specific health topic of concern to people all over the world.

Depression affects people of all ages, from all walks of life, in all countries. It causes mental anguish and impacts on people’s ability to carry out even the simplest everyday tasks, with sometimes devastating consequences for relationships with family and friends and the ability to earn a living. At worst, depression can lead to suicide, now the second leading cause of death among 1529-year olds.

Yet, depression can be prevented and treated. A better understanding of what depression is, and how it can be prevented and treated, will help reduce the stigma associated with the condition, and lead to more people seeking help.

WHO World Heath Day

“The release of this much awaited Draft Fifth National Mental Health Plan is another important opportunity to support reform, and it’s now up to the mental health sector including consumers and carers, to help develop a plan that will benefit all.”

A successful plan should help overcome the lack of coordination and the fragmentation between layers of government that have held back our efforts to date.”

NACCHO and Mental Health Australia CEO Frank Quinlan have welcomed the release of the Draft Fifth National Mental Health Plan and is encouraging all ACCHO stakeholders to engage with the plan during the upcoming consultation period.

Download the Draft Fifth National Mental Health Plan at the link below:

PDF Copy fifth-national-mental-health-plan

You can download a copy of the draft plan;or see extracts below

Fifth National Mental Health Plan – PDF 646 KB
Fifth National Mental Health Plan – Word 537 KB

View all NACCHO 127 Mental Health articles here

View all NACCHO 97 Suicide Prevention articles here

Priority Area 4: Aboriginal and Torres Strait Islander mental health and suicide prevention

What we aim to achieve

Culturally competent care through integrating social and emotional wellbeing services with a range of mental health, drug and alcohol, and suicide prevention services.

What it means for consumers and carers?

You will receive culturally appropriate care.

Both your clinical and social and emotional wellbeing needs, and the needs of your community, will be addressed when care is planned and delivered.

Summary of actions

  1. Governments will work collaboratively to develop a joined approach to social and emotional wellbeing support, mental health, suicide prevention, and alcohol and other drug services, recognising the importance of what an integrated service offers for Aboriginal and Torres Strait Islander people.
  2. Governments will work with Primary Health Networks and Local Hospital Networks to implement integrated planning and service delivery for Aboriginal and Torres Strait Islander people at the regional level.
  3. Governments will renew efforts to develop a nationally agreed approach to suicide prevention for Aboriginal and Torres Strait Islander people.
  4. Governments will work with service providers, including with Aboriginal Community Controlled Health Organisations, to improve Aboriginal and Torres Strait Islander access to and experience with mental health and wellbeing services.
  5. Governments will work together to strengthen the evidence base needed to inform development of improved mental health services and outcomes for Aboriginal and Torres Strait Islander people.

Overview

Mental health and related conditions have been estimated to account for as much as 22 per cent of the health gap between Aboriginal and Torres Strait Islander people and other Australians, as measured in Disability-Adjusted Life Years. Mental health conditions are estimated to contribute to 12 per cent of the gap in the burden of disease, with another four per cent of the gap attributable to suicide and another six per cent to alcohol and other drug misuse.[1]

The 2012-2013 Australian Aboriginal and Torres Strait Islander Health Survey found that Aboriginal and Torres Strait Islander adults were almost three times more likely to experience high or very high levels of psychological distress than other Australians, are hospitalised for mental health and behavioural disorders at almost twice the rate of non-Aboriginal people, and have twice the rate of suicide than that of other Australians. The breadth and depth of such high levels of distress on individuals, their families, and their communities is profound.

Despite having greater need, Aboriginal and Torres Strait Islander people have limited access to mental health services and professionals. In 2012-2013, the most common Closing the Gap service deficits reported by organisations were around mental health and social and emotional wellbeing services.[2]

Issues such as rural and remoteness, and the diversity and fractured coordination of government funding, policy frameworks and service systems, play a role in hindering the ability of services to adequately and appropriately address the needs of Aboriginal and Torres Islander people. It is also recognised that many services and programmes designed for the general population are not culturally appropriate within a broader context of social and emotional wellbeing as understood by Aboriginal and Torres Strait Islander people.

Aboriginal and Torres Strait Islander people embrace a holistic concept of health, which inextricably links mental and physical health within a broader concept of social and emotional wellbeing. A whole-of-life view, social and emotional wellbeing recognises the interconnectedness of physical wellbeing with spiritual and cultural factors, especially a fundamental connection to the land, community and traditions, as vital to maintaining a person’s wellbeing.

Disruption to this holistic understanding of social and emotional wellbeing caused by dispossession, dislocation, and trauma over generations has, for some Indigenous Australians, created a legacy of grief and psychological distress.

Most Aboriginal and Torres Strait Islander people want to be able to access services where the best possible mental health and social and emotional wellbeing strategies are integrated into all health service delivery and where health promotion strategies are developed with Aboriginal communities to provide a holistic approach. This approach needs an appropriate balance of clinical and culturally informed mental health system responses, including access to traditional and cultural healing, to address mental health issues for Aboriginal and Torres Strait Islander people.

Many Aboriginal and Torres Strait Islander people also continue to experience high levels of exclusion and victimisation, discrimination and racism at personal, societal, and institutional levels. Racism continues to have a significant impact on Aboriginal and Torres Strait Islander people’s decisions about when and why they seek health services, their acceptance of and adherence to treatment.[3]

While governments have been committed to supporting Aboriginal and Torres Strait Islander mental health and suicide prevention, Aboriginal and Torres Strait Islander people have regularly informed governments that much more could be done to improve both the way in which services are structured and the range of services available. There is a need to better coordinate efforts and focus on achieving improved integration of culturally appropriate mental health, social and emotional wellbeing, suicide prevention, and alcohol and other drug services for Aboriginal and Torres Strait Islander people.

Leadership will involve better collaboration and coordination across governments, and set the direction for how services and programmes can better work together. It will assist in driving and embedding change towards a better joined up and whole-of-life approach to mental health, social and emotional wellbeing, suicide prevention, and alcohol and other drug services for Aboriginal and Torres Strait Islander people, to drive the actions that are needed to support better mental health and social and emotional wellbeing, and reduced incidence of suicide, for Aboriginal and Torres Strait Islander people.

The Fifth Plan recognises that self-determination is essential to overcoming the disadvantage that Aboriginal and Torres Strait Islander people experience. While governments have a critical role in providing leadership, actions will be developed in partnership with Aboriginal and Torres Strait Islander people and their communities to ensure that appropriate solutions are developed and key challenges are addressed.

Governments will work collaboratively to improve the cultural safety and capability of the mental health and social and emotional wellbeing workforce, including increasing the proportion of Aboriginal and Torres Strait Islander people working in this field, strengthening the Aboriginal and Torres Strait Islander community controlled health sector and developing the cultural competence of mainstream mental health services. An important factor in this collaborative process will be the inclusion of local Aboriginal and Torres Strait Islander communities in the design and implementation of culturally relevant mental health services. Supporting skill development to enable Aboriginal and Torres Strait Islander people to actively participate in, and conduct research relating to, their own cultures is also important.

Governments recognise the need to improve access to information on what has been shown to work in Aboriginal and Torres Strait Islander communities to improve social and emotional wellbeing, reduce the impact of mental illness and harms associated with alcohol and other drug use, and to prevent suicide.

Action 14: Governments will work with service providers, including with Aboriginal Community Controlled Health Organisations, to improve Aboriginal and Torres Strait Islander access to and experience with mental health and wellbeing services by:

  • increasing knowledge of social and emotional wellbeing concepts and improving the cultural competence and capability of mainstream providers;
  • recognising the importance of Indigenous leadership and supporting implementation of the Gayaa Dhuwi (Proud Spirit) Declaration; and
  • training all staff delivering mental health services to Aboriginal and Torres Strait Islander people, particularly those in forensic settings, in trauma-informed care.

The National Aboriginal and Torres Strait Islander Leadership In Mental Health Group launched the Gayaa Dhuwi (Proud Spirit) Declaration in 2015. The Declaration emphasises the importance of Indigenous leadership in addressing the mental health challenges faced by Aboriginal and Torres Strait Islander people

The Gayaa Dhuwi (Proud Spirit) Declaration[4] was developed and launched by the National Aboriginal and Torres Strait Islander Leadership in Mental Health in 2015. It provides a platform for governments to work collaboratively to embed culturally competent and safe services within the mental health system that are adaptable and accountable to Aboriginal and Torres Strait people.

The five themes of the Declaration are:

  1. Aboriginal and Torres Strait Islander concepts of social and emotional wellbeing, mental health and health should be recognised across all parts of the Australian mental health system, and in some circumstances support specialised areas of practice.
  2. Aboriginal and Torres Strait Islander concepts of social and emotional wellbeing, mental health and healing combined with clinical perspectives will make the greatest contribution to the achievement is the highest attainable standard of mental health and suicide prevention outcomes for Aboriginal and Torres Strait Islander people.
  3. Aboriginal and Torres Strait Islander values-based social and emotional wellbeing and mental health outcome measures in combination with clinical outcome measures should guide the assessment of mental health and suicide preventions services and programmes for Aboriginal and Torres Strait Islander people.
  4. Aboriginal and Torres Strait Islander presence and leadership is required across all parts of the Australian mental health system for it to adapt to, and be accountable to, Aboriginal and Torres Strait Islander people for the achievement of the highest attainable standard of mental health and suicide prevention outcomes.
  5. Aboriginal and Torres Strait Islander leaders should be supported and valued to be visible and influential across all parts of the Australian mental health system.

More info here

What is depression?

Depression is about a person’s state of mood. When a person has depression (often called clinical depression) they feel very low in mood (sad, unhappy, or ‘down in the dumps’) and also lose interest in activities they used to gain happiness from.

It is normal for people to feel sad every once in a while, but clinical depression is very different from the occasional feeling of sadness. There are several ways clinical depression differs from the occasional feeling of sadness, they include:

  • severity (how serious it is); clinical depression usually ranges from mild to severe
  • persistence (strength of the episode)
  • duration (how long it lasts)
  • the presence of typical symptoms (see next section).

When people feel sad or ‘down’ for a long time, usually for longer than 2 weeks, they may be depressed. Depression can affect anyone at any age.

What are the signs and symptoms of depression?

There are a number of signs or symptoms people may show when they have depression. People do not have to have all of them to be diagnosed with depression. The signs and symptoms of depression can include any of the following:

  • waking up feeling sad and not wanting to get out of bed
  • feeling sad for most of the day
  • feeling restless
  • feeling irritable (short-tempered) and/or angry which may lead to arguments with other people
  • not wanting to be around other people (may want to be alone)
  • thoughts of dying or hurting oneself
  • feeling guilty when not at fault
  • crying for no reason
  • losing interest in the things one likes
  • feeling worthless or hopeless
  • not sleeping well (maybe walking around all night), or sleeping too much
  • not eating well, or eating too much
  • less energy; tiredness
  • having problems concentrating, remembering things, or making decisions
  • weight loss or gain.

Does the understanding of depression differ between Aboriginal and Torres Strait Islander communities?

Depression needs to be seen within the wider scope of the social and emotional wellbeing of Aboriginal and Torres Strait Islander people; this means looking more holistically at health. The warning signs for depression in Aboriginal and Torres Strait Islander people may vary between communities, so it is vital that the people working in the area of social and emotional wellbeing are aware of the different languages and understandings used by individual communities when talking about depression.

What are the risk factors for depression?

The factors that can contribute to depression include:

  • previous mental illness
  • poor physical health or long-term illness
  • grief, loss, and bereavement (referred to as a psychological cause)
  • trauma or stressful events
  • recently becoming a parent
  • too much alcohol, or gunga, or other drugs
  • family history of depression (referred to as a biological or genetic cause)
  • stopping any treatment for depression
  • breaking the law
  • social surroundings (e.g., environmental, housing conditions)
  • cultural or spiritual separation from country.

A person’s personality can also be a risk factor for depression. People who are: anxious or worry easily; unassertive (people who do not stand up for themselves); negative and self-critical (people who see themselves in a negative way); or shy and have low self-esteem (lack confidence) are at a higher risk of depression than people who do not have these types of personalities.

How do you treat depression?

There are many different ways to help people suffering from depression. People need to know that they do not have to put up with the feelings of depression. It is important to be supportive and encourage people to seek help from doctors, counsellors, Aboriginal Health Workers, or staff at the local Aboriginal medical service.

Medical treatments for depression can involve:

  • a full health check from a doctor to screen for any contributing health conditions (e.g., diabetes or hepatitis)
  • getting help from mental health professionals to work through any problems
  • medication (usually anti-depressant drugs)
  • limiting the intake of alcohol and other drugs.

Other tips for managing depression include:

  • talking to someone, for example, friends, family, or an Elder
  • getting involved in daily exercise
  • getting involved in activities that make you feel happy (e.g., fishing, going back to country)
  • trying to sleep and eat well
  • learning skills that a person can use when they feel they’re not coping well with a situation.

If the treatment is not working, it is important that people discuss this with their doctor, counsellor, or other mental health professional so that other options can be explored.

NACCHO Aboriginal Health Closing the Gap #justjustice : PM overturns Government’s opposition to target Indigenous imprisonment

             This post contains 7 articles on the issue of reducing Indigenous Incarceration rates  #JustJustice

“I am pleased that COAG has agreed to progress renewed targets in the year ahead.

A cornerstone of the refresh will be engaging meaningfully with Aboriginal and Torres Strait Islanders and organisations, including at a local level to make sure the agenda reflects their needs and aspirations for the future.”

 

1.Prime Minister Malcolm Turnbull has overturned his Government’s staunch opposition to establishing a target for reducing Indigenous imprisonment rates.

 ” The Labor Party is encouraged by reports today that the Prime Minister might finally overturn his government’s ridiculous opposition to implementing justice targets under the Closing the Gap framework.

Indigenous Affairs Minister Nigel Scullion has long ignored the calls for justice targets, despite repeated urgings from Aboriginal and Torres Strait Islander organisations and expert bodies.

If Malcolm Turnbull is ready to accept that his Minister is wrong, and to adopt Labor’s policy, that is excellent news.

National justice targets will allow us to focus on community safety, particularly the protection of women and children, preventing crime and reducing incarceration rates among Aboriginal and Torres Strait Islander Australians.

2.The Hon Bill Shorten LEADER OF THE OPPOSITION SHADOW MINISTER FOR INDIGENOUS AFFAIRS or read in full below

Download Press Release 25 March Labor CTG Prison Rates

 

 ” Lives can be changed, hope can flourish and outcomes achieved but the helping hand is needed – pre-release and post-release. As a society we should be doing everything possible to keep people out of prison – and not everything we can to jail people, but where incarceration is the outcome, then everything must be done to help the people within them.

“They look at us like we are nothing or we are animals,” Former prisoner

It is better I am here so my children can have some hope,” Prisoner

“There is nothing for us to do inside except to keep our heads down and avoid trouble,” Prisoner

We need to invest in education opportunities while people are incarcerated in Juvenile Detention and in adult prisons and from effectively as soon as someone is incarcerated. What is on the outside can also be on the inside – prisons do not have to be vile dungeons of psychological torment. They can be communities of educational institutions, places of learning, social support structures.

3.Transform Australia’s prisons by Gerry Georgatos from Stringer

4.NACCHO

NACCHO Aboriginal Health and #prisons #JustJustice : Terms of references released Over-representation of Aboriginal peoples in our prisons

 ” It’s a record, but not one to be proud of: one in four prisoners in NSW jails are Indigenous, a statistic that has risen by 35 per cent since the Coalition government came to power in 2011.

The Minister for Corrections David Elliott conceded “it is a tragedy”. Aboriginal and Torres Strait islanders represented 24 per cent of the prison population in October 2016, up from 22 per cent in March 2011 “

5. NSW See Article here

” We know being incarcerated affects someone’s health and yet it is not one of the Closing the Gap targets. It’s Close the Gap Day and the Close the Gap Campaign Steering Committee’s Progress and Priorities report 2017 has been released.

The 2017 report calls for a social and cultural approach and covers many issues, including justice. This is the forth report from the Steering Committee to call for Justice Targets.

Since 2004, there has been a 95 per cent increase in the number of Aboriginal and Torres Strait Islander people in custody. Over the same time, we have seen the crime rates decrease across the country.

Urgent action is required to reduce incarceration if we are ever to see life expectancy parity between Aboriginal and Torres Strait Islander people and other Australians.”

6.Summer May Finlay from Just Justice Croakey : Read Full report HERE Or Below

7.Dan Conifer for ABC TV reports from here

Despite making up just 3 per cent of the general population, about a quarter of Australia’s prison population is Aboriginal or Torres Strait Islander.

The Greens, Labor, the Australian Medical Association, lawyers and other groups have long urged the Coalition to add a federal justice target to the Closing the Gap goals.

Greens Senator Rachel Siewert last month renewed her push in a letter to Mr Turnbull.

Mr Turnbull recently replied, indicating the target would be considered amid a current review of the decade-old targets.

“I am pleased that COAG has agreed to progress renewed targets in the year ahead,” Mr Turnbull wrote.

“A cornerstone of the refresh will be engaging meaningfully with Aboriginal and Torres Strait Islanders and organisations, including at a local level to make sure the agenda reflects their needs and aspirations for the future.

“I have invited the Opposition and the crossbench to participate, particularly all of our Indigenous members of Parliament.”

Conspicuously, Mr Turnbull did not rule out the target.

Indigenous Affairs Minister Nigel Scullion has repeatedly rejected the idea of a federal justice target.

“The Commonwealth can’t have a justice target,” Senator Scullion said in September last year.

“It does absolutely nothing because we have none of the levers to affect the outcomes in terms of incarceration or the justice system but the states and territories do.”

Mr Turnbull reports to Parliament every year on seven Closing the Gap targets, such as Indigenous school attendance and life expectancy.

Senator Siewert said she was now more hopeful of change.

“I’m a little bit more optimistic that in fact they’re now looking at it a bit more favourably and see the sense in having a justice target,” she said.

“I hope they move swiftly on it and I’m looking forward to progress.”

Aboriginal or Torres Strait Islander young people are over 20 times more likely to be in jail than their peers.

The rate of Aboriginal women going to prison has more than doubled since 2000.

And fresh statistics from New South Wales show there has been a 35 per cent increase in Aboriginal inmates in the state’s prisons since 2011 — from 2,269 to 3,059.

‘I find it embarrassing’: Wyatt

Northern Territory Chief Minister Michael Gunner said he was glad the door had been opened to the idea.

“That’s very heartening, especially as we go through a [youth detention] royal commission process,” he said.

“We are talking with the Commonwealth about what that may mean as a future investment into the broken youth justice system here in the territory.”

Mr Gunner said if a federal target was not implemented, the Territory would go it alone.

West Australian Labor’s Ben Wyatt is the nations’ first Indigenous Treasurer.

He has backed the federal target, but knows it is states that control the levers which make a difference.

“I would support anything that focuses the mind of a Government to reduce the rate of Indigenous incarceration,” he said.

“Western Australia is the worst in the nation, we need to have a strong, powerful look at how we go about reducing the number of Aboriginal people we have in our prisons.

“I find it embarrassing and personally distressing that my state continues to do that.”

2.TURNBULL MUST ACT ON INCARCERATION RATES & SUPPORT JUSTICE TARGETS : Labor Press Release

The Labor Party is encouraged by reports today that the Prime Minister might finally overturn his government’s ridiculous opposition to implementing justice targets under the Closing the Gap framework.

Indigenous Affairs Minister Nigel Scullion has long ignored the calls for justice targets, despite repeated urgings from Aboriginal and Torres Strait Islander organisations and expert bodies.

If Malcolm Turnbull is ready to accept that his Minister is wrong, and to adopt Labor’s policy, that is excellent news.

National justice targets will allow us to focus on community safety, particularly the protection of women and children, preventing crime and reducing incarceration rates among Aboriginal and Torres Strait Islander Australians.

The targets should be developed in cooperation with state and territory governments, law enforcement agencies, legal and community services, and guided by community leaders, Elders and Aboriginal representative organisations.

There has to be as much focus on the factors that can help prevent the high levels of incarceration, as well as what happens to individuals once in the criminal justice and corrective services system.

A young Indigenous man today is more likely to go to jail than university, and an Indigenous adult is 15 times more likely to be imprisoned than a non-Indigenous adult.

These appalling numbers demand action, including the reversal of the Government’s cuts to Aboriginal and Torres Strait Islander Legal Services, further examination of noncustodial options and alternatives to mandatory detention, as well as a focus on justice reinvestment.

We call on the Prime Minister to urgently confirm this report, and work with Labor to make justice targets a reality.

The Turnbull Government can’t keep ignoring the Indigenous incarceration crisis. It must start showing national leadership and confront this challenge. Business as usual will not work. If we continue with the same approach, we’ll get the same results.

SATURDAY, 25 March

6.What gets measured gets managed

Summer May Finlay writes:

We know being incarcerated affects someone’s health and yet it is not one of the Closing the Gap targets. It’s Close the Gap Day and the Close the Gap Campaign Steering Committee’s Progress and Priorities report 2017 has been released.

The 2017 report calls for a social and cultural approach and covers many issues, including justice. This is the fourth report from the Steering Committee to call for Justice Targets.

Since 2004, there has been a 95 per cent increase in the number of Aboriginal and Torres Strait Islander people in custody. Over the same time, we have seen the crime rates decrease across the country.

Urgent action is required to reduce incarceration if we are ever to see life expectancy parity between Aboriginal and Torres Strait Islander people and other Australians.

Despite the urgency of the need, and the calls by Aboriginal and Torres Strait Islander people and organisations for an urgent response to this need, there has been no indication that governments are responding with the level of urgency required.

While governments fail to measure justice targets at the national level, there can be no management of the issues.

It’s been 25 years since the Royal Commission into Aboriginal Deaths in Custody and very few of the recommendations have been implemented. It should be no surprise then that in the four years the Close the Gap Steering Committee have been calling for Justice targets that the Federal Government is moving at a glacial pace.

Former Prime Minister Tony Abbott and Minister for Indigenous Affairs Nigel Scullion had resisted the calls for Closing the Gap justice targets. Until late 2016, there appeared to be no consideration that the federal government might even have a role to play in reducing incarceration.

In September 2016, Minister Scullion said he would push the states and territories to introduce Aboriginal and Torres Strait Islander justice targets. He said it is a state/territory responsibility and that the Federal government doesn’t have any of the levers to reduce Aboriginal and Torres Strait Islander incarceration. This demonstrates a clear lack of understanding of the issues that drive incarceration, such as violence rates, including social determinants such as poverty and socio-economic disadvantage.

We have yet to hear whether Minister Scullion was able to work with the states and territories and see them introduce targets.

The Steering Committee reports are not the only reports which address the Aboriginal and Torres Strait Islander incarceration rates.

Prime Minster Malcolm Turnbull was handed the Redfern Statement by Aboriginal and Torres Strait Islander leaders at a breakfast at Parliament House last month. It calls for a focus on targets addressing incarceration and access to justice.

Aboriginal and Torres Strait Islander leaders want to see solutions which are evidence-based with a focus on prevention and early intervention.

Despite the Prime Minister being handed the Statement, the Federal Government do not appear to even seriously consider the inclusion of a justice target. At the Redfern Statement breakfast, the Prime Minister said:

“My Government will not shy away from our responsibility. And we will uphold the priorities of education, employment, health and the right of all people to be safe from family violence.”

He made no mention of incarceration and justice.

The Redfern Statement represented the unified voice of Aboriginal and Torres Strait Islander leaders in health, justice, children and families, disability and family violence sectors. Eighteen Aboriginal and Torres Strait Islander organisations were the drivers. These organisations have a wealth of knowledge and experience that should not be dismissed. Aboriginal and Torres Strait Islander organisations’ core business is Aboriginal and Torres Strait Islander affairs. They know what works in our communities.

The Federal Government can act quickly when they want on Aboriginal and Torres Strait Islander justice issues. After Four Corners aired video footage of an Aboriginal boy Dylan Voller hooded and strapped to a chair in the youth detention centre Don Dale, Prime Minister Turnbull initiated a Royal Commission into youth detention and child protection in the Northern Territory.

Our people are continuing to die way too young and one of the contributing factors is incarceration; the Federal Government is either ignoring the issue, or hoping someone else deals with it.

How many more people do we need to lose before they look to address all factors contributing to a reduced life expectancy, including #JustJustice?

• Download, read and share the 2nd edition of #JustJustice – HERE.


 

3.Transform Australia’s prisons

The more west we journey across the nation the higher the arrest rates, the higher the jailing rates. In the last two decades Australia’s prison population has doubled. The national prison population is nearly 40,000. More than 85 per cent of inmates have not completed a Year 12 education, more than 60 per cent have not completed Year 10, while 40 per cent did not get past Year 9. More than half were not in any paid employment when they were arrested, while half had been homeless.

According to the Australian Bureau of Statistics (2015), Tasmanian prisons incarcerated 519 inmates, the Australian Capital Territory 396, NSW 11,797, Queensland 7,318, Victoria 6,219, South Australia 2,732, the Northern Territory 1,593 and Western Australia incarcerated 5,555. There are 5 prisons in Tasmania, one in the ACT, 34 in NSW, 10 in Queensland, 13 in Victoria, 8 in South Australia, 4 in the Northern Territory and 16 in Western Australia.

As the prison population has increased so has the number of privately managed prisons – 2 in NSW, 2 in Queensland, one in South Australia and 2 in Western Australia. The national prison population may double again but it appears this will only take ten years. Privately managed prisons will increase. The majority of the prison population is comprised of males but the female prison population is increasing. Ten per cent of Queensland’s prison population is comprised of women, 9 per cent in Western Australia and the Northern Territory.

More than 10,000 inmates are Aboriginal and/or Torres Strait Islanders – 28 per cent of the total prison population. 94 per cent of the Northern Territory prison population is comprised of Aboriginal peoples, 38 per cent in Western Australia, 32 per cent in Queensland, 24 per cent in NSW, 23 per cent in South Australia, 19 per cent in the ACT, 15 per cent in Tasmania and 8 per cent in Victoria. Non-Aboriginal Australians are incarcerated at less than 200 per 100,000 adults but Aboriginal and Torres Strait Islanders adults are incarcerated at 2,330 per 100,000 Aboriginal and Torres Strait Islander adults. It is worst in Western Australia where Aboriginal adults are incarcerated at close to the world’s highest jailing rate – 2nd highest at 3,745 per 100,000. But Western Australia enjoys the nation’s highest median wage – one of the world’s highest but not so for its Aboriginal peoples. If you are born Black in Western Australia you have a two in three chance of living poor your whole life.

If you are born Black in the Northern Territory you have a three in four chance of living poor your whole life. One in 8 of the nation’s Aboriginal and/or Torres Strait Islanders have been to jail. One in 6 has been to jail in Western Australia and for the Northern Territory. Poverty, homelessness, racism sets up people for failure, for prison, for reoffending. The situational trauma of incarceration is compounded by its ongoing punitive bent – and the majority of people come out of prison in worse condition than when they went in.

Art programs alone and some recreation will not transform the lives of the majority in the significant ways that matter. The prison experience is one of dank concrete cells, of isolation, of a constancy of trauma and anxieties, of entrenching depression and for many a degeneration to aggressive complex traumas. Australian prisons are not settings for healing, trauma recovery, restorative therapies, wellbeing, educational opportunities and positive future building. But they should be and can be.

Lives can be changed, hope can flourish and outcomes achieved but the helping hand is needed – pre-release and post-release. As a society we should be doing everything possible to keep people out of prison – and not everything we can to jail people, but where incarceration is the outcome, then everything must be done to help the people within them.

They look at us like we are nothing or we are animals,” Former prisoner

It is better I am here so my children can have some hope,” Prisoner

There is nothing for us to do inside except to keep our heads down and avoid trouble,” Prisoner

We need to invest in education opportunities while people are incarcerated in Juvenile Detention and in adult prisons and from effectively as soon as someone is incarcerated. What is on the outside can also be on the inside – prisons do not have to be vile dungeons of psychological torment. They can be communities of educational institutions, places of learning, social support structures.

There are 10, 11 and 12 year olds in Juvenile Detention facilities – child prisons – and the situational trauma of incarceration should not be allowed to degenerate these children into serious psychological hits. These are critically at-risk children who need support and not the rod. The majority of the children will respond to the helping hand, as long as they are validated and not denigrated.

With Aboriginal and/or Torres Strait Islander children, nearly 80 per cent will be jailed again after release from their first stint in Juvenile Detention. The punitive with all its associated denigrations is not working. The psychosocial self has been humiliated, debilitated, stressed by traumas. It is positive that there is an increased onus on post-prison mentoring, healing and education and work programs. There should be much more of this but we should not be waiting for this as post-prison options only and that all this should be in place from the commencement of incarceration. This would assist in reducing depression, anxieties and the building up of a sense of hopelessness. I am advocating for all so-called correctional facilities to be significantly transformed into communities of learning and opportunity. This is what any reasonably-minded society would support.

In NSW, 48 per cent of adult prisoners released during 2013 returned to prison within two years. In Victoria, 44 per cent returned within two years. In Queensland it was 41 per cent. In Western Australia it was 36 per cent. Western Australia incarcerates Aboriginal and Torres Strait Islanders at 17 times the non-Aboriginal rate while for Queensland, NSW and Victoria it is 11 times. In South Australia 38 per cent of adult prisoners released during 2013 returned within two years. South Australia incarcerates Aboriginal people at 13 times the non-Aboriginal rate. In Tasmania 40 per cent were returned within two years. In the ACT 39 per cent were returned and Aboriginal people were 15 times more likely to be incarcerated. In the Northern Territory 58 per cent were returned and Aboriginal people were 14 times more likely to be incarcerated. Australia’s prisons – no different in my experience with child protection authorities – carry on as if people cannot change. Australian prisons are administered by the States and Territories and therefore the onus for change must be argued to them although the Commonwealth can galvanise change and argue an onus on the humane, educative, transformational instead of the punitive which has led to the building of more ‘correctional facilities’ and the filling of them.

 

“The degree of civilization in a society can be judged by entering its prisons,” Fyodor Dostoyevsky

As soon as we are locked up there should be plans for us to better us,” Former prisoner

Too many of us come out with less hope than ever before,” Former prisoner

NACCHO Aboriginal Health and #Alcohol : Cashless welfare card in Indigenous communities ‘cuts use of alcohol and drugs says new report

“But what we had before the card, which is just open sort of slather of people buying heaps of alcohol with the money that they get, the amount of damage it was doing, I think that this is definitely an improvement on what we had previously,”

I  would support the card being rolled out across the country.

Yes I do, I think this is a more responsible way of actually delivering support and social services to our people regardless of what colour they are,”

Ian Trust, the executive director of the Wunan Foundation, an Aboriginal development organisation in the East Kimberley in Western Australia, said his support for the card had come at a personal cost. SEE ABC Report Photo: A Kununurra resident in WA’s Kimberley holding a cashless welfare card. (ABC News: Erin Parke)

“Inevitably, people would prefer to have fewer restrictions than more restrictions, particularly if you are an alcoholic, but the evaluation and the data shows that it is having a positive net impact on reducing alcoholism, gambling and illicit substance abuse.

The rights of the community, of the children and of elderly citizens to live in a safe community are equally important as the rights of welfare recipients.”

Human Services Minister Alan Tudge said while the card was not a “panacea”, it had led to stark improvements in the trial communities, warranting an extension of the card, despite it not being popular with all welfare recipients. Reported by Sarah Martin in Todays Australian

A cashless welfare card that stops government benefits being spent on drugs and alcohol will be made permanent in two remote communities and looks set to be ­expanded, after trials found it greatly reduced rates of substance abuse and gambling.

The 175-page government commissioned review by Orima Research of the year-long trial.

The evaluation involved interviewing stakeholders, participants and their families.

It found on average a quarter of people using the card who drank said they were not drinking as often.

While just under a third of gamblers said they had curbed that habit.

The Turnbull government will today release the first major independent audit of the cashless welfare system and announce that the card will continue in Ceduna and East Kimberley, subject to six-monthly reviews.

Establishing a clear “proof of concept” in the two predomin­antly indigenous communities also paves the way for the ­Coalition to roll out the welfare spending restrictions further, with townships in regional Western Australia and South Australia believed to be under consideration.

In October, Malcolm Turnbull flagged that an expansion of the welfare card was dependent on the results of the 12-month trial, but praised the scheme’s ­initial success in reducing the amount of taxpayer money being spent on alcohol and illicit drugs.

Under the welfare shake-up, first flagged in Andrew Forrest’s review of the welfare system in 2014, 80 per cent of a person’s benefit is restricted to a Visa debit card that cannot be used for spending on alcohol or gambling products or converted to cash. After year-long trials at the two sites capturing $10 million in welfare payments, the first quantitative assessment of the scheme has found that 24 per cent of card users reported less alcohol consumption and drug use in their communities, with 27 per cent of people noting a drop in gambling.

See full details support and Q and A below from DSS

Binge drinking and the frequency of alcohol consumption by card users was also down by about 25 per cent among those who said they were drinkers ­before the trials began.

Those not on welfare saw even greater benefits, with an average of 41 per cent of non-participant community members across the two trial sites reporting a ­reduction in the drinking of alcohol in their area since the trial started. The report concluded that, overall, the card “has been effective in reducing alcohol consumption, illegal drug use and gambling — establishing a clear ‘proof-of-concept’ and meeting the necessary preconditions for the planned medium-term outcomes in relation to reduced levels of harm related to these behaviours”.

However the audit, undertaken by ORIMA Research, found that despite the community improvements, many people remained unhappy with the welfare restrictions, with about half saying it had made their lives worse, and 46 per cent reporting they had problems with the card.

This view was reversed in the wider community, with 46 per cent of non-participants saying the trial had made life in their community better, and only 18 per cent reporting that it had made life worse.

Many of the reported problems with the card were attributed to user error or “imperfect knowledge and systems” among some merchants. Of the 32,237 declined transactions between April and September last year, 86.2 per cent were because of user error, with more than half found to be because account holders had insufficient funds.

While there was a large amount of anecdotal evidence in favour of the card, there were also reports of a rise in humbugging — where family members are harassed for money — and some reports of an increase in crime linked to the need for cash, including prostitution.

Human Services Minister Alan Tudge said while the card was not a “panacea”, it had led to stark improvements in the trial communities, warranting an extension of the card, despite it not being popular with all welfare recipients. However, he stressed that no decision had been made to expand the card to new sites, which would require legislation.

“Inevitably, people would prefer to have fewer restrictions than more restrictions, particularly if you are an alcoholic, but the evaluation and the data shows that it is having a positive net impact on reducing alcoholism, gambling and illicit substance abuse,” Mr Tudge said. “The rights of the community, of the children and of elderly citizens to live in a safe community are equally important as the rights of welfare recipients.”

The government has introduced the card only to regions where it has the support of community leaders, allowing the Coalition to secure the backing of Labor for the two trial sites despite opposition from the Greens and the Australian Council of Social Service.

Liberal MP Melissa Price, who represents the vast West Australian regional electorate of Durack, said yesterday she was hopeful the card could be rolled out across the Kimberley, the Pilbara and the Goldfields, estimating that about half of the 52 councils in her electorate had expressed an interest in signing up.

“I know it is not popular with everybody, but we are in government and we need to make these decisions to improve people’s lives; if we don’t make changes, nothing changes,” Ms Price said.

Cashless Debit Card Trial – Overview

The Commonwealth Government is looking at the best possible ways to provide support to people, families and communities in locations where high levels of welfare dependence exist alongside high levels of harm related to drug and alcohol abuse.

The Cashless Debit Card Trial is aimed at finding an effective tool for supporting disadvantaged communities to reduce the consumption and effects of drugs, alcohol and gambling that impact on the health and wellbeing of communities, families and children.

How the cashless debit card works

The cashless debit card looks and operates like a normal bank card, except it cannot be used to buy alcohol or gambling products, or to withdraw cash.

The card can be used anywhere that accepts debit cards. It will work online, for shopping and paying bills. The Indue website lists the approved merchants (link is external) and excluded merchants (link is external) for the trial.

Who will take part in the trial?

Under the trial, all recipients of working age income support payments who live in a trial location will receive a cashless debit card.

The full list of included payments is available on the Guides to Social Security Law website.

People on the Age Pension, a veteran’s payment or who earn a wage can volunteer to take part in the trial. Information on volunteering for the trial is available. Application forms for people who wish to volunteer can be downloaded from the Indue website (link is external).

How will it affect Centrelink payments?

The trial doesn’t change the amount of money a person receives from Centrelink. It only changes the way in which people receive and spend their fortnightly payments:

  • 80 per cent is paid onto the cashless debit card
  • 20 per cent is paid into a person’s regular bank account.

Cashless debit card calculator

To work out how much will be paid onto your cashless debit card, enter your fortnightly payment amount into the following calculator.

Enter amount of fortnightly Centrelink payment Calculate

Money on the card 

Use it for:

  • Groceries
  • Pay bills
  • Buy clothes
  • Travel
  • Online

Anywhere with eftpos except:

  • No grog
  • No gambling
  • No cash

   Note: 100% of lump sum payments will be placed on the card. More information is available on the Guides to Social Security Law website.

More information

For more information, email debitcardtrial@dss.gov.au (link sends e-mail) or call 1800 252 604

This weeks NACCHO Aboriginal Health News Alerts will  include

Wednesday Job alerts Thursday NACCHO Members Good News

How to submit ? Email to Colin Cowell NACCHO Media   4.30 pm  day before publication

NACCHO Aboriginal Health and #Alcohol : Draft terms of reference for a another comprehensive review of alcohol policy in the #NT

 ” The Northern Territory has the second highest alcohol consumption in the world. Misuse of alcohol has devastating health and social consequences for NT Aboriginal communities.

APO NT believes that addressing alcohol and drug misuse, along with the many health and social consequences of this misuse, can only be achieved through a multi-tiered approach.

APO NT supports evidence based alcohol policy reform, including:

  • Supply reduction measures
  • Harm reduction measures, and
  • Demand reduction measures.

To address alcohol and drug misuse within Aboriginal and Torres Strait Islander communities, the social and structural determinants of mental health must be addressed,

Parliamentary Inquiry into the Harmful use of Alcohol in Aboriginal Communities

On 17 April 2014, APO NT submitted their written evidence to the House of Representatives Standing Committee on Indigenous Affairs on the Inquiry into the harmful use of alcohol in Aboriginal and Torres Strait communities.

The APO NT submission made 16 recommendations to the committee: SEE INFO Here

Read  NACCHO Alcohol and other drugs 164 Articles over 5 years HERE

RESPONSIBLE ALCOHOL POLICY =

A SAFER COMMUNITY :  NT Government Press Release 10 March 2017

The Health Minister Natasha Fyles today released draft terms of reference for a comprehensive review of alcohol policy in the Northern Territory.

Minister Fyles said the Government was determined to tackle the cost of alcohol abuse on our community and the review will give all Territorians an opportunity to have their voices heard.

“We recognise that, while everyone has the right to enjoy a drink responsibly, alcohol abuse is a significant cause of violence and crime in our community,” Ms Fyles said.

“All Territorians have the right to feel safe, to have their property, homes and businesses secure from damage and theft.

“They also have the right to access health, police and justice services, without having critical resources diverted by the crippling effects of alcohol abuse.

“That’s why Territory Labor has consistently advocated, and implemented, a range of policies to reduce the harm caused by alcohol abuse.

“When last in Government we implemented the Banned Drinker Register (BDR), described by Police as the best tool they had to fight violent crime.

“In Opposition we were clear we would reinstate the BDR and impose a moratorium on new takeaway licences.

“Since coming to Government we have:

  • worked efficiently across agencies to bring back the BDR by September 1
  • imposed a moratorium on new takeaway liquor licences (except in exceptional circumstances) – October 2016
  • strengthened legislation to ensure Sunday trade remains limited – November 2016
  • limited the floor space for take away alcohol stores – December 2016
  • introduced new Guidelines for liquor licensing to allow for public hearings – 2 February 2017

“While some of these policies aren’t popular, their effectiveness is backed by evidence.

“This review is an important chance for the community to have their say and to ensure that all facets of alcohol policy complement our determination to make the Territory safer.

“An expert panel will be commissioned to look at alcohol policies and alcohol legislation, reporting to government on:

  • evidence based policy initiatives required to reduce alcohol fuelled crime
  • ensuring safe and vibrant entertainment precincts
  • the provision of alcohol service and management in remote communities
  • decision-making under the Liquor Act
  • the density of liquor licences (concentration, type, number and location of liquor licences ) and the size of liquor outlets

“Broad public consultation will be undertaken as part of the review, with multiple avenues for interested people, groups and communities to put forward their views.

“I look forward to hearing from not only the loudest and most powerful voices in our community, but also the many women, children, families and communities who all too often bear the cost of alcohol abuse in the Northern Territory.”

The review will start in April with a report and recommendations delivered to government in late September 2017.

The government will then develop a response to the recommendations for the development of the Alcohol Harm Reduction Strategy and legislative reform agenda.

These will be released publicly along with the Expert Advisory Panel’s final report.

To view the draft terms of references go to: https://health.nt.gov.au/professionals/alcohol-and-other-drugs-health-professionals/alcohol-policies-and-legislation-review

Submissions are now being accepted at:  AODD.DOH@nt.gov.au

NACCHO #IWD2017 Aboriginal Women’s #justjustice :Indigenous, disabled, imprisoned – the forgotten women of #IWD2017

 

” Merri’s story is not uncommon. Studies show that women with physical, sensory, intellectual, or psychosocial disabilities (mental health conditions) experience higher rates of domestic and sexual violence and abuse than other women.

More than 70 per cent of women with disabilities in Australia have experienced sexual violence, and they are 40 per cent more likely to face domestic violence than other women.

Indigenous women are 35 times more likely to be hospitalised as a result of domestic violence than non-Indigenous women. Indigenous women who have a disability face intersecting forms of discrimination because of their gender, disability, and ethnicity that leave them at even greater risk of experiencing violence — and of being involved in violence and imprisoned

Kriti Sharma is a disability rights researcher for Human Rights Watch

This is our last NACCHO post supporting  International Women’s Day

Further NACCHO reading

Women’s Health ( 275 articles )  or Just Justice  See campaign details below

” In-prison programs fail to address the disadvantage that many Aboriginal and Torres Strait Islander prisoners face, such as addiction, intergenerational and historical traumas, grief and loss. Programs have long waiting lists, and exclude those who spend many months on remand or serve short sentences – as Aboriginal and Torres Strait Islander people often do.

Instead, evidence shows that prison worsens mental health and wellbeing, damages relationships and families, and generates stigma which reduces employment and housing opportunities .

To prevent post-release deaths, diversion from prison to alcohol and drug rehabilitation is recommended, which has proven more cost-effective and beneficial than prison , International evidence also recommends preparing families for the post-prison release phase. ‘

Dying to be free: Where is the focus on the deaths occurring post-prison release? Article 1 Below

Article from Page 17 NACCHO Aboriginal Health Newspaper out Wednesday 16 November , 24 Page lift out Koori Mail : or download

naccho-newspaper-nov-2016 PDF file size 9 MB

As the world celebrates International Women’s Day, this week  I think of ‘Merri’, one of the most formidable and resilient women I have ever met.

A 50-year-old Aboriginal woman with a mental health condition, Merri grew up in a remote community in the Kimberley region of Western Australia. When I met her, Merri was in pre-trial detention in an Australian prison.

It was the first time she had been to prison and it was clear she was still reeling from trauma. But she was also defiant.

“Six months ago, I got sick of being bashed so I killed him,” she said. “I spent five years with him [my partner], being bashed. He gave me a freaking [sexually transmitted] disease. Now I have to suffer [in prison].”

I recently traveled through Western Australia, visiting prisons, and I heard story after story of Indigenous women with disabilities whose lives had been cycles of abuse and imprisonment, without effective help.

For many women who need help, support services are simply not available. They may be too far away, hard to find, or not culturally sensitive or accessible to women.

The result is that Australia’s prisons are disproportionately full of Indigenous women with disabilities, who are also more likely to be incarcerated for minor offenses.

For numerous women like Merri in many parts of the country, prisons have become a default accommodation and support option due to a dearth of appropriate community-based services. As with countless women with disabilities, Merri’s disability was not identified until she reached prison. She had not received any support services in the community.

Merri has single-handedly raised her children as well as her grandchildren, but without any support or access to mental health services, life in the community has been a struggle for her.

Strangely — and tragically — prison represented a respite for Merri. With eyes glistening with tears, she told me: “[Prison] is very stressful. But I’m finding it a break from a lot of stress outside.”

Today, on International Women’s Day, the Australian government should commit to making it a priority to meet the needs of women with disabilities who are at risk of violence and abuse.

In 2015, a Senate inquiry into the abuse people with disabilities face in institutional and residential settings revealed the extensive and diverse forms of abuse they face both in institutions and the community. The inquiry recommended that the government set up a Royal Commission to conduct a more comprehensive investigation into the neglect, violence, and abuse faced by people with disabilities across Australia.

The government has been unwilling to do so, citing the new National Disability Insurance Scheme (NDIS) Quality and Safeguard Framework as adequate.

While the framework is an important step forward, it would only reach people who are enrolled under the NDIS. Its complaints mechanism would not provide a comprehensive look at the diversity and scale of the violence people with disabilities experience, let alone at the ways in which various intersecting forms of discrimination affect people with disabilities.

The creation of a Royal Commission, on the other hand, could give voice to survivors of violence inside and outside the NDIS. It could direct a commission’s resources at a thorough investigation into the violence people with disabilities face in institutional and residential settings, as well as in the community.

The government urgently needs to hear directly from women like Merri about the challenges they face, and how the government can do better at helping them. Whether or not there is a Royal Commission, the government should consult women with disabilities, including Indigenous women, and their representative organizations to learn how to strengthen support services.

Government services that are gender and culturally appropriate, and accessible to women across the country, can curtail abuse and allow women with disabilities to live safe, independent lives in the community.

Kriti Sharma is a disability rights researcher for Human Rights Watch

 

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