NACCHO Aboriginal #MentalHealth and #SuicidePrevention : @ozprodcom issues paper on #MentalHealth in Australia is now available. It asks a range of questions which they seek information and feedback on. Submissions or comments are due by Friday 5 April.

 ” Many Australians experience difficulties with their mental health. Mental illness is the single largest contributor to years lived in ill-health and is the third largest contributor (after cancer and cardiovascular conditions) to a reduction in the total years of healthy life for Australians (AIHW 2016).

Almost half of all Australian adults have met the diagnostic criteria for an anxiety, mood or substance use disorder at some point in their lives, and around 20% will meet the criteria in a given year (ABS 2008). This is similar to the average experience of developed countries (OECD 2012, 2014).”

Download the PC issues paper HERE mental-health-issues

See Productivity Commission Website for More info 

“Clearly Australia’s mental health system is failing Aboriginal people, with Aboriginal communities devastated by high rates of suicide and poorer mental health outcomes. Poor mental health in Aboriginal communities often stems from historic dispossession, racism and a poor sense of connection to self and community. 

It is compounded by people’s lack of access to meaningful and ongoing education and employment. Drug and alcohol related conditions are also commonly identified in persons with poor mental health.

NACCHO Chairperson, Matthew Cooke 2015 Read in full Here 

Read over 200 Aboriginal Mental Health Suicide Prevention articles published by NACCHO over the past 7 years 

Despite a plethora of past reviews and inquiries into mental health in Australia, and positive reforms in services and their delivery, many people are still not getting the support they need to maintain good mental health or recover from episodes of mental ill‑health. Mental health in Australia is characterised by:

  • more than 3 100 deaths from suicide in 2017, an average of almost 9 deaths per day, and a suicide rate for Indigenous Australians that is much higher than for other Australians (ABS 2018)
  • for those living with a mental illness, lower average life expectancy than the general population with significant comorbidity issues — most early deaths of psychiatric patients are due to physical health conditions
  • gaps in services and supports for particular demographic groups, such as youth, elderly people in aged care facilities, Indigenous Australians, individuals from culturally diverse backgrounds, and carers of people with a mental illness
  • a lack of continuity in care across services and for those with episodic conditions who may need services and supports on an irregular or non-continuous basis
  • a variety of programs and supports that have been successfully trialled or undertaken for small populations but have been discontinued or proved difficult to scale up for broader benefits
  • significant stigma and discrimination around mental ill-health, particularly compared with physical illness.

The Productivity Commission has been asked to undertake an inquiry into the role of mental health in supporting social and economic participation, and enhancing productivity and economic growth (these terms are defined, for the purpose of this inquiry, in box 1).

By examining mental health from a participation and contribution perspective, this inquiry will essentially be asking how people can be enabled to reach their potential in life, have purpose and meaning, and contribute to the lives of others. That is good for individuals and for the whole community.

Background

In 2014-15, four million Australians reported having experienced a common mental disorder.

Mental health is a key driver of economic participation and productivity in Australia, and hence has the potential to impact incomes and living standards and social engagement and connectedness. Improved population mental health could also help to reduce costs to the economy over the long term.

Australian governments devote significant resources to promoting the best possible mental health and wellbeing outcomes. This includes the delivery of acute, recovery and rehabilitation health services, trauma informed care, preventative and early intervention programs, funding non-government organisations and privately delivered services, and providing income support, education, employment, housing and justice. It is important that policy settings are sustainable, efficient and effective in achieving their goals.

Employers, not-for-profit organisations and carers also play key roles in the mental health of Australians. Many businesses are developing initiatives to support and maintain positive mental health outcomes for their employees as well as helping employees with mental illhealth continue to participate in, or return to, work.

Scope of the inquiry

The Commission should consider the role of mental health in supporting economic participation, enhancing productivity and economic growth. It should make recommendations, as necessary, to improve population mental health, so as to realise economic and social participation and productivity benefits over the long term.

Without limiting related matters on which the Commission may report, the Commission should:

  • examine the effect of supporting mental health on economic and social participation, productivity and the Australian economy;
  • examine how sectors beyond health, including education, employment, social services, housing and justice, can contribute to improving mental health and economic participation and productivity;
  • examine the effectiveness of current programs and Initiatives across all jurisdictions to improve mental health, suicide prevention and participation, including by governments, employers and professional groups;
  • assess whether the current investment in mental health is delivering value for money and the best outcomes for individuals, their families, society and the economy;
  • draw on domestic and international policies and experience, where appropriate; and
  • develop a framework to measure and report the outcomes of mental health policies and investment on participation, productivity and economic growth over the long term.

The Commission should have regard to recent and current reviews, including the 2014 Review of National Mental Health Programmes and Services undertaken by the National Mental Health Commission and the Commission’s reviews into disability services and the National Disability Insurance Scheme.

The Issues Paper
The Commission has released this issues paper to assist individuals and organisations to participate in the inquiry. It contains and outlines:

  • the scope of the inquiry
  • matters about which we are seeking comment and information
  • how to share your views on the terms of reference and the matters raised.

Participants should not feel that they are restricted to comment only on matters raised in the issues paper. We want to receive information and comment on any issues that participants consider relevant to the inquiry’s terms of reference.

Key inquiry dates

Receipt of terms of reference 23 November 2018
Initial consultations November 2018 to April 2019
Initial submissions due 5 April 2019
Release of draft report Timing to be advised
Post draft report public hearings Timing to be advised
Submissions on the draft report due Timing to be advised
Consultations on the draft report November 2019 to February 2020
Final report to Government 23 May 2020

Submissions and brief comments can be lodged

Online (preferred): https://www.pc.gov.au/inquiries/current/mental-health/submissions
By post: Mental Health Inquiry
Productivity Commission
GPO Box 1428, Canberra City, ACT 2601

Contacts

Inquiry matters: Tracey Horsfall Ph: 02 6240 3261
Freecall number: Ph: 1800 020 083
Website: http://www.pc.gov.au/mental-health

Subscribe for inquiry updates

To receive emails updating you on the inquiry consultations and releases, subscribe to the inquiry at: http://www.pc.gov.au/inquiries/current/mentalhealth/subscribe

 

 Definition of key terms
Mental health is a state of wellbeing in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.

Mental illness or mental disorder is a health problem that significantly affects how a person feels, thinks, behaves and interacts with other people. It is diagnosed according to standardised criteria.

Mental health problem refers to some combination of diminished cognitive, emotional, behavioural and social abilities, but not to the extent of meeting the criteria for a mental illness/disorder.

Mental ill-health refers to diminished mental health from either a mental illness/disorder or a mental health problem.

Social and economic participation refers to a range of ways in which people contribute to and have the resources, opportunities and capability to learn, work, engage with and have a voice in the community. Social participation can include social engagement, participation in decision making, volunteering, and working with community organisations. Economic participation can include paid employment (including self-employment), training and education.

Productivity measures how much people produce from a given amount of effort and resources. The greater their productivity, the higher their incomes and living standards will tend to be.

Economic growth is an increase in the total value of goods and services produced in an economy. This can be achieved, for example, by raising workforce participation and/or productivity.

Sources: AIHW (2018b); DOHA (2013); Gordon et al. (2015); PC (2013, 2016, 2017c); SCRGSP (2018); WHO (2001).

An improvement in an individual’s mental health can provide flow-on benefits in terms of increased social and economic participation, engagement and connectedness, and productivity in employment (figure 1).

This can in turn enhance the wellbeing of the wider community, including through more rewarding relationships for family and friends; a lower burden on informal carers; a greater contribution to society through volunteering and working in community groups; increased output for the community from a more productive workforce; and an associated expansion in national income and living standards. These raise the capacity of the community to invest in interventions to improve mental health, thereby completing a positive reinforcing loop.

The inquiry’s terms of reference (provided at the front of this paper) were developed by the Australian Government in consultation with State and Territory Governments. The terms of reference ask the Commission to make recommendations to improve population mental health so as to realise higher social and economic participation and contribution benefits over the long term.

Assessing the consequences of mental ill-health

The costs of mental ill-health for both individuals and the wider community will be assessed, as well as how these costs could be reduced through changes to the way governments and others deliver programs and supports to facilitate good mental health.

The Commission will consider the types of costs summarised in figure 4. These will be assessed through a combination of qualitative and quantitative analysis, drawing on available data and cost estimates, and consultations with inquiry participants and topic experts. We welcome the views of inquiry participants on other costs that we should take into account.

 

NACCHO Aboriginal Health and #SuicidePrevention Crisis : Five Indigenous teenage girls between the ages of 12 and 15 years of age have taken their own lives in the past few days. Comments from @TracyWesterman @joewilliams_tew @cultureislife @GerryGeorgatos

 

” Five indigenous teenage girls between the ages of 12 and 15 years of age have taken their own lives in the past nine days.

The most recent loss was of a 12-year-old Adelaide girl who died last Friday.

Three of the other cases occurred in Western Australia and one was in Queensland.

The spate of deaths, first reported by The Australian, is believed to have began on January 3, when a 15-year-old girl from Western Australia died in Townsville Hospital from injuries caused by self-harm. She had been visiting relatives in the beachside town.

A 12-year-old girl took her own life in South Headland, a mining town in WA, the next day.

On January 6, a 14-year-old also took her own life in Warnum, an Aboriginal community in the Kimberley.

Another 15-year-old indigenous girl is believed to have taken her own life in Perth’s south last Thursday, according to The Australian.

A 12-year-old boy is also on life support after what is believed to have been a suicide attempt. He remains in Brisbane Hospital where he was flown for treatment from Roma on Monday.

From news.com.au see Part 1 Below

Graphic above NITV see Part 3 article below

– Readers seeking support and information about suicide prevention contact: Lifeline on 13 11 14, the Suicide Call Back Service on 1300 659 467 or NACCHO find an Aboriginal Medical Service here.

There are resources for young people at Headspace Yarn Safe.

Read over 128 Aboriginal Health and Suicide Prevention articles published by NACCHO over past 7 years 

We have enormous amounts of funding injected into this critical area; yet, suicides continue to escalate. Our Indigenous youth are dying by suicide at EIGHT times the rate of non-Indigenous children and it is only right that we ask why this level of funding has had little to no impact.

There are actually two tragedies here; the continued loss of the beautiful young lives through suicide, and secondly, that all efforts to fund an adequate response capable of applying the science of what prevents suicide have failed.

I am as concerned that the primary focus is on encouraging people to simply ‘talk’ about suicide without the clinical and cultural best practice programs and therapies available to respond to this awareness raising, particularly in our remote areas.

Wasted opportunities for prevention are like an endless cycle in which money is thrown at band aid, crisis driven, reactive and ill-informed responses that disappear as fast as the latest headlines.

It is time to start demanding evidence of what works when we look at funded programs. Until we can get these answers, rates will continue to escalate.” 

Dr Tracy Westerman is a proud Njamal woman from the Pilbara region of Western Australia. She holds a Post Graduate Diploma in Psychology, a Master’s Degree in Clinical Psychology and Doctor of Philosophy (Clinical Psychology).

WEBSITE 

She is a recognised world leader in Aboriginal mental health, cultural competency and suicide prevention achieving national and international recognition for her work. This is despite coming from a background of disadvantage and one in which she had to undertake most of her tertiary entrance subjects by Distance Education. 2018 Western Australian of the Year

See Part 2 Below

” When a Suicide occurs; we are constantly telling people to ‘speak up’ when they aren’t well – it’s very easy to say that to people, but when you are hurting mentally, you can’t speak up, you don’t tell people yr not well and you pretend everything is ok whilst slowly dying inside!!

What’s stopping you from reaching in to help??

Don’t wait for people to speak up; start paying more attention to others; watch their behaviours, listen to how they respond.

If every person in the world pays attention to those close; family, kids, relatives, friends, work colleagues, team mates – then every person will be able to notice when someone isn’t well.

If we are not noticing, then I’m sorry, but we are not paying enough attention.

We are losing too many lives, every statistic is a person – don’t wait for others to reach out; reach in and help them when they feel silenced and it’s too hard for them to talk!!!

It starts with us – are we paying enough attention?

Joe Williams : Although forging a successful professional sporting career, Joe battled the majority of his life with suicidal ideation and Bi Polar Disorder. After a suicide attempt in 2012, Joe felt his purpose was to help people who struggle with mental illness. Joe is also an author having contributed to the book Transformation; Turning Tragedy Into Triumph & his very own autobiography titled Defying The Enemy Within – available in the shop section of this site.

Website 

In 2017 Joe was named as finalist in the National Indigenous Human Rights Awards for his work with suicide prevention and fighting for equality for Australia’s First Nations people and in 2018 Joe was conferred the highest honour of Australia’s most eminent Suicide Prevention organisation, Suicide Prevention Australia’s LiFE Award for his outstanding work in communities across Australia.

 “How can a child of 10 feel such ­despair that she would end her life? What must she have seen, heard and felt in such a short life to ­destroy all hope? What had she lived? How do her parents, her siblings, their communities live with the pain? How can they possibly endure the all-consuming grief of losing their child?

Now imagine if this were your child, your family, your close-knit community. Wouldn’t there be outrage, a wailing from the heart of overwhelming grief?

This is what is happening to ­indigenous children and young people in our country.”

See Part 4 Below : Love and hope can save young Aborigines in despair 

Published The Australian 17 January 

Download Press Release : culture is life press release 17 jan

Part 1 : Five indigenous girls take their own lives in nine-day period

“Suicides are predominantly borne of poverty and disparities,” said Gerry Georgatos, who heads up the federal government’s indigenous critical response team.

Writing in The Guardian, he described rural communities as being disparate from the rest of Australian society, where high incarceration rates infect communities, few complete schooling, employment is scant and “all hope is extinguished”.

He also said sexual abuse and self harm played a role in the suicides, with the recent spate taking the lives of young girls being “notable”.

The West Australian Government has advised that co-ordinators have been installed in every region of the state, alongside Aboriginal mental health programs.

These programs were introduced after a 2007 inquiry into 22 suicides across the Kimberley. The inquiry found the suicide rate was not due to mental illness such as “bipolar or schizophrenia” and that Aboriginal suicide was not for the most part attributable to individual mental illness.

It noted that the suicide rate, which had “doubled in five years”, was attributable to a governmental failure to respond to many reports.

Part 2 : It is time to start demanding evidence of what works when we look at funded programs. Until we can get these answers, rates will continue to escalate.

The Minister for Indigenous Affairs has recently shared that the Commonwealth Government has allocated $134M of funding into Indigenous suicide prevention. If you look at the current suicide statistics this crudely translates to $248,000 per suicide death annually – without adding State funding into the mix.

We have enormous amounts of funding injected into this critical area; yet, suicides continue to escalate. Our Indigenous youth are dying by suicide at EIGHT times the rate of non-Indigenous children and it is only right that we ask why this level of funding has had little to no impact.

I am not privy to how funding decisions are made and I have ZERO funding for my services, research or programs but the gaps are sadly too clear and have been for decades.

As a country facing this growing tragedy, we still have no nationally accepted evidence-based programs across the spectrum of early intervention and prevention activities. This needs to be our first priority.

Currently, and staggeringly, funding does not require that programs demonstrate a measurable reduction in suicide and mental health risk factors in the communities in which they are delivered. This needs to be our second priority.

What this means is that we are not accumulating data or research evidence of ‘what works’. If we don’t evaluate programs and accumulate evidence, we have no hope of informing future practice to halt the intergenerational transmission of suicide risk. This needs to be a third priority.

Additionally, we are the only Indigenous culture in the world that has a virtual absence of mental health prevalence data. Until we have a widely accepted methodology for the screening of early stages of mental ill health and suicide risk, early intervention will remain elusive; evidence based programs cannot be determined and treatment efficacy not able to be monitored. This needs to be our fourth priority.

There are actually two tragedies here; the continued loss of the beautiful young lives through suicide, and secondly, that all efforts to fund an adequate response capable of applying the science of what prevents suicide have failed.

When suicide becomes entrenched, approaches need to be long term and sustainable. Report after report has pointed to the need for ‘evidence-based approaches’ but has anyone questioned why this continues to remain elusive?

When you have spent your life’s work working in Indigenous suicide prevention and self funding evidence based research, as I have, I can also tell you that despite extensive training the complex and devastating issue of suicide prevention challenges you at every level.

It challenges your core values about the right of people to choose death over life; it stretches you therapeutically despite your training in best practice; and it terrifies you that you have missed something long after you have left your at-risk client.

The nature of suicide risk is that it changes. Being able to predict and monitor suicide risk takes years and years of clinical and cultural expertise and well-honed clinical insight and judgement. Throw culture into the mix and this becomes a rare set of skills held by few in this country. Indeed, a senate inquiry in December found that not only are services lacking in remote and rural areas of Australia, but culturally appropriate services were often not accessible.

Funding decisions that are unsupported by clinical and cultural expertise in suicide prevention must be challenged and redirected in the best way possible. Toward the evidence.

Instead we have inquiry after inquiry, consultation after consultation, statistics and mortality data quoted by media purely to satisfy the latest ‘click bait’ 24-hour news cycle headline. On top of that, there are continued calls from those who receive large amounts of funding that they need “more funding”.

I am as concerned that the primary focus is on encouraging people to simply ‘talk’ about suicide without the clinical and cultural best practice programs and therapies available to respond to this awareness raising, particularly in our remote areas.

Wasted opportunities for prevention are like an endless cycle in which money is thrown at band aid, crisis driven, reactive and ill-informed responses that disappear as fast as the latest headlines.

It is time to start demanding evidence of what works when we look at funded programs. Until we can get these answers, rates will continue to escalate.

The time is now to make these changes and ask these questions. I am up for the challenge and have spent my life building and self-funding evidence of what can work to halt these tragic rates in Aboriginal communities and amongst our people. Will the decision makers join me in finding evidence-based ways to address this or continue to throw money at approaches and programs that are simply not working?

Aboriginal people deserve better, our future generations deserve better

Part 3 NITV  Indigenous youth suicide at crisis point

Originally published HERE 

Communities and families are mourning the loss of five young Aboriginal girls who took their own lives in separate incidents in Western Australia, Townsville and Adelaide this year.

In early January, a 15-year old girl from Western Australia died two-days after self-harming on a visit to Townsville.

Last Sunday, a 12-year old girl died in the Pilbara mining town of Port Hedland, followed by a 14-year old girl in the East Kimberley community of Warmun last Monday.

Another was a 15-year-old Noongar girl from Perth who died last Thursday and a fifth was a 12-year-old girl from a town near Adelaide who died last Friday.

Another 12-year-old boy is reportedly on life support at a hospital in Brisbane after what is suspected to be an attempted suicide. He was flown from Roma to Brisbane yesterday, The Australian reports.

The Director of Suicide Prevention Australia, Vanessa Lee, is calling on the federal government to support an Aboriginal and Torres Strait Islander suicide prevention strategy tailored specifically to meet the needs of Indigenous people.

“When are we going to see change… when are we going to see a national Indigenous suicide prevention strategy supported by the COAG, delivering for Aboriginal and Torres Strait Islander people by Aboriginal and Torres Strait Islander people,” Ms Lee said.

“We need to remember that Indigenous people know the solutions. We know the answers. We didn’t write the Redfern Statement  for a joke… funding needs to be put into Indigenous organisations, into Indigenous hands.”

Aboriginal people know the answers

“We need to remember that Indigenous people know the solutions, we know the answers” – Vanessa Lee

National coordinator for the National Child Sexual Abuse Trauma Recovery Project, Gerry Georgatos, told NITV News the recently reported suicides have weighed heavily on the affected families and communities.

“These incidences… have impacted –psycho-socially– the family. Hurt them to the bone. There are no words for anyone’s loss,” he said.

“To lose a child impacts ways that no other loss does, and to lose a child is a haunting experience straight from the beginning and doesn’t go away.”

South-western Noongar woman, Grace Cockie, lost her 16-year old daughter to suicide last March in their home in Perth.

“It was a devastating experience, I don’t ever want to go through that again and I don’t want no one else to go through that,” Ms Cockie told NITV News.

“She went to school every day. She loved going to school, hanging out with her friends, playing football with her Aunties.

“Part of us is gone… No one is going to replace her,” she said.

Ms Cockie wants other parents to encourage their children to speak-out if they feel unwell and said there needs to be more mental health initiatives which offer culturally supportive help for Aboriginal youth.

“Keep an eye on them and talk to them all the time,” she said.

“There’s a lot of avenues for whitefella kids, you know, and with our Aboriginal kids they’re probably too scared… they probably think they (mental health workers) won’t help them,” she said.

The Kimberley region faces alarming suicide rates

The deaths come as WA waits on a final report from an inquest into 13 Indigenous youth suicides in the Kimberley region from 2012 to 2016.

The Kimberley region has the highest Indigenous suicide rates in Australia – not just for Aboriginal youth, but for the entire Aboriginal and Torres Strait Islander population.

The inquest by state coroner Ros Fogliani is expected to table findings early this year.

The Australian Bureau of Statistics found last month that Indigenous children aged between five and 17 died from suicide-related deaths at five times the rate of non-Indigenous children.

This rate was 10.1 deaths by suicide per 100,000 between 2013 and 2017, compared with 2 deaths by suicide per 100,000 for non-Indigenous children.

One in four people who took their own life before turning 18 were Aboriginal children.

Mr Georgatos said nine out of 10 suicides in the Kimberley region have involved Aboriginal and Torres Strait Islander people.

A senate inquiry in December found that not only are services lacking in remote and rural areas of Australia, but culturally appropriate services were often not accessible.

The inquiry found that the lack of culturally supportive services is leaving Aboriginal and Torres Strait Islander people accessing mental health services at a far lower rate than non-Indigenous people.

Mr Georgatos said that services aren’t accessible to the majority of people living in the Kimberley, saying that suicide prevention has come down to community support as opposed to accessible mental health professionals.

“Many of these communities [in the Kimberley region] have no services… It is forever community buy-in to support, to have a watchful eye …, but people become exhausted,” he said.

Mr Georgatos said he believes investing in local workforces that possess local cultural knowledge and training these workers to understand intense psychosocial support for young adults is the way forward.

Poverty the ‘driver’ towards suicide

Poverty and sexual abuse in the Kimberley region may be a leading factor for youth suicide, according to Mr Georgatos.

“Nearly 100 per cent of First Nations suicides… are of people living below the poverty line,” he said.

“Crushing poverty [in Kimberley and Pilbara] is the major driver of suicidal ideation, of distorted thinking, of unhappiness, of watching the world pass one by right from the beginning of life.

“One-eighth of First Nations people living in the Kimberley live in some form of homelessness… sixty per cent live below the poverty line.”

A Medical Journal of Australia report in 2016 showed seven per cent of all people living in the Kimberley were homeless.

Last year, forty per cent of youth suicides in Australia were Aboriginal and Torres Strait Islanders.

“It is a humanitarian crisis… one-third of those suicides is identified as children of sexual abuse, and we don’t have the early intervention to disable the trauma of child sexual abuse,” Mr Georgatos said.

“We don’t have the early intervention and the trauma recovery for them, we don’t have the outreaches for them but what we also don’t have is the talking up and calling out of sexual predation in communities.”

Mr Georgatos said he believes if we have education in communities about what young children should do if they were to ever be predated upon, it would reduce the child internalising their trauma which may lead to suicidal ramifications.

“What we need to do is we need to outreach more personal on the ground to outreach into these communities to support them into pathways where they can access education,” Mr Georgatos said.

“We need more psychosocial support, people just to spread the love… to keep people on a journey to a positive and strong pathway and to ordered thinking, not disordered thinking.”

“We need more psychosocial support, people just to spread the love” – Gerry Georgatos.

Government supported resources

Australian youth mental health organization, headspace, last week received a $47 million funding boost from the federal government.

Chief Executive Officer, Jason Trethowan, told SBS World News the organisation will be working closely with Indigenous communities thanks to the new funding.

“We know there are challenges around rural remoteness and often headspace hasn’t been there for them… that’s why we have a trial going on in the Pilbara region of Western Australia where there are actually headspace services without a headspace centre,” he said.

Indigenous health minister, Ken Wyatt, told NITV News the federal government will continue to invest $3.9 billion over the next three years (from 2018-22) in Primary Health Networks (PHNs) to commission regionally and culturally appropriate mental health and suicide prevention services, particularly in the Kimberley and the Pilbara regions.

Currently the key active programs in these regions include the government’s $4 million Kimberley Suicide Prevention Trial and the $2.2 million Pilbara headspace trial, which opened in April last year.

The Pilbara headspace trial was co-designed with local communities, including young people, service providers, community members and local Elders.

The Pilbara headspace team has staff located in Newman, Port Hedland and Karratha, with employees spending their time in schools, youth centres, Aboriginal Medical Services, community centres and other locations.

This allowing them to reach out to youth who may not typically engage with school or youth services, said Samara Clark, manager of headspace, Pilbara.

“It’s all about engagement first, building trust, building visibility,” she said.

“What we’re hoping for is positive help-seeking behaviour, where they feel safe and comfortable enough to come up to us,” she said.

Ms Clark encourages anyone who sees a headspace worker, who may be identified by their green t-shirts, to reach out to them for support.

“If a young person sees one of the team members around, even if a community member sees them, just go up and have a yarn … the team will talk to you then and there.”

– Readers seeking support and information about suicide prevention can contact: Lifeline on 13 11 14, the Suicide Call Back Service on 1300 659 467 or find an Aboriginal Medical Service here.

There are resources for young people at Headspace Yarn Safe.

Part 4 Love and hope can save young Aborigines in despair 

Published The Australian 17 January 

How can a child of 10 feel such ­despair that she would end her life? What must she have seen, heard and felt in such a short life to ­destroy all hope? What had she lived? How do her parents, her siblings, their communities live with the pain? How can they possibly endure the all-consuming grief of losing their child?

Now imagine if this were your child, your family, your close-knit community. Wouldn’t there be outrage, a wailing from the heart of overwhelming grief?

This is what is happening to ­indigenous children and young people in our country. And to parents and communities as our young people are dragged into a vortex of suicide by despair.

In a week, five Aboriginal girls have taken their own lives — prompting a warning from one ­researcher that indigenous children and young people could soon comprise half of all youth suicides. Researcher Gerry Georgatos says poverty is a major issue in suicide among young indigenous Australians, but also that sexual predation is a factor in a third of cases. My heart breaks for these girls and their families and their unimaginable pain.

The organisation that I lead, Culture is Life, wants our country to treat this as the national emergency it is. We want every Australian to think about the devastating toll of indigenous youth suicide and to help us to stop it. Urgently.

Instead of expecting youth suicide, we must take a stand of ­defiance against it. Unfortunately, across Australia, suicide and self-harm are on the increase. This is being driven by a deep sense of hopelessness and despair, by a lack of belonging and connection, and in some cases by the abuse young people have experienced.

Indigenous young people today are living with the consequences of acts committed by other human beings in charge of policies and laws through more than two centuries of trauma and dispossession. This history haunts us. It lives within us. It’s there in our families’ experiences of stolen land, children and wages, of killings and cruelty and abuses of power. They see this history in their grandparents’ eyes, if they are still alive. They discover it in their family stories of exclusion and unfairness.

And when they, too, feel the slap and sting of racism and ignorance when it comes at them as abuse in the schoolyard, or they sense the awkwardness of others in understanding their Aboriginality, or someone’s eyes won’t meet theirs, this history becomes the present. It eats away at them — at their confidence, their self-belief and their self-love — every time they are the target of racism and discrimination or at the end of ignorance and apathy, and when they are directly affected by abuse.

The task of repair and healing requires a powerful counterforce to all that.

We can tackle this together. We can begin to repair these wounds through daily acts of love and hope in communities, schools, universities and workplaces. Daily acts that send a message to our young people that there is belonging, strength and pride in indigenous peoples and cultures.

We are asking all Australians to show our young people that there is cause for love and hope. Show them that you share a deep sense of pride in who they are, in our inspiring cultures and in our strength. Tell them they matter, by showing your pride in Aboriginal and Torres Strait Islander cultures. Share it with #loveandhope and #cultureislife.

Because when our children have love and hope in their lives, it combats helplessness and reduces the risk of self-harm. It gives them the support and courage required to take the steps they need and want to take. And when the broader community shows our kids that they care, it deepens our connections as Australians. One of the things I love most about my people is our willingness to invite ­others to connect with us and to experience our culture. And the only reciprocal ask is to take up the invitation to connect. Once you take up the invitation, you will be an ally in rectifying some of the most haunting statistics for our country.

We know from the research, and from psychologists who work with young indigenous people, that such small gestures of affirmation can make a powerful difference to their safety. Tanja Hirvonen, an Aboriginal psychologist, says many people don’t know the power of “warm interactions and warm gestures” at just the right moment to avert disaster.

She hears time and again from young people that “there was someone there for them at a particularly tricky time in their life … a coach or a teacher or an aunt or a grandmother … someone has said something pivotal to them at a particular time. Those warm ­interactions matter.”

Culture and connection are powerful protective factors against indigenous youth suicide. That’s why the work of Aboriginal leaders across the country in ­cultural pride, revitalisation and renewal programs is so crucial. People such as Yuin elder Uncle Max Harrison, who is teaching young men the ways of the old people, their lore, their duties, their responsibilities. And, as he does so, he is building their pride, strength and resilience.

So that they walk taller, knowing who they are, that they are cared for and supported and connected to this land. It’s a model for us all to feel more connected as Australians.

We cannot fail to act when we are able to save children and young people from the agony and hopelessness and torment that leads to suicide. We can affirm them in who they are, and in so doing, we can save lives.

Belinda Duarte, a Wotjobaluk woman, is chief executive of Culture is Life.
For help: Lifeline 13 11 14, Beyondblue 1300 22 4636.

NACCHO Aboriginal #MentalHealth #HOSW8 : Health Minister @GregHuntMP releases  terms of reference for the Productivity Commission’s inquiry into mental health but no specific reference to the needs of young people, Aboriginal and  CALD and LGBTIQ communities

The Coalition Government has this week released the terms of reference for the Productivity Commission’s inquiry into mental health and announced the appointment of an Associate Commissioner for the inquiry.

The Federal Government will establish a Productivity Commission Inquiry into the role of mental health in the Australian economy and the best ways to support and improve national mental wellbeing.

Mental health challenges not only have a devastating personal impact, but significantly affect individuals’ employment and productivity. This has an effect on incomes, living standards, physical wellbeing, and social connectedness.

Mental health also affects businesses, the hospital system, and social services, and therefore has a large effect on Australia’s economy.”

See Part 1 below for Terms of Reference

Productivity Commission’s inquiry into mental health website

Read over 200 NACCHO Aboriginal Mental Health articles published over past 6 years : Subscribe 

” The Minister for Health promised the Inquiry would begin in October but delayed the release of the Terms of Reference until today.

Labor wrote to Minister Hunt and Treasurer Frydenberg seeking input into the Terms of Reference of this important Inquiry.

We are pleased the Inquiry will have regard to previous work by the National Mental Health Commission and the Productivity Commission but are disappointed emphasis on prevention, early intervention and the need for data has not been explicitly mentioned.Labor also hoped to see specific reference to the needs of young people, Aboriginal and Torres Strait Islanders , Culturally and Linguistically Diverse (CALD ) and Lesbian, Gay, Bisexual, Transgender, Intersex, Queer/Questioning and Allied ( LGBTIQ)  communities in the Terms of Reference.

We are disappointed that the needs of these communities have not been explicitly addressed in the Terms of Reference despite the fact that, sadly, mental ill health and suicide continues to disproportionately impact these groups ” 

Federal Opposition Press Release see Part 2

The Commission will consult with Indigenous leaders including the National Mental Health Commission’s Professor Helen Milroy and Professor Ngiare Brown on their expertise.

Four million Australians deal with some form of chronic or episodic mental health condition. As well as the individuals affected and people close to them, poor mental health also affects businesses, the hospital system, emergency services and social services.”

Minister for Health, Greg Hunt said he has consulted with state and territory health and mental health ministers as well as the National Mental Health Commission to seek their views on the scope and terms of reference of the inquiry.

Part 1 The terms of reference will include:

  •  Examining the effect of supporting mental health on economic and social participation, productivity and the Australian economy;
  • Examining how sectors beyond health, including education, employment, social services, housing and justice can contribute to improving mental health and economic participation and productivity;
  • Examining the effectiveness of current programs and initiatives across all jurisdictions to improve mental health, suicide prevention and participation, including by governments, employers and professional groups;
  • Assessing whether the current investment in mental health is delivering value for money and the best outcomes for individuals, their families, society and the economy;
  •  Drawing on domestic and international policies and experience, where appropriate; and
  • Developing a framework to measure and report the outcomes of mental health policies and investment on participation, productivity and economic growth over the long term.

To assist the Commission in undertaking this inquiry, Professor Harvey Whiteford has been appointed as an Associate Commissioner.

Professor Whiteford is a member of the National Mental Health Commission’s Advisory Board, Professor of Population Mental Health at the University of Queensland, and Professor of Global Health at the Institute of Health Metrics and Evaluation, University of Washington.

He brings extensive experience to the role, having worked on mental health policy with the World Health Organisation, World Bank, OECD and governments in Europe, Africa and Asia. Authorised by Greg Hunt MP, Liberal Party of Australia, Somerville, Victoria.

The two Commissioners overseeing the inquiry are Dr Stephen King and Julie Abramson.

Treasurer Josh Frydenberg said: “The inquiry will be able to make recommendations as to how the Government can better support Australians living with mental illness, to enable them to lead fulfilling and contributing lives.”

The Commission will take submissions and will hold public consultations, including in regional areas.

All interested parties, including carers and patients, are encouraged to participate.

The inquiry will begin immediately and is due to report to Government within 18 months.

Part 2 Federal Opposition press release

While Labor welcomes the release of the Terms of Reference for the Productivity Commission Inquiry into Mental Health, we reiterate the Abbott-Turnbull-Morrison Government should not use this Inquiry to delay action in progressing reform that is needed.

The Productivity Commission inquiry will be important to understanding the social and economic costs in relation to mental health. But sadly there have already been delays to getting the Inquiry underway. Questions remain about why this Inquiry is being initiated now, 18 months after former National Mental Health Commission chairman Professor Allan Fels called for it.

The Minister for Health promised the Inquiry would begin in October but delayed the release of the Terms of Reference until today.

Labor wrote to Minister Hunt and Treasurer Frydenberg seeking input into the Terms of Reference of this important Inquiry. We are pleased the Inquiry will have regard to previous work by the National Mental Health Commission and the Productivity Commission but are disappointed emphasis on prevention, early intervention and the need for data has not been explicitly mentioned.

Labor also hoped to see specific reference to the needs of young people, ATSI, CALD and LGBTIQ communities in the Terms of Reference. We are disappointed that the needs of these communities have not been explicitly addressed in the Terms of Reference despite the fact that, sadly, mental ill health and suicide continues to disproportionately impact these groups.

Too often the Abbott-Turnbull-Morrison Government has played catch-up in this vital area of policy, approaching mental health reform from a piecemeal perspective. Australians living with mental ill health cannot afford more delays. The Productivity Commission Inquiry represents a real opportunity for reform and should not be squandered by this government.

The Morrison Government should be leading the states and territories with reform to ensure the 4 million Australians living with mental ill health get the vital support and services they need. Labor will be closely monitoring the progress of this important Inquiry.

Part 3 Background

Productivity Commission’s inquiry into mental health website

This comprehensive inquiry will reveal the true impact of mental illness on the economy, and provide recommendations on how the Government can most effectively improve population mental health, and social and economic participation.

The Federal Government will spend an estimated $4.7 billion this year on mental health. Once state and territory government funding is added to this, the investment in mental health rises to around $9 billion per year – that is equivalent to $1 million per hour – every hour of every day.

Treasurer Josh Frydenberg said: “It is crucial that we know that this funding is delivering the best possible outcomes for individuals and their families, and that is one of the issues the inquiry will investigate.”

Minister for Health, Greg Hunt, said he has worked closely with the Prime Minister and Treasurer to finalise the terms of reference and establish the inquiry.

“Every year around four million Australians deal with some form of chronic or episodic mental health condition. Sadly, one in five Australians affected by mental illness do not seek help because of stigma,” Minister Hunt said.

“I have consulted with state and territory health and mental health ministers to seek their views on the scope and terms of reference of the inquiry and have welcomed their support.

“As we enter Mental Health Week it is important that we continue to shine a light on mental health and work hard to ensure we are providing the best possible support to Australians living with mental illness.”

The Productivity Commission will undertake broad consultation, including holding hearings in regional Australia and inviting public submissions. It will then make recommendations on measures to improve population mental health to help people lead full and productive lives.

The inquiry is due to begin later this month and the final report should be provided to the Government within 18 months.

The Morrison Government is committed to making a difference and has made mental health a key pillar in our Long Term Health Plan.

Our commitment is also reflected in our extra $338.1 million investment in suicide prevention, research, and programs for older Australians in this year’s Budget.

Update

Representatives from more than 60 mental health organisations will meet with politicians at Parliament House today, Tuesday 27 November, to ask three key questions ahead of the 2019 Federal Election and Productivity Commission Inquiry.

The Mental Health Australia Parliamentary Advocacy Day will see key Ministers, Senators and MPs including Minister for Families and Social Services, The Hon Paul Fletcher MP Minister for Health The Hon Greg Hunt MP, and Shadow Minister for Ageing and Mental Health The Hon Julie Collins MP, meet with over 100 sector delegates to discuss mental health reform.

Advocacy efforts will focus on ensuring policy makers recognise the value of investment in mental health, asking parties to articulate their policies ahead of the election, address gaps in the NDIS, and keep funding programs that work while the Productivity Commission Inquiry is underway.

Mental Health Australia CEO Frank Quinlan says the timing is right for the sector as a whole to ask politicians to commit to expanding and reorienting mental health reform.

“Firstly, we will be asking the major parties to prepare standalone mental health policies as part of their 2019 election platforms and we will assess these policies ahead of the election,” said Mr Quinlan.

“We are looking for major parties to articulate their plans for systematically increasing investment in mental health services and programs over the coming decade, along with plans to address the social determinants of mental health.”

“Secondly, we will be asking for urgent commitments to address the major gaps that are opening up in psychosocial support and community based mental health as the NDIS is rolled out, and as related programs are being wound back.

“As we know, nearly 800,000 Australians report experiencing serious mental illness each year. Estimates suggest some 300,000 would benefit from individualised supports. However, only 64,000 will receive supports through the NDIS.”

“The current investments in ‘continuity of support’, new psychosocial support measures, and state-based community mental health, are inadequate to meet this demand. This issue continues to require urgent attention from policy- makers.”

“Thirdly, rather than waiting for the Productivity Commission’s report in 18 months’ time, we will be asking for continued investment in programs and services that are supported by evidence.”

“The KPMG and Mental Health Australia Report ‘Investing to Save’ provides an excellent starting point for this investment, with well documented initiatives – supported by the very best international evidence – with enormous potential to provide substantial return on investment to governments and the community.”

https://mhaustralia.org/sites/default/files/images…

The 2018 Mental Health Australia Parliamentary Advocacy Day and Members Policy Forum will be held at Parliament House, Canberra TODAY Tuesday 27 November from 9:30am.

NACCHO Aboriginal Health and #SuicidePrevention : #ATSISPC18 #refreshtheCTGRefresh Pat Turner CEO NACCHO Setting the scene panel : Health led solutions through Aboriginal Community Controlled Health #Leadership

” It is well established that Aboriginal led solutions deliver better outcomes.

Aboriginal community-controlled health services should be funded based on need and so that they can develop comprehensive suicide prevention initiatives with the communities they service. 

The Aboriginal and Torres Strait Islander Suicide Prevention Evaluation Project identifies successful Indigenous community led health led responses including providing positive health messages and mental health support underpinned by a cultural framework and tackling harmful drug and alcohol use.

These initiatives can be delivered by properly funded and supported Aboriginal Community Controlled Health Organisations.

I also believe in regular full health checks for at risk people so that critical issues that can impact on a persons wellbeing, like poor hearing, can be picked up and addressed early. 

We also know that mainstream mental health service provision for Aboriginal and Torres Strait Islander people across the country is inadequate and inappropriate.

Many people feel unsafe accessing the care they need.

Aboriginal Community Controlled Health Organisations should be priortised for funding to support our own people.” 

Pat Turner AM CEO NACCHO who is working with Aboriginal and Torres Strait Islander peak bodies across Australia to ask COAG for a seat at the table on the Closing the Gap Refresh: so that we get that policy right : Part 1 Below

Picture above @CroakeyNews : Prof Pat Dudgeon kicks off the keynote panel session: “Setting the scene”. #ATSISPC18. Prof Tom Calma, Prof Helen Milroy, and our CEO Pat Turner

See the #RefreshtheCTGRefresh Campaign post HERE

Read over 120 NACCHO Aboriginal Health and #SuicidePrevention articles published over last 6 years 

Suicide among Aboriginal and Torres Strait Islander communities is regularly in the media and public conversations. Often the focus is on an individual completed or attempted suicide or the negative statistics.

The second National Aboriginal and Torres Strait Islander Suicide Prevention Conference, to be held in Perth on November 20-21, will shift the focus to solutions identified by Indigenous people themselves. The program consists of only Indigenous people from Australia and internationally.

Our voices are important because it is our mob who understand what is going on in our communities best. We live and breathe it, with many of us either having considered taking our own lives, making an attempt or having had family members who have.

This is why the program includes a focus on community-based solutions. “

Summer May Finlay writes Part 2 below for Croakey 

Part 1 : Why an urgent need for action

  • Our people are more than twice as likely to commit suicide than other Australians.
  • Young Aboriginal and Torres Strait Islander men are the most at risk of suicide in Australia.
  • Those in remote area are more disproportionately affected
  • Suicide and self-inflicted injuries was the greatest burden of disease for our young people in 2011.
  • If, Western Australia’s Kimberley region was a country, it would have the worst suicide rate in the world, according to World Health Organisation statistics.
  • Rate of suicide for Aboriginal people in the Kimberley is seven times the rest of Australia.
  • This is not news to us: but it is unacceptable and it is why we are here today.

Aboriginal control

  • At the heart of suicide is a sense of hopelessness and powerlessness.
  • Our people feel this powerlessness at multiple levels, across multiple domains of our lives.
  • It is why we have the Uluru Statement from the Heart: a cry from Aboriginal and Torres Strait Islander peoples across the nation to have a say over matters that impact on us.
  • At the national level, it means a Voice to the Commonwealth Parliament and a full partnership between Indigenous people and governments on the Closing the Gap Refresh with COAG.
  • At the regional level, it is about the formation of partnerships – like in the Kimberley one on suicide prevention – working together and advocating as a region.
  • At the local level, it is about Aboriginal people being in control of the design and delivery of programs to their own people.
  • The importance of Aboriginal control or Indigenous led is highlighted consistently as a way to achieve better outcomes for our people.
  • This is also reinforced at the Kimberley Roundtable and in the Aboriginal and Torres Strait Islander Suicide Prevention Evaluation Project.
  • Community-led actions are the most effective suicide prevention measure for our people. This fundamental point cannot be ignored if the situation is to change.

Healing

  • Aboriginal suicide rates have been accelerating since 1980.
  • Aboriginal people did not have a word for “suicide” before colonisation.
  • To go forward, we must go back and identify and draw on those aspects of our culture that gives us strength and identity.
  • We also must heal by acknowledging and addressing the effects of intergenerational trauma.
  • Part of healing must include challenging the continuing impacts of colonisation on Indigenous peoples’ contemporary lives.
  • Aboriginal and Torres Strait Islander Suicide Prevention Evaluation Project identifies the success of Elder-driven, on-country healing for youth which has the dual effect of strengthening intergenerational ties as well as increasing cultural connection.
  • Red Dust Healing is another example of cultural reconnection achieving positive outcomes with people at risk.
  • The Healing Foundation also achieves similar outcomes with the same principles of empowerment and connection to culture.

A public policy crisis

  • Almost all Aboriginal people who commit suicide are living below the poverty line.
  • Other common factors are:
    • Aboriginal people who have been incarcerated and come out of prison with little to no hope on the horizon.
    • Aboriginal people who are homeless.
    • Aboriginal people who have been recently evicted from their public housing rentals.
    • Aboriginal people who are exposed to violence and alcohol misuse and suffer domestic abuse.
    • Aboriginal people who have multiple underlying health and metal health issues.
    • Aboriginal people who are young; males; and those who live in remote areas.
  • This tells us that we need a comprehensive public policy response to address suicide rates in our people – that suicide in our people is linked to our status and situation more broadly in Australia.
  • It is therefore unacceptable that the National Partnership Agreement on Remote Indigenous Housing has been allowed to lapse and no further investment has been agreed.
  • We must overturn and replace the Community Development Program that is leaving our young people completely disengaged.
  • We must also tackle the issues that lead to the greater incarceration of our peoples, with greater investment in ear health programs, employment and education.
  • It is why we must join the call for Newstart to be raised, so that our people who cannot find work, are not living in poverty.
  • And it is why myself and NACCHO are working with Aboriginal and Torres Strait Islander peak bodies across Australia to ask COAG for a seat at the table on the Closing the Gap Refresh: so that we get that policy right.
  • Whilst these matters can be overlooked in our efforts to respond to suicide in our people, and because it is difficult for governments, but they are fundamental drivers.

 .

Part 2 Follow #ATSISPC18 for news from National Aboriginal and Torres Strait Islander Suicide Prevention Conference : From Croakey 

The second National Aboriginal and Torres Strait Islander Suicide Prevention Conference will take place in Perth this week.

Summer May Finlay, who will cover the discussions for the Croakey Conference News Servicetogether with Marie McInerney, writes below that the focus will be on community-based solutions, as well as listening to young people and LGBTIQ+ sistergirls and brotherboys.

For news from the conference on Twitter, follow #ATSISPC18@SummerMayFinlay@mariemcinerney and @CroakeyNews.


 

Healing and support crew on hand should the be needed 

Summer May Finlay writes:

Suicide among Aboriginal and Torres Strait Islander communities is regularly in the media and public conversations. Often the focus is on an individual completed or attempted suicide or the negative statistics.

The second National Aboriginal and Torres Strait Islander Suicide Prevention Conference, to be held in Perth on November 20-21, will shift the focus to solutions identified by Indigenous people themselves. The program consists of only Indigenous people from Australia and internationally.

Our voices are important because it is our mob who understand what is going on in our communities best. We live and breathe it, with many of us either having considered taking our own lives, making an attempt or having had family members who have. This is why the program includes a focus on community-based solutions.

While the term “Aboriginal and Torres Strait Islander” is used as a collective term for the Indigenous nations in Australia, each community within each nation is unique – culturally, socially and historically. This means that solutions need to be tailored to each community. Again, this focus is reflected in the conference program.

That’s not to say everyone in each community has the same needs and concerns. Within communities there are sub-groups who also have distinct needs, such as young people and LGBTQI+ sister girls and brother boys.

Representation matters

Our young people and community of LGBTIQ+ sistergirls and brotherboys experience disproportionate rates of suicide. Their voices on how to address the situation are important to hear, which is why these groups are well represented at the conference, with sessions where people will share their stories of ways forward.

Dion Tatow, a conference presenter, says the focus needs to be on ways forward because being “LGBTIQ+ sistergirls and brotherboys isn’t the cause of suicide, it is the discrimination and exclusion that are the cause”.

He says: “The shame [and] secrecy. You have to hide it, so it’s not good for your own health and wellbeing.”

Tatow is an Iman and Wadja man from Central Queensland and South Sea Islander (Ambrym Island, Vanuatu) and chairperson of gar’ban’djee’lum, a Brisbane-based, independent, social and support network for Aboriginal & Torres Strait Islander people with diverse genders, bodies, sexualities and relationships.

He believes that Aboriginal and Torres Strait Islander people and organisations like Aboriginal Community Controlled Health Organisations (ACCHOs) and cisgender people and mainstream organisations have a role to play in improving the health and wellbeing of LGBTIQ+ sistergirls and brotherboys.

However, many health services “staff aren’t trained to deal with some LGBTIQ+ sistergirls and brotherboys’ health concerns such as gender reassignment.” This can mean LGBTIQ+ sistergirls and brotherboys can feel uncomfortable accessing a service.

Safe spaces needed

Tatow believes that ACCHOs need to step up and become “safe spaces” for LGBTIQ+ sister girls and brother boys. He says that there is a perception among LGBTIQ+ sistergirls and brotherboys that ACCHOs may be unsafe, with concerns particularly around confidentiality.

According to Tatow, the program Safe and Deadly Spaces run by Aboriginal and Torres Strait Islander Community Health Service in Brisbane (ATSICHS) is a great example of what ACCHOs can do to offer appropriate services to LGBTIQ+ sister girls and brother boys.

ATSICHS is “committed to being inclusive of all sexual orientations, gender identities and intersex variations to ensure every member our community feels safe, accepted and valued when they access our services and programs”.

Young Aboriginal and Torres Strait islander people also have a strong presence at the conference.

Culture is Life, led by the Chief Executive Officer Belinda Duarte, has taken charge of the youth program. Culture is Life backs Aboriginal-led solutions that deepen connection and belonging to culture and country, and supports young Aboriginal and Torres Strait Islander people to thrive. This includes allowing young Aboriginal and Torres Strait Islander people to take on leadership roles.

Will Austin, 22, a Gunditjmara man, from South West Victoria who is the Community Relations manager for Culture is Life, was charged with leading development of the youth program. He believes that young people being part of the program was important because “Aboriginal leadership and expertise needs to be shared in a really inclusive way with young people through listening and reciprocity across the generations.”

Culture is key

Culture is Life, as the name implies, places culture at the centre of the work they do, and Austin sees culture as key to health and wellbeing for our young people, connecting to cultural practice in traditional and modern ways. He says:

Modern culture is marching down the street and finding the balances in different ways such as art, dance and contemporary dance, poems, song writing, music.

Our culture has been around for thousands of years and shared through our Elders. It will evolve. There is no better feeling than going out on country, dancing on country, feeling your feet on the earth your ancestors have walked on. Connecting to the ancient knowledge and using modern ways to communicate it.”

Katie Symes, Culture is Life General Manager – Marketing and Communications, also believes Culture is a key “protective factor” for Aboriginal and Torres Strait Islander young people.

Will Austin and Katie Symes encourage young people at the conference to have their voices heard.

Austin said: “Don’t be shame. Make sure you step up. Make sure you contribute to the conversations…young Indigenous people are the heartbeat of the nation.”

Symes said: “It’s important for young people to be supported to cut their teeth in a really safe space.”

And the conference is designed to be just that, a safe space.

Listening with heart

Culture is Life is promoting the importance of “Listening with our hearts to the lived experiences of First Nations young people, their friends, families and communities” through its LOVE and HOPE campaign, which aims to aims to raise awareness through communicating the evidence, lived experiences and Aboriginal-led solutions. This aim is echoed through the conference.

You can watch the two campaign videos featuring young Aboriginal and Torres Strait Islander people and Professor Pat Dudgeon, chair of the conference organising committee, here and here. Also follow the campaign on social media using the hashtags #loveandhope  #culturesquad  #cultureislife.

The conference showcases evidence from research and lived experience from Aboriginal and Torres Strait Islander people and Indigenous brother and sisters from other countries. The uniqueness of the program will lend itself to a unique experience for attendees.

This conference follows the first conference held in Alice Springs in 2016 as part of the Aboriginal and Torres Strait Islander Suicide Prevention Evaluation Project funded by the Commonwealth Government (see this Croakey report compiling coverage of the conference).

• If you or someone you know needs help or support, call Lifeline on 13 11 14 (24 hours-a-day), contact your local Aboriginal Community-Controlled Organisation, call Beyondblue on 1300 22 4636 or call Q Life: 1800 184 527.

• Further reading: On World Suicide Prevention Day, calls for the Federal Government to invest in Indigenous suicide prevention.

• The feature image above is detail from an artwork on the conference website: Moortang Yoowarl Dandjoo Yaanginy: Families (Cultures) Coming Together for a Common Purpose (Sharing) Shifting SandsThe website says: “This artwork represents our people doing business on country that is recovering from colonisation; our lands taken over, our cultures decimated, and our families separated, causing hardship, despair, and loss of hope

Aboriginal Health Alcohol and Other Drugs : Minister @KenWyatt and John Havnen #NACCHO deliver #NIDAC18 keynotes : What is currently being done to reduce the high levels of alcohol and other drug use within Aboriginal communities? 

 ” All of us want to see better health for First Nations Australians. 

We know that the excessive consumption of drugs and alcohol is associated with health problems in all societies.

It has been linked to chronic conditions such as cancer and liver disease, the spread of hepatitis and HIV, injuries and deaths from motor vehicle accidents and assaults, increased encounters with the law, deaths in custody, suicides and family breakdown.

The reasons why First Nations’ people engage in high risk drug and alcohol consumption are indeed, complex.

When families, communities, local organisations and governments join hands, we are powerful together.

Alcohol and other drugs, tobacco, lifestyle risk factors and social determinants represent more than half of the quest for health and life equality.

It’s now been 10 years since the launch of the Closing the Gap initiative.

The agenda is being refreshed and it’s time to refresh our approach – including by acknowledging the complexity of the drug and alcohol challenge and making even greater efforts to address it.

This conference NIDAC18 will be an important part of that solution – and I look forward to hearing the outcomes. ” 

Minister Indigenous Health Ken Wyatt see full speech Part 2 below

Read over 200 NACCHO Aboriginal Health Alcohol and Other Drugs articles we have published over past 6 years 

Part 1 NACCHO Keynote by John Havnen Senior Policy Officer 

The harmful use of alcohol is a problem for the Australian community as a whole – alcohol misuse and alcohol-related disease remains a recognised as a nationwide problem.

It is estimated that in 2011 alcohol misuse caused 5.1% of the total burden of disease in Australia.

Alcohol related harm has clear social and economic determinants and it is closely related to disadvantage.

As such Aboriginal and Torres Strait Islander communities, which as we all know rate disproportionately in all measures of disadvantage, experience higher rates of alcohol misuse and alcohol-related harm than non-indigenous Australians.

This discrepancy leads to Aboriginal and Torres Strait Islander people experiencing significant health and social problems in a rate unequal to non-Indigenous Australians. But not all of us drink, in the 2016 National Drug Strategy Household Survey, Indigenous Australians aged 14 and over were more likely to abstain from drinking alcohol than non-Indigenous Australians.

This abstinence rate has been increasing over the last decade with more and more of us deciding not to drink.

So although there are proportionately more Indigenous people than non-Indigenous people who refrain from drinking, those of us who do drink are more likely to do so at high-risk levels.

In 2014-15 the National Aboriginal and Torres Strait Islander Social Survey found 19% of Indigenous Australians over the age of 15 exceeded the lifetime risk guidelines for alcohol consumption.

This is no more than 2 standard drinks per day on average or no more than 4 drinks per occasion.

Even though the rate of harmful drinking has declined in recent years, this has been mainly in non-remote areas, so there is still high rates of harmful drinking in remote areas and drinking at risky levels puts a person at risk of medical and social problems.

Due to these high levels of risky drinking, Aboriginal and Torres Strait islanders are more likely to be hospitalised for alcohol-related conditions and accidents than non-Indigenous Australians including acute intoxication, liver disease, injuries, suicide or self-harm and cancer.

There is big differences in the rates with Indigenous males over 9 times more likely to need hospitalisation and Indigenous females 13 times more than non-Indigenous Australians.

These drinking patterns highlight that it is possible that risky drinking and binge drinking has been normalised within some communities and this could potentially act as a barrier to seeking treatment when needed.

However, alcohol is not the only substance that presents a major concern for in Aboriginal and Torres Strait Islander people.

In 2014-15, the National Aboriginal and Torres Strait Islander Social Survey stated that 30% of Indigenous Australians over the age of 15 years reported using an illicit substance in the previous 12-months.

This was an increase from 23% in 2008. The substances most commonly used by Aboriginal and Torres Strait islanders were cannabis with 19% reporting, non-prescription analgesics and sedatives (such as painkillers, sleeping pills and tranquillisers) at 13%, and amphetamines or speed with a rate of 5%.

Smoking has overtime become common place in Aboriginal and Torres Strait islander communities and whilst tobacco smoking is declining in Australia, rates remain disproportionately high among Aboriginal and Torres Strait Islander people.

Indigenous Australians more than twice as likely to be current daily smokers as non-Indigenous Australians.

Despite declines in rates of smoking in Aboriginal and Torres Strait Islander people in the last 20 years there appears to have been no change to the gap in smoking prevalence between the Indigenous and non-Indigenous Australian adult population.

Tobacco-related disease is responsible for between 1.5 and 8 times more deaths in the Aboriginal and Torres Strait islander community than in non-Indigenous Australians.

The harmful use of alcohol, in addition to tobacco and other drugs, are both the cause and effect of serious harm to physical health.

The health status of Aboriginal and Torres Strait Islander people is considerably lower than for non-Indigenous Australians with 71.0% of Indigenous Australians reporting having a long-term health condition compared with 55.3% of non-Indigenous Australians.

Those with long-term health conditions are also more likely to be a daily smoker or misuse alcohol and other drugs. Aboriginal and Torres Strait Islander people who experience multiple diagnoses are more likely to have more difficulty accessing treatment and have poorer outcomes when they do receive treatment than either a physical health condition or an alcohol or other drug disorder alone.

There is a well-known high rate of co-morbidity of substance use disorders with other mental health / social and emotional wellbeing issues, and medical conditions in particular chronic diseases.

These issues tend to cluster in individuals and communities along with other markers of social, economic and intergenerational disadvantage.

These high rates of comorbidity contribute to complexities in the treatment and causality of disorders and remains a significant challenge for the delivery of effective healthcare services for our people.

This is in part due to the complexity of the mental and physical health issues individuals display, and in part because of the burden of multiple disadvantages including; poverty and intergenerational disadvantage and this can reduce the capacity to engage consistently and meaningfully in treatment.

So, what is currently being done to reduce the high levels of alcohol and other drug use within Aboriginal and Torres Strait Islander communities?

Existing mainstream models of practice in the alcohol and other drug field have been developed within Western systems of knowledge and focus on a biomedical model with an emphasis on biological factors and discounts any psychological, environmental, and social influences. As a result, it is not generalisable to Aboriginal and Torres Strait islander culture and ignores important indigenous perspectives and needs.

Including the need for access to culturally appropriate and comprehensive services to address multiple problems, and the need for local links with Indigenous services.

Western alcohol and other drug services are based on an abstinence model and focuses on residential rehabilitation which is aimed more on the needs of alcohol users and not illicit drug users.

Residential alcohol and drug programs provide care and support for people within a residential community setting and can be medium to long-term duration of anywhere from 4 weeks to 12 months and but again only supports residents’ psychological needs only.

This model also lacks consideration to the prevention and early intervention strategies of risky drinking and drug use, lacks acknowledgement of family, culture and community which we know are important aspects in the holistic model of care.

Despite a paucity of data, the knowledge of how to prevent alcohol misuse among the general population – while not consistently translated to policy and practice – is extensive.

The evidence for the effectiveness of such programs for Indigenous Australians, however, remains scant.

Racism is still present in mainstream services so many Aboriginal and Torres Strait Islanders might have limited access to mainstream health services.

Systemic racism in the health system directly influences Indigenous Australians’ quality of and access to healthcare.

The severity of this impact intensifies levels of psychological stress, which is closely linked to poorer mental and physical health outcomes.

Racism not only provides a major barrier to Aboriginal and Torres Strait Islander peoples’ access to health care but also to receiving the same quality of healthcare services available to non-Indigenous Australians.

There is also a tendency to stereotype Aboriginal and Torres Strait Islanders as ‘drunks’ or ‘alcoholics’ which, as I have previously discussed today is not necessarily the case.

So, what will work if mainstream alcohol and other drug services have limited evidence for our people?

Historically, reactions to the concerns of alcohol and other drug misuse among Aboriginal and Torres Strait Islander people were driven not by governments, but by Aboriginal and Torres Strait Islander people themselves who recognised the fact that mainstream services were non-existent or largely culturally inappropriate.

Today, Indigenous Australians are acutely aware of the impacts of alcohol and other drugs and have been actively involved in responding to alcohol and other drugs misuse in their communities.

Any initiative to reduce the harmful effects of alcohol and other drugs in Aboriginal and Torres Strait Islander communities should be developed with, and led by, those communities.

There is value in supporting these communities, including the evaluation of strategies implemented so that communities can learn from their own and from other communities’ experience.

Any action that attempts to treat alcohol and other drugs needs to come from a holistic model of care that is comprehensive and culturally appropriate.

Awareness of the land, the physical body, clan, relationships, and lore, it is the social, emotional and cultural wellbeing of the whole community and not just the individual.

This is why western models of treatment just won’t work.

Comprehensive primary health care is a key strategy for improving the health of Indigenous Australians and is an important platform from which to address the complex health and social issues associated with alcohol and drug misuse.

A holistic approach locally designed and operated by Indigenous people is favoured in its ability to be tailored to community needs and in a cultural context that is owned and supported by the community. 

Despite inadequate funding and resources, the ACCHOs sector has been identified as having a unique role in making alcohol and other drug treatment services more accessible.

One of the unique attributes of Aboriginal controlled drug and alcohol services is that they are a practical expression of Aboriginal peoples’ self-determination, reflected in their governance and treatment models.

A recent example of what works is the pilot of an integrated model of care within Central Australian Aboriginal Congress based in Alice Springs.

Congress developed an integrated non-residential treatment model for Aboriginal and Torres Strait Islanders with alcohol and other drug issues and it is based on providing care for all aspects of health through three streams of care:

Social and cultural support – which is delivered by Indigenous workers with cultural knowledge, language skills and an in-depth knowledge of the Aboriginal community alongside social workers. This stream includes case management and care coordination, advocacy on behalf of clients, social support, cultural support, access to medical care, and opportunistic alcohol and other drug counselling and brief interventions.

Psychological therapy – which is carried out by qualified therapists delivering evidence-based treatments including cognitive behaviour therapy (CBT) and related psychological therapies and access to neuropsychological assessment and treatment. And:

Medical treatment – which is provided by Congress GPs and other members of the primary health care team, and includes medical assessments of alcohol and other drug clients, management of chronic disease and prescription of pharmacotherapies where appropriate to assist with alcohol withdrawal.

This model recognises the comorbidities that occur with alcohol and other drug clients and sought to address within a holistic approach that is adaptable based on needs of individuals.

In 2016-17, in the presenting alcohol and other drug clients, 28% received only one stream of care, 59% received two-streams and the remainder, 13% received all three streams of care.

The Congress ‘three streams model’ of care for alcohol and other drug treatment has been developed over many years to provide a single, integrated multidisciplinary service organised around social and cultural support; psychological therapy; and medical care.

In doing so, it reduces demands on clients presenting with alcohol and other drug issues to navigate multiple health care providers, and attempts to address their holistic needs, including advocacy and support around the social determinants of health and wellbeing including housing, welfare and employment, criminal justice, and basic life needs.

This is a great example of how well it can work when the system is correct and can be used as a model for other ACCHOs to learn from.

The diversity of Aboriginal Australia means that no service model can be simply transferred from one place to another. Instead, the strength of Aboriginal community-controlled health services is their capacity to adapt successful models to the particular needs, strengths and histories of the communities they serve.

But funding is a barrier in implementing optimal services in many regions.

A recent report on organisations conducting Indigenous-specific alcohol and other drug services found that a lack of government commitment to funding community-controlled organisations has compromised the capacity of Indigenous Australians to address alcohol and other drug issues within their own communities.

In addition, the capacity of Aboriginal community-controlled organisations to deliver services was severely constrained by staff shortages, lack of trained and qualified staff, and very limited access to workforce development programs.

Treatment is also not the only key, continuing to increase the community awareness and education about the effects of alcohol and other drugs and the treatment options for dealing with issues is vital.

Including a range of health promotion activities and groups including exercise and nutrition programs, tobacco use treatment and preventions groups to address the holistic needs is essential and well help to reduce the levels of risky drinking and the efficacy of treatment once in treatment.

We need to enable our people to have control over their health and improve health literacy on risky behaviours to help stop the impacts of alcohol and other drugs.

 Part 2 Minister Indigenous Health Ken Wyatt keynote 

Good morning. In West Australian Noongar language I say “kaya wangju” – hello and welcome.

I acknowledge the traditional custodians of the land on which we’re meeting, the Kaurna people, and pay my respects to Elders past and present.

The 5th National Indigenous Drug and Alcohol Conference is a positive opportunity to make progress on a difficult issue.

The conference theme is Responding to Complexity – and there certainly is no one-size-fits-all solution to the challenges our people face.

This is why we have to attack the scourge of drug and alcohol dependency and abuse on multiple fronts.

To form new partnerships.

To speak and to listen, with open minds and hearts.

All of us want to see better health for First Nations Australians.

We know that the excessive consumption of drugs and alcohol is associated with health problems in all societies.

It has been linked to chronic conditions such as cancer and liver disease, the spread of hepatitis and HIV, injuries and deaths from motor vehicle accidents and assaults, increased encounters with the law, deaths in custody, suicides and family breakdown.

The reasons why First Nations’ people engage in high risk drug and alcohol consumption are indeed, complex.

Working together, we are making progress, reducing binge drinking rates among our people from 38 per cent to 31 per cent between 2008 and 2014–15.

But there is still much work to be done.

As we see in the Aboriginal and Torres Strait Islander Health Performance Framework report, social determinants are estimated to make up 34 per cent of the gap in health outcomes between First Nations’ people and other Australians.

Together, with behavioural risk factors, such as alcohol, drug and tobacco use, they account for 53.2 per cent of the health gap.

Alcohol and drug abuse has a broad and insidious impact.

We have a moral and social imperative to work together to put an end to violence and dysfunction and the drug- and alcohol-driven neglect of children in our communities.

Our Government is committed to working with families and individuals to address substance misuse and to break the cycle of disadvantage that prevents children from attending school, and adults from going to work.

Particularly for the protection of children, we have invested over $10 million to provide better diagnosis and management, develop best practice interventions and services to support high-risk women.

A 10-year FASD Strategic Action Plan is in the final stage of development.

Just as important, we see outstanding examples of local warriors for health – like June Oscar and her team in Fitzroy Crossing – who have tackled alcohol in their communities, with life-changing results for children and families.

We must try harder to understand and address the underlying causes of alcohol and drug misuse.

The percentage of First Nations’ people who drink is no greater than for other Australians – in fact, there are many of our people who do not drink at all.

Equally, the impacts of trauma on the health of our communities cannot be ignored, because they add to the complexity of the challenge.

Trauma is no excuse for substance abuse, violence or neglect – but understanding its history can help us reduce its impact.

It reaches across generations of Aboriginal and Torres Strait Islander people, and must be acknowledged and addressed.

Significant health impacts have resulted from displacement from family and country, institutionalisation, racism, abuse and neglect.

This has led to increasingly high rates of incarceration and juvenile detention, suicide, family violence, children being taken into care, and poorer physical and mental health.

63 per cent of First Nations’ prisoners are incarcerated as a result of violent crimes and offences that cause harm.

First Nations’ offenders are also more likely to be under the influence of alcohol when they offend.

It’s a sad fact, that alcohol was involved in 80 per cent of cases of domestic homicide, where both the offender and the victim were First Nations’ people.

That’s more than three times the level of domestic homicides involving other Australians.

It’s also known that First Nations people who engage in alcohol-related crime are themselves more likely to be the victims of such offences.

The question is, how do we reduce high-risk levels of alcohol consumption?

Harm reduction programs can minimise the immediate danger posed by alcohol misuse; but our broader aim should be to reduce alcohol intake.

Our Government is investing in a series of activities which have been shown to be effective.

These range from alcohol restrictions to treatment and rehabilitation.

Under the Indigenous Advancement Strategy, the Government has committed around $70 million in 2017–18 to support over 80 Indigenous alcohol and other drug treatment services.

They are located in places with high First Nations’ populations, in capital cities and regional centres as well as outer regional and remote areas.

Alcohol is a particular problem in the Northern Territory.

Our Government recognises this and is providing more than $91 million over seven years for targeted local action to reduce alcohol related harm.

A significant part of our national support to reduce risk also includes primary healthcare and population health programs addressing smoking and alcohol, in urban, regional and remote locations across Australia.

Poor mental health as a result of drug and alcohol problems is a huge issue and one which I am pleased will be addressed during this important conference.

It is equally high on our Government’s agenda.

The Australian Health Ministers’ Advisory Council recently endorsed the National Strategic Framework for Aboriginal and Torres Strait Islander Peoples’ Mental Health and Social and Emotional Wellbeing 2017–2023.

The council has prioritised development of a national Indigenous Health and Medical Workforce Plan, which aims to increase the number of Aboriginal doctors, nurses and health workers on country and in our towns and cities.

Primary Health Networks across Australia also have mental health and Aboriginal and Torres Strait Islander health among their priorities.

I am very keen to ensure Primary Health Networks provide a strong platform for culturally comfortable drug, alcohol and mental health services.

To that end, we have targeted more than $85 million to improve access for integrated, culturally appropriate and safe mental health services for First Nations people.

Our Primary Health Networks are also currently investing a further $79 million on the provision of alcohol and other drug services specifically designed to meet the needs of First Nations people, at the local level.

While the effects of alcohol and drugs can be dire, the insidious damage caused by tobacco is significant.

Statistics show that smoking is responsible for 23 per cent of the gap in health outcomes between First Nations’ people and other Australians.

That is why reducing smoking rates among Aboriginal and Torres Strait Islander people is central to our efforts to close the gap.

By supporting locally linked projects within a national campaign, we are seeing some success.

The daily smoking rate for First Nations’ people aged 15 years and over has declined from 49 per cent in 2002 to 39 per cent in 2014–15, with most of this since 2008, when targeted measures commenced.

However, the daily smoking rate in remote areas is still 47 per cent, and worryingly, the number of First Nations’ women smoking while pregnant remains far too high, at 46 per cent.

To continue supporting change for the better – through funding certainty and proven programs – we have gone to a four-year, $300 million funding commitment for the successful Tackling Indigenous Smoking program.

We are supporting Aboriginal and Torres Strait Islander specific education programs, as part of the National Tobacco Campaign.

“Don’t Make Smokes Your Story” targets First Nations’ smokers aged 15 years and over.

Since its third phase concluded at the end of June, evaluation has shown its effectiveness.

86 per cent of First Nations smokers were aware of the campaign.

7 per cent had quit and 26 per cent said they had reduced the amount they smoke.

If we can maintain this sort of momentum, I am we will see significant improvements in health in future.

We have also had significant success in reducing petrol sniffing, which can cause brain damage and even death.

Independent research undertaken since 2005 indicates that in communities with low aromatic fuel, petrol sniffing has dropped by 88 per cent.

Low aromatic fuel, subsidised by the Government, has now replaced regular unleaded in around 175 outlets in the Northern Territory, Queensland, Western Australia and South Australia.

There were special factors related to petrol sniffing which make it impractical to apply the same approach to alcohol and drug misuse.

But there is one big lesson from that success.

When families, communities, local organisations and governments join hands, we are powerful together.

Alcohol and other drugs, tobacco, lifestyle risk factors and social determinants represent more than half of the quest for health and life equality.

It’s now been 10 years since the launch of the Closing the Gap initiative.

The agenda is being refreshed and it’s time to refresh our approach – including by acknowledging the complexity of the drug and alcohol challenge and making even greater efforts to address it.

This conference will be an important part of that solution – and I look forward to hearing the outcomes.

NACCHO Aboriginal Health News : #NACCHOagm2018 Delegates agree unanimously to motion that the #CDP is discriminatory and is causing significant harm, hardship , distress and they call on cross bench senators to reject the Bill in its entirety

” The National Association of Aboriginal Controlled Community Health Services, in its submission, warned that extending the four-week payment cutoff penalty to CDP and requiring recipients to reapply would be much more difficult for people in remote areas who may have language barriers, lack access to a phone or have underlying cognitive or health impairments and will likely mean that Aboriginal people in CDP regions will have less access to income support payments than other Australians”.

The Australian 

 ” NACCHO is deeply concerned by the Community Development Program (CDP) and its impact on Aboriginal people living in remote areas or CDP regions. We believe that the CDP is discriminatory and is causing significant harm, hardship and distress to Aboriginal people across Australia. NACCHO does not support the CDP nor does it support the proposed Bill. We believe the proposed Bill will only worsen the impact of the current CDP.

The Senate must recognise the unanimous voice of Aboriginal and Torres Strait Islander people and reject this Bill.”

Background : Extracts from NACCHO submission  post 15 October Read in full

We haven’t come here to bash the government or criticise, we’ve come here with a solution and the solution is here and we’re willing to work with all government at all levels,” he said.

What it reminds me of is a modern day Wave Hill situation- where Aboriginal people were paid sugar, flour and tea,

Those sorts of conditions and that sort of wage offer and assistance for Aboriginal Australians should not be offered in this day and age.”

John Paterson, CEO of Aboriginal Peak Organizations said the current program is “not an effective piece of work” and claims it puts “so many breaches on Aboriginal people” 

Picture below speaking at Parliament House September 2018 see NITV SBS Article

Motion below by John Paterson on CDP to the NACCHO 2018 Conference, 1 Nov 2018

Moved: Tim Agius, Durri ACMS, Kempsey NSW

Seconded: Vicki O’Donnell, KAMS

Agreed unanimously.

That the NACCHO 2018 Conference endorses the following:

NACCHO member services are deeply concerned by the Community Development Program (CDP) and its impact on Aboriginal people living in remote areas or CDP regions.

We believe that the CDP is discriminatory and is causing significant harm, hardship and distress to CDP participants and their families and deepening poverty in communities.

We do not support the Social Security Legislation Amendment (Community Development Program) Bill 2018 (CDP Bill) currently before the Parliament. We believe the Bill will only worsen the impact of the current CDP.

In particular, the proposed application of the mainstream Targeted Compliance Framework (TCF) is inappropriate for remote community conditions and will result in a worsening of already unacceptable rates of serious breaches and penalties applied to participants and an increase in disengagement from the scheme.

Other proposed changes, such as reducing the number of hours that CDP participants must Work for the Dole and offering wage subsidies, can be achieved without the Bill.

We are heartened by the opposition to the Bill expressed by Labor and the Greens and the support for Aboriginal concerns expressed by cross bench members of the Senate.

We urge cross bench Senators to reject the Bill in its entirety.

We call for urgent and fundamental reform of the program to be achieved through direct engagement and collaboration with Aboriginal peak and community organisations.

We propose the Fair Work and Strong Communities scheme proposed by APO NT and a coalition of Aboriginal organisations and national peak bodies as the appropriate basis for this discussion.

NACCHO Aboriginal Health : Download @HealingOurWay report, titled #LookingWheretheLightIs: creating and restoring safety and healing, to coincide with PM Morrison’s apology to victims and survivors of institutional child sexual abuse.

“The Healing Foundation has released a report, titled Looking Where the Light Is: creating and restoring safety and healing, to coincide with Prime Minister Scott Morrison’s apology to victims and survivors of institutional child sexual abuse.

The report details a cultural framework that aims to address the inaction that followed the 1997 Bringing Them Home Report, which outlined 54 recommendations to redress the impact of removal policies and tackle ongoing trauma – most remain unresolved.”

Download Copy of Report Looking-Where-The-Light-Is-Final

With more than 14 per cent of respondents to the Royal Commission coming from Aboriginal and Torres Strait Islander communities, the effects of institutional child sexual abuse are overwhelming.

While an apology is welcome and seen as a good first step, the inaction from the Bringing Them Home report necessitates a direct response.

The Royal Commission made a number of recommendations in relation to advocacy, support and treatment services for survivors, including providing access to tailored treatment and support services for as long as necessary, along with funding Aboriginal and Torres Strait Islander healing approaches as an ongoing, integral part of therapeutic responses.

The way forward is clear. However, it requires long term commitment from governments, the broader Australian community and mainstream organisations, Aboriginal and Torres Strait Islander people, communities and organisations.

 

NACCHO Aboriginal Health and #ElderCare funding up to $46 million : Applications close on 26 Nov 2018: Donna Ah Chee CEO @CAACongress welcomes @KenWyattMP announcement of increased funding to assist Aboriginal people growing old with their families in their own communities


Improvements in Aboriginal health have more of our people living into old age than there were even a decade ago and necessitates a need to meet the increasing demand for these types of services.

Being on country as you grow old is a very strong cultural obligation for Aboriginal people and for too long our people have had to move into population centres to access services.

We now have two major recent initiatives that will help our older people stay on country. Firstly, the announcement of the new Medicare item for nurse assisted dialysis on country and now this announcement from Minister Wyatt.

This continuing connection to country is vital for the spiritual foundation and quality of life of Aboriginal people.

It is a key part of keeping our older people healthy and happy.

Our people have a very strong desire to be on country when they die and announcements like this will help to make sure that people grow old and die on country and with family. We know that social isolation is very damaging to older people’s health and this will ensure people remain socially and culturally connected.

While keeping people at home with aged care packages is a key goal there are some very successful aged care facilities on country at places like Mutitjulu. This also is important for people who need this level of care

Central Australian Aboriginal Congress (Congress) Chief Executive Officer, Donna Ah Chee, welcomes the announcement of increased funding to assist Aboriginal people growing old in a well-supported way, with their families in their own communities

Originally published Talking Aged Care 

Photos above Ken Wyatt meeting with the elders from the Yindjibarndi Aboriginal Corporation in Roebourne WA 2017

Read NACCHO Aboriginal Health and Elder Care Articles HERE

Ageing First Australians living remotely will now have increased access to residential and home aged care services close to family, home or country following an announcement by Federal Government to expand their Budget initiative – the National Aboriginal and Torres Strait Islander Flexible Aged Care (NATSIFAC) program

The $105.7 million Government commitment, which will benefit more than 900 additional First Australians, is set to be expanded progressively over the next four years.

Federal Minister for Senior Australians, Aged Care and Indigenous Health Ken Wyatt announced the first round of expansion funding under the program – up to $46 million – to increase the number of home care places delivered through NATSIFAC program in remote and very remote areas.

“Aged care providers are invited to apply for funding under the expanded NATSIFAC program’s first grants round, which is designed to improve access to culturally-safe aged services in remote Aboriginal and Torres Strait Islander communities,” the Minister explains.

“The program funds service providers to provide flexible, culturally-appropriate aged care to older Aboriginal and Torres Strait Islander people close to home and community.

“Service providers can deliver a mix of residential and home care services in accordance with the needs of the community.”

Minister Wyatt reiterates the importance of home care in enabling senior Australians to receive aged care to live independently in their own homes and familiar surroundings for as long as possible, and says the initiative is all about “flexibility and stability”.

“It is improving access to aged care for older people living in remote and very remote locations, and enables more Aboriginal and Torres Strait Islander people to receive culturally-safe aged  care services close to family, home or country, rather than having to relocate hundreds of kilometres away,” he says.

“At the same time, it helps build the viability of remote aged care providers through funding certainty.”

Applicants can apply for new or additional home care places under the NATSIFAC program or approved providers can apply to convert their existing Home Care Packages, administered under the Aged Care Act 1997, to home care places under the NATSIFAC program.

Applications close on 26 November 2018 with more details about the expansion round available online.

GO ID: GO1606
Agency:Department of Health

Close Date & Time:

26-Nov-2018 2:00 pm (ACT Local Time)
Primary Category:
101001 – Aged Care

Publish Date:

4-Oct-2018

Location:

ACT, NSW, VIC, SA, WA, QLD, NT, TAS

Selection Process:

Targeted or Restricted Competitive

Description:

This Grant Opportunity is to increase the number of home care places under the NATSIFAC Program in remote and very remote Australia (geographical locations defined as Modified Monash Model (MMM) 6 and 7).

Eligibility:

To be eligible you must be one of the following:

Type A:

Existing NATSIFAC Program providers delivering services in geographical locations MMM 6-7

Type B:

Approved providers currently delivering Commonwealth funded home care services (administered under the Aged Care Act 1997) to Aboriginal and Torres Strait Islander people in geographical locations MMM 6-7, with up to 50 home care recipients per service, for conversion to the NATSIFAC Program

Type C:

Organisations not currently delivering aged care services in geographical locations MMM 6-7, however but existing infrastructure and the capability to deliver aged care services to Aboriginal and Torres Strait Islander people

Total Amount Available (AUD):

$46,000,000.00

Instructions for Lodgement:

Applications must be submitted to the Department of Health by the closing date and time.

Other Instructions:

$46 million (GST exclusive) over 4 years, 2018-2022.

 

 

NACCHO Aboriginal #MentalHealthWeek News : 1.Download Report Monitoring #mentalhealth and #suicideprevention reform 2.Government has announced a new Productivity Commission Inquiry into the role of mental health in the Australian economy

“As background to this development, the National Mental Health Commission has published its sixth national report – Monitoring Mental Health and Suicide Prevention Reform: National Report 2018 – which provides an analysis of the current status of Australia’s core mental health and suicide prevention reforms, and their impact on consumers and carers.”

Part 1 Download a copy of report 

Monitoring Mental Health and Suicide Prevention Reform National Report 2018

Engaging Aboriginal and Torres Strait Islander communities in regional planning

” One of the priorities for PHNs is engaging Aboriginal and Torres Strait Islander communities and community controlled organisations in co-designing all aspects of regional planning for Aboriginal and Torres Strait Islander mental health and suicide prevention services.

There has been some early success in building partnerships between PHNs and Aboriginal community controlled organisations (see Case study). In contrast, some PHNs have primarily commissioned mainstream providers rather than community controlled health services to provide services to Aboriginal and Torres Strait Islander communities.

Leading Aboriginal organisations consider this approach to be flawed, and believe it will result in poorer outcomes for Aboriginal and Torres Strait Islander people.

It is important for PHNs to recognise and support the cultural determinants of Aboriginal and Torres Strait Islander mental health and social and emotional wellbeing, in addition to clinical approaches.26 Recent research by the Lowitja Institute highlights the need for a specific definition of mental health for Aboriginal and Torres Strait Islander people, as mental illness is more likely to occur when social, cultural, historical and political determinants are out of alignment.27

Extract from Page 20 of Report 

Read over 150 NACCHO Aboriginal Mental Health artices published over 6 years

Part 2

 ” The Government has announced a new Productivity Commission Inquiry into the role of mental health in the Australian economy. 

This move is significant recognition of the considerable impact of mental health challenges on individuals and the wider community.”

The Productivity Commission’s inquiry will take 18 months and will scrutinise mental health funding in Australia, which is estimated at $9 billion annually across federal, state and territory governments. Last week the Australian Bureau of Statistics revealed 3,128 people committed suicide in 2017, which is up from 2,866 people in 2016.

The commission will be expected to recommend key priorities for the Government’s long-term mental health strategy and will accept public submissions. AHCRA looks forward to meaningful and authentic consumer engagement by the Inquiry.

The inquiry was welcomed by many, including Labor’s mental health spokeswoman, Julie Collins. Beyond Blue CEO Georgie Harman also praised the inquiry. “There have been numerous investigations and reviews into mental health in Australia, but this is the first time the Productivity Commission will take the lead. It is a significant step forward and one that has the potential to drive real change,” Ms Harman said in a media release.

AHCRA highlights the 2018 Report as a valuable source of information that outlines the size of the problem and the prevalence and impact of mental illness and suicide in Australia.

ABC News item: https://ab.co/2E725r5
Guardian coverage: https://bit.ly/2IKNYqh
Media release: https://bit.ly/2E9Bxpo

The Mental Health Commission website is here: https://bit.ly/2pJ216U
The 2018 report link: https://bit.ly/2C30YpM

NACCHO Aboriginal #WorldMentalHealthDay : Culture as key to mental wellbeing , evidence shows that culturally-safe early intervention and prevention programs and services are the most effective in reducing poor mental health and suicide

 ” NACCHO and the Sector Support Organisations appreciate the opportunity to make this submission on behalf of our Member Services.

With circumstances unimproved after many years of multiple policy approaches, there is a dire need to overturn poor mental health outcomes for Aboriginal and Torres Strait Islander people.

This will require attention to the full spectrum of Aboriginal life experience. There needs to be commitment at all levels of government in terms of funding, policy development and support, for the implementation of culturally-appropriate programs and services.

There must be recognition that self-determination of Aboriginal people will be the foundation of true progress.

NACCHO strongly recommends that government engage in meaningful dialogue with it, the Sector Support Organisations and ACCHSs, in relation to the proposals canvassed in this submission, and work in partnership to address the significant and continual inequity of access to culturally-safe mental health and social / emotional wellbeing services for all Aboriginal people.”

Download a full NACCHO copy :

Network Submission – Mental Health Services Rural Remote Aust – 23.8.18 – FINAL

Read over 190 NACCHO Aboriginal Mental Health articles pubished over last 6 years 

 

In keeping with this Indigenous model of SEWB, AMSANT believes that integrating SEWB,
Mental health and AOD, which work toward preventing and addressing these issues, into
Primary Health Care (PHC) Services is the most cost-effective approach to the delivery of
mental health services throughout rural and remote NT.

In keeping with the model, SEWB programs require funding for multidisciplinary, culturally and trauma informed teams with expertise across these various aspects of wellbeing for Aboriginal communities.

SEWB services are designed to support individuals, families and communities in all aspects of life
that strengthen wellbeing,”

From AMSANT’s seperate submission 

sub129_AMSANT

Introduction

The National Aboriginal Community Controlled Health Organisation (NACCHO) welcomes the opportunity to provide input for the Senate inquiry into Accessibility and quality of mental health services in rural and remote Australia.

Aboriginal and Torres Strait Islander people represent approximately 3% of the population, yet are disproportionately over-represented in a negative way on almost every indicia of social, health and wellbeing determinants.[i]

Commonly recognised factors causing these disparities include intergenerational trauma, racism and social exclusion, as well as loss of land and culture.[ii] They are vastly over-represented in mental health services[iii], and evidence of the gap in mental health outcomes compared with their non-Indigenous peers is well documented.[iv]

For example, a 2016 report states that Aboriginal males aged 25–29 years have the highest rates of suicide in the world.[v] Underscoring these health disparities, the rate of admissions to specialised psychiatric care has been found to be double that of non-Indigenous Australians.[vi]

Mental health and wellbeing is integral to the individual and collective ability to think, express and engage productively in work and in life.[vii] A multitude of relevant national frameworks and reforms have highlighted the mental health of Aboriginal and Torres Strait Islander people as a priority, with a focus on prevention and early intervention. The nexus for bridging the gap is cultural security, which includes access to culturally-safe mental health and social / emotional wellbeing services.[viii] However, this access, in particular in regional, remote and very remote locations, is highly inconsistent and in many locations is non-existent.

Aboriginal Community Controlled Health Services

NACCHO is the peak body representing 145 Aboriginal Community Controlled Health Services (ACCHSs) across Australia. ACCHSs provide comprehensive primary health care to Aboriginal and Torres Strait Islander people at over 300 Aboriginal medical clinics. Three million episodes of care are delivered to around 350,000 people each year (over 47% of the Aboriginal population); a third of these in remote areas.

The ACCHS sector is the largest single employer of Aboriginal and Torres Strait Islander people in the country, employing 6,000 staff. Evidence that the ACCHS model of primary health care delivers better outcomes for Aboriginal people is well established. The model has its genesis in the people’s right to self-determination, and is predicated on principles that incorporate a holistic, person-centred, whole-of-life, culturally-safe approach. Without exception, where Aboriginal and Torres Strait Islander communities lead, define, design, control and deliver their own services and programs, they achieve improved outcomes.[ix] The principles of self-determination and community control remain central to the people’s wellbeing and sovereignty.

Aboriginal and Torres Strait Islander people continue to experience disadvantage in equity of access to mental health services. This is a major concern requiring immediate redress by governments at all levels. Despite inequitable levels of funding and resources[x], ACCHSs continue to meet the challenges of addressing the burden of disease and mental ill-health of communities. Further investment is needed to expand and build capacity of the Aboriginal Mental Health Workforce (AMHW), to deliver culturally-safe mental health and social / emotional wellbeing services. As the predominant primary health care providers to Aboriginal people, ACCHSs are best placed to deliver appropriate services. Aboriginal Health Workers and Health Practitioners (AHW/P) as ‘cultural brokers’ are vital to bridge the prevailing gap between mainstream mental health services and Aboriginal consumers’ access to mental health care, treatment and support.[xi]

The nature and underlying causes of rural and remote Australians accessing mental health services at a much lower rate

Aboriginal and Torres Strait Islander people continue to under-utilise health services, despite experiencing poorer health. They are over-represented in rural and remote areas, so the issue of remoteness in accessing mental health services is particularly important for them.[xii] Data from the 2011 Census show that 3% of Australians (669,881) identified as Indigenous; 21% lived in remote or very remote areas[xiii], compared to only 1.7% of non-Indigenous Australians. Aboriginal people represent 16% and 45% of all people living in remote and very remote areas respectively.[xiv]

The geographical challenges in ACCHS availability and lack of resources to access culturally-appropriate mental health services restricts choice for Aboriginal people; this is compounded when they have to travel long distances from their communities for care and treatment. Mainstream services cannot provide culturally-appropriate care for the mental health needs of Aboriginal people, particularly those living in rural, remote and very remote locations.

Culturally-safe mental health services – ACCHS’ preferred provider status

Aboriginal and Torres Strait Islander people identify culture as key to mental wellbeing and evidence shows that culturally-safe early intervention and prevention programs and services are the most effective in reducing poor mental health and suicide.

Like all Australians, Aboriginal people are influenced by their experiences when accessing health services, including cultural responsiveness.[xv] In 2012–13, a reported 7% of Aboriginal adults avoided seeking health care because they had been treated unfairly by doctors, nurses or other staff at hospitals or surgeries.[xvi] Those with mental illness experience extreme social and emotional divorcement, alienation from their families, country of origin and their identity. Self-esteem and a sense of empowerment are important in recovery-based models of care, and arguably the best way to achieve this for Aboriginal people is to hand over control of the design and delivery of services to them.[xvii] In providing culturally-safe, holistic and community-based care, Aboriginal community controlled organisations have been identified as best placed to deliver mental health services.

It is important to emphasise that culture must be considered for best practice mental health models of service for Aboriginal people. This includes the multi-faceted impact of intergenerational trauma and its inextricable link to mental health and social / emotional wellbeing.[xviii]

Funding inequities

Despite 30% of Australia’s population living in regional, rural and remote areas[xix], Commonwealth mental health funding is inequitably distributed, and the delivery of services to these locations is severely compromised, resulting in greater costs overall. Ample evidence suggests that better allocation of resources and cost-effective funding in the ACCHS sector would result in better mental health outcomes for Aboriginal people.

Aboriginal and Torres Strait Islander people not seeking the mental health care they need in a timely manner, if at all, due to a lack of culturally-safe services, results in individuals becoming increasingly unwell. This escalates emergency or voluntary admissions to hospitals, usually in an acute state – admission, treatment and follow-up cost around $19,782 per person.[xx] This is a significantly higher cost than investing in ACCHSs to deliver community-based mental health services, closer to where people live, keeping people well in the community and preventing hospital admissions.

Despite the ACCHS sector’s ongoing advice to governments at all levels, about effectively addressing the mental health disadvantage and disparities experienced by Aboriginal Australians, funding continues to be directed to mainstream services. Substantial funding and essential resources are redirected from ACCHSs and administered to Primary Health Networks. This lack of transparency is having a deleterious and inequitable impact on Aboriginal people’ access to appropriate services. Despite the rhetoric, funding needed for ACCHSs is not ending up in Aboriginal hands; if government is serious about closing the gaps in health and mental health services, it is imperative to direct funding for Aboriginal service delivery to the ACCHS sector.

The higher rate of suicide in rural and remote Australia

The 2016 Aboriginal and Torres Strait Islander Suicide Prevention Evaluation Project (ATSISPEP) report noted that suicide has emerged in recent decades as a major cause of Aboriginal premature mortality and contributes to overall health and life expectancy gaps. In 2014, suicide was the fifth leading cause of death among Aboriginal people, with the age-standardised rate around twice as high as the non-Indigenous rate.[xxi] Alarmingly, Aboriginal children and young people are particularly vulnerable, comprising 30% of suicide deaths among those under 18 years of age. Suicide is the leading cause of death for Aboriginal people aged 14–34[xxii] and those aged 15–24 are over five times as likely to commit suicide as their non-Indigenous peers.

In Australia, rates of suicide and self-harm are higher in rural and remote areas, [xxiii]; and Aboriginal people are more than twice as likely to commit suicide than non-Indigenous people.[xxiv] From 2001–2010, most suicides among Aboriginal people occurred outside of capital cities, in stark contrast to non‑Indigenous suicides, which mostly occurred within cities.[xxv]

In recent years, several efforts have been made to tailor and implement suicide awareness training for Aboriginal and Torres Strait Islander health workers and communities. However, as highlighted in the ATSISPEP report, efforts to reduce suicide must not only address social and economic disadvantage but narrow the gap in health status. Strategies need to promote healing and build the resilience of ‘individuals, families and communities by strengthening social and emotional wellbeing and culture’.[xxvi]

Addressing the higher rates of suicide in Aboriginal communities is a priority for any plan that aims to reduce suicide in rural and remote areas. It will require investment by all levels of government to increase the response capacity of health workers. Further investment in consultation with the communities is needed to design a national capacity-building strategy to respond to the issue.[xxvii]

The nature of the mental health workforce

A range of strategies and actions are required to create an effective, empowered workforce for the mental health wellbeing of Aboriginal and Torres Strait Islander people. These have been identified in a National Strategic Framework for 2017–2023[xxviii] on this topic. A key requirement is a highly skilled and supported workforce, operating in a clinically and culturally-safe way.

Identifying current capacity and gaps in the workforce is important, to better target investment[xxix]. This includes the organisational capacity of Aboriginal and mainstream mental health services as well as skill and availability gaps in the primary mental health professions – nursing, occupational therapy, psychiatry, psychology and social work. It is also vital to consider the links and development opportunities across the different workforces in mental health, social / emotional wellbeing, alcohol and other drugs, family violence and relevant others.

Aboriginal Mental Health Workforce

Critical to positive mental health outcomes for Aboriginal people in rural and remote areas is a reinvestment in community mental health services, and in a committed workforce. A comprehensive Aboriginal Mental Health Workforce (AMHW) is required to improve the cultural responsiveness and safety of these services, to provide appropriate systems of care.

The AMHW plays an important role as ‘cultural broker’, through its advocacy and cultural advice, in the mental health legislation of a number of jurisdictions. Established in both mainstream health services and the ACCHS, the AMHW delivers specialist, holistic and culturally-safe services, which are key to addressing disadvantage and improving mental health outcomes. It helps to bridge the cultural gap, enabling Aboriginal consumers to effectively access mental health services, including presence of an AHW/P during assessment and treatment.

In recognising that Aboriginal community controlled organisations are best placed to deliver health services to communities, improved coordination between ACCHSs and Local Health Districts is needed. The placement of Aboriginal mental health workers in the ACCHS sector, working in conjunction with mainstream services, could help develop integrated models of care, to increase the capacity and confidence of services to work with communities. This working partnership could potentially progress a historically arduous relationship and would increase the capacity of AHW/P in mental health and access to specialist support.

The uncertain and cyclic funding paradigm is a factor undermining the retention of a skilled Aboriginal workforce, and its training and working conditions. Consequently, this has a deleterious effect on achieving sustained improvements in treatment and care of Aboriginal people with mental health problems, particularly those with complex, severe and persistent illnesses.

The challenges of delivering mental health services in the regions

The challenges for people with mental illness in rural and remote areas are well known, and include distance, availability of health services, lower socioeconomic status, and shortages of GPs, specialist medical services and AHW/P. Most barriers in accessing mental health services in these communities are structural, including cost, transportation, or time constraints.[xxx] Geographic and professional isolation also make rural or remote communities less attractive to mental health practitioners, making it difficult to recruit and retain them.[xxxi]

Lack of funding for the ACCHS sector

A major contributor to the poor delivery of mental health services in rural and remote areas is the lack of funding. In the current context where health services, for mental health in particular, are under extreme pressure to meet urban population needs, the capacity of state governments to fund specialist mental health services to people outside of cities is diminished.[xxxii] The funding transition in 2013, from the Ministry of Health – Office of Aboriginal and Torres Strait Islander Health to the Department of the Prime Minister in Cabinet, led to a reduced AMHW and programs in the ACCHS sector, disadvantaging communities and the sector itself.

Continual under-funding of ACCHSs is a limiting factor that impedes the capacity to improve the mental health outcomes of Aboriginal people, particularly in rural, remote and very remote areas. Government investment is ad hoc, often directed towards mainstream service delivery, with non-Aboriginal services delivering care to Aboriginal people. These services are seen to lack the cultural knowledge, competence, capacity and understanding to effectively engage with Aboriginal people and their communities. Funding referred to mainstream services has resulted in many Aboriginal people failing to present at appointments or dis-engaging due to these services being culturally unsafe or inappropriate. It has also contributed to expensive increases in hospital admission rates for acute and complex conditions.

The ACCHS sector has consistently shown its capacity to achieve better health outcomes for Aboriginal people through delivering comprehensive, culturally-safe health, prevention and early intervention services in a more cost-effective way. However, adequate funding is still required to expand services in regions where they are inaccessible or demand is greater. ACCHSs contend that procurement approaches lacking in cultural safety will not provide equity of access for communities. These approaches, which deny Aboriginal community controlled services the opportunity to access resources to deliver appropriate services related to mental health, will continue to fall short, preventing effective social policy implementation and outcomes for communities and for government.

It is in the government’s interest to invest in the ACCHS sector to provide prevention and early intervention services, due to the significant economic burden of mental illness. There is a strong argument for optimising investment in areas where populations are most at risk and vulnerable.

Service delivery – need for greater coordination

Better services coordination between government and non-government organisations is a significant issue impacting Aboriginal people, particularly to address their needs in a culturally-appropriate and holistic way. Like many governments, the South Australian Government has acknowledged the barriers that departmental silos represent for the provision of appropriate and effective mental health care to Aboriginal people.

The Commonwealth Government’s Better Access to Mental Health Services Initiative is an example. This initiative is intended to mitigate access disparities and provide more coordinated care. However, application of the Modified Monash Model geographical classification system to determine eligibility requirements denies access for Aboriginal people living in many regional, remote and very remote locations, particularly in Western Australia.

Improved coordination of services is essential to reduce hospital admissions and ensure that Aboriginal people do not continue to be ‘lost’ in a system that does not understand or respond to their cultural and mental health needs. Paramount to ensuring consumers receive the right care is a more ‘wrap-around’, culturally-safe, holistic service model, implemented at all levels of government and non-government organisations. The ACCHS sector is the expert in this regard and is best placed to deliver services and educate the mainstream sector, with respect to relevant services for Aboriginal people.

Opportunities that technology presents for improved service delivery

The delivery of mental health services using new technologies is a growing area of practice and research interest. Building capacity within ACCHSs to effectively deliver technology‑based services is a sensible option, but how they will improve patient experience or access must be considered. Online services need to complement rather than replace an early human response in a crisis.

While the relative benefits of online services have not yet been evaluated in terms of their ability to augment traditional face-to-face mental health services, there are positive cost and service efficiencies. Research indicates that web-based services that provide mental health information and support can significantly improve mental health outcomes. New developments mean that cognitive behavioural therapies can be adapted into an online environment and be delivered without a counsellor, while providing the same outcomes at a fraction of the cost.[xxxiii]

Telehealth initiatives – such as teleconferencing and videoconferencing – are being used globally to deliver mental health services (assessment, consultation and therapy), and to fill prevention, assessment, diagnosis, counselling and treatment[xxxiv] service gaps in rural and remote locations. For people living in rural and remote Australia, the recent introduction of a new Medicare rebate, aimed at improving access to telehealth psychological services, is an important step. This means people can claim a rebate for up to seven videoconferencing consultations with psychologists and other mental health professionals. With Medicare data showing that per capita MBS expenditure on mental health services in remote areas is less than a quarter of that in major cities[xxxv], this is indeed a substantial improvement in the supply of services to disadvantaged populations.

A significant benefit of technology is the online access to training and referral advice for health professionals in rural and remote areas. Not only can web-based services have great potential for consumers, they can also offer education to mental health professionals, GPs and other staff.

While many approaches to online service delivery are still in their infancy, there are plenty of opportunities to combine research with new telehealth programs and evaluation of their effectiveness. A number of Member Services are currently trialling telehealth in remote areas with positive results, despite facing challenges with set-up and costs. While there is great potential for the development of mental health internet-based and mobile apps, it is important that these are inclusive and culturally appropriate for Aboriginal consumers. This requires investment and direct involvement of the ACCHS sector.