NACCHO Aboriginal #MentalHealth @georgeinstitute Download new screening tool to help Aboriginal and Torres Strait Islander people combat depression

“ This tool, which was developed in conjunction with Aboriginal communities and researchers, will help us address easily treated problems that often go undiagnosed. It will also help us to assess the scale of mental health problems in communities.

Up until now, we couldn’t reliably ascertain this in a culturally appropriate way, which has remained a huge concern.

We need better resources and funding for mental health across Australia, but particularly for Aboriginal and Torres Strait Islander people and within under-resourced health services. We hope this tool will be a turning point.”

Lead researcher Professor Maree Hackett, of The George Institute for Global Health, said mental health problems experienced by Aboriginal and Torres Strait Islander peoples have been overlooked, dismissed and marginalised for too long. 

A culturally-appropriate depression screening tool for Aboriginal and Torres Strait Islander peoples not only works, it should be rolled out across the country, according to a new study.

Researchers at The George Institute for Global Health, in partnership with key Aboriginal and Torres Strait primary care providers conducted the validation study in 10 urban, rural and remote primary health services across Australia.

The screening tool is an adapted version of the existing 9-item patient health questionnaire (PHQ-9) used across Australia and globally accepted as an effective screening method for depression. The adapted tool (aPHQ-9) contains culturally-appropriate questions asking about mood, appetite, sleep patterns, energy and concentration levels. It is hoped the adapted questionnaire will lead to improved diagnosis and treatment of depression in Aboriginal communities.

The results of the validation study were published in the Medical Journal of Australia 1 July 2019

Download the 7 page study  mja250212

The aPHQ-9 is freely available in a culturally-appropriate English version, and can be readily used by translators when working with First Nation communities where English is not the patients first language.

It is estimated up to 20 per cent of Australia’s general population with chronic disease will have a diagnosis of comorbid major depression. [1]

Approximately similar proportions will meet criteria for moderate or minor depression. Mental illness and depression are also considered to be key contributors in the development of chronic disease.

Across the nation, chronic disease (cardiovascular disease, cerebrovascular disease, diabetes, chronic kidney disease and chronic obstructive pulmonary disease) accounts for 80 per cent of the life expectancy gap experienced by Aboriginal people [2]  

How the tool works

The adapted tool, which was evaluated with 500 Aboriginal and Torres Strait Islander peoples, contains culturally-appropriate questions.

For example, the original (PHQ-9) questionnaire asks:

  • Over the last two weeks, how often have you been bothered by any of the following problems: Little interest or pleasure in doing things?
  • Feeling down, depressed or hopeless

The adapted (aPHQ-9) tool instead asks:

  • Over the last two weeks have you been feeling slack, not wanted to do anything?
  • Have you been feeling unhappy, depressed, really no good, that your spirit was sad?

Download: Adapted Patient Questionnaire with scoring (PDF 117 KB)

Download: Adapted Patient Questionnaire without scoring(PDF 114 KB)

Professor Alex Brown, of the South Australian Health and Medical Research Institute, who was co-investigator on the study, said the importance of using culturally appropriate language with First Nations people cannot be underestimated.

“In Australia, as with many countries around the world, everything is framed around Western understandings, language and methods. Our research recognises the importance of an Aboriginal voice and giving that a privileged position in how we respond to matters of most importance to Aboriginal people themselves.

“What we found during this study was that many questions were being lost in translation. Instead of a person scoring highly for being at risk of depression, they were actually scoring themselves much lower and missing out on potential opportunities for treatment.

“It was essential that we got this right and that we took our time speaking with Aboriginal people and ascertaining how the wording needed to be changed so we can begin to tackle the burden of depression.”

Aboriginal psychologist Dr Graham Gee, of the Murdoch Children’s Research Institute, saidAboriginal communities have unacceptably high rates of suicide which need to be addressed. “Identifying and treating depression is an important part of responding to this major challenge. It’s clear this tool is much needed.”

The new tool will be available for use at primary health centres across Australia and will be available to download here from Monday July 1.

The George Institute for Global Health

The George Institute for Global Health conducts clinical, population and health system research aimed at changing health practice and policy worldwide.

Established in Australia and affiliated with UNSW Sydney, it also has offices in China, India and the UK, and is affiliated with the University of Oxford.  Facebook at thegeorgeinstitute  Twitter @georgeinstitute Web georgeinstitute.org.au

[1] https://www.aihw.gov.au/reports/mentalhealthservices/mentalhealthservicesinaustralia/reportcontents/summary/prevalenceandpolicies

[2] https://www.aihw.gov.au/reports/indigenousaustralians/contributionofchronicdiseasetothegapinmort/contents/summary

Additional Media 

Doctors can now use the new tool

Extract from the Conversation 1 July 2019

In 2014-15, more than half (53.4%) of Aboriginal and Torres Strait Islander peoples aged 15 years and over reported their overall life satisfaction was eight out of ten or more. Almost one in six (17%) said they were completely satisfied with their life. These positive data are testament to Aboriginal and Torres Strait Islander peoples’ ongoing endurance.

But over the years, events like colonisation, racism, relocation of people away from their lands, and the forced removal of children from family and community have disrupted the resilience, cultural beliefs and practices of many Aboriginal and Torres Strait Islander Australians. In turn, these factors have impacted their social and emotional well-being.

This may explain why Aboriginal and Torres Strait Islander peoples are twice as likely to be hospitalised for mental health disorders and die from suicide than their non-Aboriginal counterparts.

Teenagers aged 15 to 19 are five times more likely than non-Indigenous teenagers to die by suicide.

The importance of being able to more accurately identify those at risk can’t be understated.

While screening all Aboriginal and Torres Strait Islander peoples who present to general practice for depression is not recommended, the new questionnaire is a free, easy to administer, culturally acceptable tool for screening Aboriginal and Torres Strait Islander peoples at high risk of depression.

People who might be at heightened risk of depression include those with chronic disease, a history of depression and those who have been exposed to abuse and other adverse events.

Without a culturally appropriate tool, Aboriginal and Torres Strait Islander people with depression and suicidal thoughts might fly under the radar. This questionnaire will pave the way for important discussions and the provision of treatment and services to those most in need.

If this article has raised issues for you or you’re concerned about someone you know, call Lifeline on 13 11 14. Visit the Beyond Blue website to access specific resources for Aboriginal and Torres Strait Islander people.

Maree Hackett, Professor, Faculty of Medicine, UNSW and Geoffrey Spurling, Senior lecturer, Discipline of General Practice, The University of Queensland

This article is republished from The Conversation under a Creative Commons license. Read the original article.

NACCHO Aboriginal Health and #SuicidePrevention @cbpatsisp The #WISPC18 #NISPC18Conference Report, released this week, confirms the urgent need for action in colonised countries throughout the world

Our people know the solutions, as is evidenced in the Aboriginal and Torres Strait Islander Suicide Prevention Evaluation Project (ATSISPEP), Solutions that work: What the evidence and our people tell us along with countless other reports and bodies of work. It’s time for all parties to work together, and with us on co-designing and implementing clinically proven culturally driven solutions.”

Professor Pat Dudgeon, a Psychologist and Project Director at the Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention (CBPATSISP), has found intergenerational trauma and suicide to be a legacy of colonisation for Indigenous peoples the world over.

Download the Report

SuicidePreventionReport_JUNE-2019_FINAL_WEB

Read over 140 Aboriginal Health and SUicide Prevention articles published by NACCHO in past 7 years 

Indigenous suicide is a global concern. The 2nd National and World Indigenous Suicide Prevention Conferences in Perth WA in November 2018 brought together Indigenous peoples from Australia, Canada, United States of America and New Zealand. The Conference Report, released today, confirms the urgent need for action in colonised countries throughout the world.

Suicide rates have been increasing worldwide and are especially high amongst Indigenous peoples. The critical importance of identifying and implementing effective suicide prevention strategies in Indigenous communities was highlighted by a report Global Overview: Indigenous Suicide Rates. Prepared for and launched at the Conferences, the report details the consistently higher rates of suicide amongst Indigenous compared to non-Indigenous people and demonstrates the urgency for action.

Indigenous Elders, policy makers, researchers and community members representing LGBTIQ+SB, Youth, and Lived Experience participants came together at the Conferences to recognise the impacts of colonisation and subsequent trauma, disadvantage, marginalisation and lack of action by government on Indigenous issues and the need for healing and recovery processes for suicide prevention.

Professor Pat Dudgeon, a Psychologist and Project Director at the Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention (CBPATSISP), has found intergenerational trauma and suicide to be a legacy of colonisation for Indigenous peoples the world over.

There’s an emerging story about people who have been colonised. Usually the takeover of their lands has been quite brutal. There were genocides and people removed from country and treated like second-class citizens, which in itself is traumatic.

Professor Dudgeon cited the work of psychologists Professor Michael Chandler and Professor Christopher Lalonde as pointing a way forward in preventing suicide in Aboriginal and Torres Strait Islander communities.

They looked at Canadian First Nation tribes and found that some communities had no suicide and others were right off the scale. So they examined the communities that had no or low suicide rates and coined the term ‘cultural continuity’. Translated into plain English, those communities had good self-determination. They had their own councils, they were in charge, they had agency over their community and their lives.

Another factor was that they were doing cultural reclamation activities. These could be simple things like building a long house or ensuring you had your cultural ceremonies happening. These issues corresponded directly to suicide rates.

Recovery from colonisation is our globally shared agenda and the conference enabled delegates to examine issues and identify solutions that are needed. Indigenous peoples from all countries who attended the conferences are calling upon their respective governments to recognise the Indigenous Rights declaration, the right to self-determination and the right for data sovereignty.

Recommendations included a dedicated National Aboriginal and Torres Strait Islander Suicide Prevention Strategy and Implementation Plan; allocation of greater levels of program funds for Aboriginal and Torres Strait Islander communities; and an Elders call on all levels of government for an immediate response to unacceptable rates of suicides of young people, including a Royal Commission or ‘Truth and Reconciliation’ as the basis for healing and moving forward, programs and services to recognise and support the restoration and maintenance of culture and identity for the younger generation.

As Professor Dudgeon says:

Our people know the solutions, as is evidenced in the Aboriginal and Torres Strait Islander Suicide Prevention Evaluation Project (ATSISPEP), Solutions that work: What the evidence and our people tell us along with countless other reports and bodies of work. It’s time for all parties to work together, and with us on co-designing and implementing clinically proven culturally driven solutions.

The next Conference will continue the legacy of the Calls to Actions and Recommendations. Ms Carla Cochrane who is the Regional Research Coordinator for the First Nations Health and Social Secretariat of Manitoba is coordinating and planning the 3rd World Suicide Prevention Suicide Prevention Conference that will take place in Winnipeg, Manitoba, Canada in August 2020.

Ms Cochrane stated:

The 2018 Conference allowed us to share our stories and to connect on all levels, including spirit, with the promotion of life.  Even though we come from different regions, our experiences and history are very similar and so is our strength, perseverance and resiliency to overcome the challenges we may face. Our connection to who we are as Indigenous people, our connection to the land and our languages set this foundation and this was highlighted at the conference.

Our focus at the 2020 Conference will be on continuing the legacy of the Calls to Actions and Recommendations from the 2018 Conference and on strengthening our communities through sharing our stories and our Knowledge.

  • Lifeline: 131 114
  • Kids Helpline: 1800 551 800
  • Mensline: 1300 78 99 78
  • Suicide Call Back Service 1300 659 467
  • Open Arms Veterans and Families Counselling 1800 011 046
  • Qlife – 1800 184 527
  • National Indigenous Critical Response Service 1800 805 801

NACCHO Aboriginal Health and #SocialMedia #MentalHealth #SuicidePrevention : Is your mob safe online ? New Report: Urges parents and communities to seek support with children’s online safety

Kids are growing up in two worlds, the real world and an online world. Just like we protect kids from dangers in the real world, it’s important to protect their safety in their online world too.

Many of our mob are unsure how to help keep their kids safe online. These resources are designed to educate Aboriginal and Torres Strait Islander parents and carers of children aged 5 – 18 about the importance of starting the chat with young people around online safety.

Visit Be Deadly Online to find out more about the big issues online, like bullying, reputation and respect for others “

Download StarttheChatandStaySafeOnlinepdf

Start the Chat

Download Aboriginal and Torres Strait Islander Resources Here

“eSafety has built engaging and award-winning educational content to help adults understand the issues and trends so they can have informed conversations with young people about what they are doing and experiencing online.

There is no substitute for being as engaged in our kids’ online lives the way we are in their everyday lives.

There is no one-size-fits-all approach when it comes to parenting in the digital-age. Our materials seek to accommodate these differing parenting styles and are tailored to be used in accordance with your child’s age, maturity and level of resilience,” 

eSafety Commissioner, Julie Inman Grant

Download the Report eSafetyResearchParentingDigitalAge

Parents are the first port of call for most young people affected by negative experiences online but less than half of parents feel confident to manage the situation, according to new research issued yesterday.

The report, Parenting in the digital age, conducted by the eSafety Commissioner (eSafety) explores the experience of parents and carers raising children in a fast-paced connected world.

eSafety found only 46% of Australian parents feel confident in dealing with online risks their children might face, with only one third (36%) actively seeking information on how to best manage situations like cyberbullying, unwanted contact or ‘sexting’ and ‘sending nudes’.

According to the eSafety Commissioner, Julie Inman Grant, the findings reinforced the importance of providing resources to support parents and carers in managing conversations about online safety.

“We know dealing with online issues can be challenging for many parents. The issues are complex, nuanced and ever-changing and are different from what we experienced growing up,” says Inman Grant.

“The research shows 94% of parents want more information about online safety. This is why it is critical to equip parents and carers with up to date resources and advice on how to keep our children safer online. Australian parents need to know they are not alone in navigating this brave new online world and that there is constructive guidance to help them start the chat.”

Starting the chat, an important part of growing up safe online

“Everyone has a role to play in further safeguarding our children online and we are seeking the help of all parents, carers, educators, counsellors and anyone else that has a connection to a child or young person to answer this call.”

 

Starting the chat with teens, key to online safety (Stars Foundation)

The report also uncovered the varied parenting styles used to help manage online safety in the home. Parents with older children were more likely to favour an open parenting style, providing guidance and advice, while parents with younger children were more likely to adopt a restrictive approach by controlling online access and setting rules around internet-use.

“There is no one-size-fits-all approach when it comes to parenting in the digital-age. Our materials seek to accommodate these differing parenting styles and are tailored to be used in accordance with your child’s age, maturity and level of resilience,” adds Inman Grant.

Now is the time to start the chat.

Visit eSafety.gov.au for a free copy of the report, as well as tools, tips and advice for parents, carers and educators to help manage these conversations, including tailored information for Aboriginal and Torres Strait Islanders as well as resources in various translated languages.

NACCHO Aboriginal #MentalHealth #SuicidePrevention @NMHC Communique : @GregHuntMP roundtable meeting to review investment to date in mental health and suicide prevention : #TimeToFixMentalHealth #TomCalma @AUMentalHealth @FrankGQuinlan @PatMcGorry @amapresident @headspace_aus

” Minister for Health, Greg Hunt, hosted a Government-led roundtable this week to review investment to date in mental health and suicide prevention, to hear from the sector on current gaps and priorities, to understand what is and is not working, and to advise on the upcoming national forum on youth mental health and suicide prevention.

Minister Hunt and Prime Minister Scott Morrison are committed to working towards zero-suicide for all Australians, including our youth.

From the National Mental Health Commission 6 June 

( The Indigenous ) Suicide rates are an appalling national tragedy that is not only depriving too many of our young people of a full life, but is wreaking havoc among our families and communities.

As anyone who has experienced a friend or family member committing suicide will know, the effects are widespread and devastating and healing can be elusive for those left behind.

It is time that we draw a line under this tragic situation that is impacting so significantly on Aboriginal and Torres Strait Islander communities  “

Noting Professor Tom Calma AO was a participant in the meeting via telephone link and opened the meeting with a discussion on Indigenous suicide. 

See this quote and 140 Plus Aboriginal Health and Suicide Prevention articles published by NACCHO in last 7 Years 

Those in attendance welcomed the Government’s commitment, with a number noting that suicide prevention needs to be a priority across all age groups, especially those groups with the highest suicide rates.

The conversation covered a range of key issues, challenges and opportunities for reform and action. Particular discussion points included:

  • Social determinants of mental health: there is a fundamental need to focus on the social determinants of mental health for all Australians, noting and emphasising the range of factors that contribute to distress in young Australians. This is an important factor for all young people and communities, with particular reference to the factors impacting on Aboriginal and Torres Strait Islander children and youth.
  • The impact of trauma and disadvantage: conversation centred on the impacts of trauma and disadvantage and the importance of supporting, for example, young people in out-of-home care, those living in poverty and individuals who are in the justice system.
  • Support for children and families: in order to improve the lives of young Australians, there is a need to better support children and families in the early years. This includes support for neurodevelopmental disorders. In the same way headspace has been developed for young people, there was a suggestion that mental health services focused on children and families could show real benefits.  There is strong support for a focus on prevention
  • Support for Schools: a continued need was highlighted around the role of, and support for, schools, including primary schools and early learning centres. Schools are a critical component of a ‘whole of community’ approach in building supportive environments for children and young people.   It was suggested that for families who may not seek services but who were in need a way of ‘connecting’ may be through digital tools, to identify and support children and parents in those families.
  • Impact on youth: young people can be seriously impacted and influenced by the suicide death of other young people who are their friends, peers, family members or celebrities. More timely and sophisticated data and comprehensive local responses are needed to assist in the reduction of risk for further lives being lost following a suicide.
  • Data: The importance of being able to collect, analyse and provide accurate data was highlighted.  This data is significant across mental health services and particularly for suicide prevention, treatment and support services.
  • Service reform: there is a need for service reform to better respond to people with mental health concerns that are too complex to be managed by a GP at a primary health care level but not so acute as to require specialist tertiary mental health services. While there are some good programs and services to build upon, there is a lack of equity across all regions and access remains a key issue for those requiring psychological and other services. We also need to integrate mental health services with drug and alcohol services.
  • Workforce development: there is an urgent need to focus on training and supporting the diverse professionals working with those at risk of or with mental health issues – health and allied health staff, drug and alcohol workers, school counsellors, psychologists, peer workers and many others. The role of peer workers was recognised as being a critical one and this must be included in all workforce development strategies and initiatives.
  • Peer and carer support: many families and peers supporting those who are in suicidal distress and/or living with challenging mental health and drug and alcohol concerns needed immediate and quality support themselves as they are also at risk for mental ill-health. Families and friends are the largest non-clinical workforce providing care and support for Australians and there is an immediate need to provide better supports for them.
  • Regional and national leadership: while attendees were supportive of regional planning and action, it was suggested that stronger guidance at a national level was needed in order to ensure equity and quality of service responses across the country, with a recognition of the importance of the role of Primary Health Networks.  Further work is needed to ensure that the roles and responsibilities of all governments were clarified, together with accountability. The Fifth National Mental Health and Suicide Prevention Plan, and particularly the Suicide Prevention Implementation Plan, are key drivers for clearer accountability and integrated and coordinated responses.
  • Funding models: there was discussion on how best to fund services across the range of needs, including the current review of Medicare and the role of private health insurance.

A collective agreement and strong commitment was reached that a collaborative approach is vital to achieving improved mental health outcomes for all Australians, including children and youth.

There is significant support for a 2030 Vision for mental health and suicide prevention, to be led by the Commission and to ensure that the systematic changes required to best service the community can be identified, prioritised and achieved. This Vision would be look beyond the current plans and strategies.

Attendees acknowledged the commitment to mental health and quality program responses in recent years, together with the increased funding in the 2019/20 federal budget for expanded youth and adult mental health services in the community, together with initiatives to strengthen the collection of critical data around suicide and mentally healthy workplaces.  They also noted the current enquiries being undertaken by the Productivity Commission and the Victorian Royal Commission.  However, there needs to be an increased focus on longer term systems reform.  The Commission has been tasked with taking a leading role in this and will work closely with the sector to develop a reform pathway.

Participants embraced the importance of hope, recognising not only the significant investment to date but that youth mental health services in Australia have been copied by other nations.  There is strong support for improvements in mental health and suicide prevention across all levels of government and community.

As outlined by the Minister for Health, this was an opportunity to review the current status and continue this important discussion.  It is one of many conversations that will continue with the sector at organisational, group and individual levels.

The Commission will provide updates in sector engagement and discussions as they occur.

Lucy Brogden

Chair, National Mental Health Commission

Christine Morgan

CEO, National Mental Health Commission

 

NACCHO Aboriginal Health and #Ice #ClosingTheGap : Some call it an epidemic, others call it the “Ice Age”. What ever you call it , it is destroying families, and Indigenous culture

“You need to trust us to be able to deliver a service to our own people linked in with culture. Who are the right people to deliver that? Our people.

I have seen it a thousand times over. Once they are addicted to ice, culture’s gone, you don’t care about your kids, your primary focus is ‘I need this drug.’ It is worse than heroin.

Ice has a terrible impact on the family. Yet there was nothing to explain to families “why all your stuff is being sold at the pawn shop” and how to get help “

Tanya Bloxsome, a Waddi Waddi woman of the Yuin, who is chief executive of a residential rehabilitation service for men, Oolong House

Read over 60 Aboriginal Health and Ice articles published by NACCHO

Originally published SMH Julie Power

It makes Nowra grandmother Janelle Burnes’ day when her grandson Lucas* says, “Nanny, you’ve got a beautiful smile. I love you.”

The Wiradjuri woman has been punched and kicked by eight-year-old Lucas, who hears voices and suffers psychosis.

Janelle Burnes had to give up work to care for her eight-year-old grandson. He suffers from a range of mental illnesses, including psychosis, attributed to his parents’ ice addictions.

Abandoned by his mother as a baby, Lucas has fetal alcohol and drug syndrome attributed to his parents’ ice use when he was conceived.

Experts told the NSW special commission of inquiry into ice in Nowra last week that they were increasingly seeing multiple generations of users living together, exposing children to violence, neglect, abuse and witnessing sex and drug use by intoxicated adults.

Some call it an epidemic, others call it the “Ice Age”.

When Lucas hit his grandmother over the head with a guitar, she didn’t yell at him. Determined to stop the boy from becoming part of another generation broken by ice, Ms Burnes ignored the blood running down her face and the waiting ambulance.

“I walked back to him, I hugged him, I cuddled him, I told him, ‘You are going to hurt Nanny if you do stuff like that.’ And I gave him a kiss and I told him I still loved him.”

Ice is a stronger and more addictive stimulant than speed, the powder form of methamphetamine, the Alcohol and Drug Foundation says. It causes aggression, psychosis, stroke, heart attacks and death. It causes confusion, making it nearly impossible to get a rational response from someone under the drug’s influence.

Tanya Bloxsome, chief executive of Oolong House, a residential rehabilitation service where more than 90 per cent of its male residents have been addicted to ice. CREDIT:LOUISE KENNERLEY

Ms Burnes doesn’t blame Lucas for his behaviour, but ice. It is destroying Indigenous and non-Indigenous families across the Shoalhaven region. It is also destroying Indigenous culture.

To recover, Indigenous leaders say they have to develop role models and restore pride in their identity.

“You need to trust us to be able to deliver a service to our own people linked in with culture. Who are the right people to deliver that? Our people,” said Tanya Bloxsome, a Waddi Waddi woman of the Yuin, who is chief executive of a residential rehabilitation service for men, Oolong House.

“I have seen it a thousand times over. Once they are addicted to ice, culture’s gone, you don’t care about your kids, your primary focus is ‘I need this drug.’ It is worse than heroin.

“Ice has a terrible impact on the family,” she said. Yet there was nothing to explain to families “why all your stuff is being sold at the pawn shop” and how to get help.

Nearly two-thirds of 52 Indigenous and non-Indigenous children placed in out-of-home care in the Nowra region in the past year were removed because of ice use by their parents. It was also a “risk factor” in about 40 per cent of the 124 families working with Family and Community Services’ case managers.

When Indigenous groups met the commission last week, they said they needed more culturally appropriate programs, rehabilitation places and detoxification units (the closest are in Sydney, Canberra and Dubbo).

Indigenous Australians are more than 2.2 times as likely to take meth/amphetamine than other Australians.

In the opening address to the commission, Sally Dowling, SC, said the impacts of colonisation and dispossession, intergenerational trauma and socio-economic disadvantage had continued to contribute to high levels of amphetamine use in Indigenous communities.

Ice use in Nowra is not as bad as out west. But the region has seen the biggest year-on-year growth in arrests for possession and use since 2014, with a 31 per cent increase compared with 6 per cent across the state.

Cheaper than Maccas

Getting high on ice was “cheaper than going for Maccas”, said Nowra’s Aboriginal Medical Corporation’s substance abuse counsellor Warren Field, who runs a weekly men’s group for recovering addicts.

Ice had also become a “rite of passage” for some young people after they had received their first Centrelink payment or wage.

Mr Field said “99 per cent” of ice users had suffered some form of trauma. Nearly all had other mental health problems, including anxiety and depression.

“Everyone says there is nothing [like it] that will numb the pain and take the grief and loss away,” he said. It also makes women lose weight and gives men incredible sexual prowess.

“Most people are vulnerable when they go through a traumatic event and the Aboriginal community has had more than its fair share of that,” he said.

He argues they know what works – culturally appropriate rehabilitation which develops strong role models and a sense of identity. But there had to be more support when people came out of rehabilitation to stop them from relapsing.

The first year of rehabilitation was particularly hard. People in recovery were often depressed and their ability to feel happiness or pleasure without the drug was dulled.

Mr Field said “black fellas” were also unfairly targeted by police who, he argued, should spend more time closing the crack houses that “everyone” knew about.

 

At Oolong House, 21 men – 18 of whom were Indigenous – were getting themselves breakfast while 42-year-old Bobby McLeod jnr played guitar and a mate accompanied him on the didgeridoo.

More than 90 per cent of men in the program had been using ice, very often with other drugs, and increasingly with heroin, Ms Bloxsome said.

“Every addicted person who comes in here has a mental health issue,” she said. And residents addicted to ice were more psychotic than those addicted to other drugs.

Most residential programs are 12 weeks, but Oolong offers 16 weeks, and Ms Bloxsome believes even longer programs would be better. But like services up and down the South Coast, it can’t keep up with demand.

The program offered cognitive behavioural therapy, addressed mental and physical health, and encouraged the men to undertake training that would help them get work. Nearly all the men arrived with hepatitis C and those released from jail were, with few exceptions, addicted to the drug, bupe (buprenorphine).

The most powerful medicine, though, was getting back to culture by doing traditional dance, learning language and going on bush walks. After a lifetime in prison, Mr McLeod  said painting and writing songs about his life had helped his recovery.

When everything else was bad, ice had made him “feel invincible”. But it cost him his family and caused anxiety and depression, which made him feel suicidal.

His old man was a successful singer, his brother had travelled around the world with an Indigenous dance group, but he was the one who “went to jail”, Mr McLeod said.

Raising money for a funeral 

Ms Burnes lives in fear of a phone call telling her that Lucas’ 39-year-old mother is dead.

In anticipation of the inevitable – her nephew died earlier this year from a heart attack caused by his ice addiction – she is raising money for anticipated funeral costs.

Lucas’ mother has had three heart attacks caused by decades of addiction.

Janelle Byrnes is planning a funeral for her ice-addicted daughter. In a Facebook post, her 39-year-old daughter asks others to stop using ice. CREDIT:FACEBOOK

In a Facebook post, her daughter wrote about how her “huge addiction” had caused two heart attacks in two weeks.

“Now I’ve got to plan my funeral just in case I don’t make the next,” she wrote. “That’s not the saddest thing. It is listening to my mum cry and plan it with me. ”

“If U love your family reconsider having that pipe or putting that needle in your arm,” Ms Burnes’ daughter said.

In the meantime, Ms Burnes does everything she can to provide a stable home for Lucas.

She quit her job of 22 years as an Aboriginal education officer to care for her grandson, to ensure he gets to doctors’ appointments and maintain his schooling.

She’s been working with him to maintain his good results in reading and spelling, despite frequent suspensions for getting into fights, so he has a chance of fulfilling his dream of becoming a police officer.

* name changed

With additional reporting by Louise Kennerley.

NACCHO Aboriginal Health & Suicide Prevention @LindaBurneyMP @GerryGeorgatos : Since 1 January a total of 78 #­Indigenous Australians have taken their own lives : 90 % of the nation’s youth suicides aged 14 and younger involve our mob

 “ Ms Burney said she would be open to travelling across Australia with her Coalition counterpart and friend Ken Wyatt — who last week became the first Aboriginal person to hold the indigenous ­affairs portfolio — to ask families whose loved ones had ended their own lives how they believed the situation could have been prevented.

The sheer horror of the crisis was revealed in The Weekend Australian, which reported that 77 ­indigenous Australians had taken their own lives in the first five months of 2019, including seven in the past week.

 Another suicide yesterday brought that figure to 78 since January 1.

Linda Burney is now Shadow Indigenous Affairs Minister. See Article Part 1 Below and full Indigenous shadow ministry Part 2

Read over 140 + Aboriginal Health and Suicide Prevention article published by NACCHO in the past 7 years 

For the past week, Indigenous and other leaders have been campaigning in The Sydney Morning Herald for an Indigenous Voice to Parliament. I, too, pray this campaign succeeds.

Empowering Indigenous Australians in the decisions that affect their destiny is critical to addressing the entrenched disadvantage they endure – the deplorable health, employment and incarceration statistics that are reflected in the shocking suicide numbers.”

Gerry Georgatos is the national co-ordinator of the National Critical Response Trauma Recovery Project. He previously led the federal government’s National Indigenous Critical Response Service : see Part 3 in full

Part 1 : Families first in Burney’s bid to tackle suicide crisis

From the Australian 3 June

Linda Burney wants to talk to the broken families of young in­digenous people who have taken their own lives, to help find solutions to the suicide crisis, after being ­appointed Labor’s first ­Aboriginal spokeswoman for indigenous Australians.

Stressing that youth suicide — particularly among regional, rural and remote communities — was not a “new tragedy”, Ms Burney said the key to turning around the devastating trend was a sharper focus on early intervention, ­ensuring Aboriginal people worked for and with youth mental health organisations, and a strengthened commitment to research on the factors behind the crisis.

Ms Burney said she would be open to travelling across Australia with her Coalition counterpart and friend Ken Wyatt — who last week became the first Aboriginal person to hold the indigenous ­affairs portfolio — to ask families whose loved ones had ended their own lives how they believed the situation could have been prevented.

The sheer horror of the crisis was revealed in The Weekend Australian, which reported that 77 ­indigenous Australians had taken their own lives in the first five months of 2019, including seven in the past week. Another suicide yesterday brought that figure to 78 since January 1.

“Youth suicide is the end of a very long line for people and it’s not a new issue,” Ms Burney told The Australian. “I want to really make that clear. I know it’s like everyone is talking about it now, but this has been an entrenched issue within Aboriginal communities for a very long time. The issue of early intervention is really important. Not just intervention in the year before or the two years before (they potentially take their life), but investment in early childhood education, healthy living, being strong in your culture and strong in yourself. Those things don’t come about when you’re 14 or 15, they’re things you build over a whole lifetime.”

Ms Burney’s beloved 33-year-old son, Binni, was found dead in October 2017 at their family home. There were no suspicious circumstances.

The former NSW state MP said she had avoided indigenous portfolios over her nearly 18-year political career, but she felt now was the time to take on the role.

“The suicides in the last three years, were there one or two common strands that every awful situation contained? I don’t know where the research is and we need to know more about it,” she said.

“(I want to) visit (affected families), sit down with them and talk to them. That’s absolutely crucial. They have to be part of putting forward what needs to happen.”

She suggested “very fine” youth mental health services that received government funding should ensure they had an indigenous strategy or employed ­Aboriginal people to demonstrate that Aboriginal children were being helped.

But many on the frontlines of the nation’s indigenous suicide crisis say funding for grassroots 24-7 prevention services is seriously lacking.

Noeletta McKenzie, a highly respected youth worker in suicide prevention in the Northern Territory, is the manager of the Balunu Foundation in Darwin, a small but mighty indigenous-owned and operated youth service that is aiming to break the cycle of disadvantage by connecting kids to identity and culture.

Balunu, like many similar ­organisations, cannot keep up with demand. Ms McKenzie has just enough funding for three staff, including herself, and each grapples with a “huge workload”. She estimates she has about 20 kids on her books in Darwin, and another 20 involved in Balunu’s outreach program.

“The kids we work with are under the poverty line, some are couch-surfing, some are homeless,” she said.

“We pick our kids up for all our programs, and we always put on a big lunch for them. For some of these kids, that could be their first feed that day, or their first feed since breakfast the day before. We don’t clock off. It can get overwhelming. I stay up all night inboxing (messaging) on Facebook with a young person who is self-harming, to get them through the night.”

Ms McKenzie said Australia needed a minister for indigenous suicide prevention. “We really need to get very serious about suicide in this country,” she said.

Tragically, the 42-year-old Darwin-based youth worker is one of many grappling both professionally and personally with the suicide epidemic.

Her beloved nephew, Sabo Young, was just 24 when he took his life in February last year. As the senior youth worker, caretaker of the youth centre, and a qualified youth justice worker in Maningrida in remote Arnhem Land, Sabo was always on call, often staying awake all night to talk a child out of suicide.

Passionate about his job, adored by his family, and idolised as a big brother by the kids he mentored, Sabo saved countless lives.

“It was a big shock to our family,” Ms McKenzie said of her nephew’s sudden death. “Sabo was a role model. He was the big brother one, and like a son to me.

“Anyone who works on the frontline, dealing with young people with suicidal thoughts, everyone feels that weight. We’ve also got to care for the carers.”

If you or someone you know may be at risk of suicide, call Lifeline (13 11 14) or the Suicide Call Back Service (1300 659 467), or see a doctor

Part 2

Australian Labor Party Anthony Albanese MP has put First Nations issues high on the Labor agenda in his Shadow Cabinet lineup. First Nations Federal Labor Caucus (FNCC) will be the body that supports the First Nations’ policies process.

Appointments to the Shadow Ministry.

Linda Burney is now Shadow Indigenous Affairs Minister.

Senator Patrick Dodson is Shadow Assistant Minister in Reconciliation & Constitutional Recognition

Warren Snowdon MP is now Shadow Assistant Minister in Indigenous Affairs

The high rates of suicide and incarceration rates, in particular of young First Nations people, is the immediate focus, along with the discriminatory CDP policy.

Part 3

Children’s graves in a row: the Indigenous youth suicide emergency

From SMH 3 June

I remember a 10-year-old Indigenous child lost to suicide. The year before her death, she found her 11-year-old first cousin had taken his life. Two years earlier her 13-year-old sister had taken her life. They lived in crushing poverty and confronted an arc of distress born of that inescapable poverty.

For the past decade, I’ve focused my research and working life on suicide prevention and its indisputable intersection with poverty.

From a trauma recovery vantage, I’ve worked alongside more than 1000 suicide-affected families. These include hundreds of First Nations families. I’ve journeyed to more than 600 First Nations communities.

I attended the funerals of three children in one community – three burials in five days, three graves in a row. Hundreds of mourners weeping, wailing. Weeks later, the loss of two more young people would make it five graves in a row of youth unlived.

One in 17 of all deaths of First Nations people is a suicide, while half of all deaths of Indigenous youth aged 17 and younger is a suicide. First Nations children account for almost 90 per cent of the suicides of children aged 14 and younger. The nation should weep.

The suicide rate of First Nations Australians is 2½ times that of the overall Australian rate. Now consider this: 14 per cent of Australians live below the poverty line while 40 per cent of First Nations Australians do.

That’s a 2½ times differential – an absolute correlation. In my research, experiential and otherwise, nearly 100 per cent of the suicides of First Nations peoples are of individuals who lived below the poverty line.

For the past week, Indigenous and other leaders have been campaigning in The Sydney Morning Herald for an Indigenous Voice to Parliament. I, too, pray this campaign succeeds. Empowering Indigenous Australians in the decisions that affect their destiny is critical to addressing the entrenched disadvantage they endure – the deplorable health, employment and incarceration statistics that are reflected in the shocking suicide numbers.

The Indigenous Voice will be a reason for long-term hope. It may well not happen, however, in this term of government. The suicide emergency  needs focus now.

Prime Minister Scott Morrison and Health Minister Greg Hunt have pledged a pronounced focus on suicide prevention, particularly youth suicide. This is to be applauded. So is the historic appointment of Ken Wyatt as the nation’s  first Indigenous Minister for Indigenous Australians.

But I had hoped the federal government would announce a Minister for Suicide Prevention. I believed that Ken Wyatt – as a widely respected Indigenous man, and with his background in health administration – was uniquely qualified to taken on such a role.

RELATED ARTICLE

INDIGENOUS

Kimberley suicide rate reflects colonial legacy and ‘mindset of consent to inaction’

Minister Ken Wyatt, with his substantive education and health backgrounds, is the best shot Australia has had thus far to further long overdue lifesaving legacies.

Each year of this century the First Nations suicide toll has been higher than the preceding year. This year, once again we are heading to another record. Thus far, there have been 78 suicides of First Nations Australians, 20 aged 18 or younger, more than half aged 26 or younger. Of all weeks, the toll shot up by seven last week. That was Reconciliation Week.

As somebody with years immersed in suicide prevention who is not desktop-bound, here is what I want everyone to know:  suicide is not complex. It is multi-factorial and multi-layered with an arc of issues, some which intertwine, but it is not complex. There is an underwriting narrative – poverty. More than two-thirds of the Australian suicide toll is intersected by poverty and a concomitant accumulation of life stressors.

Eight of 10 First Nations children in remote areas do not complete school. Even in our capital cities, one in two First Nations children living in public housing do not complete school.

There are guiding lights. Like overseas-born children who fled to Australia from oppressive disadvantage, First Nations youth who go to university are among the most likely and most driven to succeed.

Unless governments heed and focus, more children than ever before will be lost. We must prioritise those most in need, those who languish in shanties without white goods, without secondary schools, without recreational facilities.

Of the many tragedies I have confronted  in my work, hauntingly etched in my mind’s eye are three children who are still alive.  Two years ago, they were aged six, eight and 10 when – together – they attempted suicide.  They were saved by older children.

We have many more children to save.

 Gerry Georgatos is the national co-ordinator of the National Critical Response Trauma Recovery Project. He previously led the federal government’s National Indigenous Critical Response Service.

 

 

NACCHO Aboriginal Women’s Health #NRW2019 #ClosingTheGap : Aboriginal mothers are incarcerated at alarming rates – and their mental and physical health suffers

 ” Aboriginal women are the fastest growing prison population in Australia.

They comprise around one-third of female prisoners in New South Wales, despite making up just 3% of the population. The majority of Aboriginal women in prison (more than 80%) are mothers.

Our research team interviewed 43 Aboriginal mothers in six prisons across NSW about their physical and mental health and well-being. We found they were overwhelmingly unable to access culturally appropriate treatments for their mental health, well-being and substance use issues.

These circumstances compounded the poor health and well-being of Aboriginal mothers, and in some instances triggered or exacerbated mental health problems.” 

Originally posted in The Conversation

Read over 380 Aboriginal Women’s Health articles published by NACCHO over past 7 years 

A cycle of trauma and incarceration

The mothers we interviewed said intergenerational trauma and the forced removal of their children by government services were the most significant factors affecting their health and well-being.

Mothers recounted their own and their relatives’ experiences of being removed from their families as children, as part of the Stolen Generations, painting a picture of longstanding and ongoing intergenerational trauma.

In prison, many of the Aboriginal mothers experienced significant distress due to the trauma of separation from children combined with the stress of the prison environment. Trauma is associated with high rates of co-occurring mental health disorders.

Many mothers had children in the care of family members, but the long distances between the prison and the family’s home made regular contact extremely difficult.

Phone contact in prison was also difficult if the mothers did not have the money to use the prison phones.

Mothers whose children had been taken by government services were reliant on government caseworkers to facilitate their children’s visits. Many mothers reported that these visits were rare, even though they had been ordered by the court. Mothers worried that their children would not be returned to them.

Some Aboriginal women use substances to cope with past trauma. But this is seen as a law and order issue rather than a health problem or coping method of last resort because they haven’t been able to access services to address intergenerational trauma.

This further increases the risk of contact with the criminal justice system and leads to deterioration of mental health and well-being. But no action is taken to address these underlying causes of discrimination and incarceration.

As a result, more than 80% of Aboriginal mothers in prison in NSW report their offences are drug-related. Aboriginal women are more likely to be charged and imprisoned for minor offences than non-Aboriginal women. Consequently, Aboriginal women often cycle through the prison system on shorter sentences or remand (unsentenced) and experience multiple incarcerations.

Indigenous women are overrepresented in the female prison population in Australia. ArliftAtoz2205/Shutterstock

This compounds intergenerational trauma and cycles of incarceration. It creates another generation of Aboriginal children forcibly removed from their mothers as well as separating Aboriginal mothers from their families and communities.

Poor physical and mental health

The mothers in our study reported having multiple physical health problems too.

Some had sustained injuries caused by family violence. Head injuries produced ongoing symptoms such as head pain, blurred vision, and memory loss, which made it more difficult to access treatment.

The mothers reported a high occurrence of reproductive health problems including endometriosis, ovarian cysts, precancerous changes of the cervix, and cervical cancer. The mothers highlighted the links between reproductive health problems and trauma, injury, and poor social and emotional well-being.

Many of the women reported extensive waiting times to access treatment and support, which exacerbated these problems.


Read more: Acknowledge the brutal history of Indigenous health care – for healing


Many women who had been taking medication that had been effective for a mental health problem in the community, for example prescription medication for anxiety, were not able to continue on that medication on admission to prison.

They were forced to withdraw from it and wait, sometimes weeks, to see a prison psychiatrist, presenting a serious and imminent risk to their stability, health and well-being.

What can be done?

The incarceration of Aboriginal mothers is a serious public health issue. The gross over-representation of Aboriginal women in prison reflects the inequity and discrimination they face, and the failure of multiple systems to address their needs and divert them from prison.

We urgently need culturally informed approaches to address the health and well-being of Aboriginal mothers in prison and after release to stop ongoing cycles of incarceration and child removal.

The mothers in our study highlighted the need for culturally appropriate services in the community that promote healing for intergenerational trauma. This includes an Aboriginal women’s healing and drug and alcohol service, long-term housing, trauma-informed counselling, and facilities specifically to support Aboriginal women in regaining access to their children.

Aboriginal mothers know what it means to be healthy and stay healthy, but too often do not have access to culturally safe services to support them in their mothering, to realise their health goals, and to remain out of prison and in the community.

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NACCHO Aboriginal Health and #SuicidePrevention : WA Government releases preliminary response to Aboriginal youth suicide reports and  accepts all 86 recommendations : Download report HERE

It is beyond distressing to see report after report about young Aboriginal people who see their lives as so bleak that they see no other option but to take their own lives.

The Statement of Intent underscores the Government will co-design services with Aboriginal people.

We are committed to be a Government that listens to and works with Aboriginal people to make a real difference in this area.

We are also determined to working with the Commonwealth Government and local groups in order to bring about a truly co-operative and collaborative approach to addressing this problem.”

WA Aboriginal Affairs Minister Ben Wyatt

“Young Aboriginal people continue to take their own lives at an unfathomable rate. I extend my deepest sympathies to those families and communities that have been heartbroken by these tragic events.

The issues are complex and it is clear that we need to develop a comprehensive reform agenda that is informed by the community, designed by the community and driven by the community.

The Statement of Intent makes it clear that our Government is absolutely committed to addressing the recommendations of the Coroner’s Inquest and the Message Stick report, to deliver real, long-term positive change for Aboriginal people.

The McGowan Government is determined to work across community and governments to ensure that this does not become another report that collects dust.”

Deputy Premier Roger Cook

  • McGowan Government releases preliminary response to the Coroner’s Inquest into Aboriginal youth suicide in the Kimberley and the Message Stick Inquiry
  • McGowan Government accepts all 86 recommendations, combined in both reports
  • Statement of Intent outlines Government’s commitment to work with Aboriginal people to tackle the issues that contribute to Aboriginal youth suicide
  • A reform agenda will be developed in partnership with local Aboriginal people to address the recommendations
  • Following further consultation with Aboriginal communities, full response expected by end of the year

The McGowan Government today released its preliminary response to the State Coroner’s Inquest into the deaths of 13 children and young people in the Kimberley and the 2016 Message Stick Inquiry into Aboriginal youth suicide in remote areas.

 

Download Here Statement-of-Intent-Aboriginal-youth-suicide

The Statement of Intent outlines the McGowan Government’s unwavering commitment to a partnership approach to address the recommendations from the Coroner’s Inquest and Message Stick Inquiry.

Of the combined 86 recommendations included in both reports, the Government has fully accepted 22, accepted 33 in principle, has already implemented or started implementing 16 and is still considering the feasibility or implications of a further 11. Four of the Message Stick recommendations have been superseded by subsequent events.

The McGowan Government will be working with Aboriginal people to develop a whole-ofgovernment reform agenda to address the recommendations, and a comprehensive response to the reports is expected by the end of the year.

The Government will co-design place-based initiatives in partnership with Aboriginal people, communities and organisations, which will positively impact the livelihood of young Aboriginal people.

4.Address Aboriginal and Torres Strait Islander youth suicide rates 

  • Provide $50 million over four years to ACCHOs to address the national crisis in Aboriginal and Torres Strait Islander youth suicide in vulnerable communities o Fund new Aboriginal support staff to provide immediate assistance to children and young people at risk of self-harm and improved case management
  • Fund regionally based multi-disciplinary teams, comprising paediatricians, child psychologists, social workers, mental health nurses and Aboriginal health practitioners who are culturally safe and respectful, to ensure ready access to professional assistance; and
  • Provide accredited training to ACCHOs to upskill in areas of mental health, childhood development, youth services, environment health, health and wellbeing screening and service delivery

Read all previous 140 NACCHO Aboriginal Health and Suicide Prevention Articles HERE

The McGowan Government is committed to addressing Aboriginal youth suicide, and a number of initiatives are included in this year’s State Budget that support Aboriginal youth wellbeing:

  • $6.5 million for the Aboriginal Community Connectors program to improve community safety and reduce community consequences of alcohol and other drugs and related ‘at risk’ behaviours;
  • Diversionary programs in the Kimberley, including the Kununurra PCYC ($2 million) and the West Kimberley Youth and Resilience Hub ($1.3 million);
  • $20.1 million for the North West Drug and Alcohol Support Program to reduce the harm caused by alcohol and other drugs in the Kimberley, Pilbara, and Mid-West;
  • Continued support for the work of the Mental Health Commission in reducing suicide risk in Western Australia via the Suicide Prevention: 2020 strategy ($8.1 million); and
  • A Kimberley Juvenile Justice Strategy ($900,000) to develop place-based prevention and diversion initiatives for young people across the Kimberley.

The Statement of Intent, which includes the Government’s preliminary response to the Coroner’s Inquest and Message Stick Inquiry, can be downloaded from the Department of the Premier and Cabinet’s website.

Useful Links

2018 Message Stick Response

State Coroner’s Inquest into the deaths of 13 children and young person in the Kimberley Region

The former Health and Education Standing Committee 2016 report, Learnings from the message stick: the report of the inquiry into Aboriginal youth suicide in remote areas.

Contact Us

If you wish to make contact with regard to the Western Australian Government’s response to the Statement of Intent, please do so via the details below:

Department of the Premier and Cabinet
Dumas House
2 Havelock Street
West Perth
Western Australia 6005

Email: AboriginalPolicy@dpc.wa.gov.au

If you would like a response, please include your preferred contact details.

 

 

NACCHO Aboriginal Health and #SuicidePrevention Recommendation 4 of 10 : Why does an Aboriginal ACCHO Health Service in one of Australia’s worst suicide regions have to self-fund #MentalHealth roles

“I think it’s appalling that we have to raise Medicare funds to subsidise services when the need is clearly demonstrated in umpteen coroner’s reports.

There are many gaps in the services that are currently available across Australia.

We welcome Labor policies to move SEWB funding into the federal health department, as well as its proposed multi-disciplinary teams of paediatricians, social workers, psychologists and Aboriginal counsellors.

But I criticize the “piecemeal approach” of the major parties. What governments don’t get is that the overall needs based funding required for Aboriginal community controlled health organisations (ACCHOs) to deliver fully on comprehensive primary healthcare hasn’t been built in to our model of care funding.”

As a result, the sector has had to seek additional funding for services like SEWB, instead of receiving a sufficient level as the base

We call for money to go to ACCHOs instead of mainstream services for Aboriginal healthcare.

We have a much better understanding of the issues [Aboriginal communities] deal with day in and day out. I also believe there should be workers engaged in the communities who are available out of hours, because most people don’t suicide between 9 and 5.”

Pat Turner AM  CEO of the National Aboriginal Community Controlled Health Organisation, told BuzzFeed News it was unacceptable, given the situation in the Kimberley

“We need those two positions given everything that’s happening in the community. People know them, they trust them, they will work with them. And it takes a long time to build up that trust with Aboriginal people.

Derby Aboriginal Health Service ( DAHS CEO )  Lynette Henderson-Yates said she is unsure how much longer DAHS will be able to find the $330,000 funding

Recommendation 4.Address Aboriginal and Torres Strait Islander youth suicide rates

  • Provide $50 million over four years to ACCHOs to address the national crisis in Aboriginal and Torres Strait Islander youth suicide in vulnerable communities
  • Fund new Aboriginal support staff to provide immediate assistance to children and young people at risk of self-harm and improved case management
  • Fund regionally based multi-disciplinary teams, comprising paediatricians, child psychologists, social workers, mental health nurses and Aboriginal health practitioners who are culturally safe and respectful, to ensure ready access to professional assistance; and
  • Provide accredited training to ACCHOs to upskill in areas of mental health, childhood development, youth services, environment health, health and wellbeing screening and service delivery.

More info https://www.naccho.org.au/media/voteaccho/

 Part 1 This is what it’s actually like to work on the frontline of Australia’s youth suicide Crisis

 “Alongside its beauty and isolation, the Kimberley is also known for its suicide rate. Last year, Indigenous health minister Ken Wyatt told the World Indigenous Suicide Prevention Conference: “If [the Kimberley] was a nation, it would have the highest suicide rate in the world.”

About eight years ago, Derby was at the epicentre of this ongoing catastrophe. In 2011 three young people died by suicide in as many weeks. The following year, the Aboriginal community of Mowanjum, 10km out of town, was rocked by the suicides of six people within six months.

Trent Ozies, 27, is a Djugun man from the Broome area who grew up in Derby. Ozies also has Filipino, Chinese and European heritage, as well as a gentle manner and a thoroughly infectious laugh. But he is grave as he recalls this terrible period.

“It was almost as if we went full circle,” he says. “Someone passed. Had their funeral, had the wake, someone passed. Had the funeral, had the wake, someone passed.

Read article in full HERE

Part 2

An Aboriginal health service in one of Australia’s worst suicide affected regions faces losing its psychologist and Aboriginal mental health worker, after money for the positions was cut in a state funding restructure last year.

The community controlled Derby Aboriginal Health Service (DAHS), located 220km east of Broome in Western Australia’s Kimberley region, delivers social and emotional wellbeing (SEWB) services in Derby.

The region has long struggled with the issue of Indigenous youth suicide. Coroner Ros Fogliani’s recent report into the deaths of 13 Aboriginal children and young people who died in the Kimberley found that 12 had died by suicide, the tragedies prompted by widespread poverty and intergenerational trauma.

The five person SEWB team in Derby is considered a model for how community mental health outreach should work in remote towns, according to Rob McPhee, the deputy CEO of Kimberley Aboriginal Medical Services.

But in a state funding restructure last year, DAHS lost funding for psychologist Maureen Robertson and mental health worker Ash Bin Omar and is now covering the $330,000 per year with money raised through Medicare consultations. SEWB services are generally funded by the Commonwealth.

Omar, who works with young Aboriginal men and boys, is also running a new project aimed at families with a low to medium risk of having their children removed to try and improve the situation and keep families together.

“For us not to have a psychologist and an Aboriginal mental health worker is really crazy,” Henderson-Yates said. “To my mind, there’s no debate about whether you have them or not have them.”

Senator Pat Dodson, who will become Indigenous affairs minister if Labor wins the election on May 18, told BuzzFeed News a Labor government would look to provide Commonwealth funding for two positions in Derby.

Labor has pledged $30 million over three years to support Aboriginal mental health and SEWB services in three high-need regions, including the Kimberley.

“If you don’t have these people being employed through the community health services, it just makes the effort to try and assist young people from taking these extreme measures totally impossible,” Dodson said.

Indigenous health minister Ken Wyatt told BuzzFeed News in a statement that the $19.6 million for suicide prevention pledged by the Coalition “builds on existing funding” provided through the Indigenous Advancement Strategy (IAS) in the department of prime minister and cabinet.

The sum includes $15 million for the rollout of mental health first aid training in 12 Indigenous communities and for youth, as well as continuing training for frontline workers. Another $4.6 million will go towards community-led programs — designed to complement existing services — in areas such as leadership, sports and culture.

The IAS currently funds about $55 million per year for SEWB, Wyatt said.

If you or someone you know needs help, you can visit your nearest ACCHO or call Lifeline Australia on 13 11 14 or Beyond Blue Australia on 1300 22 4636.

 

NACCHO #VoteACCHO Aboriginal Health and #SuicidePrevention debate @TracyWesterman Suicide risk factors are being incorrectly stated as suicide causes : and Comments from Harley Thompson @TheAHCWA Youth Co-ordinator

” First, we need to recognise the significant societal contributors to escalating rates of child suicides.

And we need to start with changing the narrative on indigenous suicides.

The core driver is that indigenous suicide is badly understood and myths about so-called causes of suicide are portrayed as if they exist as a direct linear relationship.

Suicide risk factors are being incorrectly stated as suicide causes and this is critical to this whole issue. Alcohol, poverty, abuse, colonialisation — these are not causes. They are risk factors, not causes. It is vital we understand this distinction to ensure adequate prevention efforts.

So, what separates Person A, who has been abused and becomes suicidal, from Person B, who has been abused and does not?

While this is an essential question, we do not have clear evidence of these critical causal pathways ” 

Adjunct professor Tracy Westerman is a clinical psychologist and proud Njamal woman from the Pilbara region of Western Australia. She was named Western Australia’s Australian of the Year last year for working to reduce the burden of mental ill health and suicide in Aboriginal communities. See full article from The Australian below Part 1

 ” Labor’s response to rising rates of indigenous youth suicide is a vote of confidence in Aboriginal health organisations such as the one Ms Thompson works for. A Shorten Labor government would make an “urgent investment” of $29.6 million in those Aboriginal community-controlled health organisations that already treat 350,000 indigenous people a year.

The money would be used to create regionally based multi­disciplinary teams of paediatricians, child psychologists, social workers, mental health nurses and ­Aboriginal health practitioners tasked with suicide prevention in vulnerable communities. “

What Ms Harley Thompson has learned in her role as a youth ­program co-ordinator at the Aboriginal Health Council of Western Australia has been seized upon by politicians scrambling to respond to Australia’s indigenous youth suicide crisis. See Full Story part 2 below 

Read all NACCHO 130+ Aboriginal Health and Suicide Articles Here 

#VoteACCHO Recommendation 4 of 10.

Address Aboriginal and Torres Strait Islander youth suicide rates

  • Provide $50 million over four years to ACCHOs to address the national crisis in Aboriginal and Torres Strait Islander youth suicide in vulnerable communities
  • Fund new Aboriginal support staff to provide immediate assistance to children and young people at risk of self-harm and improved case management
  • Fund regionally based multi-disciplinary teams, comprising paediatricians, child psychologists, social workers, mental health nurses and Aboriginal health practitioners who are culturally safe and respectful, to ensure ready access to professional assistance; and
  • Provide accredited training to ACCHOs to upskill in areas of mental health, childhood development, youth services, environment health, health and wellbeing screening and service delivery.

See all 10 #VoteACCHO recommendations HERE

Part 1

Indigenous Affairs Minister Nigel Scullion has allocated $134 million for indigenous suicide prevention. This crudely translates to $248,000 per death based on the suicide mortality rate — without adding state funding into the mix.

From the Australian April 20

Despite this, and as a country facing a growing tragedy of generational indigenous child suicides, we still have no nationally accepted evidence-based programs across the spectrum of early intervention and prevention activities.

Staggeringly, funded programs are not required to demonstrate evidence of impact, nor are they required to demonstrate a measurable reduction in suicide and mental health risk factors.

So, given this, can governments truly claim they are funding suicide prevention? You cannot claim prevention if you aren’t measuring risk. It’s that simple.

In an area as complex as indigenous suicide, it is crucial that funding decisions unsupported by clinical and cultural expertise are challenged and redirected in the best way possible: towards the evidence. Report after report has pointed to the need for “evidence-based approaches”, but has anyone questioned why this continues to remain elusive?

Perhaps we need to start with what constitutes evidence.

It doesn’t mean attendance. This is not evidence of impact. It means measurable, outcome-based evidence — a reduction in suicide risk factors attributable to the intervention provided.

Without measurability there is no accountability. Without measurability we are failing to gather crucial evidence of what works to better inform current and future practitioners struggling to halt the intergenerational transmission of suicide risk.

Clinicians terrified

Up to 30 per cent of clinicians will experience the suicide death of a client in our clinical lifetime. It is complex, it is scary, and very few of us understand what it is like to feel as though you are holding someone’s life in your hands.

I can tell you that, despite extensive training, 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 it takes years of clinical expertise and well-honed clinical insight and judgment.

Throw culture into the mix and this becomes a rare set of skills held by few in this country. Indeed, back-to-back coronial inquiries, a 2016 parliamentary inquiry and 2018 Senate inquiry all concluded that not only are ser­vices lacking in remote and rural areas of Australia but culturally appropriate services were often non-existent.

Prevention focus

First, we need to recognise the significant societal contributors to escalating rates of child suicides.

And we need to start with changing the narrative on indigenous suicides.

The core driver is that indigenous suicide is badly understood and myths about so-called causes of suicide are portrayed as if they exist as a direct linear relationship.

Suicide risk factors are being incorrectly stated as suicide causes and this is critical to this whole issue. Alcohol, poverty, abuse, colonialisation — these are not causes. They are risk factors, not causes. It is vital we understand this distinction to ensure adequate prevention efforts.

So, what separates Person A, who has been abused and becomes suicidal, from Person B, who has been abused and does not? While this is an essential question, we do not have clear evidence of these critical causal pathways.

Once we establish a causal pathway, we can then focus on determining treatments of best practice to ensure that clinicians are focused in the best possible way to eliminate the established cause.

This can be done only through rigorous assessment of individual risk factors. Some of these risk factors will be static and historical, meaning they cannot be changed: you cannot change someone’s date or place of birth, for example.

Other risk factors will be dynamic and changeable: we can work on changing anxiety and responses to trauma.

Once we have a comprehensive picture of an individual’s risk factors, treatment is then determined as being effective based on a reduction in the symptoms attributable to the clinical intervention. Presenting poverty and colonialisation as causes offers little to clinicians, who need to focus therapeutic interventions on what is alterative and treatable.

It distracts us from the true causes of indigenous suicide that enable a genuine opportunity for prevention. Our people are not killing themselves because they are poor. They are killing themselves because of racism, trauma, most likely co-morbid with depression and alcohol and drug use, isolation and a lack of access to culturally competent clinicians and evidence-based programs.

A further danger in confusing causes with risk factors is that it also informs government approaches to this issue.

So, taking this example of alcohol, the government decided to solve suicides through establishing dry communities and restricting alcohol. There has not been a decrease in suicide in alcohol-restricted communities; in fact, the opposite is true. Suicide is so multidimensional and multifaceted that, unless you can undertake rigorous assessment, there is going to be an endless cycle of risk that is “predicted” only once a child dies by suicide.

The most distressing outcome of failing to understand suicide causes is it further stigmatises bereaved Aboriginal parents, inferring that most, if not all, are perpetrators or alcoholics.

Perpetuating such stereotypes contributes to a general lack of empathy for Aboriginal people bereaved by suicide. It is a “they did it to themselves” mentality that is not only inaccurate but also unhelpful and unkind.

When non-indigenous children die by suicide, we rightly look for deficits in society or systems and how we need to “do better” as a society.

When indigenous children die by suicide, we look for deficits in their families, in their culture. Why don’t we have a more empathetic view of indigenous child suicides and for indigenous families bereaved by suicide?

Finding answers

Unfortunately the gaps are obvious and have been for decades.

First, universities need to set minimum standards of cultural competence as prerequisites in the degrees undertaken by those in the “helping professions”.

Most would be lucky to have an hour of cultural training in their degrees and then are sent out to remote indigenous communities where cultural barriers are so significant they render the most gifted clinicians into paralysis.

I have developed a normed Aboriginal Mental Health Cultural Competency Profile, which has demonstrated the capacity to measure, support and improve cultural competency development. This is objective and measurable, and provides a useful method for educational institutions to set minimum standards.

Second, we need to assess and screen for early risk. My PhD resulted in the development of the Westerman Aboriginal Symptom Checklist, a culturally validated psychometric test to screen youth at risk.

Despite this, we do not have a widely accepted methodology to assess for suicide risk in indigenous people.

While the youth version (WASCY) and adult version (WASCA) have existed for two decades, and more than 25,000 clinicians have chosen to be accredited in it, access into high-risk areas is limited by the lack of wide-scale government rollout of the tool.

Third, we need to understand the causes of indigenous suicide. The priority needs to be to analyse the suicide death data to firmly establish causal pathways to suicide. If the suicide data were analysed in a way that determined “causal” pathways it would quite simply change the paradigm of this area.

The big-picture thinking is to use continuous suicide data (suicide risk factors that move and change) gathered by the WASCY and WASCA to determine causal pathways and co-variates (that is, impulsivity, depression and suicide risk) and determine whether a reduction in these factors reduces the overall suicide death rate.

This is complex but these two data sets will enable us to determine what risk factors are reducing the suicide death rate in more of an immediate, measurable and responsive way.

Access to this data is likely to take many more months to pass through several ethics committees, but we will self-fund this analysis to fast-track this vital information and to speed up crucial gaps in our knowledge in this area.

Fourth, we need to determine whether indigenous suicide is different. The WASCY has determined a different set of risk factors for indigenous suicide, finding among other things that up to 60 per cent of suicide risk is accounted for by impulsivity.

Those with impulse-control issues are likelier to have limited coping mechanisms that enable self-soothing specific to interpersonal conflict. This pattern often occurs with those who have trauma and attachment-related issues — the origins of which for Aboriginal families often lie in the forcible removal from primary attachment figures.

With the increasing evidence of the impacts of race-based trauma there is a need to address societal contributors to indigenous suicides. Thema Bryant-Davis and Carlota Ocampo, among others, have noted similar courses of mental illness between victims of violent crime and victims of racism.

In Australia, Yin Paradies has found that racism explains 30 per cent of depression and reduces Aboriginal life expectancy more than smoking.

Just as trauma frequently becomes a central organising principle in the psychological structure of the individual, trauma has become a central organising principle in the psychological structure of whole communities. This is known as “repetition compulsion”, meaning individuals who have had a previous traumatic event are at increased risk for future trauma experiences.

Suicide “clusters” are an obvious and common consequence of trauma repetition compulsion.

From a suicide prevention perspective, racism manifests as a sense of hopelessness and helplessness, which has consistently been implicated in suicide risk. When the origin of this lies in rac­ial identity it seems inherently “untreatable” as a core risk factor and unchallengeable as a core driver when a suicidal individual develops thought processes based on a belief they don’t matter.

When those within the “system” and broader community show no visible sign of caring, this cognition then becomes increasingly ingrained through daily reinforcement.

The best I can do as a clinician is to assist my clients to develop healthy and robust cultural identity and develop the skills and resilience to manage racist events.

The WASCY provides a cultural resilience assessment that enables clinicians to “treat” factors that have been demonstrated to moderate or buffer suicide risk. This is crucial to prevention.

We are also about to publish on the impacts of a whole-of-community suicide intervention response to indigenous deaths.

This is the first evidence-based program to demonstrate a measurable reduction in suicide risk factors. It is crucial that these programs are widely available in high-risk communities.

Epigenetics tells us that racism impacts on Aboriginal people in the same way as a traumatic event. The fact most of our suicides are so impulsive makes absolute sense from a trauma perspective.

Finally, we turn to our political leadership. We look for guidance in what resonates in the conscience of our nation.

I wrote recently about the silence of our political leaders during the Fogliani coronial inquiry into the 13 deaths of indigenous children in the Kimberley.

Not a single question in the lower house of the West Australian parliament has been asked about the coroner’s report, nor what was going to be done about it.

The ABC reported only nine of the 95 members of parliament have brought up the inquest in any way, in either chamber, this year.

Studies support that a “hierarchy of newsworthiness” exists in which “cultural proximity” to the audience plays a crucial role in the extent of empathy generated for victims. The more the audience relates to victims, the greater the newsworthiness.

If the broader community can’t connect in a “this could happen to me or my family” manner, then there is less community outcry, and significantly less pressure on politicians to respond because, ­ultimately, they are very aware there will be little to no backlash about it.

When those who are mandated to care fail to respond your trauma becomes magnified.

The silence of our political leaders has served to magnify the trauma of these families and in effect has become systemically perpetuated by them.

Part 2

Hayley Thompson has been listening as Indigenous teenagers tell her what makes them happy as well as what troubles them, and she says the answers might surprise adults who believe social media makes young people miserable and even suicidal.

From The Australian April 20

“The young people don’t talk about social media as a problem,” Ms Thompson said. “The good thing about listening to the young people is you hear what they think is important, and that can be quite different to what older generations think is important.”

What Ms Thompson has learned in her role as a youth ­program co-ordinator at the Aboriginal Health Council of Western Australia has been seized upon by politicians scrambling to respond to Australia’s indigenous youth suicide crisis.

Indigenous Australians die by suicide at twice the rate of other Australians and this rate is even higher for youth. So far this year, 12 indigenous boys aged 12 to 18 have taken their own lives.

The tragedies have prompted questions about what works and what should happen next. In Inquirer today, clinical psychologist Tracy Westerman writes: “Suicide risk factors are being incorrectly stated as suicide causes and this is critical to this whole issue.”

Labor’s response to rising rates of indigenous youth suicide is a vote of confidence in Aboriginal health organisations such as the one Ms Thompson works for. A Shorten Labor government would make an “urgent investment” of $29.6 million in those Aboriginal community-controlled health organisations that already treat 350,000 indigenous people a year.

The money would be used to create regionally based multi­disciplinary teams of paediatricians, child psychologists, social workers, mental health nurses and ­Aboriginal health practitioners tasked with suicide prevention in vulnerable communities.

The Coalition’s mental health and suicide prevention plan includes $34.1m to “support indigenous leadership that delivers culturally appropriate, trauma-informed care” as well as “services that recognise the value of community, cultural artistic traditions and protective social factors”.

Indigenous Health Minister Ken Wyatt earlier gave just over $1m to the youth strategy Ms Thompson is part of. She says young indigenous people in cities and remote areas all tell her they want to feel closer to their culture.

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