NACCHO Aboriginal Health Newspaper and NDIS : National Disability Insurance Scheme (NDIS) set to transform the lives of Aboriginal people living with a disability.

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It’s great to be employed here because having a disability, I have a lot of knowledge to offer and I can be a strong advocate for locals because everyone knows me around here,” she said with a laugh.

This job means a lot to me. I really feel like I’m contributing. “

Stella Raymond, a proud Indigenous woman born and raised in Alice Springs, is the ‘face’ of the NDIS office in Tennant Creek.  See Case Study Below :

Articles are from Page 19  NACCHO Aboriginal Health Newspaper out Wednesday 16 November , 24 Page lift out Koori Mail : or download

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

The National Disability Insurance Scheme, commonly referred to as the NDIS, is set to transform the lives of Aboriginal and Torres Strait Islander people living with a disability.

The NDIS will provide all Australians under the age of 65 who have a permanent and significant disability with the reasonable and necessary supports they need to enjoy an ordinary life. NDIS participants include people with intellectual, physical, sensory and psychosocial disabilities.

It will help people with disability achieve their goals; whether it be greater independence, community involvement, employment and improved wellbeing.

Supports funded by the NDIS may include personal care and support, access to the community, therapy services and essential equipment.

The NDIS will progressively roll out across Australia over the next three years to ensure the Scheme is successful and sustainable. People will move to the NDIS at different times depending on where they live.

The NDIS is already transforming lives in the Barkly region in the Northern Territory, and from January 2017, will start to roll out in East Arnhem. Ultimately the Scheme will support more than 6,500 people across the Territory.

Once fully implemented , the NDIS is expected to support 460,000 people nationwide.

Staff from the National Disability Insurance Agency (NDIA) have worked with Aboriginal elders and community members to roll out the Scheme in Indigenous communities, which has been vital to building local understanding and ownership. Seventy five per cent of NDIA staff working in the Barkly region are Indigenous, including Stella Raymond.

National Disability Insurance Agency Chief Executive Officer David Bowen, said that the Scheme was much-welcomed by people with disability, their families and carers.

“The NDIS is exciting because, at long last, people with disability will have choice and control over the supports they need to live an ordinary life,” Mr Bowen said

“The Scheme is revolutionising the way we support people with disability in Australia – for the first time, all Australians with disability will have equity of access to support, no matter where they live.”

To become an NDIS participant, you must meet certain access criteria. For more information, contact the NDIS on 1800 800 110 or visit www.ndis.gov.au

Case study: Stella Raymond

Stella Raymond, a proud Indigenous woman born and raised in Alice Springs, is the ‘face’ of the NDIS office in Tennant Creek. Known for her smiling and welcoming demeanour, Stella was one of the first NDIS participants in the Northern Territory and later got a job with the NDIA.

“I’ve been an NDIS participant since the Scheme started here in the NT two years ago, and I’ve been working for the NDIS for 11 months now,” Stella said. “It’s been great. I’m a Business Support Officer. I do all the receptionist/admin work – I answer phones, check emails and I help my colleagues out when they need a hand.’

“The NDIS has helped me out with my new wheelchair. It will have automatic wheels and it’s going to make it a lot easier to get around,” Stella said.

“It’s great to be employed here because having a disability, I have a lot of knowledge to offer and I can be a strong advocate for locals because everyone knows me around here,” she said with a laugh.

“This job means a lot to me. I really feel like I’m contributing.

“At home, and right through school, I’ve been treated just like everyone else,” Stella said. “I’ve had a really great life and I have no regrets but it’s nice to have a great job at the NDIS and to know, as a participant, I’m covered by the Scheme for li

Learn more about these NACCHO programs  at the  NACCHO Members Conference in Melbourne

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1. NACCHO Interim 3 day Program has been released -Download
2. The dates are fast approaching – so register today

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NACCHO #NTRC Royal Commission and Aboriginal Health : #FASD , Malnutrition, hearing and #mentalhealth are major factors

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 ” The profoundly damaging consequences of heavy drinking by pregnant women, malnutrition in early childhood and intergenerational “psychic trauma” are neither properly diagnosed nor treated in Aborigines coming into contact with the law, a royal commission has heard.

The effects of these conditions, which can stunt a child for life, meant affected youngsters were both more likely to become involved in criminal activity and less likely to benefit from punitive forms of rehabilitation.”

As reported in the Australian today

 ” Studies linked FAS-D to a “profound level of social morbidity in terms of violence, engagement in the justice system, depression, suicidal thoughts, suicide, very low chance of meaningful occupation and a very high risk of being in prison as adults requiring mental institution and support with drug addiction

Professor Boulton and NACCHO FASD Articles

 ” Most infants with FASD are irritable, have trouble eating and sleeping, are sensitive to sensory stimulation, and have a strong startle reflex. They may hyperextend their heads or limbs with hypertonia (too much muscle tone) or hypotonia (too little muscle tone) or both. Some infants may have heart defects or suffer anomalies of the ears, eyes, liver, or joints.

Adults with FASD have difficulty maintaining successful independence. They have trouble staying in school, keeping jobs, or sustaining healthy relationships. They require long-term support and some degree of supervision in order to succeed. “

Make FASD History  Image above a full story see below

 “Many boys caught up in the Northern Territory’s juvenile justice system suffer a “disease of disadvantage” that has crippled almost every aspect of their lives, the Northern Territory’s royal commission into youth detention and protection has heard.

Jody Barney, who works as a deaf indigenous community consultant, told the inquiry she has spoken to several young Aboriginal people with hearing impairments who have had their faces covered by spit hoods and bound behind bars.

News Report

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The Royal Commission website is available at https://www.childdetentionnt.royalcommission.gov.au.

Moreover they were perpetuating, meaning the effects could be passed through neurological and genetic means from generation to generation, the Royal Commission into the Protection and Detention of Children in the NT heard today.

The Commission looks likely to probe these effects more deeply, following depressing but insightful evidence given by University of Newcastle professor of pediatrics John Boulton, who clearly captured the commissioners’ interest.

“I think the Foetal Alcohol Spectrum Disorder issue, together with the evidence that we have had this afternoon about deafness, throws such a complexion upon the participation of so many of these children in the criminal justice system, not to mention the child protection system, that we need to look at this carefully,” Commissioner Margaret White said.

“I think it’s fairly original inasmuch as the other many reports that we’ve been exposed to … have not had an opportunity to consider these areas of study.”

Professor Boulton told the Commission there was an urgent need for FAS-D and to be recognised under the National Disability Insurance Scheme. He said estimates in Canada of the lifelong cost of treating the condition reached into the millions of dollars.

“If there are one or two per cent of the total population of whom a fraction are severely affected with FASD, and therefore suffer the huge mental health and other subsequent complications and disabilities with FASD, then we are talking about an enormous burden to the overall Australian community in the tens of millions of dollars,” he said.

Studies linked FAS-D to a “profound level of social morbidity in terms of violence, engagement in the justice system, depression, suicidal thoughts, suicide, very low chance of meaningful occupation and a very high risk of being in prison as adults requiring mental institution and support with drug addiction” Professor Boulton continued.

He likened FAS-D to the thalidomide disaster, heavy metal poisoning or radiation sickness.

Professor Boulton said progress had been made through alcohol restrictions brought about in the Kimberley towns of Halls Creek and Fitzroy Crossing by local women. He said the restrictions had produced a “massive reduction in the amount of violence and of women seeking refuge”, and that there was evidence young children were growing better.

Earlier in the day the Commission was told many Aboriginal youngsters from the remotest areas suffered hearing problems related to ear infections in early life. In one example retold before the Commission, a boy before court had been crash tackled by a guard who thought he was trying to escape, when in fact the boy simply hadn’t heard an instruction.

Deafness holding NT’s indigenous kids back

Many boys caught up in the Northern Territory’s juvenile justice system suffer a “disease of disadvantage” that has crippled almost every aspect of their lives, the Northern Territory’s royal commission into youth detention and protection has heard.

Jody Barney, who works as a deaf indigenous community consultant, told the inquiry she has spoken to several young Aboriginal people with hearing impairments who have had their faces covered by spit hoods and bound behind bars.

“Taking away another sense from a person who already has a limited sense is frightening. And that fear stays forever… long after their sentence,” she said.

Footage of boys being tear gassed, shackled and put in spit hoods at Don Dale Youth Detention Centre was aired on national television in July, sparking the royal commission

Psychologist Damien Howard told the inquiry a chronic housing shortage is creating an “epidemic” of hearing loss in indigenous children that leads to learning difficulties, family breakdown and criminal involvement.

“It’s very much a disease of disadvantage,” Dr Howard told Darwin’s Supreme Court.

Crowded housing overwhelms a child’s capacity to maintain hygiene, allows infections to pass quickly, and increases exposure to cigarette smoke and loud noises, while the poverty limits nutrition.

On average, non-Aboriginal kids experience middle ear disease for three months of their childhood while indigenous children can get fluctuating hearing loss for more than two years.

This can result in a permanent condition, which Dr Howard says is a “smoking gun” leading to over-representation in the criminal justice system.

Make FASD History

Fetal Alcohol Spectrum Disorders (FASD) are 100% preventable. If a woman doesn’t drink alcohol while she is pregnant, her child cannot have FASD.

There is a humanitarian crisis in the Fitzroy Valley region of remote North Western Australia, which has one of the highest Fetal Alcohol Spectrum Disorders (FASD) in the world.

The effects of alcohol on the fetal brain are a common cause of intellectual impairment in developed countries. Problems that may occur in babies exposed to alcohol before birth include low birth weight, distinctive facial features, heart defects, behavioural problems and intellectual disability.

Most infants with FASD are irritable, have trouble eating and sleeping, are sensitive to sensory stimulation, and have a strong startle reflex. They may hyperextend their heads or limbs with hypertonia (too much muscle tone) or hypotonia (too little muscle tone) or both. Some infants may have heart defects or suffer anomalies of the ears, eyes, liver, or joints.

Adults with FASD have difficulty maintaining successful independence. They have trouble staying in school, keeping jobs, or sustaining healthy relationships. They require long-term support and some degree of supervision in order to succeed.

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Bright Blue is very proud to partner with Nindilingarri Cultural Health Services to support the development and implementation of a comprehensive, evidence-based prevention and community capacity building programme, which aims to make FASD history.

The outcomes of this programme will work to:

  • Improve the health, quality of life and social and economic potential for the next generation of Fitzroy Valley children, and thus the fabric of the community itself;
  • Identify practical strategies that can be implemented elsewhere in Aboriginal and non-Aboriginal communities to reduce and eliminate FASD;
  • Make WA a leader in FASD prevention;
  • Decrease costs associated with service provision, productivity, welfare and justice.

stacks_image_6848Led by Aboriginal community leaders Maureen Carter and June Oscar; and Paediatrician Dr James Fitzpatrick, it is important that the leadership of the Marulu strategy reflects the community ownership of the process.

Bright Blue needs your support to assist in prevention and capacity building, to develop an effective community – level support for women to abstain from drinking during pregnancy and child bearing years, so that all babies born in this community and across Australia have a full potential for a long and productive life.

Become a part of history. Together, let’s make FASD history.

The inquiry led by co-commissioners Margaret White and Mick Gooda continues.

NACCHO Aboriginal health : #AIHW #AustraliasHealth2016 : What are the health experts saying about the report ?

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” The report has also pointed out ongoing areas of health inequality in Australia, driven by socioeconomic factors and social determinants.

Communities suffering socioeconomic disadvantage continued to have systematically poorer health including lower life expectancy, higher rates of chronic disease and higher smoking rates.

Aboriginal and Torres Strait Islander peoples recorded improved health indicators in some areas, including lower rates for smoking and infant mortality.

However, the report found life expectancy was shorter by 10 years than for non-Indigenous Australians, and Aboriginal and Torres Strait Islander peoples continued to suffer higher rates of diseases such as diabetes, coronary heart disease and end-stage kidney disease.

The impact of risk factors such as smoking, physical inactivity, poor nutrition and harmful alcohol use have been emphasised as significant contributors to Australia’s rising rates of chronic disease.

This is an opportunity for health leaders and the Commonwealth Government to heed the report’s message that lifestyle factors and social determinants are significant contributors to ill-health, and to address the issues of health inequality and the importance of reform across all of our care systems “

AHHA Chief Executive Alison Verhoeven

Download the report here australias-health-2016

 #AIHW and Minister Sussan Ley press releases from launch #AustraliasHealth2016 report

Life expectancy gap between Indigenous and non-Indigenous Australians remains about one decade

The life expectancy gap between Indigenous and non-Indigenous Australians remains about one decade, according to new statistics.

The latest report from the Australian Institute of Health and Welfare (AIHW) said that while health outcomes had improved for Aboriginal and Torres Strait Islander people, they still remain below those of non-Indigenous Australians.

The biennial report, published today, shows Indigenous males born between 2010 and 2012 have a life expectancy of 69.1 years, a decade less than their non-Indigenous counterparts.

The gap for women was slightly lower at 9.5 years.

Between 2009 and 2013, 81 per cent of all Indigenous deaths were of people under 75. This is more than twice the rate of non-Indigenous Australians, which stands at 34 per cent.

The latest statistics come 10 years after the establishment of the Closing the Gap campaign, which aims to end the disparity on life expectancies.

Earlier this year, Prime Minister Malcolm Turnbull pledged that the Government would better engage with Indigenous people in “hope and optimism rather than entrenched despair”.

Indigenous sobriety rate higher than non-Indigenous Australians

While smoking rates have been falling nationally, they remain high among Indigenous Australians, with 44 per cent of Aboriginal and Torres Strait Islander people aged 15 and over describing themselves as a current smoker.

The report states that 42 per cent smoke daily, 2.6 times the rate of their non-Indigenous counterparts.

However, Indigenous Australians drink less alcohol than non-Indigenous counterparts — 26 per cent of Aboriginal and Torres Strait Islander people aged 15 and over had not consumed alcohol in past 12 months.

This equates to a sobriety rate 1.6 times that of non-Indigenous Australians.

Potentially avoidable deaths — categorised as deaths that could have been avoided given timely and effective health care — accounted for 61 per cent of deaths of Indigenous Australians aged up to 74 years between 2009 to 2013.

This was 10 per cent more than their non-Indigenous counterparts.

Australians are living longer than ever but with higher rates of chronic disease, the latest national report card shows.

Reports below from the Conversation

According to the Australian Institute of Health and Welfare’s Australia’s Health 2016 report, released today, Australian boys can now expect to live into their 80s (80.3), while the life expectancy for girls has reached the mid-80s (84.4).


A boy born and girl born in 1890 could only expect to live to 47.2 and 50.8 years respectively. AIHW

The single leading cause of death in Australia is coronary heart disease, followed by:

Grouped together, cancer has overtaken cardiovascular disease (heart disease and stroke) as Australia’s biggest killer. Cancer is also the largest cause of illness, followed by cardiovascular disease:


Burden of disease, by disease group, Australia, 2011 AIHW

Chronic diseases are becoming more common, due to population growth and ageing. Half of Australians (more than 11 million) have at least one chronic disease. One quarter have two or more.

The most common combination of chronic diseases is arthritis with cardiovascular disease (heart disease and stroke):


AIHW

Australians have high rates of the biomedical risk factors that increase the risk of heart disease and stroke. Almost a quarter (23%) of Australian adults have high blood pressure and 63% have abnormal levels of cholesterol.


Lifestyle choices

Fron Jackson-Webb, Health + Medicine Editor, The Conversation

The good news is Australians are less likely to smoke and drink at risky levels than in the past.

Australia now has the fourth-lowest smoking rate among 34 OECD countries, at 13% in 2013. This is almost half that of 1991 (24%).


AIHW

The volume of alcohol Australians consume fell from 10.8 litres per person in 2007–08 to 9.7 litres in 2013–14. This is the lowest level since 1962–63. But 16% of Australians are still drinking to very risky levels: consuming 11 or more standard drinks on one occasion in the past 12 months.


AIHW

Around eight million Australians have tried illicit drugs in their lifetime, including 2.9 million in the last 12 months. The most commonly used illicit drugs are cannabis (10%), ecstasy (2.5%), methamphetamine (2.1%) and cocaine (2.1%).

Use of methamphetamine has remained stable in recent years. However, more methamphetamine users are opting for crystal (ice) rather than powder (speed).

The bad news is Australians are still struggling with their weight. Around 63% are overweight or obese, up from 56% in 1995. This equates to an average increase of 4.4kg for men and women. One in four children are overweight or obese.

Junk foods high in salt, fat and sugar account for around 35% of adults’ energy intake and around 39% of the energy intake for children and young people.

Most Australians (93%) don’t consume the recommended five serves of vegetables a day and only half eat the recommended two serves of fruit. Just 3% of children eat enough vegetables, though 70% consume the recommended amount of fruit.

Almost half (45%) of adults aged 18 to 64 and 23% of children aren’t meeting the national physical activity recommendations. These are for adults to accumulative 150 to 300 minutes of moderate intensity physical activity or 75 to 150 minutes of vigorous intensity physical activity each week. Children are advised to accumulate at least 60 minutes of moderate to vigorous physical activity every day.

Lifestyle choices have a huge impact on the risk of chronic disease; an estimated 31% of the burden of disease in Australia could have been prevented by reducing risk factors such as smoking, excess weight, risky drinking, physical inactivity and high blood pressure.

Proportion of the burden attributable to the top five risk factors


AIHW

Preventing chronic disease

Rob Moodie, Professor of Public Health, University of Melbourne

This report outlines a number of positives in Australia’s health – our life expectancy, the health services at our beck and call, major declines in tobacco and road deaths. We’re doing well, it says, but we could do better.

If we took prevention and health promotion far more seriously, we could do a lot better.

The report nominates tobacco use, alcohol, high body mass and physical inactivity as the chief causes of preventable illness and the chief causes of our increasing level of chronic illnesses. Yet national investment in prevention is declining.


Further reading: Focus on prevention to control the growing health budget


Tobacco use is rapidly declining because of really effective measures (plain packaging, advertising bans and increasing price through taxes) that save lives and enormous amounts of money over a lifetime for people who used to smoke.

However, we can’t seem to make any major dent in the commercial, industrial and lifestyle diseases related to junk food and drinks, harmful consumption of alcohol and car dependency.

We’ve known what will work for many years but the power of some of these unhealthy industries is still overwhelming – a situation in which our politicians fear these industries and their associations more than they fear the voters.

Our collective health would have been much better if we’d been able to follow the guidance of our own national task forces and learnt from other countries. The report card should read, “Doing well, but could have done a lot better”.


Inequities

Fran Baum, Matthew Flinders Distinguished Professor and Foundation Director at the Southgate Institute for Health, Society & Equity, Flinders University

Australia’s Health 2016 shows many Australians are not getting a fair go at health. There is a gradient across society whereby the richer the area you live in, the longer you can expect to live. The difference between the highest and lowest is four years.

Deaths by socioeconomic group: 1 = lowest; 5 = highest


AIHW

The gradient is evident from early life. Children most at risk of exclusion – those from poor areas who experience problems with education, housing and connectedness – are most likely to die before they reach 15 years from potentially preventable or treatable causes.


Further reading: Want to improve the nation’s health? Start by reducing inequalities and improving living conditions


Our most glaring inequity is the ten-year life gap between Aboriginal and Torres Strait Islander Australians and others. Indigenous life expectancy is 69.1 years for males and 73.7 years for females.

Compared with the non-Indigenous population, Indigenous Australians are:

  • 3.5 times as likely to have diabetes and four times as likely to be hospitalised with it or to die from it
  • five times as likely to have end-stage kidney disease
  • twice as likely to die from an injury
  • twice as likely to have heart disease.

Australians living outside major cities have higher rates of disease and injury. They also live in environments that make healthy lifestyles choices harder (such as more difficulties buying fresh fruit and vegetables) and so their risk of chronic diseases is increased.


AIHW

The data on who has private health insurance coverage points to the emergence of a two-tiered health system, where those who can afford to pay receive better access and quality of care. Just 26% of those in the lowest socioeconomic group have cover compared to about 80% of the top group.

Coverage with private health insurance and government health-care cards


AIHW

Cost of care

Professor Stephen Duckett, Director of the Health Program at Grattan Institute

Over the last decade, health expenditure grew about 5% each year, above the 2.8% average growth in Gross Domestic Product (GDP). As a result, health took up an increasing share of GDP.

Spending more on health means Australia spent less on other things. This is not necessarily bad, as long as the benefits from that increased expenditure – such as increasing life expectancy or increased quality of life – are worth the increased costs.

But spending above GDP growth cannot continue indefinitely. And the last few years saw an increase in rhetoric about health spending increases being “unsustainable” from so-called “futurists” and politicians.

Informed commentators have generally rejected the unsustainability claim, some labelling it a “myth”, while others take a more nuanced view.

Australia’s Health 2016 shows a slowing of the real growth rate in the most recent two years to about half that of the previous decade – 1.1% from 2011-12 to 2012-13 and 3.1% from 2012–13 to 2013–14.


Annual growth rates in health expenditure AIHW

This suggests the “unsustainability” rhetoric is at least overblown and potentially prompting budget decisions which are counter-productive, such as introducing a co-payment for general practice.

Commonwealth government expenditure was more or less stable over these most recent two years, declining 2.5% initially then increasing 2.4% in the last year.

Health expenditure by area (adjusted for inflation)


AIHW

Savings to the government came from shifting costs to consumers, by slowing the growth in government subsidies to private health insurers, and also by slowing spending on pharmaceuticals.

This latter slowdown was achieved through tighter controls on payments to drug manufacturers and because some big-selling drugs came off patent, resulting in falls in prices.

NACCHO Aboriginal Health Newspaper Next AGM Edition

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NACCHO #NDIS NEWS: Understanding the NDIS: the scheme does not yet address all the needs of Indigenous people with disabilities

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” Life on a remote Indigenous settlement in central Australia, surrounded by red dust and scorched country may be tough. But it’s even tougher if you’re sick, old or living with a disability.

“Some people with disabilities who are in a wheelchair are pretty much living under their carport because they don’t even have enough support to put in a ramp [out the front of their house.

“Or, they may be stuck sitting around all day because no there is no access to an appropriate wheelchair to get up a bush track. So they can’t get to where they need to go and sometimes can’t leave the house.”

I believes a cultural barrier between Indigenous communities and government systems is preventing people with disabilities living in remote Australia from getting the basic services they need. That’s because there’s no actual word for disability in most Indigenous languages so the notion of ‘disability’ and ‘disability services’ gets lost in translation.

 Tracy Barrell, former Paralympian and spokesperson of the First Peoples Disability Network.

Clockwise from top: Carol Gilligan, Sandra Windy, Annette Wilyuka and Cora Meruntji from Waltja. (Photo supplied by Waltja Tjutangku Palyapayi Aboriginal Corporation) See second article below

” As my research has shown, the factors that impact on Indigenous people’s access to disability specific services are not just geographical. They also include the ways in which disability is conceptualised in Indigenous communities as well as lack of trust for mainstream services and lack of community connections.

Many Indigenous people don’t engage with disability support programs because of the stigma associated with the mainstream definition of disability adopted by government and non-government agencies.

My research has also highlighted the fact that Indigenous people often focus on a person’s strengths, which is contrary to the clinical deficit model of disability adopted by the current service system. “

John Gilroy  ARC Research Fellow in Indigenous Health, Disability and Community Development, University of Sydney Full Article here

On July 1 2016, the National Disability Insurance Scheme (NDIS) moved from a trial phase to a full national roll-out. In this series on Understanding the NDIS, we explore how the scheme works, why Australia needs it, and the issues to be addressed before eligible Australians can receive the benefits they are entitled to.


The National Disability Insurance Scheme (NDIS) allows Australians with a disability to choose which agencies or people they wish to collaborate with to help achieve their goals.

For Indigenous people, there are many positives to this scheme. It provides the opportunity to address the identified shortfalls of the former institutionalised service system, some of which uniquely impact Indigenous people.

For instance, if an NDIS participant is not satisfied with a support worker or an agency, they can recruit a different person or withdraw their funding and transfer to another agency. This will enable Indigenous people to access those supports that are culturally appropriate for them and their needs.

The growing Indigenous disability rights movement has fostered more involvement in the planning and development of the NDIS. But there is still a need to acknowledge those who feel their voices are not being heard by the government.

I have previously expressed my frustration with the National Disability Insurance Agency (NDIA) – the agency responsible for overseeing the NDIS – for its lack of transparency on the NDIS rollout, with limited evidence that it is meeting the needs of Indigenous people.

Unrepresentative participation

As of March 2016, nearly 30,000 people with disabilities were participating in NDIS trial sites, around 5% of them Indigenous. The latest National Aboriginal and Torres Strait Islander Social Survey reported that 45% of Indigenous Australians aged 15 years and over said they had experienced a disability, and nearly 8% needed assistance with core activities (such as self-care or mobility) some or all of the time.

Added to this is the high rate of chronic health conditions that lead to physical impairments and disability, such as renal disease, middle ear diseases and glaucoma; as well as issues of low cognitive ability among many Indigenous children.

While adequately estimating the NDIS eligibility rate in the Indigenous population is problematic, the 5% does not seem to be representative of the rates of disability in Indigenous communities.

While the reasons for a lack of participation are many and complex, the underlying problem is access. A 2008 report showed that nearly half of Indigenous people with severe core activity limitations identified problems in accessing generic and specialist services.

As my research has shown, the factors that impact on Indigenous people’s access to disability specific services are not just geographical. They also include the ways in which disability is conceptualised in Indigenous communities as well as lack of trust for mainstream services and lack of community connections.

Many Indigenous people don’t engage with disability support programs because of the stigma associated with the mainstream definition of disability adopted by government and non-government agencies.

My research has also highlighted the fact that Indigenous people often focus on a person’s strengths, which is contrary to the clinical deficit model of disability adopted by the current service system.

Challenges of remote Australia

The state of disadvantage in Indigenous communities presents a range of problems that exist outside of the NDIS’s scope and objectives.

There are many Indigenous communities where basic housing and utilities are either limited or absent. As such, many Indigenous people with disability have their energies focused on addressing the basics of day-to-day living.


In remote regions, staff often have to travel hundreds of kilometres to deliver services to people. shutterstock.com

The NDIA has been promoting the NDIS model as one that expands personal choice when it comes to the services and support people with disabilities can access. Yet individual choice requires service and support opportunities to exist in local communities. Limited opportunities, especially in remote communities, equates to limited choice for those on NDIS plans.

The costs to deliver supports and services to remote and very remote communities can be astronomical when compared with metropolitan regions. Research into remote service delivery conducted by the National Disability Services identified workforce shortages further inhibited service growth and development.

In remote regions, staff often have to travel hundreds of kilometres to deliver services to people. The distance between the regional centre of Alice Springs to another town in Central Australia, Tennant Creek, is 500km.

There is limited evidence to assess whether the NDIS can effectively and efficiently provide equitable opportunities for those living so far away from regional centres.

Research shows more than 13% of Indigenous adults have provided unpaid assistance to people with a disability, such as relatives; the highest number of these are in very remote communities. Establishing a system that enables people to recruit family members needs more discussion throughout the scheme’s rollout.

Self-managed funds

According to the First People’s Disability Network, the peak body representing Indigenous Australians with a disability, many Indigenous people need accessible support and training to self-manage their NDIS plans.

If we consider the language diversity among Indigenous communities, options for training in managing personalised NDIS plans may be limited for those with English as a second or third language.

Further, operating in a market-based system requires adequate access to information and skills in budgeting and book-keeping. Indigenous people who are socially isolated and don’t have either this information, or the skills or resources with which to seek help, may find these tasks difficult.

The NDIA will need to further explore these challenges as they plan and implement culturally responsive training and support programs for those who wish to self-manage their packages.

The principles of the World Health Organisation’s twin-track approach should be adopted in the roll-out of the NDIS. Broadly speaking, this approach aims to build specialist, targeted disability programs and supports for Indigenous people (such as Indigenous community controlled organisations) while simultaneously considering their needs in all generic policies, initiatives and programs.

The NDIS provides us an opportunity to address the gaps between Indigenous and non-Indigenous people with disabilities. But this should run parallel to government spending on specialist services and community controlled organisations.


You can read previous stories on groups likely to miss out under the NDIS, and the risk to support services for parents with newly diagnosed children with disability.

What would your life be like if you lived in a remote community in central Australia? How would you fare if you developed a disability or chronic disease?

Life on a remote Indigenous settlement in central Australia, surrounded by red dust and scorched country may be tough. But it’s even tougher if you’re sick, old or living with a disability.

“Some people with disabilities who are in a wheelchair are pretty much living under their carport because they don’t even have enough support to put in a ramp [out the front of their house],” says Tracy Barrell, former Paralympian and spokesperson of the First Peoples Disability Network.

“Or, they may be stuck sitting around all day because no there is no access to an appropriate wheelchair to get up a bush track. So they can’t get to where they need to go and sometimes can’t leave the house.”

Barrell believes a cultural barrier between Indigenous communities and government systems is preventing people with disabilities living in remote Australia from getting the basic services they need. That’s because there’s no actual word for disability in most Indigenous languages so the notion of ‘disability’ and ‘disability services’ gets lost in translation.

“There are so many different types of disabilities and [many people in remote Indigenous communities] can’t differentiate between a brain injury or a mental illness because ‘that’s just Mary’. They don’t see disability and everyone helps to look after that person.

“But that also means they can’t access support. They don’t understand that they have to say ‘this person has cerebral palsy or mental health issues’ to access government help.”

Barrell is hopeful that the situation will change once the National Disability Insurance Scheme (NDIS) rolls out from this month and people start to get the services they request and need.

“For our mob, the conversation about the NDIS has only just started in the last year and is filtering down. So when people who have never received any services or transport, find out about the NDIS and when I tell them to start writing their wish-lists of the things they could have in their life to improve their standard of living, they think they have won the lotto.”

“They don’t understand that they have to say ‘this person has cerebral palsy or mental health issues’ to access government help.”

Executive director of Waltja Tjutangku Palyapayi Aboriginal Corporation, Irene Nangala tells me that accessing seniors’ services in her home town of Kintore, situated around 530 kilometres west of Alice Springs, isn’t quite as desperate.

The remote location of Kintore (Walungurru) has its own health clinic and aged care workers help relatives to care for the elderly at home, in the community.

“The families make the bed, cook supper for them, and make breakfast,” says Nangala. “Sometimes if the old people want to sleep outside, they sleep outside because they all help to make a fire for them.”

But one real problem is that many of the aged care staff are ‘work for the dole’ volunteers: No pay means no income and the continuation of poverty, poor housing conditions and bad diets for many.

It’s also important to recognise that ageing means something different in this community. The Australian Institute of Health and Welfare, ‘older’ Indigenous Australians are considered to be those aged 50 and over, not 65-plus, because of the life expectancy gap between Indigenous and non-Indigenous Australians.

Kate Lawrence, Waltja Management Support Worker, explains that although some elders are aged well over 70 – who grew up on bush tucker – are fighting fit, many others aged around 50 are not in such good helath.

“A lot of the older people are getting heart problems and they can’t do exercise and can’t stay healthy,” says Lawrence. “It’s really hard for people to afford to eat healthy food and no one’s got much money.

“People need to go out to hunt to keep feeding people but they need a car and petrol. The conditions of housing are really hard for people. I think people here deal really well with a tough situation.”

“A lot of the older people are getting heart problems and they can’t do exercise and can’t stay healthy.”

Kidney disease is also quite common throughout the community of 400 Indigenous residents. Kidney Health Australia states that the incidence of end stage kidney disease (ESKD) for Aboriginal and Torres Strait Islander people is 20 times higher for those living in remote and very remote areas of Australia, compared with non-Indigenous peoples. According to a report on the health of people from Kintore, the prevalence of ESKD in the town’s Pintupi Aboriginal group is 40 times higher than in the average Australian population.

But with only four dialysis chairs available at the local health clinic, most renal patients have to live the majority of the year in Alice Springs in order to access life saving dialysis services.

“The chairs aren’t only for people at Kintore but for the mob all over community,” says Lawrence. “It’s really hard for renal patients to come in and stay in a hostel in Alice. They can’t bring family to live with them when they are here so they are usually here by themselves. They are lonely and it’s really disruptive to family.”

Nangala, aged 54, is one of Kintore’s many seniors forced to leave home to receive treatment. Diagnosed with kidney disease around four years ago, she requires dialysis three times a week. So she lives most of the year in a hostel in Alice Springs, at a subsidised cost, so she can receive the treatment she needs to stay alive and travels to Kintore every few months whenever a chair becomes available.

“I am on a dialysis machine and I have to stay in Alice Springs,” Nangala says. “I dilate and after that, I feel a little sick. So I have to go straight to bed and have a rest.”

Nangala adds that although it’s nice to be in the city and have time off from the duties of being a grandparent, she longs for home and misses feeling connected to community.

“Sometimes I want to go back and see my family. The grandchildren, they worry for me when I am in Alice Springs. It’s lonely when family goes away.

“We need something better for old people.”

 .Women story telling and singing in Kintore, Northern Territory.

Women story telling and singing in Kintore, Northern Territory. (Photo supplied by Waltja Tjutangku Palyapayi Aboriginal Corporation)

The community needs connectingIt was this hunt for ‘something better’ and a greater sense of connectedness that lead Nangala and the other Waltja Tjutangku Palyapayi directors to create a temporary solution.

The Aboriginal organisation, governed by senior Aboriginal women from remote communities across central Australia, will run a four-day festival, for older people and those with disabilities this September, to reconnect Indigenous people who have been excluded from community because of poor health, age or disability.

The idea is that around 200 seniors and Indigenous people with disabilities from central Australia’s most remote communities will be brought into participate in The Waltja Aged and Disability Festival, at a bushland camp east of Alice Springs.

“There’ll be a lot of making fire and telling stories,” says Nangala. “There’ll be a lot of lot of laughing, crying, singing and dancing too.”

It’s the sixth time the corporation has held the festival since 1999, as it can only ever be run when the group has enough money to fund it.

“[In past festivals], we’ve had lots of old people sleeping there and making fire,” she adds. “It was so lovely to see the old people. They were so happy together.

“People come from many places, a long way away. We bring everyone in to have a celebration of those older people and people with disabilities. They normally don’t meet as they can’t travel across to community without help.

“There’ll be a lot of making fire and telling stories. There’ll be a lot of laughing, crying, singing and dancing too.”

There’ll also be pampering and information sessions about NDIS services available to Indigenous communities like Kintore.

Barrell, a proud Indigenous woman with a disability, says she’ll also be attending.

“The festival will bring like-minded people together to have yarn ups and make connections that they’ve never made before,” says Barrell. “The way it’s been organised, you’ve got time. You don’t have to worry about your transport, home care coming or going or any of your daily struggles.

“The event is all about being able to be yourself. We’ll be able to just sit back and actually be a person.”

NACCHO #HealthElection16 #TowardsRecovery Mental Health , NDIS , PHN’s and Aboriginal Community Controlled Health

PHNs-in-scope

Current Commonwealth programs migrating to PHN’s

Indigenous ?

The mental health sector is in the midst of “a perfect storm” of change, as one speaker put it during the recent VICSERV #TowardsRecovery conference in Melbourne. This comes as the sector grapples with how to offer people with mental illness not just choices but control over their lives.

Mental Health Australia CEO Frank Quinlan told delegates that the system was in a period of “quite unprecedented change”, with the rollout of the National Disability Insurance Scheme (NDIS), the new role in mental health of Primary Health Networks (PHNs) and other reforms planned or underway in response to the National Mental Health Commission’s Review of Mental Health Programmes and Services.”

A delegate from an Aboriginal community controlled health organisation (ACCHO) raised issues for her sector, where Aboriginal communities are estimated to have twice the incidence of disability as non-Aboriginal communities but much less access to services, and agencies that are not specialists for disability support.

“If you focus most of the effort on transitioning current supports (to the NDIS), that will continue to leave Aboriginal communities under-supported,” she told the NDIS panellists.

She was told the NDIA had identified it needed to do a lot more work around Aboriginal disability, and would step up that engagement and transition work. Other culturally and linguistically diverse (CALD) communities will also get a bigger focus.

Another ACCHO representative voiced fears that if Aboriginal people with disability transitioned to other services under the NDIS, only to find they were not culturally safe for them, that the ACCHO workforce might not still be there for them to return to.

Marie McInerney writes: Melissa Sweets edits in

Croakey New

While many of the major system changes underway, including the NDIS, are welcomed in the mental health sector, there is confusion over details and concern that many people with mental health issues could fall through new gaps in the system.

Some at the conference said the upheaval rivals the days of deinstitutionalisation, particularly in Victoria which has just emerged from much criticised recommissioning of mental health services and where there is also uncertainty about what of its mental health community support funds will be committed to the NDIS.

These concerns are only exacerbated by the uncertainty surrounding the policy outcomes likely to result from the July 2 federal election, and the marathon eight-week election campaign and caretaker period.

Despite all the planning for the NDIS, which on 1 July begins its full national rollout after three years of trials, the fate of some programs such as the Personal Helpers and Mentors (PHaMs) program is still not known.

(As a measure of ‘reform fatigue’, Victorian Alcohol and Drug Association CEO Sam Biondo told one session that when he started out in the 1970s, all he wanted was change; now all he wants is some stability).

“Some organisations don’t know what contracted services they’ll be offering on July 1,” Quinlan told Croakey in a follow-up interview yesterday. “That means uncertainty for their clients, people who rely on them, and also for their workforce who don’t know whether they will have employment in six weeks time.”

At the weekend Mental Health Australia released its election platform, saying the important reforms that are underway “cannot be forgotten during the current electoral cycle”. It is calling on political leaders for long-term commitment to:

  • reducing the national suicide rate
  • improving the physical health of people with a mental illness
  • increasing employment rates for people experiencing mental illness and their carers
  • increasing mental health consumer and carer participation and choice in national policy design and implementation
  • maintaining current overall levels of investment in mental health, with measures that support full reinvestment of cost efficiencies and savings.

Mental Health Australia will produce a ‘report card’ to be released prior to the election, outlining the major parties’ response on these issues.

Meanwhile, just a few days after the conference ended, one of its speakers, Professor Jane Burns, CEO of the Young and Well Cooperative Research Centre, joined other mental health leaders in releasing details on suicide across 28 Federal electorates, calling on party leaders and candidates to spell out what they intend to do to address the rising toll of suicide and self-harm across Australia.

NDIS concerns

The mental health sector has welcomed the NDIS, saying a well funded and well run scheme will meet many needs.

But the numbers provide the context for some of the concerns raised at the conference: it is estimated that each year in Australia, there are around 600,000 people who experience severe mental illness, and 300,000 who experience severe mental illness with “complex inter-agency needs”.

By comparison, there are around 60,000 places in the NDIS for people with mental health issues.

VICSERV CEO Kim Koop said the conference message was: “The NDIS is a welcome addition to a contemporary mental health system but is not sufficient replacement for the current offering.”

She said Victorian community managed mental health services were “desperate for more information” about the NDIS.

But the State Government has an equal role to play, she said, pointing out that the bilateral agreement makes clear that the introduction of the NDIS is a shared responsibility between the States and the Commonwealth. “Both need to step up and provide information,” she said.

VICSERV has played a lead role in documenting the Victorian trial of the NDIS in the Barwon area, but is waiting to hear back on how its concerns will be addressed.

Koop said:

The NDIS is not a bad thing (for mental health).

The trouble is that the funding for the existing services is being transferred to the NDIS and that it is still very uncertain if the NDIS will offer a similar range of services.

At the moment it’s just really unclear. We’re waiting to hear from the NDIA (National Disability Insurance Agency) around the review of supports for people with mental illness but until that comes out, we just don’t know what kind of supports, what price they will be at, what workforce (levels) there will be required.”

Delegates at one conference session peppered a panel that included senior managers in the National Disability Insurance Agency (NDIA) about many details of the NDIS’s likely operation.

A delegate told the panel it had been great to have different trials conducted across Australia over the past three years but their different reports on different experiences have created “confusion and misinterpretation…trying to compare apples with oranges”.

Others expressed continuing concern about how people with episodic mental health issues would be included in a Scheme designed around permanent disability.

On markets and mental health

The session followed a keynote by UK philosopher Dr Simon Duffy raising issues such as citizenship and the need to focus on community rather than institutional and organisational interests. By contrast, the language of the NDIS discussions was all around markets, market failures, entrants and competition.

In an aside to me, one delegate questioned whether there is a “market” in people with mental illness.

Asked at another session whether there really was a “fair dinkum market’” for organisations to start competing in, National Mental Health Commissioner Rob Knowles said there wasn’t yet.

But he warned that one would develop as it has in other countries, and he was not sure people in the sector understood the significance of the changes that will occur.

When the UK went down this road, about 80 per cent of existing services were provided by not for profit organisations, the remainder by private providers. That was soon reversed, he said.

A mistake many not-for-profits made was to think “people stick with us”. Knowles said: “People are much more fickle than that. I think there are significant challenges for those operating in this: how they make themselves be a service provider of choice”.

What will PHNs offer mental health?

Another panel session focused on the news, announced last year, that funds will be reallocated from Canberra to primary health networks (PHNs) to commission — but not deliver — mental health services.

Again, the sector has welcomed the move, particularly as a bridge between States and Commonwealth, but with concerns about how it all might work in practice.

Quinlan gaps

The aim of the PHNs, to make sure they get local services on the ground where they are needed, was very welcome, Quinlan said. The concern is how to maintain national standards.

He said: “For example with eating disorders and suicide prevention, you can quickly see you wouldn’t want 31 PHNs across the country all inventing their own way of doing things. Addressing how we tackle some national issues while ensuring local suitability is a big challenge.”

The PHN session involved panelists Jason Trethowan – Chief Executive, Western Victoria PHN, Lyn Morgain – Chief Executive, cohealth, and Christopher Carter – Chief Executive, North Western Melbourne PHN. They outlined what PHNs would cover, and what they wouldn’t.

The questions they sought to answer in their session demonstrated the issues of concern for many of the delegates there:

  • How will planning be undertaken that ensures the range of demographic, clinical, aged related, cultural, socio-economic and comorbidity of people is properly planned for?
  • How will the flexible funding pool work – be prioritised – is it flexible for service models of care?
  • How will PHNs work with the State system, and with each other to ensure continuity – especially given the transient nature of some consumers?
  • What does this mean for existing youth primary mental health services? Youth with severe mental health?
  • How will we ensure that services for Aboriginal and Torres Strait Islander people recognise the social determinants of health and cultural safety?
  • What are the potential approaches to reduce fragmentation (suicide prevention)?
  • What are the commissioning challenges and opportunities for rural communities?
  • There will likely be a gap with the move of specialist recovery based community mental health support services to the NDIS. Will PHN’s be able to fund recovery based CMH or will as suggested PHNs be limited to commissioning only “clinical primary MH” as has been suggested in some of the guidance documents?

PHNs not in scope

PHN perspectives

Croakey later asked panellist Chris Carter for his reflections on the session.

Q: What were the main messages you wanted to get across during the session on the role of PHNs within the context of national mental health reforms?

That the role of PHNs is developing – in the first phase this will be about development of a stepped care model that reflects regional needs, and is focussed around safe, quality mental health care.  There will be a number of stages and phases in the evolution of an integrated system given the high level of fragmentation in the healthcare system.

Q: What key concerns emerged from the session? What’s your response to them?

Not really concerns, but a genuine desire to participate in the conversation about reform – how PHNs will take into account the diversity of populations, families and individuals when considering future planning and investments in the mental health system.

Q: The Federal Opposition said recently: “The PHNs, as the critical commissioners under the new reform agenda, are stuck in an unenviable position, wedged between the enormous pressure to deliver the reforms with unreasonable demands and an information vacuum from the Department of Health and at the same time trying to manage an increasingly agitated mental health sector hungry for information and advice.” What’s your response to that?

Our role as PHNs is to help facilitate as much information sharing and participation in planning processes as is possible.  Some of the tension lies between acute and primary systems, as well as State and Commonwealth systems.  At a regional level, our job is to bring local intelligence / evidence and wisdom to try and meet the needs of consumers / citizens, whilst bringing along the sector – which we acknowledge is reform / change fatigued in Victoria.

Q: What do you want to see promised for mental health in the federal election? Has the campaign put major work on hold? What certainty is needed now?

I support Mental Health Australia’s call for a long-term strategy for mental health – and would add that we need to integrate State and Commonwealth responses at a regional level in order to target diverse populations and diverse needs.  The election campaign has not put our work on hold – we are on track to implement continuing and new arrangements ready for July 1 and beyond in partnership with stakeholders.

Some Twitter observations

PHNs twitterPHNs twitter2

Control, not choice

Another big theme at the conference was given a sharp focus by keynote speaker Simon Duffy – that the idea of ‘choice’ is not enough for people with disabilty.

Rather, he said, control is what’s vital. (See also Duffy’s views about the NDIS in this earlier Croakey story and in this interview on Radio National’s Life Matters).

In a similar vein, RMIT Associate Professor Paul Ramcharan told delegates about the It’s My Choice toolkit (DVD, discussion guide and booklets) developed with Inclusion Melbourne, a day service that supports people with intellectual disability. The project sought to inform people with disabilities, family, friends and others as well as service personnel about how to explore choices within complex lives and relationships. .

Ramcharan later told Croakey:

“Of the nine principles of choice (identified), one in particular challenges us to rethink the notion of choice. In this principle,  the important question is not whether people with disability have choice – given that no one really has a total choice in what happens in their lives and that choices are made within a complex of relationships, services and environments. The question should be whether the limitations placed on their choices are reasonable or not.

Organisations delivering services should be looking at discrimination and community norms and other barriers that get in the way of people expressing their choices not just about mundane matters like what to eat and wear (though important) but pervasive areas relating to health, education, work, family and intimacy.

Choice of services alone does not equate to personal choice. It’s the journey of life that counts, not formal academic indicators, but the rich fabric that enriches our lives day to day.”

(Note: this quote above was added to the original published story to give more context about the project).

See his slide below.

PRINCIPLE6
Conference perspectives

Quinlan view from front

Quinlan twitter

• Marie McInerney is covering the #TowardsRecovery conference for the Croakey Conference News Service. Bookmark this link to track the coverage.

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Response to our NACCHO Aboriginal Health Newspaper from our members, community, stakeholders and Government  has been nothing short of sensational over the past 3 years , with feedback from around the country suggesting we really kicked a few positive goals for Aboriginal health.

NACCHO is the national peak body for Aboriginal health. It is entrusted to represent the needs and interests of Aboriginal health on behalf of its members in the national arena.

NACCHO has and continues to be a living embodiment of the aspirations of Aboriginal people

10 good reasons to advertise in the NACCHO Aboriginal Health Newspaper :

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  10. Support NACCHO vision to Close the Gap

Our media partner Koori Mail Turns 25 this week

The Koori Mail is an Australian media institution, 100% owned and controlled by Aboriginal people. The fortnightly newspaper circulates all states and covers the issues that matter the most to black Australians. 25 years since its first print, the Indigenous paper is still breaking ground for Indigenous journalism.

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This 24-page newspaper is produced and distributed as an insert in the Koori Mail, circulating 14,000 full-colour print copies nationally via newsagents and subscriptions.

Our audited readership (Audit Bureau of Circulations) is 100,000 readers!

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NACCHO Aboriginal #HealthElection16 : One Gateway proposed for over 30 phone and online mental health services in Australia,

carer_gateway_square

“We are undertaking this crucial reform because the Mental Health Commission and Expert Reference Group found there were over 30 phone and online mental health services in Australia, but no co-ordinated way to access them.

This means people with specific mental health needs may not have been aware of specialist services or were falling through the cracks altogether.

It also means many of these mental health phone services were being overburdened – or underutilised – because people were not aware of alternative services that may better suit their mental health needs.”

The Hon. Sussan Ley MP Minister for Health Mental Health Gateway to save lives Press Release May 15 : Picture above example of a Gateway

A re-elected Turnbull Coalition Government will continue delivering on our promise to develop a digital mental health gateway that will ensure Australians get the right help at the right time in a bid to stop people falling through the cracks and save lives.

Reports that some phone counselling services have had their funding ‘axed’ are therefore incorrect and misleading.

Our digital gateway is a key recommendation of the Mental Health Commission’s (MHC) landmark Report and is being implemented in line with the guidance provided by our independent Mental Health Expert Review Committee, who were tasked with taking the MHC’s findings from paper to policy.

In addition to our digital gateway being a first point of entry to mental health services across the country, Australians will have the option to call one single phone number to access the mental health phone and online services they need.

This single phone number will act as a triage service that will put them in touch with a specialist phone or online service that is best suited to their personal circumstances.

For example, the triage service may determine a person would be best serviced by a specialist counselling service addressing LGBTIQ mental health or eating disorders, rather than a general service.

The triage service is not designed to replace existing phone counselling services, but enhance access to them.

Australians will still be able to call their preferred phone counselling service directly if they believe this is the best service to help them.

We are undertaking this crucial reform because the Mental Health Commission and Expert Reference Group found there were over 30 phone and online mental health services in Australia, but no co-ordinated way to access them.

This means people with specific mental health needs may not have been aware of specialist services or were falling through the cracks altogether.

It also means many of these mental health phone services were being overburdened – or underutilised – because people were not aware of alternative services that may better suit their mental health needs.

Another key recommendation of the Mental Health Commission was that some – but not all – phone and online mental health services may be unnecessarily duplicating each other’s work and funding may be better targeted to ensure a high-quality mix of services to cover the varying mental health needs of Australians by filling service gaps.

The Coalition will therefore work with all phone and online mental services to transition to this new model of improving access to over-the-phone/online mental health services from 2017-18, including greater funding security. Until then, all services will continue to be funded at current levels.

I understand the importance of mental health organisations running fundraising drives, however it is important their campaigning methods do not end up hurting those who they are ultimately meant to help.

Labor treated mental health as a “second-term priority”. Only the Coalition is committed to delivering these brave and bold reforms aimed at ensuring Australians with mental health issues no longer fall through the cracks.

Recommendations from the Mental Health Commission’s Landmark Report

“Currently telephone helplines are not integrated, they do not have common standards and there are limited referral pathways. There are various levels of duplication of target client groups and potential to be accessing the ‘wrong door’ by users.”

“For telephone and online support services, the strategic direction is in creating a ‘joined-up’ model of crisis support helplines, with each helpline playing its part according to its expertise. This would reduce duplication, increase efficiency and enable collaborative work.”

“Create a coordinated, better integrated model of telephone and online support services, including crisis support and seamless pathways to online and offline information, education, biometric monitoring and clinical intervention.”

Improve access to services and support through innovative technologies

“Improve emergency access to the right telephone and internet-based forms of crisis support and link crisis support services to ongoing online and offline forms of information/education, monitoring and clinical intervention.”

“Implement cost-effective second and third generation e-mental health solutions that build sustained self-help, link to biometric monitoring and provide direct clinical support strategies or enhance the effectiveness of local services.” Volume 1, page 11

Recommendations from the Mental Health Expert Reference Group Implementation Report

“The ERG acknowledged the evidence that demonstrates telephone and e-mental health services can play a significant role in a stepped care model of mental health service delivery if there were triaging, clinical guidelines and targeting of their use. The ERG endorsed appropriate promotion of existing self-help and clinician moderated e-mental health services to consumers and clinicians as an important component.”

“The ERG noted the significant number of providers in this space, some of whom provide similar or competing services. A simpler structure and a secure funding base for these services is required. A single telephone line linked as appropriate to other telephone based services was proposed. Similarly, the ERG supported the consideration of how a single gateway for web-based services could be utilised to provide initial triage and to facilitate consumer access to the most appropriate services.

This would encourage and enable optimal use of the web-based services that are available, particularly in the context of better promoting the availability of self-help services to individuals who could benefit from them. The ERG recommended the Commonwealth work with the states and territories to streamline entry to all e-mental health services through one national gateway.”

“The Commonwealth should immediately:

Establish a single gateway and platform for initial access to existing web based services.

Similarly with phone based mental health support, a single phone access point should be established with the capacity to provide soft transfer to other phone services. Ensure a simple triage system is developed and offered through these new arrangements.”

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NACCHO #HealthElection16 : AMA launches Key Health Issues / Aboriginal Health policy for 2016 Federal Elections

Brian

” The gap in health and life expectancy between Aboriginal and Torres Strait Islander people and other Australians is still considerable, despite the commitment to closing the gap.

The AMA sees progress being made, particularly in reducing early childhood mortality rates, and in addressing major risk factors for chronic disease, such as smoking. However, to close the gap in Indigenous health, Government must commit to improving resourcing for culturally appropriate primary health care for Aboriginal and Torres Strait Islander people, and the health workforce.

Including increased investment in Aboriginal and Torres Strait Islander community controlled health organisations. Such investment must support services to build their capacity and be sustainable over the long term;

Brian Owler AMA President pictured above Matthew Cooke Chair of NACCHO at recent NACCHO Event Parliament House Canberra : The Aboriginal Policy is part of a 16 Page AMA Health Issues Document  

“The Medicare freeze is not just a co-payment by stealth – it is a sneaky new tax that punishes every Australian family,”

Professor Owler said, with the elderly and chronically ill among those most affected see press release here AMA LAUNCHES NATIONAL CAMPAIGN AGAINST THE MEDICARE REBATE FREEZE (FED)

Putting Health First

Download the 16 Pages here AMA Key Health Issues Federal Election 2016

Health policy will be at the core of the 2016 Federal Election.

The AMA is non-partisan. It is our role during election campaigns, as it is throughout the terms of governments, to highlight the issues we think will be of greatest benefit to the health system, the medical profession, the community, and patients.

As is customary, the AMA will focus on the respective health policy platforms presented by the major parties in the coming weeks.

The next Government must invest significantly in the health of the Australian people.

Investment in health is the best investment that governments can make.

We must protect and support the fundamentals of the health system.

The two major pillars of the system that mean most to the Australian people are quality primary health care services, led by general practice, and well-resourced public hospitals.

The AMA has advocated strongly and tirelessly on these issues for the term of the current Government.

General practice and public hospitals are the priority health issues for this election.

The AMA is calling on the major parties to lift the freeze on the Medicare Benefits Schedule (MBS) patient rebate. The freeze was extended until 2020 in the recent Budget. The freeze means that patients will pay more for their health care. It also affects the viability of medical practices.

We also need substantial new funding for public hospitals. The Government provided $2.9 billion in new funding in the Budget, but this is well short of what is needed for the long term.

We must build capacity in our public hospitals. Funding must be better targeted, patient-focused, and clinician led.

The AMA is also calling for leadership and effective policy from the major parties on Indigenous health, medical workforce and training, chronic disease management, and a range of important public health measures.

The AMA will release a separate Rural Health Plan, responding to the unique health needs of people in rural and regional Australia, later in the election campaign.

Elections are about choices. The type of health system we want is one of those crucial decisions.

In this document, Key Health Issues for the 2016 Federal Election, the AMA offers wide-ranging policies that build on what works. We offer policies that come from the experience of doctors who are at the coalface of the system – the doctors who know how to make the system work best for patients.

The AMA urges all political parties to engage in a competitive and constructive health policy debate ahead of the election on 2 July.

Indigenous Health Policy Continued

Despite the recent health gains, progress remains frustratingly slow and much more needs to be done. A life expectancy gap of around 10 years remains between Aboriginal and Torres Strait Islander people and other Australians, with recent data suggesting that Indigenous people experience stubbornly high levels of treatable and preventable conditions, high levels of chronic conditions at comparatively young ages, high levels of undetected and untreated chronic conditions, and higher rates of co-morbidity in chronic disease. This is completely unacceptable.

It is not credible that Australia, one of the world’s wealthiest nations, cannot address health and social justice issues affecting just three per cent of its citizens. The Government must deliver effective, high quality, appropriate and affordable health care for Aboriginal and Torres Strait Islander people, and develop and implement tangible strategies to address social inequalities and determinants of health.

Without this, the health gap between Indigenous and non-Indigenous Australians will remain wide and intractable.

The AMA calls on the major parties to commit to:

  • correct the under-funding of Aboriginal and Torres Strait Islander health services;
  • establish new and strengthen existing programs to address preventable health conditions that are known to have a significant impact on the health of Aboriginal and Torres Strait Islander people such as cardiovascular diseases (including rheumatic fever and rheumatic heart disease), diabetes, kidney disease, and blindness;
  • increase investment in Aboriginal and Torres Strait Islander community controlled health organisations. Such investment must support services to build their capacity and be sustainable over the long term;
  • develop systemic linkages between Aboriginal and Torres Strait Islander community controlled health organisations and mainstream health services to ensure high quality and culturally safe continuity of care;
  • identify areas of poor health and inadequate services for Aboriginal and Torres Strait Islander people and direct funding according to need;
  • institute funded national training programs to support more Aboriginal and Torres Strait Islander people to become health professionals to address the shortfall of Indigenous people in the health workforce;
  • implement measures to increase Aboriginal and Torres Strait Islander people’s access to primary health care and medical specialist services;
  • adopt a justice reinvestment approach to health by funding services to divert Aboriginal and Torres Strait Islander people from prison, given the strong link between health and incarceration;
  • appropriately resource the National Aboriginal and Torres Strait Islander Health Plan to ensure that actions are met within specified timeframes; and
  • support for a Central Australia Academic Health Science Centre. Central Australia faces many unique and complex health issues that require specific research, training and clinical practice to properly manage and treat, and this type of collaborative medical and academic research, along with project delivery and working in remote communities, is desperately needed.

Australian Medical Association joins campaign against Medicare rebate freeze

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AMA LAUNCHES NATIONAL CAMPAIGN AGAINST THE MEDICARE REBATE FREEZE (FED)

Article below originally published here

Tens of thousands of specialist doctors are joining GPs’ war against the Turnbull government’s extended freeze on Medicare rebates, increasing pressure on the Coalition’s health record ahead of the federal election.

The Australian Medical Association has distributed posters to its members, warning patients that they will be out of pocket because the cost of running the medical practice will continue to rise as Medicare rebates stay frozen until 2020.

“You will pay a new or higher co-payment every time you visit your GP, every time you visit other medical specialists, every time you need a blood test, and every time you need an X-ray or other imaging,” it says, alongside a photo of a woman comforting a crying child.

It comes a week after the Royal Australian College of General Practitioners announced its 32,000 members would urge their patients to lobby local MPs against the move. The groups share about 8000 members, adding about 22,000 more specialist doctors to the campaign.

The AMA’s campaign similarly encourages patients to contact their local MPs and election candidates, but goes further to directly blame the Turnbull government for the extra cost: “The government has cut Medicare and wants you to pay for it.”

While pathologists on Friday agreed to retain bulk-billing rates in exchange for reduced regulatory pressure on rents under a deal with Health Minister Sussan Ley, the AMA maintains that they and diagnostic imaging services will remain under pressure to charge patients, with the government’s cuts to bulk-billing incentive payments deferred till later in the year.

The AMA’s president, Professor Brian Owler, said many doctors had absorbed costs but the extension “has pushed them over the edge”. They may charge patients a $30 co-payment to cover costs associated with moving to a private billing system, more than triple the Abbott government’s failed and deeply unpopular $7 GP co-payment, he said.

“The Medicare freeze is not just a co-payment by stealth – it is a sneaky new tax that punishes every Australian family,” Professor Owler said, with the elderly and chronically ill among those most affected.

While most specialists (about 70 per cent) already charged patients a co-payment, having had their rebates frozen for decades, the extended freeze could reduce the bulk-billing rate further, an AMA spokesman said.

Labor froze indexation for eight months in 2013, lifting it briefly for GPs in 2014-15. The Coalition extended it for four years in 2014, and this year extended it a further two years to 2020, to save $925.3 million.

Opposition Leader Bill Shorten said Labor opposed the extended freeze at the leaders’ debate on Friday, but would not say whether it would commit to lifting it if elected.

Thirty per cent of 400 GPs surveyed by the College said they would stop all bulk-billing, including for concession card holders, due to the extended freeze. Another 18 per cent said the practice would start charging a co-payment, but cap annual out-of-pocket fees for concession card holders.

Thirty per cent said they would maintain a mixed billing policy, and 10 per cent would continue to bulk bill all patients. Twelve per cent said they were already privately billing all their patients.

The Turnbull government plans to cut bulk-billing incentives for pathology and diagnostic imaging services to save $650 million over four years. Pathology Australia, which had warned this would lead more doctors to charge patients for pap smears, blood and urine tests, has agreed to drop its public campaign against the cuts.

Ms Ley said: “The Coalition will increase Medicare investment to $26 billion per year by 2020-21, while introducing revolutionary reforms such as Health Care Homes that cement a GP’s role at the centre of patient care.”

While she appreciated many GPs’ efforts to keep costs down during the indexation freeze, she was disappointed that “there’s no reciprocal offer to assist taxpayers with the immediate financial challenges our budget faces while [Health Care Homes are] implemented”.

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NACCHO Aboriginal health #Stroke Stories : Written by the mob for the mob

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“It’s very important that it belongs to the local community.And the community chose the stories, artwork and analogies that would be best to make it work.

The river is compared to the blood flow through the body,” says Rachel. “If it’s dammed with silt and trees then nothing gets past, like when an artery gets blocked. Or if the river floods it kills the land it goes over, which can be like a bleed in the brain.”

Rachel Peake, Stroke Care Coordinator in from Hunter New England Health.

A book of personal stroke stories from Aboriginal community members is proving effective at getting authentic, relatable information across to others in the community and raising stroke awareness.

All the words in Stroke: Written by the Mob for the Mob come from the Aboriginal people of the Kamilaroi/Gomeroi/Gamilaraay/Gamilaroi nations. The booklet was published by the Hunter New England Local Health District of NSW.

Download Stroke: Written by the Mob for the Mob (PDF, 12 MB)

“It’s very important that it belongs to the local community,” says Rachel Peake, Stroke Care Coordinator in from Hunter New England Health. “And the community chose the stories, artwork and analogies that would be best to make it work.”

The stories were gathered through a series of yarning sessions, which let people direct the conversation themselves. This makes sure that nothing important is missed, and that the authentic voices of the participants come through.

The result is a relaxed mix of humour and art. This includes the painting on the booklet’s cover, a representation of stroke and the brain created by students from the Peel High School. This picture also demonstrates the analogy of the river, which is central to the booklet’s message.

“The river is compared to the blood flow through the body,” says Rachel. “If it’s dammed with silt and trees then nothing gets past, like when an artery gets blocked. Or if the river floods it kills the land it goes over, which can be like a bleed in the brain.”

Since its publication the booklet has taken on a life of its own, with hardly any copies left from the original print run of 2000. This is partly due to people’s pride in their own family members, demonstrating that the booklet is reaching the community it was created for.

As Rachel says, “This is the message the community wanted: if they’re given a voice, they can educate their own people.”

You can find the Stroke: Written by the Mob for the Mob booklet on enableme and InformMe, as well as a series of videos of respected community members telling their own stories.

Download Stroke: Written by the Mob for the Mob (PDF, 12 MB)

Declaration: Colin Cowell editor of NACCHO Aboriginal Health News Alerts is stroke survivor and was recently elected to the board of Stroke Foundation as a Consumer director

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Aunty Pam’s story

Audrey’s story

Bill and Coral’s story

Delphine’s story

Tales from Toomelah

  Declaration of interest: Colin Cowell editor of NACCHO Aboriginal Health News Alerts is stroke survivor and was recently elected to the board of Stroke Foundation as a Consumer director

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NACCHO NDIS News Alert : Indigenous disability advocates speak about the NDIS

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“A lot of our communities don’t acknowledge the word disability, so getting to the next step of having an assessment for themselves or a child is a huge step, so they’re not accessing services,”

“When you look at our kids in school and our kids in the justice system, these behaviours and this inability to fit in with community impact on their lifestyles, and life looks very different for them.”

We’ve got to have hope, if we don’t have hope we don’t have much of a future, it’s only got to be better for us.”

Robyn Smith is a regional coordinator with National Disability Services

PHOTO :Steve Widders, Liza Geddes and Robyn Smith stand together at the ACT Now 3 conference ABC Coffs Coast, Liz Keen

NACCHO Articles about NDIS

Federal Government Website NDIS

Indigenous people from throughout northern New South Wales have come together to discuss accessing disability services .

According to the latest Australian Bureau of Statistics figures, Indigenous Australians are 1.7 times more likely to have a disability, although Indigenous disability workers say, because they are less likely to access health care, the real figures are probably much higher.

This week, Aboriginal disability support services and Aboriginal people with disabilities have been meeting in Coffs Harbour to prepare for the roll-out of the National Disability Insurance Scheme, which will land on the North Coast in July 2017.

The gathering, All Communities Coming Together Now, is a the third in a series of joint Indigenous services events that have brought together 340 people with disabilities and service providers from Kempsey to the Tweed.

One of the event organisers, Liza Geddes, works with Indigenous people with physical and intellectual disabilities, and she said the event was trying to address the fact that the uptake of the NDIS by Indigenous people in the launch sites was low.

A lot of our communities don’t acknowledge the word disability, so getting to the next step of having an assessment for themselves or a child is a huge step.

Ms Geddes said the rates of disability were higher among Indigenous communities because of the trauma from colonisation that has lead to mental illness, drug and alcohol abuse, and in turn disadvantage.

“That disadvantage takes a lifecycle of its own, and is repeated generationally and inter-generationally,” she said.

Robyn Smith is a regional coordinator with National Disability Services and she said, from her personal experience, the Aboriginal community around her was still damaged from stolen generations and other past injustices, and because of that she believed the gap was getting bigger, not smaller.

“From my own personal experience we are a long way from that healing moving forward, we are disjointed and fragmented in a lot of ways, but we do have a long way to go and we need a lot of understanding and a lot of empathy from the broader community as well,” she said.

Ms Geddes hoped the NDIS could help break the ongoing cycle of disadvantage.

“The NDIS could be a service system that supports the community to have control, which might bring some redress to that long-term disadvantage,” she said.

“We’ve got to have hope, if we don’t have hope we don’t have much of a future, it’s only got to be better for us.”

Steve Widders is an Aboriginal man who is legally blind and an advocate and a supporter of new initiatives for people who live with disabilities, and he said the NDIS brought hope.

“I think the NDIS is a great vehicle, not only for the Aboriginal people to put their hands up but more for people with disabilities to stand up, to be counted, and to participate,” he said.

“That’s where a good community comes from, from more people participating.”

Hidden rates of disability

The latest figures from the Australian Bureau of Statistics show that while across all ages, Indigenous people are 1.7 times more likely to have a disability, that is worse for Indigenous children who are 2.5 times more likely to have a disability.

Ms Smith said those statistics were in themselves alarming, but in reality there were probably many more people with a disability in Indigenous communities, because they are not accessing health services and also many disabilities in Indigenous communities were not obvious.

“A lot of our communities don’t acknowledge the word disability, so getting to the next step of having an assessment for themselves or a child is a huge step, so they’re not accessing services,” she said.

“When you look at our kids in school and our kids in the justice system, these behaviours and this inability to fit in with community impact on their lifestyles, and life looks very different for them.”

Mr Widders agreed that many people in Aboriginal communities were living with undiagnosed disability.

The best part of Aboriginal communities and disability is they are all-inclusive, they don’t exclude people as non-Aboriginal communities do for having a disability.

Liza Geddes, disability support worker

“People don’t see themselves as disabled and they aren’t regarded as disabled by their families, they just see it as their responsibility to look after them,” he said.

This care of communities for people with a disability might mean fewer people are accessing healthcare, but people like Liza Geddes say it is also a great strength for the communities.

“The best part of Aboriginal communities and disability is they are all-inclusive, they don’t exclude people as non-Aboriginal communities do for having a disability,” she said.

While Robyn Smith was disappointed by how often she saw discrimination in our society, she also said she believed we could see a change for Indigenous people.

“We’ve got to have hope, if we don’t have hope we don’t have much of a future, it’s only got to be better for us.”