NACCHO Aboriginal #MentalHealth and #SuicidePrevention : Read and Watch @beyondblue Chair The Hon Julia Gillard AC speech @UniofAdelaide Truth-telling and reconciliation will enhance the social and emotional wellbeing of Indigenous Australians.

” Suicide in our Indigenous communities is one of the greatest challenges of our times and its causes are complex.

Beyond Blue cannot claim or seek to be a specialist or comprehensive provider of social and emotional wellbeing or suicide prevention services for Aboriginal and Torres Strait Islander people.

That is a role which is more appropriately the domain of Aboriginal-led and community-controlled organisations.

But we can apply what we have learnt so far through our Reconciliation Action Plan, our growing cultural competencies, and strong relationships with Aboriginal and Torres Strait Islander peoples, leaders and organisations.

We can complement the work of the Aboriginal organisations and others by ensuring our major interventions are suitable for, and accessible to, Aboriginal and Torres Strait Islander people wherever possible, and use our well-known brand and strength in communications to fight racism and discrimination.

We will recognise those inherent protective factors of Indigenous cultures and communities – those powerful forces of resilience, humour, spirituality and connectedness – that can and should be utilised as sources of strength and healing.

We are ready to work alongside Indigenous people and communities in co-designing solutions to provide better outcomes for health and wellbeing.

We intend to be the best ally we can be, lend our voice when required and listen to learn.

We need to educate ourselves and ask questions when we need to; to commit, to support, to ally.

We pledge to be a positive force for change as the nation addresses the issue of constitutional recognition of Aboriginal and Torres Strait Islander peoples.

Aboriginal and Torres Strait Islander peoples have always resisted actions designed to destroy their culture, disperse their families and sever their connections to Country.

The day will come when we look with pride upon that determination, and indeed celebrate it as a complete history.

The Hon Julia Gillard AC University of Adelaide public lecture 2019 3 September 2019

Yellaka Dance Group 

Read over 230 Aboriginal Mental Health articles published by NACCHO in past 7 years

Read over 150 Aboriginal Suicide Prevention articles published by NACCHO in Past 7 years

I acknowledge the traditional owners of the land on which we meet and in the spirit of reconciliation, pay my respects to Elders past and present. Yellaka, thank you for your warm Greeting to Country.

Introduction

The is the second time I have had the privilege of being so welcomed by Yellaka. The first time was at the recent South Australian State dinner to celebrate 125 years of women’s suffrage in our State – a milestone to be inspired by.

In fact, that dinner was very important for me in preparing for this lecture.

It caused to me to reflect on the complexity of history; on our achievements and failings. In that speech I spoke about the need to erect a permanent monument to celebrate the fight for women’s suffrage and all that was gained here in South Australia in 1894.

But in doing so, I said care must be taken to tell the whole story, not part of it.

Despite Aboriginal men and, as a result of women’s suffrage, Aboriginal women having the right to vote, it was common for them neither be told about it nor supported to enrol. Sometimes this oppressive neglect morphed into a more active discouragement from participating.

This pernicious repudiation of a human right was compounded by a direct legal bar, when in the 1902 Commonwealth Franchise Act, Aboriginal and Torres Strait Islander people were excluded from voting in federal elections. It was not until 1962 that Indigenous Australians could have a say in who governed our nation.

We cannot tell the history of how our democracy developed without looking squarely at how equality was denied for so long.

This is just one example of the need to tell the deeper truths that lie beyond the surface.

To quote the words of Labor Prime Minister Paul Keating in his famed Redfern Speech, we need:

Recognition that it was we who did the dispossessing.

We took the traditional lands and smashed the traditional way of life. We brought the diseases. The alcohol.

We committed the murders.

We took the children from their mothers.

We practised discrimination and exclusion.

It was our ignorance and our prejudice.

And our failure to imagine these things being done to us.

With some noble exceptions, we failed to make the most basic human response and enter into their hearts and minds.

We failed to ask – how would I feel if this were done to me?

Friends, this question is as profoundly challenging today as it was when Paul spoke those words almost thirty years ago. Trying to answer it requires honesty, empathy, intellectual understanding, spiritual depth.

Today, I am asking you to bring those characteristics with you as we discuss the tragic topic of suicide and Indigenous Australians.

Honesty

First, with honesty, let’s confront the facts.

Since 2012, suicide has been the leading cause of death among young Aboriginal and Torres Strait Islander people aged 15 to 34.

The suicide rate for Aboriginal and Torres Strait Islander teenagers aged 15 to 19 of both genders is around four times that of their non-Indigenous peers.

Despite Aboriginal and Torres Strait Islander people comprising around three per cent of the Australian population, they account for thirty per cent of the suicide deaths among those under 18 years of age.

There are significant suicide or self-harming clusters that can occur within a single community or locale over a period of weeks or months.

For example, In February, Western Australia’s State Coroner handed down her report on a cluster of 13 deaths that occurred in less than four years in the Kimberley region and included five children aged 10 to 13.

The Coroner spoke of the deaths as profoundly tragic, individually and collectively, of dysfunction, alcohol, domestic violence and grief.

But she added:

to focus only upon the individual events that occurred shortly before their deaths would not adequately address the circumstances attending the deaths. These tragic individual events were shaped by the crushing effects of inter-generational trauma and poverty upon entire communities. That community-wide trauma, generated multiple and prolonged exposures to individual traumatic events for these children and young persons.

Watch video 

Please note : Julia Gillard starts her talk at about 27 minutes into the 1hr 10 min event, and talks for just under 30 minutes. It finishes with a Q&A session (of about 20 minutes).

Empathy

The Coroner here is calling to our ability to show empathy. To walk alongside our First Peoples and try to understand how history and lived reality come together and can create circumstances of despair.

Great damage has been done to our Aboriginal and Torres Strait Islander communities through two centuries of discrimination, dislocation and cultural disruption.

Culture is a word that is often tangled up with nationality, but it entails much more.

Our culture determines so much of our identity; our values, the way we view the world, the way we interact with others, our sense of belonging.

And if the foundations of culture are systemically disrupted – connection to land, traditional places and practices, languages, spirituality, family and kinship ties – it causes devastation across generations.

But honesty also requires us to recognise that there is both deep lingering pain from our history, and new pain that arises in the present.

Imagine not getting the job you’re qualified for because of the colour of your skin; to know you are being followed by a store detective just for being you; to feel the stranger sitting beside you slip sideways to create greater distance.

These are everyday situations – the constant but subtle cues of difference – and where being racially different is nearly always positioned as a liability.

Put simply, racism, including these kinds of behaviours, is not only bad for mental health and wellbeing – it both causes and perpetuates high levels of social and emotional distress for Aboriginal and Torres Strait Islanders. In addition, there is a ‘dose’ effect for psychological distress caused by racism: the more a person is exposed to it, the greater the impact.

That was why Beyond Blue launched its Stop, Think, Respect invisible discriminator campaign in 2014 with a repeat run in 2016.

The campaign – the most viewed and shared in Beyond Blue’s history – highlights the routine everyday impact of subtle racism on the social and emotional wellbeing of Aboriginal and Torres Strait Islander people.

The campaign aimed to change behaviour by encouraging non-Indigenous Australians to think about their often, unconscious behaviours and to think again before they act.

  • To think before they laughed along – even uncomfortably – at a racist joke in the pub.
  • To challenge why they may not sit beside an Aboriginal person on a crowded bus.

But it was the reaction from Indigenous people that was most revealing.

They told us they loved the campaign because finally somebody had noticed that, for them, every day could be a little tougher than it should be.

Over half of Aboriginal and Torres Strait Islander people who experience racial discrimination report feelings of psychological distress, meaning they are at elevated risk of anxiety and depression, substance use and contemplating or attempting suicide.

Empathy requires us to recognise that the threads of the past and the attitudes shown in the present day are woven together. For non-Indigenous Australians, our collective failure to face up to all of the brutal truth of our history and its ongoing effects holds us back from full understanding today.

For Indigenous Australians, the interconnected issues of cultural dislocation, personal trauma and the ongoing stresses of disadvantage, racism and exclusion are absolutely contributing to the heightened risk of mental health problems, substance misuse and suicide.

All this was acknowledged by the Royal Commission Into Aboriginal Deaths In Custody. That report was tabled in 1991.

Intellectual understanding

Driven by empathy, we also need to engage intellectually on the best ways to provide culturally appropriate services and supports to prevent Indigenous suicide.

Nothing less than profound systemic reform is needed to improve social and emotion wellbeing.

Such major change must be culturally informed and co-designed. As many Aboriginal and Torres Strait Islander people continue to remind us, Indigenous policies and responses must be led by Indigenous people, which might mean solutions that look different to anything that has been implemented before.

Innovation and new efforts are needed nationally and locally.

In 2009 the Rudd Government launched the ‘Closing the Gap’ response as a measurable account of Indigenous disadvantage that would be reported to parliament annually on progress.

In the 10 years since launch most of the indicators of disadvantaged have remained stubbornly unmoved. Aboriginal and Torres Strait Islander people can expect to live 10 to 17 years less than other Australians.

While there have been some improvements against some performance indicators, these have been small and incremental.

And babies born to Indigenous mothers still die at more than twice the rate of other Australian babies.

Aboriginal and Torres Strait Islander people experience higher rates of preventable illness such as heart disease, kidney disease and diabetes.

And a major contributing factor to the life expectancy gap is suicide.

There are no mental health or suicide prevention targets in Australia’s Closing the Gap strategy despite the alarming statistics on Indigenous suicide and psychological distress, but as a member of the steering committee, Beyond Blue is adding our voice to rectifying this.

At the same time, we are calling for this act of national leadership, as an organisation we are trying to be a good partner in locally led change models.

In November 2018, Beyond Blue launched Be You: a Commonwealth-funded national initiative that aims to strengthen the mental health literacy, resilience, self-care and help-seeking of every member of Australia’s school communities and early childhood settings.

In January, Minister Wyatt announced $2.3 million over two years to pilot and evaluate a culturally appropriate, place-based adaptation of Be You for schools in the Kimberley and Pilbara regions of WA, in partnership with Aboriginal communities.

That work is now underway. And we are taking a very different approach to this work than what we would normally.

Local stakeholder engagement has confirmed that we must be guided by local communities to genuinely co-design the project; to employ people with community relationships and credibility; and to engage Aboriginal community-controlled organisations to support implementation and delivery of the program.

It’s still very early days, but we are gaining much from partnering with Indigenous communities.

Spiritual depth – Uluru Statement from the Heart

Honesty, empathy, intellectual understanding, all are necessary in the cause of tackling the rate of Indigenous suicide.

But so is spiritual depth, the ability to transcend a divided past, address the dispiriting inequalities of the present and embrace a united future.

Just over two years ago, 250 Aboriginal and Torres Strait Islander leaders endorsed by standing ovation the Uluru Statement from the Heart.

In burning prose it describes that the sovereignty of this nation’s First peoples is ‘a spiritual notion: the ancestral tie between the land, or ‘mother nature’, and the Aboriginal and Torres Strait Islander peoples who were born therefrom, remain attached thereto, and must one day return thither to be united with our ancestors. This link is the basis of the ownership of the soil, or better, of sovereignty.’

It goes on to say:

Proportionally, we are the most incarcerated people on the planet. We are not an innately criminal people. Our children are aliened from their families at unprecedented rates. This cannot be because we have no love for them. And our youth languish in detention in obscene numbers. They should be our hope for the future.

These dimensions of our crisis tell plainly the structural nature of our problem. This is the torment of our powerlessness.

We seek constitutional reforms to empower our people and take a rightful place in our own country. When we have power over our destiny our children will flourish. They will walk in two worlds and their culture will be a gift to their country.

We call for the establishment of a First Nations Voice enshrined in the Constitution.’

As we all know, changing our constitution is difficult in every sense. Conducting and carrying a referendum by a special majority is hard to do. Our history books are littered with the stories of failed referendums. Nineteen referendums proposing 44 changes to the Constitution have been held since Federation but the Australian people have agreed to only eight changes with the last ‘yes’ vote occurring in 1977.

Of course, the Indigenous leaders who gave us the Uluru statement from the heart know this history. They neither underestimate how hard it is to have voters accept change, nor the joy that can come when they do. Many of them were alive when more than 90 percent of Australians voted in the 1967 referendum to allow First Nations people to be included in the census and for the Federal Parliament to have the power to legislate for an improved future.

In the Uluru statement, Indigenous leaders are specifically calling for a comparable act of national unity. There is some reason to believe that voting Australians in their millions are prepared to answer that call.

The Australian Reconciliation Barometer is a national research study conducted every two years to measure and compare attitudes and perceptions towards reconciliation.

In 2018 the Barometer found:

  • 90 per cent of Australians believe the relationship between Aboriginal and Torres Strait Islander people is important;
  • 95 per cent believe that it is important for our First Peoples to have a say in matters that affect them;
  • and 80 per cent support a formal truth telling process.

That there is a public mood for change is further confirmed by the Australian Constitutional Values Survey of 2017 released by the Centre for Governance and Public Policy at Griffith University.

It found 61 per cent of respondents would vote “yes” in a referendum to add an Indigenous voice to Parliament.

So, we increasingly desire a richer understanding of our shared history and some form of national reconciliation, but change can be hard to achieve, even when the majority is willing.

Successive Prime Ministers and governments, Indigenous leaders and organisations have tried to advance this cause.

The government I led set out to bring a referendum on constitutional recognition to the people by the 2013 election. I appointed an Expert Panel on Constitutional Recognition of Indigenous Australians to advise on the wording.

On that panel were some of our most persuasive and respected Indigenous leaders, including The Hon. Ken Wyatt AM, the first Indigenous Australian to serve in the House of Representatives.

The panel’s recommendations were sensible and smart.

But before we could proceed, we needed to diagnose the prospects of success at a referendum. The very worst thing we could do would be to put a referendum proposal forward only to have it fail.

The consensus was we did not have time to build momentum for change ahead of a 2013 election.

That need for certainty remains a critical issue for today’s leaders as they move towards a proposal to put to the people.

But much has changed since 2013 and we can all be heartened by that.  I am especially heartened that we have, for the first time, extremely talented and respected Aboriginal people from both sides of politics leading Indigenous policy and discussion on this issue.

With bi-partisan support, shared commitment and collaboration, change is achievable.

We know wellbeing is intrinsically linked to a strong sense of self, connections to community, and recognition of culture.

That is why I and my Beyond Blue Board colleagues recently approved a comprehensive Aboriginal and Torres Strait Islander Strategy to guide our contribution for the next five years. Through the Strategy, we have resolved to continue to advocate on national issues of importance to Aboriginal and Torres Strait Islander people.

We are particularly determined to raise our voice in support of an openhearted and respectful response to the Uluru Statement from the Heart.

Beyond Blue acknowledges that there are still community and political discussions occurring about constitutional change and recognition. As that conversation continues, Beyond Blue advocacy will be aimed at our nation adopting the kind of far-sighted change that can bring a new era of healing and unity.

This isn’t a mental health organisation dabbling in politics. We do it because structural discrimination has a profound and proven negative impact on individual and community wellbeing and mental health.

This is absolutely about ‘sticking to our knitting’.

This is about the Board of Beyond Blue supporting action on the basis there will be significant benefit to a population group at higher risk of mental health conditions and suicide, and who experience discrimination and disadvantage.

The Board of Beyond Blue also accepts the invitation issued in the Uluru Statement from the Heart to walk with you in ‘a movement of the Australian people for a better future’.

To our federal parliamentarians who are working through how best to respond to the Uluru statement my personal message is this; I know what it is like to be beset with doubts about the best way to respond to a call to address trauma and despair. To worry about making the wrong decision, one that risks more damage.

I went through every painful permutation of that in my head when I worked through whether to call a Royal Commission into Child Sexual Abuse in Institutional Settings. I am not ashamed to say here that in the face of such a major decision, I was afraid.

Specifically, I was afraid that holding a Royal Commission would retraumatise, rather than heal.

As history records, I worked through those fears and called the Commission. I know now from my own observations of the impact of the Royal Commission that great healing can come from heeding the call, truth-telling and acknowledgement of past trauma.

I ask our current leaders on all sides of the parliamentary chamber to work through their fears and concerns. I ask our current leaders to heed the call of the Uluru Statement from the Heart.

Conclusion

Suicide in our Indigenous communities is one of the greatest challenges of our times and its causes are complex.

Beyond Blue cannot claim or seek to be a specialist or comprehensive provider of social and emotional wellbeing or suicide prevention services for Aboriginal and Torres Strait Islander people.

That is a role which is more appropriately the domain of Aboriginal-led and community-controlled organisations.

But we can apply what we have learnt so far through our Reconciliation Action Plan, our growing cultural competencies, and strong relationships with Aboriginal and Torres Strait Islander peoples, leaders and organisations.

We can complement the work of the Aboriginal organisations and others by ensuring our major interventions are suitable for, and accessible to, Aboriginal and Torres Strait Islander people wherever possible, and use our well-known brand and strength in communications to fight racism and discrimination.

We will recognise those inherent protective factors of Indigenous cultures and communities – those powerful forces of resilience, humour, spirituality and connectedness – that can and should be utilised as sources of strength and healing.

We are ready to work alongside Indigenous people and communities in co-designing solutions to provide better outcomes for health and wellbeing.

We intend to be the best ally we can be, lend our voice when required and listen to learn.

We need to educate ourselves and ask questions when we need to; to commit, to support, to ally.

We pledge to be a positive force for change as the nation addresses the issue of constitutional recognition of Aboriginal and Torres Strait Islander peoples.

Aboriginal and Torres Strait Islander peoples have always resisted actions designed to destroy their culture, disperse their families and sever their connections to Country.

The day will come when we look with pride upon that determination, and indeed celebrate it as a complete history.

I look forward with hope to that day and I thank you.

NACCHO Aboriginal Health and #SuicidePrevention @pat_dudgeon @TTanja23 : Download New @CBPATSISP guidelines to improve assessments for our mob presenting to hospital with self-harm and suicidal thoughts

There is now growing evidence that the legacy of colonisation has contributed to the disproportionate rat.   es of suicide and suicidal behaviours and other disadvantages experienced by Aboriginal and Torres Strait Islander people.

The effects of colonisation are evident in the structural barriers and lack of access to culturally responsive hospitals and family support services that underscore the urgent need for these guidelines as part of a broader suicide prevention strategy.”

Professor Pat Dudgeon, Director of the Centre for Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention  ( CBPATSISP )

“Assessing risk of suicide is a complex task in any setting, but particularly in the hospital setting, as it can be a very discomforting time for people. There is a pressing need to respond adequately and carefully during this time.”

Aboriginal clinical psychologist, Tanja Hirvonen

Read over 150 Aboriginal Health and Suicide Prevention articles published by NACCHO over past 7 years 

The Menzies School of Health Research (Menzies), commissioned by CBPATSISP have developed evidenced-based the Guidelines for best practice psychosocial assessment of Aboriginal and Torres Strait Islander people presenting to hospital with self-harm and suicidal thoughts (the Guidelines) to improve the quality of care and outcomes for people presenting with suicidal thoughts and behaviours.

Download 30 Page PDF Copy 

CBPATSISP best practice_guidelines_FINAL

A history of self-harm is one of the strongest known risk factors for suicide and represents an important opportunity to engage with people in a preventive intervention.

The Guidelines contain 227 evidence-based recommendations that have been endorsed by an expert panel of Aboriginal and Torres Strait Islander and non-Indigenous professionals and those with lived experience using the Delphi method for establishing an expert consensus on best practice.

The Guidelines provide the principled basis for culturally appropriate health care. To better achieve cultural responsiveness in practice and improve the quality of care for Aboriginal and Torres Islander people presenting to hospital with self-harm and suicidal thoughts, the guidelines contains recommendations for appropriately and effectively interacting with and engaging Aboriginal and Torres Strait Islander people in ways that are empowering and de-stigmatising.

Tanja Hirvonen states,

“It was highlighted that the type of assessment tool that is used is significant, but just as critical is to ensure that the right information is gathered, and people are appropriately supported during a very critical time in their lives, within a culturally safe model of practice and care.”

Recommendations in the guidelines for evaluating risks, strengths and needs of Aboriginal and Torres Strait Islander people have a strong grounding in the concept of social and emotional wellbeing to ensure that assessments inform the most appropriate and effective options for care in the hospital and recovery in the community.

A number of recommendations have also been included to help clinicians respond in developmentally and culturally appropriate ways to self-harm and suicidal thoughts amongst young Aboriginal and Torres Strait Islander people.

Professor Pat Dudgeon concluded:

“These new Guidelines have potential to make a genuine difference for Aboriginal people at risk of suicide or self-harm who present at emergency departments. CBPATSISP is committed to disseminating these guidelines widely and we will advocate to ensure that relevant agencies, such as the Australian Indigenous Psychology Association, are supported to develop cultural competence training and engage hospitals in embedding these guidelines into practice at a national level.”

The guidelines can be also be found online from CBPATSISP and Menzies websites

If you or someone you know needs help contact your nearest ACCHO or call:

 

NACCHO Aboriginal #MentalHealth and #SuicidePrevention : Remote jobless ” CDP ” to be trained as Indigenous ‘crisis’ contacts says @KenWyattMP #Garma2019

 

“In the past we used to walk with our fathers and our grand­fathers and have a yarn with them.

If we had a proper look at the data we would find there were a lot less suicides when our communities were strong and our families were there all the time.

And then the policies of the past impacted that level of bonding, families have been broken in some instances.”

Mr Wyatt revealed his plan as he prepares to visit Garma and a remote Northern Territory community where leaders say jobs have helped save their young people.

On Saturday 3 August at 11.15 the Voices workshop at Garma

The official Program Booklet can be viewed HERE

Featuring

Minister for Indigenous Australians Ken Wyatt

Pat Turner : Coalition of Peak Organisations

Mick Dodson

June Oscar

From Today’s Australian 

Unemployed Indigenous people in remote towns and communities will be trained as round-the-clock emergency contacts for troubled young people as part of the Morrison government’s plan to address the scourge of indigenous suicide.

Minister for Indigenous Australians Ken Wyatt wants some of the 29,000 Aboriginal people in the Community Development Program — formerly work-for-the-dole — to serve as “permanent part-time youth engagement people”.

CDP participants are required to complete 20 hours a week of work-like duties that benefit their community, but so far none have performed this role.

Those indigenous people found suitable for the role would complete a mental health first aid course and be available to listen and mentor, Mr Wyatt said.

Aboriginal Australians take their own lives at twice the rate of other Australians, and the figures are even higher among indigenous youth.

The Arnhem Land community of Gunyangara was crippled by ­indigenous youth suicide in the years before the local Aboriginal corporation took control of the town’s services and began employing its young residents to run a diverse range of businesses. ­Locals now build their own houses, including by making bricks and milling the wood for frames.

Djawa Yunupingu said the community had survived “very bad times”. No resident had taken their own life for 10 years: “We made our own destiny,” he said.

Mr Wyatt will visit 10 newly built houses at Gunyangara today before facing some of the nation’s most respected backers of the Uluru Statement from the Heart at the Garma festival at nearby Gulkula.

He has pledged to take Australians to a referendum on constitutional recognition of indigenous Australians, one of the elements of the Uluru statement. He has not committed to what many consider the most important first step — a constitutionally enshrined voice. Woolworths — Australia’s biggest employer — and mining giants BHP and Rio Tinto are among corporate supporters of a constitutionally enshrined voice, and two former High Court chief justices have set out to explain why it can be achieved without compromising the authority of parliament. But yesterday Mr Wyatt made his strongest plea yet for Uluru backers to compromise.

“There are some things I have had to set aside from my younger days when I had fire in my belly,” he said. “We hope to have what we want, an optimum outcome. We also have to be pragmatic.”

Mr Wyatt warned that if the referendum failed, statistics showed it was unlikely to be resurrected. He indicated it was better to take the question of constitutional recognition of indigenous Australians to a referendum and win, than to ­include the question of a constitutionally enshrined voice and lose.

NACCHO Aboriginal Health and #SuicidePrevention #MentalHealth #ClosingTheGap : Read full speech @BeyondBlue Chair The Hon. Julia Gillard AC opening #NSPC19

 ” I acknowledge the Traditional Owners of the land on which we meet, the Boon Wurrung people of the Kulin Nation, and, in a spirit of reconciliation, pay my respect to their Elders – past and present………….

Today, First Nations people are twice as likely to die by suicide than non-Indigenous people.

Since 2012, suicide has been the leading cause of death among young Aboriginal and Torres Strait Islander people aged 15 to 34 years of age.

Improving social and emotional wellbeing in Aboriginal and Torres Strait Islander communities and reversing the suicide toll are inextricably linked to issues of post-colonial, intergenerational trauma, the need for secure housing, a fair go inside and outside the justice system, access to education and employment opportunities, and tackling racism.

And as many Aboriginal and Torres Strait Islander people continue to remind us, Indigenous policies must be led by Indigenous people whose solutions look different to ours. “

The Hon Julia Gillard Chair of Beyond Blue and 27th Prime Minister of Australia.

To read full speech 

Read over 140 + Aboriginal health and Suicide Prevention articles published by NACCHO over past 7 years 

Here are selected extracts

1.Today, First Nations people are twice as likely to die by suicide than non-Indigenous people.

In every part of our country, and for the sake of our society and economy, we need to continue to stress that maintaining good mental health and preventing suicide is a social, economic and political imperative.

As we all know, this imperative is especially vital for some groups who face significantly higher risk of suicide.

People of culturally and linguistically diverse backgrounds, LGBTI communities, rural and regional Australians, and our young people and the most elderly.

Once again, I am drawn to the leadership of Professor De Leo who observed that great cultural sensitivity should be applied when designing effective suicide-prevention strategies to tackle social issues of such importance and magnitude.

That they must reflect the unique needs and experiences of communities and that the communities themselves must show us the way.

He points out that many risk factors for suicide are the same for both Indigenous and non-Indigenous people: trauma, housing stress, substance abuse and unemployment among them.

But there are also personal issues that show more frequently in Indigenous suicide such as relationship breakdown and recent bereavement.

The significance of culture has never been as apparent to me as when I visited Aboriginal and Torres Strait Islander communities.

Culture is a word that is often tangled up with nationality, but it entails much more.

Our culture determines so much of our identity; our values, the way we view the world, the way we interact with others, our sense of belonging.

Our culture protects us.

And if a single piece of our culture is taken away, erased or replaced, it leaves us feeling uncertain, disconnected.

Today, First Nations people are twice as likely to die by suicide than non-Indigenous people.

Since 2012, suicide has been the leading cause of death among young Aboriginal and Torres Strait Islander people aged 15 to 34 years of age.

Improving social and emotional wellbeing in Aboriginal and Torres Strait Islander communities and reversing the suicide toll are inextricably linked to issues of post-colonial, intergenerational trauma, the need for secure housing, a fair go inside and outside the justice system, access to education and employment opportunities, and tackling racism.

And as many Aboriginal and Torres Strait Islander people continue to remind us, Indigenous policies must be led by Indigenous people whose solutions look different to ours.

I am heartened that we have, for the first time, Aboriginal people from both sides of politics leading Indigenous policy.

It is hard to believe that, despite the alarming statistics on Indigenous suicide and psychological distress, there are no mental health or suicide prevention targets in Australia’s Closing the Gap strategy.

Rectifying this is something Beyond Blue has been calling for.

2. Research and the #YouCanTalk Campaign 

In February 2018, Beyond Blue released research by the University of Melbourne and Whereto Research Based Consulting, which detailed what advice can be given to the public to increase the likelihood that they will ask about and support someone who may be at risk of suicide.

This was rigorous, scientific but also humanistic research that I hope Diego would approve of.

The research team spoke to experts, studied existing literature and surveyed over 3,000 Australians from all walks of life.

People who said they had not been affected in any way by suicide.

People who had been touched directly by suicide.

And people who had attempted suicide in the previous 12 months.

Those who had thought about or attempted suicide confirmed that having someone listen to them with empathy and show care and support was the most important and helpful thing to them.

The research confirmed a deep community concern about suicide, and that most people want to do more to prevent suicide in their communities, but don’t know how.

They were unsure where to start, how to identify the often very subtle verbal and non-verbal warning signs.

The words to use, or even whether they should say anything at all.

Because:

• 50 per cent of research participants believed only a professional can help prevent suicide;

• 40 per cent worried that talking about suicide made things worse;

• And 30 per cent believed discussing suicide would make it happen.

That research underpinned a collaborative response by the Black Dog Institute, Everymind, headspace, Lifeline, ReachOut, RU OK? and Beyond Blue.

The result was the #YouCanTalk campaign.

#YouCanTalk aims to debunk the myths, build up the confidence of the community, and equip individuals to have safe and helpful conversations about suicide and provide empathetic and practical support to people thinking about suicide.

It is about mobilising the community and empowering family and friends to act as ‘eyes and ears’, hopefully before their loved ones reach crisis point.

The first phase of the social media campaign went live in July last year.

Using the combined power and reach of the social networks and online communities of all seven organisations, the message reached an audience of over 18 million and was the top trending Twitter topic on launch day.

A second phase is in development with an expanded group that now includes SANE Australia, the Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention and Roses in the Ocean.

#YouCanTalk is owned, and can be used, by everyone.

And it’s already having positive ripple effects.

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 #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 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.

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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.