” Merri’s story is not uncommon. Studies show that women with physical, sensory, intellectual, or psychosocial disabilities (mental health conditions) experience higher rates of domestic and sexual violence and abuse than other women.
More than 70 per cent of women with disabilities in Australia have experienced sexual violence, and they are 40 per cent more likely to face domestic violence than other women.
Indigenous women are 35 times more likely to be hospitalised as a result of domestic violence than non-Indigenous women. Indigenous women who have a disability face intersecting forms of discrimination because of their gender, disability, and ethnicity that leave them at even greater risk of experiencing violence — and of being involved in violence and imprisoned
” In-prison programs fail to address the disadvantage that many Aboriginal and Torres Strait Islander prisoners face, such as addiction, intergenerational and historical traumas, grief and loss. Programs have long waiting lists, and exclude those who spend many months on remand or serve short sentences – as Aboriginal and Torres Strait Islander people often do.
Instead, evidence shows that prison worsens mental health and wellbeing, damages relationships and families, and generates stigma which reduces employment and housing opportunities .
To prevent post-release deaths, diversion from prison to alcohol and drug rehabilitation is recommended, which has proven more cost-effective and beneficial than prison , International evidence also recommends preparing families for the post-prison release phase. ‘
Dying to be free: Where is the focus on the deaths occurring post-prison release? Article 1 Below
Article from Page 17 NACCHO Aboriginal Health Newspaper out Wednesday 16 November , 24 Page lift out Koori Mail : or download
As the world celebrates International Women’s Day, this week I think of ‘Merri’, one of the most formidable and resilient women I have ever met.
A 50-year-old Aboriginal woman with a mental health condition, Merri grew up in a remote community in the Kimberley region of Western Australia. When I met her, Merri was in pre-trial detention in an Australian prison.
It was the first time she had been to prison and it was clear she was still reeling from trauma. But she was also defiant.
“Six months ago, I got sick of being bashed so I killed him,” she said. “I spent five years with him [my partner], being bashed. He gave me a freaking [sexually transmitted] disease. Now I have to suffer [in prison].”
I recently traveled through Western Australia, visiting prisons, and I heard story after story of Indigenous women with disabilities whose lives had been cycles of abuse and imprisonment, without effective help.
For many women who need help, support services are simply not available. They may be too far away, hard to find, or not culturally sensitive or accessible to women.
The result is that Australia’s prisons are disproportionately full of Indigenous women with disabilities, who are also more likely to be incarcerated for minor offenses.
For numerous women like Merri in many parts of the country, prisons have become a default accommodation and support option due to a dearth of appropriate community-based services. As with countless women with disabilities, Merri’s disability was not identified until she reached prison. She had not received any support services in the community.
Merri has single-handedly raised her children as well as her grandchildren, but without any support or access to mental health services, life in the community has been a struggle for her.
Strangely — and tragically — prison represented a respite for Merri. With eyes glistening with tears, she told me: “[Prison] is very stressful. But I’m finding it a break from a lot of stress outside.”
Today, on International Women’s Day, the Australian government should commit to making it a priority to meet the needs of women with disabilities who are at risk of violence and abuse.
In 2015, a Senate inquiry into the abuse people with disabilities face in institutional and residential settings revealed the extensive and diverse forms of abuse they face both in institutions and the community. The inquiry recommended that the government set up a Royal Commission to conduct a more comprehensive investigation into the neglect, violence, and abuse faced by people with disabilities across Australia.
While the framework is an important step forward, it would only reach people who are enrolled under the NDIS. Its complaints mechanism would not provide a comprehensive look at the diversity and scale of the violence people with disabilities experience, let alone at the ways in which various intersecting forms of discrimination affect people with disabilities.
The creation of a Royal Commission, on the other hand, could give voice to survivors of violence inside and outside the NDIS. It could direct a commission’s resources at a thorough investigation into the violence people with disabilities face in institutional and residential settings, as well as in the community.
The government urgently needs to hear directly from women like Merri about the challenges they face, and how the government can do better at helping them. Whether or not there is a Royal Commission, the government should consult women with disabilities, including Indigenous women, and their representative organizations to learn how to strengthen support services.
Government services that are gender and culturally appropriate, and accessible to women across the country, can curtail abuse and allow women with disabilities to live safe, independent lives in the community.
Kriti Sharma is a disability rights researcher for Human Rights Watch
How you can support #JustJustice
• Download, read and share the 2nd edition – HERE.
• Buy a hard copy from Gleebooks in Sydney (ask them to order more copies if they run out of stock).
• Send copies of the book to politicians, policy makers and other opinion leaders.
• Encourage journals and other relevant publications to review #JustJustice.
• Encourage your local library to order a copy, whether the free e-version or a hard copy from Gleebooks.
NACCHO invites all health practitioners and staff to the webinar: An all-Indigenous panel will explore youth suicide in Aboriginal and Torres Strait Islanders. The webinar is organised and produced by the Mental Health Professionals Network and will provide participants with the opportunity to identify:
Key principles in the early identification of youth experiencing psychological distress.
Appropriate referral pathways to prevent crises and provide early intervention.
Challenges, tips and strategies to implement a collaborative response to supporting Aboriginal and Torres Strait Islander youth in crisis.
Join hundreds of doctors, nurses and mental health professionals around the nation for an interdisciplinary panel discussion. The panellists with a range of professional experience are:
Dr Louis Peachey (Qld Rural Generalist)
Dr Marshall Watson (SA Psychiatrist)
Dr Jeff Nelson (Qld Psychologist)
Facilitator: Dr Mary Emeleus (Qld GP and Psychotherapist)
” Participants identified a range of encouraging aspects of the Royal Life Saving Society program including cultural appropriateness, community participation, positive effects on health, swimming ability and wellbeing and the promotion of good behaviour among youth.
Evidence suggested the pool encouraged younger students to attend school through the implementation of the ‘No School No Pool’ policy.
The poor health of remote Aboriginal communities has been well documented. Children in these regions are more likely to suffer severe skin, ear, eye and respiratory infections as a result of inadequate hygiene, exposure to a dusty and dirty environment and insufficient health services.”
If you have an Aboriginal Health program that works contact NACCHO News
A unique study conducted by the Royal Life Saving Society WA has found swimming pools in remote Aboriginal communities are positive enablers of community cohesion, improved health and well-being and higher school attendance.
The Remote Aboriginal Swimming Pool (RASP) program focuses on providing the remote communities of Burringurrah, Jigalong, Yandeyarra, Bidyadanga, Warmun and Fitzroy Crossing with recreational and educational swimming programs, to encourage safe aquatic participation.
Funding is provided by WA’s State Government and BHP Billiton, while the pools are run and managed by the Royal Life Saving Society.
In order to gather feedback on the effectiveness of the RASP program, and to encourage the communities to identify areas for improvement, Royal Life Saving Society researchers engaged with participants in three of the six communities over a six month period.
RASP is premised on the basis that providing well-maintained, well-supervised aquatic facilities and swimming programs can potentially improve the overall health status of Aboriginal communities, particularly Aboriginal children.
Research shows that the children appear healthier since the pools have opened, and the incidence of skin sores and ear infections has decreased. At Burringurrah, ear problems have decreased from 90% to 54% and severe skin sores have decreased from 28% to 3%. Similar results were recorded in Jigalong.
Swimming proficiency has reduced mortality rates from drowning; a key issue in these communities which are located close to rivers that flood during the wet season.
Interviews were conducted with adults, while students took photos of things they liked and didn’t like about the pools; captions written to describe these photos were then analysed
Greg Tate, Royal Life Saving Society WA General Manager for Community Health, believes the results from this project provide further evidence of the health benefits of remote pools, explaining “while our findings are based purely on observations, community members consistently report that infections among children are reduced during the pool season.”
Tate says these results further justify enhanced government support of the project, adding “our findings are not limited to one facet of the community.
There is evidence to suggest that the building and running of pools in these regions enhances multiple aspects of individual and community wellbeing.
Western Australian Parliamentarian Dr. Kim Hames “Aboriginal swimming pools are one of the single most successful interventions influencing health, social and education outcomes for these communities in our state. “
These pools are a community hub and the focal point for social interactions and recreation for those in very remote locations.
The community ownership they facilitate and their benefits for wellbeing make them valuable investments.”
The Remote Aboriginal Swimming Pools project (RASP) has delivered significant positive outcomes for the communities involved, including health and social benefits and education and training opportunities.
Each community has embraced the No School, No Pool policy and school principals have reported a marked increase in school attendance and an overall improvement in the children’s behaviour. For example the Jigalong community school has increased school retention rates from approximately 20% to 80%.
“The school attendance has definitely improved. In fact, at Jigalong we were told that they had to increase the number of teachers because so many kids were going to school …”
[Mary Tennant, Research Assistant, Telethon Kids Institute]
Further benefits include an increase in physical activity levels in the host communities, enhanced community cohesion and reported decrease in vandalism.
“It is quite interesting that the policeman said that in the summer months the crime rate among adolescent children went to zero. In the winter months when the pool was closed, it went up … it is definitely helping with crime.”
[Mary Tennant, Research Assistant, Telethon Kids Institute]
The children participate in a number of activities at the pool including swimming lessons, work experience and holiday programs. They have painted brightly coloured murals on the buildings, displaying their creative and artistic talents.
Social programs at the aquatic facility are popular, with birthday parties, pool-fishing events, barbeques and movie nights proving to be regular features on the community calendar. Swimming and lifesaving carnivals are also a social highlight.
Training & Employment Benefits
Mentoring and training is being provided for community members with a view to management responsibility and ownership passing back to the community in the longer term.
In association with the management training, the Royal Life Saving Society also runs a pool lifeguard training course and approximately 45 Aboriginal trainees have progressed to pool lifeguard standard. Part of the training is completed at the community pool, with the remainder undertaken at the nearest regional centre. The partnership covers all accommodation and travel costs incurred by the trainees.
“Swimming pool management training courses are an ideal employment pathway allowing an individual within a remote community to obtain portable work sills and qualifications that can be used in mainstream society.”
[Education and Health Standing Committee, Swimming Pool Program in Remote Communities, Report No. 2 in the 37th Parliament, 2006]
The course is a modified version, designed to be more accessible for the Indigenous learner.
“We have found that a more hands-on training approach works well and as a result of the changes most Indigenous students who commence training achieve a successful outcome and meet the standards required by industry for employment.”
[Greg Tate, Manager Community Relations, Royal Life Saving Society WA]
Royal Life Saving is continuing to work closely with the remote communities to develop new and innovative programs to ensure we are adequately servicing the community’s needs
“To tell you the truth, no services really helped, I reached out, reached out for all my kids. All [services] let me down. Where we are, for instance, there’s no mental health there. We’re in a little town 230 kays away from Kal[goorlie].
We have nothing. Our kids have no hope, nothing, just a sense of no belonging, nothing. Lost everything, culture. Do more, do more things for our youth, put things there, especially in country towns,” she said.
I know it’s hard, but set some programs up, give them some sense of belonging, sense of hope.”
Norma Ashwin from Leonora in WA’s Goldfields region lost her son to suicide about a year ago and travelled to Canberra for the ATSISPEP suicide prevention report launch.
Ms Ashwin was part of a group of Aboriginal families who have lost relatives to suicide that met Prime Minister Malcolm Turnbull before Thursday’s launch.
She urged Governments to focus on young people in regional areas.
Part 3 NACCHO Coverage #ATSISPEP report
Our thanks to Suicide Prevention researcher and campaigner, Gerry Georgatos – Institute of Social Justice and Human Rights for assistance with photos
“There’s nothing worse, as you would know, to get a call in the middle of the night or the early hours of the morning from a relation, and most of us experience this as Aboriginal people, to tell you that someone has died,” he said.
The West Australian Labor senator is based in the Kimberley region and recalled the death at Fitzroy Crossing, a town east of Broome.
“Someone very young has taken their life,” Senator Dodson said.
“I know it happened in Fitzroy [Crossing], a dear 12-year-old boy whose parents found him.
“Whatever caused that, I don’t know, and it’s very hard for us to understand.”
Nearly a third of children who take their own lives in Australia are Indigenous.
Government commits to adopting some recommendations
The Aboriginal and Torres Strait Islander Suicide Prevention Evaluation Project (ATSISPEP) was undertaken over more than a year.
“The ATSISPEP report was commissioned by the Coalition Government to look into what is working and what is not working in the services we fund to help prevent suicide in Indigenous communities,” Minister Scullion said.
“It breaks my heart that almost every one of the communities I have visited has been touched by suicide. We know that Indigenous suicide rates are double that of non-Indigenous people, five times higher for young Indigenous Australians and the rate in the Kimberley is one of the highest nationally.
“This report is a critical first step in helping to understand what works in Indigenous communities to tackle what has become an epidemic in some places.
Minister for Indigenous Affairs, Nigel Scullion
The report was released at a ceremony in Parliament House attended by members of the project team, key stakeholders, the Minister for Indigenous Affairs, Nigel Scullion, Minister for Health and Aged Care, Sussan Ley, and Assistant Minister for Health and Aged Care, Ken Wyatt.
Picture aboveAt launch at Parliament House with politicians from all parties and special guests the family of Norma from Leonora who lost a son not long ago and Lena from Fitzroy Crossings who lost a daughter.
Coalition Press Release
The Coalition Government today released the Aboriginal and Torres Strait Islander Suicide Prevention Evaluation Project (ATSISPEP) report,
Solutions that Work: What the Evidence andOur People Tell Us.
The report sets out a new blueprint to improve suicide-prevention services and programmes for Aboriginal and Torres Strait Islander people based on the principle of prioritising community led, culturally-appropriate services.
Minister Scullion said the Government welcomed the report, but did so with a very heavy-heart.
“It builds on the Coalition Government’s commitment to do things with Aboriginal and Torres Strait Islander communities. To this end, we recently attended a roundtable in the Kimberley to work with the local community on the report’s findings and how to trial some of the approaches it recommends.”
Minister Ley said the Government had worked closely with the report’s authors to ensure recommendations could be quickly implemented on the ground.
“The Coalition Government has committed to trialling the community-led approaches recommended in the report,” Minister Ley said.
“This is reflected in our election commitment to invest $192 million in mental health and suicide prevention, which includes the establishment of 12 suicide-prevention trial sites, including one in the Kimberley.
“The Government is also establishing a Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention to continue to build the evidence base of what works to ensure we are continuously learning and adapting to what is working on the ground.
“The report’s findings will also inform future funding decisions for suicide prevention and mental health programmes and how best to deliver them for Indigenous communities.” Assistant Minister Wyatt thanked the University of Western Australia’s School of Indigenous Studies for its work on the project.
“Your report shows that Aboriginal and Torres Strait Islander Australians want to have their health needs met in ways that are tailored to their circumstances and that recognise their unique needs, including their cultural needs,” Assistant Minister Wyatt said.
ATSISPEP is one of several Indigenous-specific suicide prevention initiatives supported by the Coalition Government. Others include the Critical Response Project which is addressing suiciderelated trauma in Western Australia and the Aboriginal and Torres Strait Islander Mental Health First Aid training which is being rolled out in more than 60 remote locations across Austra lia.
” The many years of community-generated work in suicide prevention is something that Indigenous Australia, as a collective, should take great pride in.
However, we have to acknowledge also that this alone has not been enough to stop Indigenous suicide rates overall getting higher recently, and that some communities remain at particularly high risk.
ATSISPEP’s first challenge was to identify ‘what works:’ the success factors evident from the suicide prevention work already undertaken in our communities. The second challenge was to support the dissemination of ‘what works’ across all communities: to share knowledge, and ensure that all can benefit from this collective wisdom and experience.”
Professor Pat Dudgeon and Professor Tom Calma AO Website
Photo above : Page 15 NACCHO Aboriginal Health Newspaper to be published 16 November
The Aboriginal and Torres Strait Islander Suicide Prevention Evaluation Project (ATSISPEP) is a unique Indigenous-led research project to identify ‘what works’ to prevent suicide in our communities.
At launch at Parliament House with politicians from all parties and special guests the family of Norma from Leonora who lost a son not long ago and Lena from Fitzroy Crossings who lost a daughter.
Our rates of suicide today are twice as high as other Australians and probably growing. Like the tip of an iceberg, high rates of suicide in a community can be a sign of deeper and complex community-wide problems, involving families and people caught in cycles of despair and a sense of hopelessness. Yet not all our communities, even those facing similar challenges, experience the same rates of suicide.
ATSISPEP was developed with the recognition that for many years Indigenous Elders, community leaders and healers in some of our worst-affected communities have been working tirelessly to prevent suicide.
Often volunteering, and with little or no financial support, they have generated community-specific and culturally-based ways of bringing people back from the edge of suicide and also supporting families who are bereaved by loss.
In some cases, they have worked with entire communities to address the underlying community-level issues that can contribute to a suicide, for example, unemployment, violence, and alcohol and drug use. In others, they have connected young people to their Indigenous identity and culture and the sense of worth this can bring.
The many years of community-generated work in suicide prevention is something that Indigenous Australia, as a collective, should take great pride in.
However, we have to acknowledge also that this alone has not been enough to stop Indigenous suicide rates overall getting higher recently, and that some communities remain at particularly high risk.
ATSISPEP’s first challenge was to identify ‘what works:’ the success factors evident from the suicide prevention work already undertaken in our communities. The second challenge was to support the dissemination of ‘what works’ across all communities: to share knowledge, and ensure that all can benefit from this collective wisdom and experience.
The report includes an analysis of Indigenous suicide prevention program evaluations and previous research and consultations on Indigenous suicide prevention. It includes the input of ATSISPEP-held regional community roundtables, and roundtables on specific topics (for example, on Indigenous young people and suicide prevention, justice issues, and Indigenous LGBTQI and suicide prevention).
ATSISPEP also held a national conference in Alice Springs this May. It was an opportunity to test our work and gather even more information from the 370 attendees, most of whom were Indigenous.
A selection of some of the success factors identified in the report includes:
Community-specific programs to address the community-level contributing factors that can lead to suicide.
Community development and ownership of programs.
Access to culturally competent counsellors and mental health support for people at immediate risk of suicide.
The involvement of Elders in programs.
Cultural frameworks for programs, and cultural elements in them: for example, culturally-informed healing practices and connecting young people to country.
Alcohol and drug use-reduction as a part of an overall response.
Gatekeeper training, whereby community members are trained to identify people at risk of suicide and connect them to help.
For young people, peer to peer mentoring, and education and leadership on suicide prevention.
24-hour, seven-day a week availability of support.
With ATSISPEP complete, the implementation of the 2013 National Aboriginal and Torres Strait Islander Suicide Prevention Strategy (with almost $18 million pledged to it) through the Primary Health Networks, and the establishment of at least two Indigenous suicide prevention trial sites (that were recently announced by the Australian Government) can proceed on an evidence-based footing. ATSISPEP has also generated tools for both Indigenous communities and Primary Health Networks to use to develop and strengthen programs.
Our NACCHO CEO Pat Turner as a contributor to the report attended the launch pictured here with Senator Patrick Dodson and co-author Prof. Pat Dudgeon
The hope of ATSISPEP is that its report will help bring about a new era in Indigenous suicide prevention in which many lives will be saved. It is now incumbent on Australian governments to ensure that our communities receive the support they need to help make this happen.
“One of the most striking results recorded in LSIC was that children experiencing seven or more major life events had average vocabulary test scores two points lower (out of 50 points) than Indigenous children experiencing fewer life events.
And a further unfortunate flow-on effect of cumulative stress is that stress on Indigenous parents results in increased smoking, which can substantially reduce the length and quality of the lives of Indigenous people. LSIC data reports for each life event a parent experiences, their likelihood of smoking is 2.5% higher. “
Tom Calma was a keynote speaker at the first Longitudinal Data Conference, hosted by the National Centre for Longitudinal Data lastweek : The Conversation Report 1 directly below
“To suggest that healthcare in Australia is institutionally racist may be confronting for some, but we argue not only that it is institutionally racist, but, more importantly, that such racism represents one of the greatest barriers to improving the health of Aboriginal and Torres Strait Islander people.
We will also indicate what might be done to overcome this institutional racism and improve Aboriginal health.”
Institutional racism in Australian healthcare: a plea for decency MJA 2004 Report 2 below what it was like in 2004
Footprints in Time, or its more formal title, the Longitudinal Study of Indigenous Children (LSIC), is approaching its tenth year of collecting data from around 1,700 Indigenous children, their families and teachers. It follows two cohorts of children: a group who were aged 6-18 months at the beginning of the study, and a group who were aged between 3.5 and 5 years.
LSIC broke new ground worldwide for studying the social, developmental and familial dynamics of a group of Indigenous children and their families. Data are collected from Indigenous families across Australia, from cities to remote locations. We can use these data to consider how our Indigenous children have grown up against a backdrop of efforts to resolve and improve long-term indicators of disadvantage.
The benefit of using longitudinal data for this kind of hindsight analysis is that we are looking at the same children and the same families; we can see what’s changed and how those changes have affected these children.
Major life events
Major life events have a significant influence, not only on the people involved, but flowing on to those around them. Things that happen to one family member may affect other or even all family members, including children. Recent research from the US showed that every suicide has impacts that affect about 135 people.
Events may be either positive or detrimental, including birth, death, marriage, divorce, being a victim of violence or observing violence, or being a victim of property crime. The list of stressors is long and can include things like the inability to practice culture and language, or continually changing government policies and funding.
Research examined the occurrence of stressful events over 12 months, and found that where fewer than three stressful events occurred, around 15% of children aged 4-11 were at high risk of emotional or behavioural difficulties.
This figure increased to 25% for families who experienced between three and six stressful events, while the percentage of children at risk of difficulties rose to 42% in families who experienced seven or more stressful events.
High Indigenous mortality together with strong social connectedness within Indigenous communities may mean that, tragically, Indigenous children may observe the death of relatives and experience grieving more often than the general population.
LSIC reports that around 25% of all LSIC parents attend one to two funerals a year; while nearly another 25% may attend four a year, and almost 9% may attend five to ten a year.
A feature of longitudinal data is it offers the chance to compare different studies. A comparison between the LSIC data with another longitudinal child development study, Growing Up in Australia: The Longitudinal Study of Australian Children (LSAC), shows that children in the Indigenous study were three times more likely than those in the Australian children study to have been affected by a death outside the household in the past 12 months.
Indigenous families were also:
twice as likely to have moved house in the past year
three times as likely to have been affected by a relative outside the household being ill, and
six times as likely to have been suffering financial stress.
One of the most striking results recorded in LSIC was that children experiencing seven or more major life events had average vocabulary test scores two points lower (out of 50 points) than Indigenous children experiencing fewer life events.
And a further unfortunate flow-on effect of cumulative stress is that stress on Indigenous parents results in increased smoking, which can substantially reduce the length and quality of the lives of Indigenous people. LSIC data reports for each life event a parent experiences, their likelihood of smoking is 2.5% higher.
Beyond Blue has previously highlighted how the non-Indigenous population discriminates against Indigenous Australians. Their report shows one in five non-Indigenous Australians admits that they would discriminate against an Indigenous person in some circumstances.
This is upsetting on any level and begs the question of what these attitudes mean for the experiences of Indigenous people themselves, and of their children. LSIC data can help to provide answers.
Looking at the data, parents who experience discrimination are less likely to report good or better health. In 2011, Indigenous parents experiencing discrimination generally reported fair or poor health at a rate 9% greater than parents who did not report discrimination.
It’s not just the deleterious effects on the parents that are of concern, but the collateral and intergenerational flow-on impact to Indigenous children’s outcomes that demonstrate the effect of discrimination on the whole family.
At six to seven years of age, 57% of Indigenous children with a mother who reported discrimination had more social, emotional and behavioural difficulties. In comparison, 43% of children of non-discriminated mothers reported increased scores of social and emotional difficulties.
The LSIC study, and a Beyond Blue report, show discrimination is significant whether you ask the non-Indigenous or the Indigenous population. Discrimination causes harm to the mental and physical health of Indigenous people, and like cumulative stress, impacts strongly on the children of affected families from one generation to the next.
The effect of cumulative stress through multiple life events can be seen to cause harm to parents, through effects such as increasing smoking.
But some efforts to address the negative health outcomes from smoking are showing strong signs of success. The LSIC data shows us the percentage of Indigenous people who smoked inside the house was around 25% in 2008, and by 2014 had dropped to around 17% (across Australia data from 2013 was 3.7%).
In the most recent (unpublished) LSIC data, fewer than 15% of Indigenous people smoke inside their house. While this is still too high, this shows messages are getting through, and critical benefits to Indigenous people are being achieved through engagement with Indigenous communities and education campaigns.
If concerted efforts can improve the lives of Indigenous people through addressing smoking, then the same should be possible for discrimination. Using authoritative data to speak out against discrimination is an important first step.
While Beyond Blue’s efforts in raising awareness of discrimination among the non-Indigenous population is commendable, more needs to be done. With powerful data sets like the LSIC resource, sharing and linking data across sectors can demonstrate not only the occurrence of events, but the impact of those events on individuals and families in the community.
Institutional racism in Australian healthcare: a plea for decency MJA 2004
There is no dispute that Aboriginal health in Australia is both poor and very much worse than that of non-Aboriginal people, and their life expectancy at birth is about 21 years less for men and 19 years less for women. Among Aboriginal and Torres Strait Islander males, 6.8% die in infancy, compared with 1% for the rest of the population. For females the figures are 6.7% and 0.8%. A large array of diseases are much more prevalent among Aborigines.1
Institutional racism in Australian healthcare — some examples
Funding inequity: Overall funding of Aboriginal healthcare is not commensurate with extra need.8
Different performance criteria for black and white: For example, in Perth, Derbarl Yerrigan Aboriginal Medical Service funding was cut when an “overspend” arose because of success in attracting clients; at the same time the teaching hospitals’ overspend was 120 times as great as that at Derbarl Yerrigan. The teaching hospitals were given an extra $100 million to cover their overspend.9
“Body part” funding: For instance, separate streams of money for conditions such as diabetes and heart disease for a health service which is intended to be holistic — 26 funding streams (and hence 26 separate accounts and 26 demands for accountability) for the Danila Dilba Aboriginal Medical Service in Darwin.
Differences in treatment regimens: Aboriginal people in Western Australia born in the 1940s received low-cost nursing care; in contrast, a white cohort of the same age received higher-cost technological care.10
Inequitable Medicare Primary Health Care (Medicare Benefits Schedule plus Pharmaceutical Benefits Scheme): In Katjungka (a remote Aboriginal community), $80 per head per year; in Double Bay (an affluent Sydney suburb), $900 per head per year.11
Cultural barriers to Aboriginal use of healthcare services: Inadequate funding to reduce these barriers (such as language barrier and lack of recognition of different constructs of health) for Aboriginal people.
This is not news. The question is how to improve this situation. The argument presented in this article rests on two core and related ideas:
that our health services are “institutionally racist” and
that such racism stems from Australia being, or at least having become, an uncaring society.
The way forward that we propose is recognising and addressing institutional racism. This would provide a framework for improving Aboriginal health. We believe, however, that acceptance of the need to address such racism can only come about through building a more compassionate and decent society.
To suggest that healthcare in Australia is institutionally racist may be confronting for some, but we argue not only that it is institutionally racist, but, more importantly, that such racism represents one of the greatest barriers to improving the health of Aboriginal and Torres Strait Islander people. We will also indicate what might be done to overcome this institutional racism and improve Aboriginal health.
Defining institutional racism
Institutional racism “refers to the ways in which racist beliefs or values have been built into the operations of social institutions in such a way as to discriminate against, control and oppress various minority groups”.2 It has been claimed that “Institutional racism is embedded in Australian institutions”.3 Often, institutional racism is covert or even unrecognised by the agents involved in it.
In recent years, interest in both the concept and practice of institutional racism has increased. In the United Kingdom, it was sparked by the Stephen Lawrence Inquiry,4 published in 1999. This examined the events which followed the completely unprovoked murder in 1993 of Stephen Lawrence, a young black man, which was “unequivocally motivated by racism”. It found that the investigation was marred by a combination of professional incompetence, institutional racism and a failure of leadership by senior officers. It claimed that “officers approached the murder of a black man less energetically than if the victim had been white and the murderers black”.
In the context of racial and ethnic disparities, Camara Jones,5 an Assistant Professor at Harvard University School of Public Health, has called for “a growing national conversation on racism”, one key aspect of which is “institutionalized racism”. This she sees as being “often evident as inaction in the face of need”. An increasing focus on institutional racism in Aotearoa (New Zealand) was prompted by a visit there by Camara Jones in 1999.6
In Australia, institutional racism has been an almost constant feature of our history, from the British designation of the continent as terra nullius, through the 1897 Convention on Federation (where the question of whether Aboriginal people should be counted as “people” in the national census was covered in just 195 words7), to the stolen generations and the failure of the federal government to issue an apology. Examples of institutional racism are shown in the Box.
Clash of cultures
We believe that any healthcare system is a social institution built on the cultural stance of the population it serves. It follows that cultural values should provide the value base for health services.
Between Aboriginal and non-Aboriginal Australians, there is not only a difference in culture, but a clash of cultures. We think some white people are at least dimly aware of this. However, the extent of their understanding of the difference between a culture based on individualism, where the individual ranks above the community in importance, and a communitarian culture, in which each individual is less important than the whole, is limited.
One of us, S H,7 a Gungulu man, has written: “Aboriginal Peoples have built a communitarian solidarity that includes an awareness and affirmation of the [cultural] difference [of Aboriginal people]. Such communitarian solidarity is a form of civic friendship between peoples that is distinguishable from other forms of friendship because it unites people who are members of the same particularistic cultural community — persons who share a common worldview and use the same primary moral vocabulary.” Yet that value base is inadequately recognised in the planning of healthcare services in this country.
Where societies or social entities have a greater awareness of and concern for mutuality, reciprocity and sharing, trust in institutions will be fostered and racism will diminish. Many Australians have embraced the individualism of neoliberalism. Uniting as a community around little other than the successes of its sporting teams, today’s white Australia lacks these “communitarian” traits.
While communitarianism need not always be a force for good (the Nazi vision of the “master race” is a case in point), it can be and has been a beneficial force in Aboriginal culture. Here it is best seen in terms of what the distinguished public servant Coombs12 describes as “the Aboriginal ethic of accountability to others”. This, he writes, “is required by their commitment that autonomy, at a personal and group level, will be exercised so as to ensure that what is done contributes to the care and nurture of others with whom they are related; so that personal behaviour remains socially grounded”.
In current health policy there is little attempt to recognise the differences in culture between black and white. The holism of Aboriginal health involves not just a “wholeness”, but a series of mutual obligations. Aboriginal Medical Services attempt to provide culturally “secure” services (ie, services based on Aboriginal preferences where differences in culture do not create additional barriers to use). Their poor funding levels, however, severely restrict them in this. Mainstream services make almost no effort to understand or provide culturally secure services. To deliver such services might increase primary healthcare costs for Aboriginal people by more than 50%.9,13 This is because, for example, questioning with respect to history has to be indirect, and preceded by time spent in building trust and confidence between the doctor and patient. This process, to be done well, can be time consuming. Also, advocacy on behalf of the client with other agencies, such as those providing housing, is often expected by Aboriginal clients as part of a GP’s role.
The prospects for creating a cohesive Australian community, advancing social capital, furthering equity and reducing racism are not bright. For example, the Human Rights and Equal Opportunities Commission conducted a series of consultations across Australia which showed racism to be widespread and institutionally based, especially with respect to Aboriginal people.14 We believe that the current Australian federal government puts at risk our social capital in its pursuit of divisive policies. This applies not only to Aboriginal people, but also to other minority groups, defined racially or otherwise. For example, extending upfront fees for universities gives the affluent greater access compared with the poor; and ignoring the principle of universality (which did not rate a mention in the Prime Minister’s media release as one of his three pillars of Medicare15) on Medicareplus creates yet more of a two-tier healthcare system. The government’s policies on immigration have been severely criticised by many, including Father Frank Brennan, the Jesuit priest and lawyer, who concludes his book on the subject with an appeal to re-create social capital in Australia: “Many of us would like to return collectively to being a warm-hearted, decent international citizen.”16
We believe that Aboriginal people have lost their trust in the institutions of government, including healthcare services. Lack of respect by white Australians for Aboriginal values, the discounting of these values by those who have sought, patronisingly and paternalistically, to “do good” to Aboriginal people (according to a “good” defined by white fellas), leads to further erosion of trust. The lack of trust by Aboriginal people in white people and white institutions is obvious. More tellingly, we believe there is a lack of trust by Aboriginal people in themselves as a people — a lack of confidence in their culture. It is this last, a legacy of colonisation and its aftermath, that has wreaked the greatest havoc of all.
We also believe that there is a lack of political will and of leadership to deal with inequalities generally in Australian healthcare. The most glaring example in recent times lies in the government’s schemes to promote private health insurance. The cost of increasing spending on primary healthcare for Aboriginal people to a level which would take into account such considerations as greater health problems, cultural-access barriers and equity (ie, increasing it to five times the per-capita level for non-Aboriginal people17) might be measured by the benefit forgone if the government were to halve the rebate (from 30% to 15%) for private health insurance.18
Progressing from institutional racism
Currently, cultural differences and ignorance create racism, and indifference nurtures it. Cultural differences must be celebrated, rather than denigrated. Former Prime Minister Paul Keating’s Redfern Speech on reconciliation pointed the way forward: “I think what we need to do is open our hearts a bit. All of us. Perhaps when we recognise what we have in common we will see the things which must be done . . . If we open one door others will follow.”19
That was 12 years ago. Today, the converse is true. As we have closed one door, others have followed. So many doors on social justice are closing in this society. We closed the door on a Norwegian freighter carrying abandoned refugees. We close the door on children in detention centres, on poor youngsters trying to get a university place. We close the door on opportunities for Aboriginal people and on the richness of an ancient culture which is potentially there for all Australians to learn from and take pride in.
What scope is there for building compassion? Not much, it might seem, in this neoliberal society and this globalising world. Yet, as the social commentator Richard Titmuss remarked 30 years ago about the UK National Health Service, altruism and compassionate acts are infectious not only to other people, but to other events and circumstances.20 Compassion is good for us.
What to do?
Firstly, white Australia must learn to understand Aboriginal culture, particularly with respect to its fundamental philosophy of “communitarian solidarity”. Only then can social institutions, such as healthcare services for Aboriginal people, be built on a genuine understanding followed by accommodation of the hopes and aspirations of Aboriginal people. More directly, only then can Aboriginal people have the chance to have health services delivered to them that are, byright, as accessible (in the broadest sense) as they are to white Australians.
Secondly, those white people who were described (above) as patronising and paternalistic would cease to be so when, in their “doing good”, good was defined by Aboriginal preferences.
Thirdly, Aboriginal communitarian preferences must drive Aboriginal health services, their funding and their performance indicators. Unless the governance of Aboriginal organisations is based on Aboriginal cultural values, these services will not function effectively or efficiently.
Fourthly, public compassion must be built into the Australian social fabric. The “fair go”, if it ever existed, has gone, but Australia needs a leadership that will articulate that fair go. The philosopher Martha Nussbaum argues against “impoverished models of humanity” with “numbers and dots taking the place of women and men”.21 She continues: “. . . when one’s deliberation fails to endow human beings with their full and complex humanity, it becomes very much easier to contemplate doing terrible things towards them . . . if you really vividly experience a concrete human life, imagine what it is like to live that life, and at the same time permit yourself the full range of emotional responses to that concrete life, you will . . . be unable to do certain things to that person. Vividness leads to tenderness, imagination to compassion.”21
Finally, our call is for a more compassionate society. Attitudes to asylum seekers, to Aboriginal people, to people who are in any way disadvantaged, are linked. Social attitudes need to be more compassionate to all who are disadvantaged, and not just to Aboriginal people.
Aboriginal people merit so much more from white Australia. First and foremost, they deserve white Australia’s trust — trust that Aboriginal people know better than white Australians what is good for Aboriginal people. They deserve (and not just in their music and dancing) recognition of their culture. Two things are necessary — first, Australian society needs to listen and hear the calls of the disadvantaged (and there are so many in Australia today, especially Aboriginal people); then, those who have compassionate voices need to use them. Many people working in healthcare and in universities have social consciences and believe in social justice. They need not only to give voice to the voiceless, but to give themselves voice as decent, white Australians.
In this Australia — this divided, divisive, racist, socially unjust society that we have built — we now need institutions and policies that will unbuild it. We need to acknowledge that the “fair go” is struggling to survive, if not already dead. Fairness and compassion need to be once again the guiding principles of our leaders and our democracy. Only then can we build a society where decency can become the fundamental in addressing Aboriginal health.
There will be no sudden breakthrough; there is no magic pill. Decency, however, is a good place to start.
This year’s theme: Strengthening Our Future through Self Determination
As you are aware, the 2016 NACCHO Members’ Meeting and Annual General Meeting will be in Melbourne this year 6-8December
” The study has raised particular concerns given rural Australians already have poorer health outcomes, with shorter life expectancies and significantly higher mortality rates, mental illness, chronic disease, family and domestic violence and more.
A complex, variable picture has emerged of methamphetamine use across the country, What is clear is that there has been a disproportionately larger increase in the misuse of methamphetamine, including crystal methamphetamine, in rural locations compared to other Australian locations.
At the same time, it’s very concerning there has been no increase in the number of people accessing help in rural areas. We need to urgently establish whether existing support services simply don’t have the capacity to deal with demand for drug treatment, or whether there are there significant reasons.
Contributing factors to rural drug problems include lower educational attainment, low socioeconomic status, higher unemployment, isolation and the deliberate targeting of rural communities by illegal distribution networks.
Professor Ann Roche, Director of the National Centre for Education and Training on Addiction at Flinders University.
Australians is on the rise have now been confirmed with the first documented evidence released today at the APSAD Scientific Alcohol and Drugs Conference.
The study – the most detailed examination to date – found lifetime and recent methamphetamine and recent crystal methamphetamine (ice) use is significantly higher among rural than other Australians, at rates double or more.
In addition, recent crystal methamphetamine use in rural Australia has more than doubled since 2007 – increasing by 150 per cent from 0.8 per cent to 2.0 per cent of people reporting lifetime and recent use.
“For some time now there have been anecdotal reports suggesting a high and increasing level of methamphetamine use in rural Australia, but this was unsupported by evidence.
Now we have this proof, the next challenge is to understand why and determine how we can best tackle this problem,” said Professor Ann Roche, Director of the National Centre for Education and Training on Addiction at Flinders University.
Significantly, more rural men and employed rural Australians use methamphetamine than their city, regional or Australian counterparts, with use most prevalent in men aged 18-25 years.
Recent methamphetamine use in rural teens aged 14-17 years also appears to be much higher than in urban areas.
The study has raised particular concerns given rural Australians already have poorer health outcomes, with shorter life expectancies and significantly higher mortality rates, mental illness, chronic disease, family and domestic violence and more.
“Our findings warrant targeted attention, especially given the pre-existing health and social vulnerabilities of rural Australians. We need tailored strategies and interventions to address this growing health problem,” said Professor Roche.
The research is being presented for the first time at the annual summit of the Australasian Professional Society on Alcohol and other Drugs (APSAD), the APSAD Scientific Alcohol and Drugs Conference, held in Sydney from 30 October to 2 November.
Ice campaign/youth: Did the federal government’s campaign, ‘What are you doing on ice’ really work?
Barriers to treatment: What are the most significant obstacles preventing people seeking treatment for their methamphetamine use? Available upon request
Women/Methamphetamines: A look at the specific treatment barriers faced by women and how to overcome them.
The global burden of methamphetamine disorders: An overview of the proportion of disease burden attributable to substance use disorders and differences in the distribution and burden of amphetamine use disorders between countries, age, sex, and year.
New treatment for methamphetamine addiction: Treatment options for methamphetamine dependence are currently limited, but a drug licensed in Australia for the treatment of attention deficit hyperactivity disorder could be an important innovation.
Comorbid mental and substance use disorders: The top 10 causes of burden of disease in young Australians (15-24 years) are dominated by mental health and substance use disorders.
OTHER MONDAY HIGHLIGHTS
Opening by The Hon. (Pru) Prudence Jane Goward, MP NSW Minister for Medical Research, Minister for Prevention of Domestic Violence and Sexual Assault, and Assistant Minister for Health
Cannabis as Medicine in Australia: Where are we now, where are we heading to, where might we end up? Professor Nicholas Lintzeris
Friend or Enemy? Emeritus Professor Geoffrey Gallop, Director, Graduate School of Government, University of Sydney and Former Premier of Western Australia
About APSAD Sydney 2016
The APSAD Scientific Alcohol and Drugs Conference is the southern hemisphere’s largest summit on alcohol and other drugs attracting leading researchers, clinicians, policy makers and community representatives from across the region. The Conference is run by the Australasian Professional Society on Alcohol and other Drugs (APSAD), Asia Pacific’s leading multidisciplinary organisation for professionals involved in the alcohol and other drug field.
This year’s theme: Strengthening Our Future through Self Determination
As you are aware, the 2016 NACCHO Members’ Meeting and Annual General Meeting will be in Melbourne this year 6-8 December
“The release of this much awaited Draft Fifth National Mental Health Plan is another important opportunity to support reform, and it’s now up to the mental health sector including consumers and carers, to help develop a plan that will benefit all.”
A successful plan should help overcome the lack of coordination and the fragmentation between layers of government that have held back our efforts to date.”
NACCHO and Mental Health Australia CEO Frank Quinlan have welcomed the release of the Draft Fifth National Mental Health Plan and is encouraging all ACCHO stakeholders to engage with the plan during the upcoming consultation period.
Download the Draft Fifth National Mental Health Plan at the link below:
The Consultation Draft of the plan identifies seven priority areas;
1. Integrated regional planning and service delivery
2. Coordinated treatment and supports for people with severe and complex mental illness
3. Safety and quality in mental health care
4. Suicide prevention
5. Aboriginal and Torres Strait Islander mental health and suicide prevention
6. Physical health of people with mental illness
7. Stigma and discrimination reduction
Summary of actions
Aboriginal and Torres Strait Islander mental health and suicide prevention
1. Governments will work collaboratively to develop a joined approach to social and emotional wellbeing support, mental health, suicide prevention, and alcohol and other drug services, recognising the importance of what an integrated service offers for Aboriginal and Torres Strait Islander people.
2. Governments will work with Primary Health Networks and Local Hospital Networks to implement integrated planning and service delivery for Aboriginal and Torres Strait Islander people at the regional level.
3. Governments will renew efforts to develop a nationally agreed approach to suicide prevention for Aboriginal and Torres Strait Islander people.
4. Governments will work with service providers, including Aboriginal Community Controlled Health Organisations, to improve Aboriginal and Torres Strait Islander access to and experience with mental health and wellbeing services.
5. Governments will work together to strengthen the evidence base needed to inform development of improved mental health services and outcomes for Aboriginal and Torres Strait Islander people.
6.Governments will develop suitable public health and communication strategies to better inform the community about suicide and suicide prevention.
Additional info Mental health services—in brief 2016
Mental health services—In brief 2016 provides an overview of data about the national response of the health and welfare system to the mental health care needs of Australians.
It is designed to accompany the more comprehensive data on Australia’s mental health services available online at <http://mhsa.aihw.gov.au>.
Mental Health Australia is pleased to be partnering with the Department of Health to run consultation workshops on the plan during November which is an important opportunity for members to provide feedback and guidance on the plan.
National consultation activities to assist with the development of the Fifth Plan will run from November to early December 2016.
A series of face-to-face workshops will be conducted in all states and territories throughout this period. These workshops will be complemented by local consultation events convened by some states and territories.
An opportunity to submit general feedback on the Fifth Plan via this webpage will also be available throughout the duration of the consultation period.
How you can share health messages stories about Aboriginal Community Controlled Health issues ?
Closing this week
Editorial OpportunitiesWe are now looking to all our members, programs and sector stakeholders for advertising, compelling articles, eye-catching images and commentary for inclusion in our next edition.Maximum 600 words (word file only) with image
Discussing experiences of the child protection system or time spent in youth detention can be difficult. This is especially so for people who experienced abuse and are telling their story for the first time.”
The Territory-wide Helpline is 1800 500 853
This is a free helpline which will be answered locally, available 9am to 5pm Monday to Friday
Experienced and qualified staff can refer people to a range of services including counsellors, therapeutic support, and health professionals
Calls made from a mobile phone may incur additional costs
Update : CANCELLATION OF HERMANNSBURG COMMUNITY MEETING
The Commission confirms that tomorrow’s proposed community in Hermannsburg (20 October 2016) has been cancelled due to other business in the community.
Details of the individual services funded and how to contact them directly are
Danila Dilba Health Service – services include:
trauma-informed and culturally safe face to face and telephone counselling and support services delivered by psychologists and qualified counsellors
practitioners experienced in pre, during and post Royal Commission counselling and support;
therapeutic group services
culturally safe support and advocacy services to young people impacted by youth detention delivered by experienced Youth Support and Engagement practitioners
a broad suite of primary health care services tailored for men, women and children delivered by Aboriginal Health Practitioners, GP’s and maternal, paediatric and allied health, etc, specialists;
Alcohol and Other Drugs services
chronic disease care coordination; and health education and promotion