NACCHO Aboriginal Health News : Indigenous Health Minister @KenWyattMP visits , promotes and engages with our ACCHO’s during #NAIDOC2017 week

 

 “ This week, celebrating and acknowledging the power of our languages, the importance of language, but even where we’ve think we’ve lost languages I’m often surprised with the older people within our communities who can still speak the language.

And in my own country there are people teaching Noongar language and reviving the veracity of the language. Now language often is an identifier of who we are and what country we’re associated with.

NAIDOC Week is about celebrating, enjoying ourselves within our community, having fun, but also reflecting. 

Alice Springs : Ken Wyatt being interviewed by Kyle Dowling from CAAMA radio about Congress ACCHO Alice Springs and  the 11 organisations partnering in the new Central Australia Academic Health Science Centre SEE PART 3 Below

Aboriginal Health #NAIDOC2017 : New Aboriginal-led collaboration has world-class focus on boosting remote Aboriginal health

Victoria / VACCHO / VAHS

APY LANDS

Kowanyama /Cairns QLD  :

“I am closely involved with the Darwin and Kimberley suicide prevention trials, part of the Federal Government’s $192 million commitment to addressing regional mental health issues,

“What we learn from those sites, which have acute suicide rates, will be made available as appropriate for North Queensland, in close collaboration with local communities.”

Mr Wyatt, in was Cairns  speaking at the myPHN Conference (see Part 3 for PHN Press Release ) said close engagement with the community and respecting locally endorsed solutions to guard against suicide was the way forward

Part 1  : Minister rolls out mental health action plan for Kowanyama

FINDINGS from suicide prevention trials being carried out in Western Australia will be implemented in the Far North to help lower the rising suicide rate in indigenous communities.

From The Cairns Post

Indigenous Health Minister Ken Wyatt says he is “very concerned” about reports of the suicide rates in the region’s remote indigenous population growing to become one of the highest in the world.

The Weekend Post has reported concerns by community leaders at Kowanyama that the mental health crisis was sparked by the tragedy in the community in October, when a vehicle rammed into a house full of mourners, resulting in one death and 25 people being serious injured.

There had been more than 20 suicides or attempts at Kowanyama, which has a population of about 1200, since the ­October tragedy.

Mr Wyatt, was Cairns  speaking at the myPHN Conference, said close engagement with the community and respecting locally endorsed solutions to guard against suicide was the way forward.

“I am closely involved with the Darwin and Kimberley suicide prevention trials, part of the Federal Government’s $192 million commitment to addressing regional mental health issues,” he said.

“What we learn from those sites, which have acute suicide rates, will be made available as appropriate for North Queensland, in close collaboration with local communities.”

An experienced social work has been flown into Kowanyama to join a mental health clinical nurse consultant who travels to the remote Cape York community for four-day visits.

Mr Wyatt said further emergency action was underway with the federally-funded Northern Queensland Primary Health Network working with the Royal Flying Doctor Service to expand mental health services at Kowanyama.

“This additional commitment has already ensured an extra clinician for the community, to provide support and targeted suicide prevention activities with this full-time position starting on Tuesday, July 11,” he said.

If you or someone you know needs assistance please call Lifeline Australia on 13 11 14.

Cairns Apunipima

 Part 2  : Working with communities to deliver better health is our primary aim
The nation’s Primary Health Networks (PHNs) are being encouraged to work closely with communities to tackle health challenges and improve the wellbeing of all Australians.
Aged Care Minister and Indigenous Health Minister Ken Wyatt said he hoped opening the 2nd annual myPHN Conference in Cairns today would help guide a new era in effective and efficient care.
 
This year’s conference theme of ‘Transforming Healthcare Together’ challenges current beliefs on the best ways to improve patient outcomes,” said Minister Wyatt.
“PHNs are leading the charge in this space. After undertaking detailed analysis of their regions’ specific health needs, they are now commissioning services to fill these gaps.
 
“These range from building the capacity of General Practitioners (GPs) and tackling mental health, chronic conditions and obesity, to engaging with consumers in disease prevention.
The Minister said the first stage of the national trial of Health Care Homes was another example of the fresh approach to the care of people with complex conditions.
“Participating GPs and Aboriginal Community Controlled Health Services will work closely with patients and specialists, pharmacists and allied health care to empower patients to take an active role in health improvements,” he said.
 
Minister Wyatt said primary health providers had a vital role in helping improve Indigenous health and that of older Australians.
“Despite the progress we’ve made to date, Indigenous people still have a shorter life expectancy and are more likely to develop chronic conditions such as diabetes  kidney and cardiovascular diseases than non-Indigenous Australians,” Minister Wyatt said.
 
We have to do better, and primary health professionals are well placed to develop innovative new programs that can make a real difference.”
A good example is the Northern Queensland PHN workforce investment, including funding more than 100 Aboriginal and Torres Strait Islander people to become qualified indigenous health workers. 
 
The conference also focuses on how social and cultural influences can effect  health outcomes, promising new hope for closing the life expectancy gap for Indigenous Peoples.
 
Innovation and new thinking will help deliver a stronger health and aged care system,” said Minister Wyatt.
 
“Learning from the experiences of other communities and nations will also keep older Australians healthier for longer, and give them more flexibility on when and how they access care as they age.
“Better health is a partnership between governments, the health sector, and the consumer. Greater collaboration and new models of care promise positive outcomes.”

Part 3 Transcript of Interview on CAAMA Radio with Kyle Dowling on 5 July 2017

Ken Wyatt:What I like about the centre is that it is an alliance of organisations that have been heavily involved in research around many of the health issues impacting on our people. But what’s more important significant is that Congress is the lead agency or the lead player in all of this and having that Aboriginal leadership working so closely with the expertise and knowledge and skills and capability of research is fantastic.

Kyle Dowling: Ken Wyatt, the Federal Minister for Indigenous Health and Aged Care, recently congratulated the 11 organisations partnering in the new Central Australia Academic Health Science Centre.

Ken Wyatt: Any of us have the capability and capacity to take leading voices. It’s whether we have the confidence and courage to do it at times. And I think Congress has really set a framework for showing that they are leaders. That they are prepared to go and fight for the things they believe in, but equally they work very closely with people who’ve got a like-minded thinking who want to make a difference.

I think the other part that is important in this is their voices are also about translating research into real change on the ground in the community with families. And that’s an important translation of research into practice. And they’ve been around a long time so their knowledge of the health of people within the area, but not only the area, but nationally has been well-based on being involved with the community, listening to community, but treating community for the range of illnesses that they’ve seen over the years. So I want to complement them on their vision, but also being a leader to demonstrate that our voices do count. That they are important.

Kyle Dowling: : So Ken, can you just talk to us about the actual role of the Central Australia Academic Health Centre and the importance of the collaboration between Aboriginal community-controlled health services and leading medical researchers.

Ken Wyatt:What’s important about the centre is that it’s now recognised as a centre of excellence for research. That means it gives them access to Commonwealth funding out of the Futures Research Fund, but also NHMRC funding as well. They’re also recognised as being of a national standing in the quality of what they are capable of doing, but the team they have within that alliance. So you’re really saying that you- you’ve brought together this incredible group of skills, resources and thinking that will be used to tackle some of those complex issues on the ground.

Yesterday, Alan Cass talked about renal disease and the work that affected him into making the decision to look at the whole issue of progression to dialysis and what we still need to do. And he talked about some of the alarming figures here that- when you think about the number of Aboriginal people within the Territory- those figures are extremely high. So we’ve got to do something about it and that’s what he’s talking about when he is involved in this collaborative centre.

Kyle Dowling: Why Central Australia? Why was this area the right place for the centre?

Ken Wyatt: Look, I think it’s just natural to expect it to be here because you’ve got an incredible organisation like Congress. You have Aboriginal leadership here whose thinking and whose passion for making a difference for people here and across Australia. But you’ve also got these incredible alliances with Flinders Uni, Baker IDI, and there’s other collaborative members of that group who are also deliverers of services. And if we think of the history of the Territory, there have been some outstanding individuals that have been involved. So you only have to look at the Menzies Research Centre, the work that they have done. It’s a natural fix and it’s a good mix of bringing some incredible people together to work on these issues.

Kyle Dowling: Now the partners in the CAAHSC have identified research priorities. Can you touch on a little bit of those?

Ken Wyatt: The five areas that they have identified are good, but the one that excites me is the whole issue of workforce and development of capacity. But developing of capacity for Aboriginal research- there was a young woman I met yesterday who has become a researcher and her passion for that work now is growing. It’s- and she becomes an example for others that research is an important area and that I can do it, so can you. And that workforce capacity also means that they will be looking at, not only what’s needed today, but the type of skills we’ll need for tomorrow and the future. And aged care is in that mix.

I had a good meeting with Congress this morning about older people who live in this area that I need to have a look at the issues around their needs, but equally be made aware of the number of older people now living in community and what we have to do for them.

Kyle Dowling: Now, Central Research has been dubbed a hub of hope for Indigenous health. How would you describe Central Research as in fact being a hub of help for Indigenous hope.

Ken Wyatt: That whole hub of hope I see in an optimistic sense. I see it as a group of people believing what they do, but then wanting to turn that into having access to further work they have to do to find and identify reasons. And I use the term causes of the cause.

So what are the causes that cause an illness or what are the causes that cause renal failure. And then to look at how do we go upstream and prevent that from happening. So if it’s skin diseases, if it’s other factors that result in kidney failure, then how do we address and tackle those. But equally what they’ll be looking at is what treatment can we provide and what treatment can we also think about providing at the local community level because the problem with dialysis is that you really need to live with the chairs are that provide you with that life-saving support. But ultimately if we can find a cure for kidney failure then that makes it far more expecting of pushing out life, but also preventing kidney failure and giving people in any individual hope for a future, hope for a longer life because the point I want to make is that every person we lose out of our community is a history book.

We never write our histories, we never write our stories on paper. We only learn in transmission in conversation, art, the stories we tell dance. Now when we take one of those people out, that’s the end of that story. We can never go back and re-read it, and that’s why that the work that this centre does is critical in keeping people alive longer because young people like you will need the knowledge of the stories, but also the history and every aspect that gives us what is important spiritually, culturally, but as an identity as an individual within our community.

Kyle Dowling: Before I do let you go, I did just want to get a quick message from you. It is NAIDOC Week. Your message to everyone across the country on NAIDOC weekend, what NAIDOC means to you as an Aboriginal person?

Ken Wyatt: This week, celebrating and acknowledging the power of our languages, the importance of language, but even where we’ve think we’ve lost languages I’m often surprised with the older people within our communities who can still speak the language. And in my own country there are people teaching Noongar language and reviving the veracity of the language. Now language often is an identifier of who we are and what country we’re associated with.

NAIDOC Week is about celebrating, enjoying ourselves within our community, having fun, but also reflecting.

Kyle Dowling: Yes, well on that note, Ken thank you for taking out your time to have a chat with us here on CAAMA Radio and thank you for tuning in.

That’s going to be it for Strong Voices today. Thank you for tuning in. I hope you enjoyed the program. Make sure you check out our CAAMA webpage. It’s caama.com.au. Make sure you check out our social media as well -our Facebook and Twitter. And we’ll be back the same time tomorrow.

NACCHO Aboriginal Mental Health : Download report “Mental health in remote and rural communities “

 ” The poorer mental health of remote and rural Indigenous Australians is also impacted by the social determinants of Indigenous health, which are well recognised nationally and internationally.

These relate to the loss of language and connection to the land, environmental deprivation, spiritual, emotional and mental disconnectedness, a lack of cultural respect, lack of opportunities for self-determination, poor educational attainment, reduced opportunities for employment, poor housing, and negative interactions with government systems

The relationship of remoteness to health is particularly important for Indigenous Australians, who are overrepresented in remote and rural Australia (Australian Institute of Health and Welfare, 2014a).

The National Mental Health Commission (2014a, p. 19) identified that “the mental health needs of Aboriginal and Torres Strait Islander people are significantly higher than those of other Australians.”

Photo above

“ The women of Inkawenyerre, a small settlement in the Utopia community four hours by road north of Alice Springs, regularly take part in a different kind of mental health therapy, known as ‘narrative therapy.’

Narrative therapy taps into the centuries-old tradition among Aboriginal people of story-telling and expression through art. At the family Urapuntja Clinic, both women and children take part in narrative therapy.

They recreate what is commonly seen on any given evening in an Aboriginal community—people sitting around the fire, relating to one another and telling stories.

The activity is enjoyable for participants with group members often laughing and supporting one another as they tell stories and work on their painting—all while promoting good mental health living practice,”

Lynne Henderson, former RFDS Central Operations mental health clinician.

“People who live in the country get less access to care. And they become sicker,”

To increase the access to care, the RFDS said it needed a massive increase in funding. Country Australians see mental health professionals at only a fifth the rate of those who live in the city,

So there should be a five-fold increase in access to mental health care for country Australians.”

RFDS CEO Martin Laverty see story Part 2 below

Mental health in remote and rural communities

Mental health disorders are not more common in rural and regional Australia than they are in Australia’s cities, according to a new report from the Royal Flying Doctor Service (RFDS), but they are a lot harder to treat.

The report, Mental Health in Remote and Rural Communities, found about one in five remote and rural Australians — 960,000 people — experience mental illness.

Download the report HERE

RN031_Mental_Health_D5

But a combination of lack of access to facilities, social stigma, and cultural barriers present challenges to getting people the help they need.

AHCRA believes that’s something that everyone should be concerned about, with access to care regardless of location.

 

Part 1  Indigenous mental health and suicide

Data from the 2011 Australian Census demonstrated that 669,881 Australians, or 3% of the population, identified as Indigenous (Australian Bureau of Statistics, 2013b), and that 142,900 Indigenous Australians, or 21% of the Indigenous population, lived in remote and very remote areas (Australian Institute of Aboriginal and Torres Strait Islander Studies, 2014).

Around 45% of people in very remote Australia (91,600 people), and 16% of people in remote Australia (51,300 people) were Indigenous (Australian Bureau of Statistics, 2013b; Australian Institute of Aboriginal and Torres Strait Islander Studies, 2014).

In 2011–2012 around one-third (30%) of Indigenous adults reported high or very high levels of psychological distress—almost three times the rate for non-Indigenous Australians (Australian Bureau of Statistics, 2014).

In 2008–2012, in NSW, Queensland (Qld), WA, SA and the NT, there were 347 Indigenous deaths11 from mental health-related conditions (Australian Institute of Health and Welfare,

2015a). Specifically, age-standardised death data demonstrated that Indigenous Australians (49 per 100,000 population) were 1.2 times as likely as non-Indigenous Australians (40 per 100,000 population) to die from mental and behavioural disorders (Australian Institute of Health and Welfare, 2015a). Age-standardised deaths from mental and behavioural disorders increased with increasing age in both Indigenous and non-Indigenous Australians in 2008–2012.

Very few Indigenous and non-Indigenous Australians under the age of 35 years died as result of mental and behavioural disorders in 2008–2012. However, Indigenous Australians aged 35 years or older were more likely to die from mental and behavioural disorders than non-Indigenous

Australians in 2008–2012. Specifically, Indigenous Australians (7.2 per 100,000 population) aged 35–44 years were 5.7 times as likely as non-Indigenous Australians (1.3 per 1200,000 population) to die from mental and behavioural disorders (Australian Institute of Health and

Welfare, 2015a). In 2008–2012, Indigenous Australians (14.7 per 100,000 population) aged 45–54 years were 4.9 times as likely as non-Indigenous Australians (3.0 per 100,000 population) to die from mental and behavioural disorders (Australian Institute of Health and Welfare, 2015a).

In 2008–2012, Indigenous Australians (18.3 per 100,000 population) aged 55–64 years were 2.7 times as likely as non-Indigenous Australians (6.9 per 100,000 population) to die from mental and behavioural disorders (Australian Institute of Health and Welfare, 2015a). In 2008–2012,

Indigenous Australians (91.2 per 100,000 population) aged 65–74 years were 2.9 times as likely

as non-Indigenous Australians (31.3 per 100,000 population) to die from mental and behavioural disorders (Australian Institute of Health and Welfare, 2015a).

Further exploration of death data from mental and behavioural disorders illustrates the significant impact of psychoactive substance use (ICD-10-AM codes F10–F19) on Indigenous mortality (Australian Institute of Health and Welfare, 2015a). In 2008–2012, 29.1% of Indigenous deaths due to mental and behavioural disorders were the result of psychoactive substance use, such as alcohol, opioids, cannabinoids, sedative hypnotics, cocaine, other stimulants such as caffeine, hallucinogens, tobacco, volatile solvents, or multiple drug use. During this period, Indigenous Australians (7.3 per 100,000 populations) were 4.8 times as likely as non-Indigenous Australians to die as a result of psychoactive substance use (Australian Institute of Health and Welfare, 2015a).

Similarly, in 2006–2010, there were 312 Indigenous deaths from mental health-related conditions (Australian Institute of Health and Welfare, 2013a). Indigenous Australians living in NSW, Qld, WA, SA and the NT were 1.5 times as likely as non-Indigenous Australians to die from mental and behavioural disorders in 2006–2010 (Australian Institute of Health and Welfare, 2013a).

11 Deaths from mental and behavioural disorders do not include deaths from intentional self-harm (suicide). Intentional self-harm is coded under ICD-10-AM Chapter 19—Injury, poisoning and certain other consequences of external causes.

Age-standardised death data demonstrated that Indigenous males (49 per 100,000 population) were 1.7 times as likely as non-Indigenous males to die from mental and behavioural disorders. Indigenous females were 1.3 times as likely as non-Indigenous females to die from mental and behavioural disorders (Australian Institute of Health and Welfare, 2013a).

The greater number of deaths from mental and behavioural disorders with age may also represent the impact of conditions associated with ageing, such as dementia. For example, in 2014, Indigenous Australians (50.7 per 100,000 population) in NSW, Qld, SA, WA and the NT were 1.1 times as likely as non-Indigenous Australians (45.3 per 100,000 population) to die from dementia (including Alzheimer disease) (Australian Bureau of Statistics, 2016a).

In 2014–2015, Indigenous Australians (28.3 per 1,000 population) were 1.7 times as likely as non-Indigenous Australians (16.3 per 1,000 population) to be hospitalised for mental and behavioural disorders (Australian Institute of Health and Welfare, 2016a).

In 2011–2013, 4.2% of Indigenous hospitalisations were for mental and behavioural disorders (Australian Institute of Health and Welfare, 2015a). Age-standardised data demonstrated that Indigenous Australians (27.7 per 1,000 population) were twice as likely as non-Indigenous Australians (14.2 per 1,000 population) to be hospitalised for mental and behavioural disorders in 2011–2013 (Australian Institute of Health and Welfare, 2015a).

In 2008–2009, Indigenous young people aged 12–24 years (2,535 per 100,000 population) were three times as likely to be hospitalised for mental and behavioural disorders than non-Indigenous young people (Australian Institute of Health and Welfare, 2011).

 

The leading causes of hospitalisation for mental and behavioural disorders amongst Indigenous young people were schizophrenia (306 per 100,000 population), alcohol misuse (348 per 100,000 population) and reactions to severe stress (266 per 100,000 population) (Australian Institute of Health and Welfare, 2011).

A preliminary clinical survey of 170 Aboriginal and Torres Strait Islander Australians in Cape York and the Torres Strait, aged 17–65 years, with a diagnosis of a psychotic disorder, was undertaken to describe the prevalence and characteristics of psychotic disorders in this population (Hunter, Gynther, Anderson, Onnis, Groves, & Nelson, 2011).

Researchers found that: 62% of the sample had a diagnosis of schizophrenia, 24% had substance-related psychoses, 8% had affective psychoses, 3% had organic psychoses and 3% had brief reactive psychoses; Indigenous Australians aged 30–39 years were overrepresented in the psychosis sample compared to their representation in the population (37% of sample versus 29% of population) with slightly lower proportions in the 15–29 years and 40 years and older age groups; almost three-quarters (73%) of the sample were male (versus 51% for the Indigenous population as a whole); Aboriginal males (63% in the sample compared to 46% for the region as a whole) were overrepresented; a higher proportion of males (42%) than females (5%), and Aboriginal (44%) than Torres Strait Islander patients (10%) had a lifetime history of incarceration; comorbid intellectual disability was identified for 27% of patients, with a higher proportion for males compared to females (29% versus 20%) and Aboriginal compared to Torres Strait Islander patients (38% versus 7%); and alcohol misuse (47%) and cannabis use (52%) were believed to have had a major role in the onset of psychosis (Hunter et al., 2011).

In 2015, Indigenous Australians (25.5 deaths per 100,000 population) in Qld, SA, NT, NSW and WA were twice as likely as non-Indigenous Australians (12.5 deaths per 100,000 population) to die from suicide (Australian Bureau of Statistics, 2016b). In their spatial analysis of suicide, Cheung et al. (2012) concluded that higher rates of suicide in the NT and in some remote areas could be explained by the large numbers of Indigenous Australians living in these areas, who demonstrate higher levels of suicide compared with the general population.

The poorer mental health of remote and rural Indigenous Australians is also impacted by the social determinants of Indigenous health, which are well recognised nationally and internationally.

These relate to the loss of language and connection to the land, environmental deprivation, spiritual, emotional and mental disconnectedness, a lack of cultural respect, lack of opportunities for self-determination, poor educational attainment, reduced opportunities for employment, poor housing, and negative interactions with government systems

Part 2 Flying Doctors fight barriers to treat mental illness in rural Australia

Source ABC

Like so many in the bush, Brendan Cullen has a lot on his plate.

He manages a 40,000-hectare property south of Broken Hill. There are 8,000 sheep to keep track of. And that’s just a fraction of the number he looked after previously at another station.

A few years ago, the mustering, the maintenance, juggling bills and family — it all caught up to him.

“You just bottle stuff up. And sometimes you can’t find an out,” he said.

“In the bush you have a lot of time by yourself.”

He spent a lot of that time thinking about his problems. But Mr Cullen was lucky.

He heard about a mental health clinic being run by the Royal Flying Doctor Service (RFDS) in a nearby community and decided to go along.

“Catching up with one of the mental health nurses gave me the tools to be able to work out how I go about living a day-to-day life,” he said.

“My life’s a hell of a lot easier now than what it used to be.”

Mental health disorders are not more common in rural and regional Australia than they are in Australia’s cities, according to a new report from the RFDS, but they are a lot harder to treat.

The report, Mental Health in Remote and Rural Communities, found about one in five remote and rural Australians — 960,000 people — experience mental illness.

But a combination of lack of access to facilities, social stigma, and cultural barriers present challenges to getting people the help they need.

“People who live in the country get less access to care. And they become sicker,” RFDS CEO Martin Laverty said.

To increase the access to care, the RFDS said it needed a massive increase in funding.

“Country Australians see mental health professionals at only a fifth the rate of those who live in the city,” Mr Laverty said.

“So there should be a five-fold increase in access to mental health care for country Australians.”

The impact of distance and isolation when it comes to treating mental disorders can be seen in suicide rates. In remote Australia, the rate is nearly twice what it is in major metropolitan areas — 19.6 deaths per 100,000 people.

The suicide rate is even greater in very remote communities.

If you or anyone you know needs help:

The RFDS has responded by increasing its mental health outreach. In communities like Menindee, about an hour’s drive from Broken Hill in the far west of New South Wales, a mental health nurse is on call once a fortnight.

“I have needed them in the past. I got down to rock bottom at one stage. Even now I appreciate that support,” Menindee resident Margot Muscat said.

Ms Muscat plays an active role in the remote community. But she has also felt pressure in the past to manage that role, her work, and family commitments.

Mental health counselling has given her a valuable outlet.

“Just to know that I wasn’t alone. And that you don’t have to take the drastic step of suiciding, so to speak,” Ms Muscat said.

Some the RFDS’s mental health counselling is done over the airwaves. From its regional base in Broken Hill, mental health nurse Glynis Thorp counsels patients over the phone. Often calls are simply people checking in.

“It’s critically important…often there might only be two people on the property. So no one to talk to maybe,” she said.

“We might get out to a clinic every fortnight, but we might have follow up phone calls to check how people are going. For myself it’s probably a ratio of four to one.”

The RFDS report reveals every year hundreds of serious mental illness incidents require airplanes to be dispatched to remote areas to fly patients out for treatment.

Over three years from July 2013 the RFDS conducted 2,567 ‘aeromedical retrievals’.

The leading causes for evacuation flights due to mental disorder are

The RFDS also uses airplanes to carry its mental health nurses to very remote areas. On a typical day in Broken Hill, the medical team takes off just after dawn to head to three communities hundreds of kilometres away: Wilcania, White Cliffs and Tilpa.

In the opal mining town of White Cliffs, the mental health nurse sees patients at the local clinic. One is “Jane”, who doesn’t want her full name used.

“Without them, we would really be lost here,” she said.

Jane has been counselled by the RFDS and was recently directed to mental health treatment in Broken Hill. But she’s still reluctant to talk openly in town about the help she’s getting.

“In a small community it’s not wise to talk to other people in town,” she said. “And mental health, it does carry a stigma.”

Back on his station south of Broken Hill, Mr Cullen believes that stigma over mental health is slowly changing in the bush.

“People get wind that someone’s had a mental health problem, people talk now. As opposed to, let’s go back five years even, 10 years. It was a closed book,” he said.

“With these clinics, once upon a time you might have had a dental nurse, a doctor, and the like.

“But now you have a mental health nurse…And these clinics are close by. So you’re able to go to them. They come to you.”

NACCHO Aboriginal #WorldHealthDay : #LetsTalk about Depression and #mentalhealth

 ” The theme of our 2017 World Health Day campaign is depression

The Gayaa Dhuwi (Proud Spirit) Declaration[4] was developed and launched by the National Aboriginal and Torres Strait Islander Leadership in Mental Health in 2015.

It provides a platform for governments to work collaboratively to embed culturally competent and safe services within the mental health system that are adaptable and accountable to Aboriginal and Torres Strait people.

Nearly one-third of Aboriginal and Torres Strait Islander people aged over 15 years reported having high to very high levels of psychological distress. This was more than twice the levels reported for other Australians.

Aboriginal and Torres Strait Islander women reported these levels of stress more than men.

It is often hard to know how common depression is in the Aboriginal and Torres Strait Islander population, however, because of the way people understand depression and their cultural understanding of mental illness.”

Subscribe to NACCHO Mental Health News Alerts  

  ” Depression needs to be seen within the wider scope of the social and emotional wellbeing of Aboriginal and Torres Strait Islander people; this means looking more holistically at health.

The warning signs for depression in Aboriginal and Torres Strait Islander people may vary between communities, so it is vital that the people working in the area of social and emotional wellbeing are aware of the different languages and understandings used by individual communities when talking about depression.

From Healthinfonet :Does the understanding of depression differ between Aboriginal and Torres Strait Islander communities?

World Health Day, celebrated on 7 April every year to mark the anniversary of the founding of the World Health Organization, provides us with a unique opportunity to mobilize action around a specific health topic of concern to people all over the world.

Depression affects people of all ages, from all walks of life, in all countries. It causes mental anguish and impacts on people’s ability to carry out even the simplest everyday tasks, with sometimes devastating consequences for relationships with family and friends and the ability to earn a living. At worst, depression can lead to suicide, now the second leading cause of death among 1529-year olds.

Yet, depression can be prevented and treated. A better understanding of what depression is, and how it can be prevented and treated, will help reduce the stigma associated with the condition, and lead to more people seeking help.

WHO World Heath Day

“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:

PDF Copy fifth-national-mental-health-plan

You can download a copy of the draft plan;or see extracts below

Fifth National Mental Health Plan – PDF 646 KB
Fifth National Mental Health Plan – Word 537 KB

View all NACCHO 127 Mental Health articles here

View all NACCHO 97 Suicide Prevention articles here

Priority Area 4: Aboriginal and Torres Strait Islander mental health and suicide prevention

What we aim to achieve

Culturally competent care through integrating social and emotional wellbeing services with a range of mental health, drug and alcohol, and suicide prevention services.

What it means for consumers and carers?

You will receive culturally appropriate care.

Both your clinical and social and emotional wellbeing needs, and the needs of your community, will be addressed when care is planned and delivered.

Summary of actions

  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 with 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.

Overview

Mental health and related conditions have been estimated to account for as much as 22 per cent of the health gap between Aboriginal and Torres Strait Islander people and other Australians, as measured in Disability-Adjusted Life Years. Mental health conditions are estimated to contribute to 12 per cent of the gap in the burden of disease, with another four per cent of the gap attributable to suicide and another six per cent to alcohol and other drug misuse.[1]

The 2012-2013 Australian Aboriginal and Torres Strait Islander Health Survey found that Aboriginal and Torres Strait Islander adults were almost three times more likely to experience high or very high levels of psychological distress than other Australians, are hospitalised for mental health and behavioural disorders at almost twice the rate of non-Aboriginal people, and have twice the rate of suicide than that of other Australians. The breadth and depth of such high levels of distress on individuals, their families, and their communities is profound.

Despite having greater need, Aboriginal and Torres Strait Islander people have limited access to mental health services and professionals. In 2012-2013, the most common Closing the Gap service deficits reported by organisations were around mental health and social and emotional wellbeing services.[2]

Issues such as rural and remoteness, and the diversity and fractured coordination of government funding, policy frameworks and service systems, play a role in hindering the ability of services to adequately and appropriately address the needs of Aboriginal and Torres Islander people. It is also recognised that many services and programmes designed for the general population are not culturally appropriate within a broader context of social and emotional wellbeing as understood by Aboriginal and Torres Strait Islander people.

Aboriginal and Torres Strait Islander people embrace a holistic concept of health, which inextricably links mental and physical health within a broader concept of social and emotional wellbeing. A whole-of-life view, social and emotional wellbeing recognises the interconnectedness of physical wellbeing with spiritual and cultural factors, especially a fundamental connection to the land, community and traditions, as vital to maintaining a person’s wellbeing.

Disruption to this holistic understanding of social and emotional wellbeing caused by dispossession, dislocation, and trauma over generations has, for some Indigenous Australians, created a legacy of grief and psychological distress.

Most Aboriginal and Torres Strait Islander people want to be able to access services where the best possible mental health and social and emotional wellbeing strategies are integrated into all health service delivery and where health promotion strategies are developed with Aboriginal communities to provide a holistic approach. This approach needs an appropriate balance of clinical and culturally informed mental health system responses, including access to traditional and cultural healing, to address mental health issues for Aboriginal and Torres Strait Islander people.

Many Aboriginal and Torres Strait Islander people also continue to experience high levels of exclusion and victimisation, discrimination and racism at personal, societal, and institutional levels. Racism continues to have a significant impact on Aboriginal and Torres Strait Islander people’s decisions about when and why they seek health services, their acceptance of and adherence to treatment.[3]

While governments have been committed to supporting Aboriginal and Torres Strait Islander mental health and suicide prevention, Aboriginal and Torres Strait Islander people have regularly informed governments that much more could be done to improve both the way in which services are structured and the range of services available. There is a need to better coordinate efforts and focus on achieving improved integration of culturally appropriate mental health, social and emotional wellbeing, suicide prevention, and alcohol and other drug services for Aboriginal and Torres Strait Islander people.

Leadership will involve better collaboration and coordination across governments, and set the direction for how services and programmes can better work together. It will assist in driving and embedding change towards a better joined up and whole-of-life approach to mental health, social and emotional wellbeing, suicide prevention, and alcohol and other drug services for Aboriginal and Torres Strait Islander people, to drive the actions that are needed to support better mental health and social and emotional wellbeing, and reduced incidence of suicide, for Aboriginal and Torres Strait Islander people.

The Fifth Plan recognises that self-determination is essential to overcoming the disadvantage that Aboriginal and Torres Strait Islander people experience. While governments have a critical role in providing leadership, actions will be developed in partnership with Aboriginal and Torres Strait Islander people and their communities to ensure that appropriate solutions are developed and key challenges are addressed.

Governments will work collaboratively to improve the cultural safety and capability of the mental health and social and emotional wellbeing workforce, including increasing the proportion of Aboriginal and Torres Strait Islander people working in this field, strengthening the Aboriginal and Torres Strait Islander community controlled health sector and developing the cultural competence of mainstream mental health services. An important factor in this collaborative process will be the inclusion of local Aboriginal and Torres Strait Islander communities in the design and implementation of culturally relevant mental health services. Supporting skill development to enable Aboriginal and Torres Strait Islander people to actively participate in, and conduct research relating to, their own cultures is also important.

Governments recognise the need to improve access to information on what has been shown to work in Aboriginal and Torres Strait Islander communities to improve social and emotional wellbeing, reduce the impact of mental illness and harms associated with alcohol and other drug use, and to prevent suicide.

Action 14: Governments will work with service providers, including with Aboriginal Community Controlled Health Organisations, to improve Aboriginal and Torres Strait Islander access to and experience with mental health and wellbeing services by:

  • increasing knowledge of social and emotional wellbeing concepts and improving the cultural competence and capability of mainstream providers;
  • recognising the importance of Indigenous leadership and supporting implementation of the Gayaa Dhuwi (Proud Spirit) Declaration; and
  • training all staff delivering mental health services to Aboriginal and Torres Strait Islander people, particularly those in forensic settings, in trauma-informed care.

The National Aboriginal and Torres Strait Islander Leadership In Mental Health Group launched the Gayaa Dhuwi (Proud Spirit) Declaration in 2015. The Declaration emphasises the importance of Indigenous leadership in addressing the mental health challenges faced by Aboriginal and Torres Strait Islander people

The Gayaa Dhuwi (Proud Spirit) Declaration[4] was developed and launched by the National Aboriginal and Torres Strait Islander Leadership in Mental Health in 2015. It provides a platform for governments to work collaboratively to embed culturally competent and safe services within the mental health system that are adaptable and accountable to Aboriginal and Torres Strait people.

The five themes of the Declaration are:

  1. Aboriginal and Torres Strait Islander concepts of social and emotional wellbeing, mental health and health should be recognised across all parts of the Australian mental health system, and in some circumstances support specialised areas of practice.
  2. Aboriginal and Torres Strait Islander concepts of social and emotional wellbeing, mental health and healing combined with clinical perspectives will make the greatest contribution to the achievement is the highest attainable standard of mental health and suicide prevention outcomes for Aboriginal and Torres Strait Islander people.
  3. Aboriginal and Torres Strait Islander values-based social and emotional wellbeing and mental health outcome measures in combination with clinical outcome measures should guide the assessment of mental health and suicide preventions services and programmes for Aboriginal and Torres Strait Islander people.
  4. Aboriginal and Torres Strait Islander presence and leadership is required across all parts of the Australian mental health system for it to adapt to, and be accountable to, Aboriginal and Torres Strait Islander people for the achievement of the highest attainable standard of mental health and suicide prevention outcomes.
  5. Aboriginal and Torres Strait Islander leaders should be supported and valued to be visible and influential across all parts of the Australian mental health system.

More info here

What is depression?

Depression is about a person’s state of mood. When a person has depression (often called clinical depression) they feel very low in mood (sad, unhappy, or ‘down in the dumps’) and also lose interest in activities they used to gain happiness from.

It is normal for people to feel sad every once in a while, but clinical depression is very different from the occasional feeling of sadness. There are several ways clinical depression differs from the occasional feeling of sadness, they include:

  • severity (how serious it is); clinical depression usually ranges from mild to severe
  • persistence (strength of the episode)
  • duration (how long it lasts)
  • the presence of typical symptoms (see next section).

When people feel sad or ‘down’ for a long time, usually for longer than 2 weeks, they may be depressed. Depression can affect anyone at any age.

What are the signs and symptoms of depression?

There are a number of signs or symptoms people may show when they have depression. People do not have to have all of them to be diagnosed with depression. The signs and symptoms of depression can include any of the following:

  • waking up feeling sad and not wanting to get out of bed
  • feeling sad for most of the day
  • feeling restless
  • feeling irritable (short-tempered) and/or angry which may lead to arguments with other people
  • not wanting to be around other people (may want to be alone)
  • thoughts of dying or hurting oneself
  • feeling guilty when not at fault
  • crying for no reason
  • losing interest in the things one likes
  • feeling worthless or hopeless
  • not sleeping well (maybe walking around all night), or sleeping too much
  • not eating well, or eating too much
  • less energy; tiredness
  • having problems concentrating, remembering things, or making decisions
  • weight loss or gain.

Does the understanding of depression differ between Aboriginal and Torres Strait Islander communities?

Depression needs to be seen within the wider scope of the social and emotional wellbeing of Aboriginal and Torres Strait Islander people; this means looking more holistically at health. The warning signs for depression in Aboriginal and Torres Strait Islander people may vary between communities, so it is vital that the people working in the area of social and emotional wellbeing are aware of the different languages and understandings used by individual communities when talking about depression.

What are the risk factors for depression?

The factors that can contribute to depression include:

  • previous mental illness
  • poor physical health or long-term illness
  • grief, loss, and bereavement (referred to as a psychological cause)
  • trauma or stressful events
  • recently becoming a parent
  • too much alcohol, or gunga, or other drugs
  • family history of depression (referred to as a biological or genetic cause)
  • stopping any treatment for depression
  • breaking the law
  • social surroundings (e.g., environmental, housing conditions)
  • cultural or spiritual separation from country.

A person’s personality can also be a risk factor for depression. People who are: anxious or worry easily; unassertive (people who do not stand up for themselves); negative and self-critical (people who see themselves in a negative way); or shy and have low self-esteem (lack confidence) are at a higher risk of depression than people who do not have these types of personalities.

How do you treat depression?

There are many different ways to help people suffering from depression. People need to know that they do not have to put up with the feelings of depression. It is important to be supportive and encourage people to seek help from doctors, counsellors, Aboriginal Health Workers, or staff at the local Aboriginal medical service.

Medical treatments for depression can involve:

  • a full health check from a doctor to screen for any contributing health conditions (e.g., diabetes or hepatitis)
  • getting help from mental health professionals to work through any problems
  • medication (usually anti-depressant drugs)
  • limiting the intake of alcohol and other drugs.

Other tips for managing depression include:

  • talking to someone, for example, friends, family, or an Elder
  • getting involved in daily exercise
  • getting involved in activities that make you feel happy (e.g., fishing, going back to country)
  • trying to sleep and eat well
  • learning skills that a person can use when they feel they’re not coping well with a situation.

If the treatment is not working, it is important that people discuss this with their doctor, counsellor, or other mental health professional so that other options can be explored.

NACCHO #IWD2017 Aboriginal Women’s #justjustice :Indigenous, disabled, imprisoned – the forgotten women of #IWD2017

 

” 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

Kriti Sharma is a disability rights researcher for Human Rights Watch

This is our last NACCHO post supporting  International Women’s Day

Further NACCHO reading

Women’s Health ( 275 articles )  or Just Justice  See campaign details below

” 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

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

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.

The government has been unwilling to do so, citing the new National Disability Insurance Scheme (NDIS) Quality and Safeguard Framework as adequate.

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

 

croakey-new

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.

• Follow Guardian Australia’s project, Breaking the Cycle.

Readers may also be interested in these articles:

NACCHO Invites all health practitioners and staff to a webinar : Working collaboratively to support the social and emotional well-being of Aboriginal youth in crisis

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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)

Read more about the panellists.

Working collaboratively to support the social and emotional well-being of Aboriginal and Torres Strait Islander youth in crisis.

Date:  Thursday 23rd February, 2017

Time: 7.15 – 8.30pm AEDT

REGISTER

No need to travel to benefit from this free PD opportunity. Simply register and log in anywhere you have a computer or tablet with high speed internet connection. CPD points awarded.

Learn more about the learning outcomes, other resources and register now.

For further information, contact MHPN on 1800 209 031 or email webinars@mhpn.org.au.

The Mental Health Professionals’ Network is a government-funded initiative that improves interdisciplinary collaborative mental health care practice in the primary health sector.  MHPN promotes interdisciplinary practice through two national platforms, local interdisciplinary networks and online professional development webinars.

 

 

 

 

 

 

NACCHO Aboriginal children’s health and what works :No School No Pool policy means improved health in remote communities

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 ” 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.”

For more information go to the Royal Life Saving WA website

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.

Download copy of report :

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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.

Health Benefits

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.

The research

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.

Social Benefits

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

 

NACCHO #ATSISPEP Aboriginal Health Suicide Prevention : Our kids have no hope: suicide victim’s mother tells PM

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“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

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 Our thanks to Suicide Prevention researcher and campaigner, Gerry Georgatos – Institute of Social Justice and Human Rights for assistance with photos

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Part 1 Article from Pat Dudgeon and Tom Calma

Part 2 Government Press Release

Response from Minister for Indigenous Affairs, Nigel Scullion, Minister for Health and Aged Care, Sussan Ley, and Assistant Minister for Health and Aged Care, Ken Wyatt.

Emotional Pat Dodson calls for action to stop devastating rate of Indigenous suicide

Aboriginal senator Pat Dodson has fought back tears telling the story of a 12-year-old boy who took his own life.

WATCH ABC VIDEO

Senator Dodson on Thursday joined MPs and senators from across the political spectrum at the launch of an Indigenous suicide prevention report.

Download report atispep-report-final-web-pdf-nov-10

“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

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The Aboriginal and Torres Strait Islander Suicide Prevention Evaluation Project (ATSISPEP) was undertaken over more than a year.

Download atispep-report-final-web-pdf-nov-10

It recommended 17 projects and strategies to drive down the devastating rate of suicide in Indigenous communities, including:

  • A national Indigenous suicide prevention implementation plan
  • Indigenous-controlled organisations to lead mental health care in communities
  • Cultural training for mental health workers
Nigel Scullion talks at a press conference.

Federal Indigenous Affairs Minister Nigel Scullion said the Government was “by and large” adopting the suggestions.

“One life lost is one life too many. There’s no targets about this. This has to stop,” Senator Scullion said.

But he said more money for Indigenous mental healthcare was not the answer, instead urging better coordination among health organisations.

“What we’ve found through this process is that there are a number of organisations within a community and those organisations just need to know what their role and responsibility is.”

Suicide rates in some Aboriginal communities, including in the Kimberley, are among the highest in the world.

In August, the Federal Government said the Kimberley would be one of 12 trial sites for a new suicide prevention approach as part of the Government’s National Suicide Prevention Strategy.

24-Hour Telephone Counselling

If you or someone you know is experiencing mental health issues, call:

NACCHO Aboriginal Health Alert : Coalition Government launches #ATSISPEP Community-led solutions for Indigenous suicide prevention

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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 above 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.

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 and Our People Tell Us.

Download

atispep-report-final-web-pdf-nov-10

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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.

 

NACCHO Aboriginal Health : #ATSISPEP report and the hope of a new era in Indigenous suicide prevention

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 ” 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

Read over 100 NACCHO articles here on suicide prevention

After almost two years of work, ATSISPEP released a final report in Canberra on the 10th of November 2016.

Download the final #ATSISPEP report here

atispep-report-final-web-pdf-nov-10

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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.

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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.

Some good examples are presented in the Elders’ Report into Preventing Indigenous Self-harm & Youth Suicide (see: https://bepartofthehealing.org/EldersReport.pdf).

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.

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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.

All of the ATSISPEP reports can be accessed at www.atsispep.sis.uwa.edu.au.

ATSISPEP was funded by the Commonwealth Department of Health.

If you are looking for help please call one of the following national helplines:
Lifeline Counselling Service: 13 11 14; Suicide Call Back Service: 1300 659 467 (cost of a local call)

atsispep

 

 

 

NACCHO Aboriginal Kids Health : How discrimination and stressful events affect the health of our Indigenous Kids

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 “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 last week : 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.

Number of funerals attended by primary carer over 5 years Author provided

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.

Discrimination

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.

LSIC parents’ experience of discrimination Author provided

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.

Relationship between discrimination and self-rated general health. Author provided

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.

Relationship between Mother’s experience of discrimination and child’s difficulties scores at 6-7 years of age. Author provided

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.

Smoking inside the house over time (Balanced panel n=950). Author provided

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, by right, 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.

Conclusion

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.

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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

1. Call to action to Present
at the 2016 Members Conference closing 8 November
See below or Download here

2.NACCHO Partnership Opportunities

3. NACCHO Interim 3 day Program has been released

4. The dates are fast approaching – so register today