NACCHO Aboriginal #MentalHealth #SuicidePrevention : New @ozprodcom report says Aboriginal and Torres Strait Islanders are twice as likely as non-indigenous people to be hospitalised because of mental illness, and twice as likely to die by suicide.

 ” The report says Aboriginal and Torres Strait Islanders are twice as likely as non-indigenous people to be hospitalised because of mental illness, and twice as likely to die by suicide.

For those up to 24 years of age, the suicide rate is 14 times higher for Aborigines and Torres Strait Islanders.

And services are far from uniform across the nation, with ­people in capital cities nearly twice as likely to access mental health services as those in ­remote areas.

It recommended services tailored to meet the needs of “particular groups”,  including First Nations people.

Aboriginal health practitioner play an important role in providing culturally capable care to Aboriginal and Torres Strait Islander people,”

The Productivity Commission, in a forensic examination of mental illness, finds it is costing the ­nation about $500m a day and recommends sweeping policy changes in the health system, workplaces, housing and the ­justice system. see Key findings below 

Download all reports HERE

Or Summary HERE

mental-health-draft-overview

Download NACCHO’s submission to this report

NACCHO-mental-health submission

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

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

Today’s news coverage

From todays The Australian

One million Australians with mental health conditions ranging from anxiety and depression to psychosis and borderline personality disorders are going untreated each year, while the economic cost of mental illness has hit $180bn.

The Productivity Commission, in a forensic examination of mental illness, finds it is costing the ­nation about $500m a day and recommends sweeping policy changes in the health system, workplaces, housing and the ­justice system.

Calling for “generational changes’’ to address a problem that is getting worse despite increasing expenditure in the area, the report, to be released on Thursday, estimates there are 3.9 million people with mental illness, but only 2.9 million are ­accessing support and services.

One in eight visits to the GP is related to mental health issues, and mental health presentations at emergency departments have risen by about 70 per cent over the past 15 years.

The system is not adequately helping many people seeking treatment, the report finds, with one million having symptoms too complex to be adequately treated by a GP and limited government-funded sessions available with mental health providers.

But their condition does not reach the threshold to access state-­funded specialised services, private psychiatrists or private hospitals because of long waiting lists or high out-of-pocket costs.

The report finds many people still avoid treatment because of stigma and, with 75 per cent of people with a mental health issue first experiencing symptoms before the age of 25, calls for a greater focus on early ­intervention.

Social and emotional development checks of Australia’s 1.25 million children aged up to three years are among 25 detailed recommendations.

Productivity Commission chairman Michael Brennan said dealing with mental illness was “one of the biggest policy challenges confronting Australia”.

“Mental ill health has huge impacts on people, communities and our economy, but mental health is treated as an add-on to the physical health system — this has to change,” Mr Brennan said.

He highlighted the need for a greater emphasis on early intervention. “Seventy-five per cent of those who develop mental illness first experience symptoms before they turn 25,” he said.

“Mental ill health in critical schooling and employment years has long-lasting effects for not only your job prospects but many aspects of your life.”

Workplace, housing and education reforms to support people with mental illness are also proposed. “Mental illness is the second largest contributor to years lived in ill health,” the report finds.

“Compared to other developed countries, the prevalence of mental illness in Australia is above the OECD average.’’

The report marks the first time mental health has been examined beyond its clinical context into policy areas such as education, housing, justice and the workplace.

The report, a draft inviting public submissions, notes that one in two Australians will be affected by issues such as anxiety and ­depression during their lifetime.

“The cost to the Australian economy of mental ill health and suicide is, conservatively, in the order of $43bn-$51bn a year. ­Additional to this is an approximately $130bn a year cost associated with diminished health and reduced life expectancy for those living with mental ill health.”

The direct costs are broken down into healthcare support and services ($18bn a year), lower economic participation and lost productivity ($10bn-$18bn) and informal care provided by friends and family ($15bn).

Broader social effects such as the cost of stigma or lower social participation aren’t quantified.

The report notes that while costs have risen, “there has been no clear indication that the ­mental health of the population has improved”.

“Community awareness about mental illness has come a long way, but the mental health system has not kept pace with needs and expectations of how the wellbeing and productive capacity of people should be supported,” the commission says.

“The treatment of, and support for, people with mental illness has been tacked on to a system that has been largely ­designed around the characteristics of physical illness.

“And while service levels have increased in some areas, progress has been patchy. The right services are not available when ­needed, leading to wasted health resources and missed opportunities to improve lives.”

The report says Aborigines and Torres Strait Islanders are twice as likely as non-indigenous people to be hospitalised because of mental illness, and twice as likely to die by suicide.

For those up to 24 years of age, the suicide rate is 14 times higher for Aborigines and Torres Strait Islanders.

And services are far from uniform across the nation, with ­people in capital cities nearly twice as likely to access mental health services as those in ­remote areas.

The commission also calls out: thin services in the regions; too clinical an approach to mental health concerns; stigma and discrimination leading to a reluctance to seek support; and a lack of clarity between the tiers of government about roles, responsibilities and funding of services.

Among its recommended reforms, it calls for greater specialist mental health services to be ­delivered outside acute, expensive, hospital settings.

It also calls for greater investment in “long-term housing solutions for those with severe mental illness who lack stable housing”. “Stable housing for this group would not only improve their mental health and inclusion within the community, but reduce their future need for higher cost mental health in­patient services,” it says.

Workplace reform is also ­proposed.

The commission invites written submissions by January 23 in response to its draft report, and a final report will be provided to the government in May.

 

 

Australia’s mental health: a generational shift is needed

·     In any year, approximately one in five Australians experiences mental ill-health. While most people manage their health themselves, many who do seek treatment are not receiving the level of care necessary. As a result, too many people suffer additional preventable physical and mental distress, relationship breakdown, stigma, and loss of life satisfaction and opportunities.

·     The treatment of mental illness has been tacked on to a health system that has been largely designed around the characteristics of physical illness. But in contrast to many physical health conditions

–        mental illness tends to first emerge in younger people (75% of those who develop mental illness, first experience mental ill-health before the age of 25 years) raising the importance of identifying risk factors and treating illness early where possible.

–        there is less awareness of what constitutes mental ill-health, the types of help available or who can assist. This creates need for not only clear gateways into mental healthcare, but effective ways to find out about and navigate the range of services available to people.

–        the importance of non-health services and organisations in both preventing mental illness from developing and in facilitating a person’s recovery are magnified, with key roles evident for — and a need for coordination between — psychosocial supports, housing services, the justice system, workplaces and social security.

–        adjustments made to facilitate people’s active participation in the community, education and workplaces have, for the most part, lagged adjustments made for physical illnesses, with a need for more definitive guidance on what adjustments are necessary and what interventions are effective.

·     The cost to the Australian economy of mental ill-health and suicide is, conservatively, in the order of $43 to $51 billion per year. Additional to this is an approximately $130 billion cost associated with diminished health and reduced life expectancy for those living with mental ill-health.

A path for maintainable long term reform

·     Changes recommended are substantial but they would set Australia on a path for maintainable long term reform of its mental health system. Priority reforms are identified and a staged reform agenda is proposed.

Reform area 1: prevention and early intervention for mental illness and suicide attempts

·     Consistent screening of social and emotional development should be included in existing early childhood physical development checks to enable early intervention.

·     Much is already expected of schools in supporting children’s social and emotional wellbeing, and they should be adequately equipped for this task through: inclusion of training on child social and emotional development in professional requirements for all teachers; proactive outreach services for students disengaged with school because of mental illness; and provision in all schools of an additional senior teacher dedicated to the mental health and wellbeing of students and maintaining links to mental health support services in the local community.

·     There is no single measure that would prevent suicides but reducing known risks (for example, through follow-up of people after a suicide attempt) and becoming more systematic in prevention activity are ways forward.

Reform area 2: close critical gaps in healthcare services

·     The availability and delivery of healthcare should be reformed to allow timely access by people with mental ill-health to the right treatment for their condition. Governments should work together to ensure ongoing funded provision of:

 

–     services for people experiencing a mental health crisis that operate for extended hours and which, subject to the individual’s needs and circumstances, provide an alternative to hospital emergency departments

–     acute inpatient beds and specialised community mental health bed-based care sufficient to meet assessed regional needs

–     access to moderate intensity care, face-to-face and through videoconference, for a duration commensurate with effective treatment for the mental illness

–     expanded low intensity clinician-supported on-line treatment and self-help resources, ensuring this is consistently available when people need it, regardless of the time of day, their locality, or the locality choices of providers.

Reform area 3: investment in services beyond health

·     Investment is needed across Australia in long-term housing solutions for those people with severe mental illness who lack stable housing. Stable housing for this group would not only improve their mental health and inclusion within the community, but reduce their future need for higher cost mental health inpatient services.

Reform area 4: assistance for people with mental illness to get into work and enable early treatment of work-related mental illness

·     Individual placement and support programs that reconnect people with mental illness into workplaces should be progressively rolled out, subject to periodic evaluation and ongoing monitoring, to improve workforce participation and reduce future reliance on income support.

·     Mental health should be explicitly included in workplace health and safety, with codes of practice for employers developed and implemented.

·     No-liability clinical treatment should be provided for mental health related workers compensation claims until the injured worker returns to work or up to six months.

Reform area 5: fundamental reform to care coordination, governance and funding arrangements

·     Care pathways for people using the mental health system need to be clear and seamless with: single care plans for people receiving care from multiple providers; care coordination services for people with the most complex needs; and online navigation platforms for mental health referral pathways that extend beyond the health sector.

·     Reforms to the governance arrangements that underpin Australia’s mental health system are essential to inject genuine accountability, clarify responsibilities and ensure consumers and carers participate fully in the design of policies and programs that affect their lives.

–      Australian Government and State/Territory Government funding for mental health should be identified and pooled to both improve care continuity and create incentives for more efficient and effective use of taxpayer money. The preferred option is a fundamental rebuild of mental health funding arrangements with new States and Territory Regional Commissioning Authorities given responsibility for the pooled resources.

–      The National Mental Health Commission (NMHC) should be afforded statutory authority status to support it in evaluating significant mental health and suicide prevention programs. The NMHC should be tasked with annual monitoring and reporting on whole-of-government implementation of a new National Mental Health Strategy.

–      These changes should be underpinned by a new intergovernmental National Mental Health and Suicide Prevention Agreement.

 

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

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

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

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

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

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

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

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

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

Download the 7 page study  mja250212

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

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

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

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

How the tool works

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

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

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

The adapted (aPHQ-9) tool instead asks:

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

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

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

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

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

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

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

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

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

The George Institute for Global Health

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

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

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

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

Additional Media 

Doctors can now use the new tool

Extract from the Conversation 1 July 2019

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

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

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

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

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

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

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

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

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

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

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

NACCHO Aboriginal #MentalHealth and #SuicidePrevention : @ozprodcom issues paper on #MentalHealth in Australia is now available. It asks a range of questions which they seek information and feedback on. Submissions or comments are due by Friday 5 April.

 ” Many Australians experience difficulties with their mental health. Mental illness is the single largest contributor to years lived in ill-health and is the third largest contributor (after cancer and cardiovascular conditions) to a reduction in the total years of healthy life for Australians (AIHW 2016).

Almost half of all Australian adults have met the diagnostic criteria for an anxiety, mood or substance use disorder at some point in their lives, and around 20% will meet the criteria in a given year (ABS 2008). This is similar to the average experience of developed countries (OECD 2012, 2014).”

Download the PC issues paper HERE mental-health-issues

See Productivity Commission Website for More info 

“Clearly Australia’s mental health system is failing Aboriginal people, with Aboriginal communities devastated by high rates of suicide and poorer mental health outcomes. Poor mental health in Aboriginal communities often stems from historic dispossession, racism and a poor sense of connection to self and community. 

It is compounded by people’s lack of access to meaningful and ongoing education and employment. Drug and alcohol related conditions are also commonly identified in persons with poor mental health.

NACCHO Chairperson, Matthew Cooke 2015 Read in full Here 

Read over 200 Aboriginal Mental Health Suicide Prevention articles published by NACCHO over the past 7 years 

Despite a plethora of past reviews and inquiries into mental health in Australia, and positive reforms in services and their delivery, many people are still not getting the support they need to maintain good mental health or recover from episodes of mental ill‑health. Mental health in Australia is characterised by:

  • more than 3 100 deaths from suicide in 2017, an average of almost 9 deaths per day, and a suicide rate for Indigenous Australians that is much higher than for other Australians (ABS 2018)
  • for those living with a mental illness, lower average life expectancy than the general population with significant comorbidity issues — most early deaths of psychiatric patients are due to physical health conditions
  • gaps in services and supports for particular demographic groups, such as youth, elderly people in aged care facilities, Indigenous Australians, individuals from culturally diverse backgrounds, and carers of people with a mental illness
  • a lack of continuity in care across services and for those with episodic conditions who may need services and supports on an irregular or non-continuous basis
  • a variety of programs and supports that have been successfully trialled or undertaken for small populations but have been discontinued or proved difficult to scale up for broader benefits
  • significant stigma and discrimination around mental ill-health, particularly compared with physical illness.

The Productivity Commission has been asked to undertake an inquiry into the role of mental health in supporting social and economic participation, and enhancing productivity and economic growth (these terms are defined, for the purpose of this inquiry, in box 1).

By examining mental health from a participation and contribution perspective, this inquiry will essentially be asking how people can be enabled to reach their potential in life, have purpose and meaning, and contribute to the lives of others. That is good for individuals and for the whole community.

Background

In 2014-15, four million Australians reported having experienced a common mental disorder.

Mental health is a key driver of economic participation and productivity in Australia, and hence has the potential to impact incomes and living standards and social engagement and connectedness. Improved population mental health could also help to reduce costs to the economy over the long term.

Australian governments devote significant resources to promoting the best possible mental health and wellbeing outcomes. This includes the delivery of acute, recovery and rehabilitation health services, trauma informed care, preventative and early intervention programs, funding non-government organisations and privately delivered services, and providing income support, education, employment, housing and justice. It is important that policy settings are sustainable, efficient and effective in achieving their goals.

Employers, not-for-profit organisations and carers also play key roles in the mental health of Australians. Many businesses are developing initiatives to support and maintain positive mental health outcomes for their employees as well as helping employees with mental illhealth continue to participate in, or return to, work.

Scope of the inquiry

The Commission should consider the role of mental health in supporting economic participation, enhancing productivity and economic growth. It should make recommendations, as necessary, to improve population mental health, so as to realise economic and social participation and productivity benefits over the long term.

Without limiting related matters on which the Commission may report, the Commission should:

  • examine the effect of supporting mental health on economic and social participation, productivity and the Australian economy;
  • examine how sectors beyond health, including education, employment, social services, housing and justice, can contribute to improving mental health and economic participation and productivity;
  • examine the effectiveness of current programs and Initiatives across all jurisdictions to improve mental health, suicide prevention and participation, including by governments, employers and professional groups;
  • assess whether the current investment in mental health is delivering value for money and the best outcomes for individuals, their families, society and the economy;
  • draw on domestic and international policies and experience, where appropriate; and
  • develop a framework to measure and report the outcomes of mental health policies and investment on participation, productivity and economic growth over the long term.

The Commission should have regard to recent and current reviews, including the 2014 Review of National Mental Health Programmes and Services undertaken by the National Mental Health Commission and the Commission’s reviews into disability services and the National Disability Insurance Scheme.

The Issues Paper
The Commission has released this issues paper to assist individuals and organisations to participate in the inquiry. It contains and outlines:

  • the scope of the inquiry
  • matters about which we are seeking comment and information
  • how to share your views on the terms of reference and the matters raised.

Participants should not feel that they are restricted to comment only on matters raised in the issues paper. We want to receive information and comment on any issues that participants consider relevant to the inquiry’s terms of reference.

Key inquiry dates

Receipt of terms of reference 23 November 2018
Initial consultations November 2018 to April 2019
Initial submissions due 5 April 2019
Release of draft report Timing to be advised
Post draft report public hearings Timing to be advised
Submissions on the draft report due Timing to be advised
Consultations on the draft report November 2019 to February 2020
Final report to Government 23 May 2020

Submissions and brief comments can be lodged

Online (preferred): https://www.pc.gov.au/inquiries/current/mental-health/submissions
By post: Mental Health Inquiry
Productivity Commission
GPO Box 1428, Canberra City, ACT 2601

Contacts

Inquiry matters: Tracey Horsfall Ph: 02 6240 3261
Freecall number: Ph: 1800 020 083
Website: http://www.pc.gov.au/mental-health

Subscribe for inquiry updates

To receive emails updating you on the inquiry consultations and releases, subscribe to the inquiry at: http://www.pc.gov.au/inquiries/current/mentalhealth/subscribe

 

 Definition of key terms
Mental health is a state of wellbeing in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.

Mental illness or mental disorder is a health problem that significantly affects how a person feels, thinks, behaves and interacts with other people. It is diagnosed according to standardised criteria.

Mental health problem refers to some combination of diminished cognitive, emotional, behavioural and social abilities, but not to the extent of meeting the criteria for a mental illness/disorder.

Mental ill-health refers to diminished mental health from either a mental illness/disorder or a mental health problem.

Social and economic participation refers to a range of ways in which people contribute to and have the resources, opportunities and capability to learn, work, engage with and have a voice in the community. Social participation can include social engagement, participation in decision making, volunteering, and working with community organisations. Economic participation can include paid employment (including self-employment), training and education.

Productivity measures how much people produce from a given amount of effort and resources. The greater their productivity, the higher their incomes and living standards will tend to be.

Economic growth is an increase in the total value of goods and services produced in an economy. This can be achieved, for example, by raising workforce participation and/or productivity.

Sources: AIHW (2018b); DOHA (2013); Gordon et al. (2015); PC (2013, 2016, 2017c); SCRGSP (2018); WHO (2001).

An improvement in an individual’s mental health can provide flow-on benefits in terms of increased social and economic participation, engagement and connectedness, and productivity in employment (figure 1).

This can in turn enhance the wellbeing of the wider community, including through more rewarding relationships for family and friends; a lower burden on informal carers; a greater contribution to society through volunteering and working in community groups; increased output for the community from a more productive workforce; and an associated expansion in national income and living standards. These raise the capacity of the community to invest in interventions to improve mental health, thereby completing a positive reinforcing loop.

The inquiry’s terms of reference (provided at the front of this paper) were developed by the Australian Government in consultation with State and Territory Governments. The terms of reference ask the Commission to make recommendations to improve population mental health so as to realise higher social and economic participation and contribution benefits over the long term.

Assessing the consequences of mental ill-health

The costs of mental ill-health for both individuals and the wider community will be assessed, as well as how these costs could be reduced through changes to the way governments and others deliver programs and supports to facilitate good mental health.

The Commission will consider the types of costs summarised in figure 4. These will be assessed through a combination of qualitative and quantitative analysis, drawing on available data and cost estimates, and consultations with inquiry participants and topic experts. We welcome the views of inquiry participants on other costs that we should take into account.

 

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 #HealthElection16 : Coalition invests $192 Million mental health reforms and suicide prevention

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“As a society we need to be alert to mental illness and remove the taboo on discussing it, which is why we are talking more often and openly about mental health issues,” he said.

“We have to learn to recognise depression in family, friends and work mates and reach out to them – before it is too late.

“This is why my Government is investing more in mental health and making services far more accessible, including through our smart phones.

Our National Suicide Prevention Strategy will draw together the current fragmented approach to suicide prevention and build on what is working well to focus on effective strategies to prevent suicide and reduce suicidal behaviour.”

Malcolm Turnbull Coalition launch 26 June

“Investing in non-Aboriginal services and organisations to deliver Aboriginal health and social services is widely acknowledged as failed policy.

NACCHO will keep building the capacity and responsiveness of the ACCHO Sector, and work to further demonstrate that investing in self-determination, and empowering Aboriginal people delivers better health outcomes and value for money.”

Matthew Cooke NACCHO Chair

Editorial Opinion NACCHO Newspaper out 29 June

A re-elected Turnbull Coalition Government will invest $192 million towards a bold package of mental health reforms to ensure help for individuals and their families across Australia, including key commitments in suicide prevention.

This is in addition to a series of important steps already undertaken in our first term, including the commissioning of regionally-delivered mental health services through Primary Health Networks (PHN’s) in partnership with state, territory and local service providers.

Our National Suicide Prevention Strategy will draw together the current fragmented approach to suicide prevention and build on what is working well to focus on effective strategies to prevent suicide and reduce suicidal behaviour.

Under a Coalition Government, we will prioritise $26 million for 10 PHN Mental Health lead sites to trial innovative approaches in mental health services. These will include establishing regional service pathways, evolving models of stepped health care and increasing use of digital technology.

Four of these locations will specifically focus on suicide prevention.

We will invest a further $24 million to add a further eight Suicide Prevention Trial sites throughout regional Australia, bringing the total number to 12.

These trial sites will build on best practice and community models and adopt new digital technologies to assist in crisis support, clinical intervention and ongoing support for individuals.

The Prime Minister said he was passionately committed to addressing the challenges of mental illness and suicide.

“And why we as leaders are talking more often and more openly about mental health.”

The Coalition will also:

  • Guarantee funding for youth mental health services, including headspace and six Early Psychosis Youth Services
  • Spend $30 million to trial new digital technologies to ensure access to mental health services wherever and whenever needed 24/7.
  • Strengthen the National Mental Health Commission, which will provide independent oversight of our mental health reforms.

Minister for Health Sussan Ley said the Coalition would also establish a $12 million Suicide Prevention Research Fund to support targeted research to develop and evaluate regional suicide prevention models and provide a best practice hub of resources.

“The Coalition Government understands the impact of depression, anxiety and poor mental health on both individuals and our productivity as a nation, is significant,” Ms Ley said.

“Our mental health reforms will result in better personalised support and care, greater opportunity and better lives for Australians.

“We are a Government that made mental health a first term priority and this announcement demonstrates our commitment to ensure it remains front and centre

Peak body welcomes Coalition plans and funding pledges to support Australians to stay alive

Suicide Prevention Australia welcomes The Coalition’s $192m suicide prevention and mental health plan announced today. This follows last weekend’s announcement of support for suicide prevention and mental health by the Australian Labor Party.

SPA CEO Sue Murray says of the announcement, “Lives depend on us recognising suicide prevention as a key national issue which requires the commitment of all parties supporting Australians to stay alive. At this time, when we face the highest suicide rate in 10 years, the commitment to funding and action is exactly what is needed.”

“The Coalition has not at this stage endorsed the goal of a 50% reduction in suicide deaths. We believe that setting this goal is essential to galvanise government, business and community action as has occurred in Scotland and other countries. That said, we welcome the commitments announced today that are, in the most part, aligned to our Election Manifesto for Suicide Prevention and the Mental Health Commission Review Report recommendations.”

Key points include:

  • $12M to establish a fund for targeted suicide prevention research, as suggested in the National Research Plan for Suicide Prevention
  • Commitment to funding 12 regional suicide prevention trials, as suggested in the National Mental Health Commissions Review
  • Support for a Crisis Text service design and trial led by SPA member Lifeline
  • Funding to open an additional 10 headspace centres to support our youth
  • Investment into Synergy project to advance technology capability
  • Continued funding for six early psychosis centres
  • Grant to College of Mental Health Nurses to fund workforce development strategy
  • National Mental Health Commission reprising its role as the independent statutory authority.

What are other parties saying about suicide prevention? Read our summary.

What are our members and colleagues saying? Read our summary.

Download the Suicide Prevention Australia 2016 Election Manifesto

New investments in mental health welcome

Mental Health Australia has welcomed today’s announcement that a re-elected Turnbull Government would make significant new investments in mental health.

“$192 million of new investment in mental health represents a welcome boost to programs and services,” said Mental Health Australia CEO Frank Quinlan.

“This kind of investment will save lives.”

“Australia faces major challenges in mental health and suicide prevention and the investments announced today will have a significant impact.”

“An independent National Mental Health Commission (NMHC) could also provide much needed accountability to a system undergoing unprecedented reform.”

Today’s announcements include the following measures:

  • Independent status for the NMHC
  • Implementation of the twelve suicide trial sites recommended by the NMHC Review
  • A new $12 million suicide research fund
  • Investment to support the further development of the Mental Health Digital Gateway
  • An additional ten headspace centres
  • Secure funding for Early Psychosis Centres until 2019
  • Funding for Lifeline for “follow up text messaging”
  • Funding for the Australian College of Mental Health Nurses to explore “workforce issues”

Mental Health Australia has updated its report card detailing the mental health commitments from all three major parties contesting the forthcoming election.

“It is encouraging the leaders of the major parties have all made specific commitments to mental health during this election campaign,” said Mr Quinlan.

Regardless of who wins the 2 July election, the process of mental health reform will require a decade long commitment to improving mental health services and programs.

Mental Health Australia’s updated report card, along with each of the parties’ full responses, can be downloaded here – https://mhaustralia.org/election-2016

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Page 1 V4

NACCHO Aboriginal Health Newspaper

Download a free PDF copy 29 June

Tuesday : NACCHO CEO plus The Greens

Wednesday : NACCHO Chair Matthew Cooke plus Members

Thursday : Labor Policy

Friday : Coalition Policy

NACCHO Mental Health Week : Time for a new deal on Aboriginal and Torres Strait Islander mental health

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“The National Mental Health Commission Review into mental health, released in April, called for Indigenous mental health to be made a national priority with a new ‘Closing the Gap’ mental health target and yet nearly four months later there doesn’t appear to be any progress,

“We also urgently need for our mental health and alcohol and other drugs services to be under the auspices of the Federal Department of Health rather than being separated into the Department of Prime Minister and Cabinet where it currently is.

This illogical separation makes coordination of health services more difficult; it is an entirely avoidable obstacle to success and the new Turnbull Government must reverse it,”

QAIHC CEO (and NACCHO Chair) , Matt Cooke, said that there were immediate steps that Governments should take to improve the effectiveness of mental health services to Aboriginal and Torres Strait Island peoples (see QAIHC full press release below )

The healing potential of wild landscapes is being used to counter the devastating impact of the history of colonisation on Indigenous mental health in the Kimberley.

FROM THE ABC Kimberley

It may look like a simple fishing trip in the vast landscape around west Kimberley’s Fitzroy River.

But the four-wheel-drive trailing a plume of dust across the seemingly endless mudflat is at the forefront of a progressive mental health initiative running out of the small town of Derby.

For four years, Aboriginal mental health worker James Howard has tackled some of Australia’s worst mental health statistics by going bush and building relationships with other Indigenous men.

“Just with my men I’ve been taking out, I’ve seen them get a bit of confidence in talking with other people,” he said.

Each week the Derby men’s mental health group goes bush for the day, cleaning up popular fishing destinations, wetting a line and enjoying the therapeutic benefits of the country.

Mr Howard leads the group with gentle, unassuming wisdom and a legendary ability with a throw-net and fishing line.

While he loves the celebrations that follow the catching of metre-long barramundi, Mr Howard prizes the impact the group has had on its members above all else.

In particular he remembers a member of the group who taught him what was really happening when they went bush.

“I think it’s the ultimate success the group can have, is after three months he told me, ‘I won’t be able to come out next week because I’m doing a computer course at TAFE’,” Mr Howard recalled.

“Ever since then I’ve seen it as not just taking them fishing, I’ve seen it as something that could be greater, and could give them a kick-start.”

But just having Indigenous men join the group is a big step in providing support.

“Another benefit is even coming into the mental health office; they’ve got that connection there,” Mr Howard said.

“I’m probably not seen as a mental health nurse or a caseworker, I’m seen as James.”

Culture and colonisation in Indigenous mental health

It’s exactly what has been missing from mental health services for Indigenous people, according to psychologist and national mental health commissioner, Professor Pat Dudgeon.

Professor Pat Dudgeon

“Often Aboriginal and Torres Strait Islander people are presenting at emergency departments with severe mental health problems, rather than engaging in services early and getting treatment in a preventative way,” she said.

Dr Dudgeon said mental health services had failed to reach many Indigenous people because they had not been culturally appropriate or locally controlled.

“No matter where the Aboriginal or Torres Strait Islander group are, there is cultural difference,” she said.

“A lot of people forget about that and they think that the same method, or program, or treatment can be used for mainstream and then for Indigenous groups.”

As well as cultural differences, Dr Dudgeon said understanding the pervasive role of history was essential to improving Indigenous mental health.

“There has been a dreadful history of colonisation. People have been removed from location, they’ve had their culture denigrated, children have been stolen off families,” she said.

Although Australia’s colonisation was historical, Dr Dudgeon said it was an overarching force in contemporary Indigenous mental health.

“We’ve got all the statistics on that about poverty, lack of employment, education, etcetera etcetera; they’re still those consequences of colonisation,” she said.

The therapeutic benefits of country

Chris is one of the Derby men’s mental health group’s success stories.

When he first joined the bush trips, he was struggling to cope with severe schizophrenia, exacerbated by alcohol abuse.

“I was really bad. I had to spend a couple of times in a mental institution,” he said.

Over three-and-a-half years, the combination of the bond he formed with Mr Howard and the healing influence of the wild landscapes have transformed Chris.

“You think real hard, and when you think too hard you get paranoid. So coming out here with James, that takes that all away,” he said.

“It helps you to relax, like switch your mind off, and all you’ve got to do is have patience now and wait for the barra to bite.”

Over time, Chris has learnt how to transfer the peace of mind found in the bush to other parts of his life.

“When you go home, it’s back there, but you reflect on the day that you had and things are sweet,” he said.

It’s an experience that has given Chris some power over his mental illness, and optimism for his future.

“I suffer from schizophrenia, but I don’t let that word get to me,” he said.

“It’s still with me, but I’m slowly getting out of it.”

QAIHC Press Release

Time for a new deal on Aboriginal and Torres Strait Islander mental health

Queensland’s Aboriginal and Islander community-controlled health organisations have called for greater coordination in the funding and delivery of mental health services.

At the start of Mental Health Week, the sector’s peak body, QAIHC, said today that the particular and unique circumstances faced by Aboriginal and Torres Strait Islander peoples required a unique approach to improving mental illness.

QAIHC CEO, Matt Cooke, said that there were immediate steps that Governments should take to improve the effectiveness of mental health services to Aboriginal and Torres Strait Island peoples.

“The National Mental Health Commission Review into mental health, released in April, called for Indigenous mental health to be made a national priority with a new ‘Closing the Gap’ mental health target and yet nearly four months later there doesn’t appear to be any progress,” said Mr Cooke.

“We also urgently need for our mental health and alcohol and other drugs services to be under the auspices of the Federal Department of Health rather than being separated into the Department of Prime Minister and Cabinet where it currently is.

“This illogical separation makes coordination of health services more difficult; it is an entirely avoidable obstacle to success and the new Turnbull Government must reverse it,” Mr Cooke said.

“The continuing high rates of self-harm, suicide, incarceration and substance misuse among Aboriginal and Torres Strait Islander people are indicators that much more needs to be done and we just don’t have the luxury of time; changes are needed right now.”

Mr Cooke also called for greater investment into workforce training to create a new cohort of Aboriginal and Islander mental health workers and counsellors.

“Much more work is needed to open pathways to university degrees in psychology and psychiatry for Aboriginal and Islander people.

“There are currently only about 80 Indigenous psychologists in the country and we need about six hundred if want to achieve parity with the population. We need trained mental health workers in every one of Queensland’s 24 community-controlled health services to begin tackling the heartache of suicide and self-harm in particular,” he said.

Mr Cooke said that there are many examples of extremely successful community-based Aboriginal and Torres Strait Islander mental health initiatives in drug rehabilitation, suicide prevention and other mental health related challenges.

“Initiatives such as the QAIHC ‘Lighting the Dark’ Suicide Prevention Program which was delivered across 10 communities in Queensland have been well received by community as an effective means of addressing suicide.

“QAIHC is partnering with St Johns to roll out Aboriginal Mental Health First Aid across our community controlled health services; increasing individual awareness of the risk factors and providing them with skills in working with individuals who are experiencing social, emotional wellbeing, mental illness or suicidal ideation. These initiatives will save lives,” said Mr Cooke.

He also referred to the National Empowerment Project currently underway in Kuranda and Cherbourg as another example of a holistic approach using culture and spirituality to empower local people and reduce the terrible burden of mental illness.

“What we truly need from Governments is a better directing of funding and a sensible approach to removing obstacles that stand in the way of community-based solutions,” he concluded.

“We have the will, the intellect and the determination to address the mental health issues in our communities; what are missing are suitable resources and a trained expert Aboriginal workforce to implement innovative programs which empower our people.

“These are the responsibilities of Governments and we remain hopeful they will take up the challenge to support us.”

NACCHO mental health news: Aboriginal mental health gap must be closed : Calma Dudgeon

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Writing in the Australian head of the 20th anniversary todays of a landmark indigenous mental health report, Tom Calma and Pat Dudgeon (pictured above)

Recommended providing indigenous Australians with the training, power and resources needed to determine and deliver our own mental health strategies, within our terms of cultural reference and understandings of mental health.

And in the article below about Aboriginal suicide

Call on governments to do more to prevent Aboriginal people choosing death. “While we take great pride in the emergence of an indigenous mental health leadership, we are also frustrated that little on the ground has apparently changed,”

FROM THE AUSTRALIAN

TWENTY years ago tomorrow, the landmark Burdekin report on mental health was launched. Among indigenous Australians it identified high rates of mental health conditions and dreadful impacts in our communities.

It recommended providing indigenous Australians with the training, power and resources needed to determine and deliver our own mental health strategies, within our terms of cultural reference and understandings of mental health.

Some things have improved in the past 20 years. Since 1993, the training of a critical mass of indigenous psychologists and other mental health workers, the establishment of the Healing Foundation, the rollout of the Aboriginal Community Controlled Health Services and the emergence of an indigenous mental health movement mean we are ready to both develop and implement our own mental health strategies.

Yet we have also seen little improvement in the statistics and a mental health gap has become apparent. At present, the rates of suicide and hospitalisation for mental health conditions among indigenous Australians are double those of other Australians. Further, poor mental health continues to exacerbate many other disadvantage gaps we suffer.

Today, one in four prisoners is indigenous, even though we comprise only one in 33 of the total population. Among them, the incidence of mental health conditions and substance abuse problems is shockingly high.

The associations between poor mental health and high imprisonment rates are clear. So, 20 years on, while we take great pride in the emergence of an indigenous mental health leadership, we are also frustrated that little on the ground has apparently changed. How then do we understand our mental health, and what might an indigenous response to the mental health gap look like?

Indigenous Australians describe their physical and mental health as having a foundation of “social and emotional wellbeing” originating in strong and positive connections to family and community, traditional lands, ancestors and the spiritual dimension of existence.

This can be understood as a protective factor against the high rates of stressors and negative social determinants (including sickness, poverty, disability, racism, unemployment and so on) that we suffer and that can lead to depression, anxiety, substance abuse and, sometimes, severe mental illness.

In the spirit of “prevention rather than cure”, then, building on culture and social and emotional wellbeing would be at the heart of any overall response to our mental health and suicide rates. We are particularly excited by research in Canadian indigenous communities that reports those with strong cultural foundations who are working to maintain and develop their culture into the future as having significantly lower rates of suicide among their young people than communities under cultural stress.

It is thought that young people from a strong cultural background have a sense of their past and their traditions and are able to draw pride and identity from them. By extension, they also conceive of themselves as having a future: a strong disincentive to suicide. Research in our communities, too, supports the idea that there is a high level of need for programs that support culture, and also those that draw on culture to ground healing, suicide prevention and mental health programs.

Cultural and social and emotional wellbeing-based policy and program development to address the mental health gap is something that indigenous Australians must lead at both the national and community level. Even with the best will in the world, Australian governments are ill-equipped to work in this profoundly cultural indigenous space.

The proper thing here is for Australian governments and others to partner and work with us. Partnership means listening to indigenous Australians and sharing power. For too long the capital in indigenous knowledge, leadership and lived experience has been marginalised and undervalued in all areas, including this one.

Such a partnership at the national level is critical because there is currently no overarching, dedicated strategic response to closing the mental health gap that both pulls together all the causal threads and recognises mental health as a potential circuit breaker in so many areas of disadvantage.

In fact, five overlapping strategies jostle in the space. An overarching plan, or policy framework, being developed under Aboriginal and Torres Strait Islander leadership is critical if these strategies are to work together towards a common goal and avoid wasteful duplication.

Such a plan would place mental health at the centre of the Council of Australian Governments’ Closing the Gap agenda. It would have a goal to close the indigenous mental health gap and inform a nationally consistent whole-of-government response that includes recognition of, and respect for, our human rights, addresses racism on a national level, and that works to complement the strategies to address disadvantage and social exclusion that already comprise much of the Closing the Gap agenda.

Placing mental health in the Closing the Gap agenda has the added benefit of harnessing the contribution closing the mental health gap could make to closing many other disadvantage gaps. In fact it is our belief that the contribution mental health conditions make to many areas of disadvantage is often underestimated – particularly in many areas that are deemed intractable. This includes lower life expectancy.

Mental health conditions, substance abuse and suicide have been estimated to account for as much as 22 per cent of the health gap. Investing in our mental health services should also be considered as a justice re-investment measure, diverting money that would have been spent on imprisonment into services that address the underlying causes of crime in our communities

. This is one possible source of the additional investment needed, and it could also help to fund the training of the required numbers of indigenous Australians to work at all levels of the mental health system, and to ensure all mental health workers are able to work competently across the cultural divide.

We call on Australian governments to support indigenous Australians to develop and deliver a national plan to close the mental health gap, and to partner with us to advance the solutions identified in the Burdekin report that have stood the test of time.

Tom Calma is a former Aboriginal and Torres Strait Islander social justice commissioner and race discrimination commissioner; Pat Dudgeon, acknowledged as Australia’s first indigenous psychologist, is a member of the National Mental Health Commission. –

Suicide maps reveal Indigenous disaster

RESEARCHERS have painted a bleak picture of suicide in Australia, using mapping technology to pinpoint clusters and hotspots like never before.

But in doing so, they have also highlighted the tragedy of an Aboriginal suicide rate that is double the norm, illustrating the need for remote and impoverished communities to be given more support, compassion and hope. Using several different techniques, based on coronial data from 2004-08, health statistician Derek Cheung and colleagues identified 15 suicide clusters, mainly located in the Northern Territory, the northern part of Western Australia and the northern part of Queensland.

While their studies had some limitations, the researchers have drawn worldwide attention to the higher suicide rate in indigenous communities – publishing their findings in the prestigious PLOS ONE journal earlier this year, and Social Science & Medicine last year – and recommended more targeted policy responses.

“Our findings illustrated that the majority of spatial-temporal suicide clusters were located in the inland areas with high levels of socio-economic deprivation and a high proportion of indigenous people,” they wrote, also pointing to higher rates among men in remote areas, and the existence of clusters in metropolitan areas. The maps demonstrate the need for not only prevention but also “postvention”, where services are directed into communities after a sudden death to help the bereaved cope.

Jill Fisher, the co-ordinator of the National StandBy Response Service, became involved in postvention counselling after a youth suicide 15 years ago was followed, on the first anniversary of the death, by the suicide of two family members.

Having received a $6 million funding boost from the commonwealth last year, Ms Fisher now co-ordinates the largest program of its kind in the world and is rolling out more services here while also briefing agencies overseas on its successes and challenges.

The program, established in 2002 by not-for-profit agency United Synergies, works with local communities to respond to crises caused by suicide.

Ms Fisher said postvention seemed to be more effective in indigenous communities “because it is based on a principle that in a crisis people come together”.

“Some Aboriginal communities start to feel that suicide is all around them, and sometimes that is erroneous and we need to deliver hope,” Ms Fisher said.

“Many people don’t realise that suicide doesn’t appear to have been part of Aboriginal culture prior to white colonisation. We have strong cultural protocols, indigenous representation and the support of elders.”

Writing in Inquirer today, ahead of the 20th anniversary tomorrow of a landmark indigenous mental health report, Tom Calma and Pat Dudgeon call on governments to do more to prevent Aboriginal people choosing death. “While we take great pride in the emergence of an indigenous mental health leadership, we are also frustrated that little on the ground has apparently changed,” they write.

If you are depressed or contemplating suicide, help is available at Lifeline on 131 114.

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