Introduction by Croakey: The coming weeks and months are expected to bring community-wide mental health challenges, and urgent action is needed to address the increased risk for Aboriginal and Torres Strait Islander peoples.
In a new report – A National COVID-19 Pandemic Issues Paper on Mental Health and Wellbeing For Aboriginal and Torres Strait Islander Peoples – 30 leaders in Aboriginal and Torres Strait Islander health write that self-determination and targeted funding will be critical in averting a mental health crisis.
The authors write:
The current pandemic mental health plan and system is not sufficient to prevent the worst-case scenario for Aboriginal and Torres Strait Islander peoples in the predicted new mental health and suicide epidemic.
In response to the COVID-19 pandemic, the Federal Government provided extra investment in mental health support. Yet, despite known risks, funding has been largely directed to mainstream services that will not meet the specific needs of Aboriginal and Torres Strait Islander peoples and communities alone.
Prior to COVID-19, Aboriginal and Torres Strait Islander peoples already faced health and mental health disadvantages and inadequate and inequitable access to mental health care.
Suicide rates among Aboriginal and Torres Strait people are double those of other Australians. An increase in suicide rates is now predicted. The impacts of the COVID-19 pandemic and health response on mental health will be devastating if not managed appropriately.
Culturally safe, trauma-informed, lived-experience solutions that respond to the health and wellbeing needs and diversity of Aboriginal and Torres Strait Islander peoples and communities have been established, but are chronically under-resourced.
Earlier this year, a national Aboriginal and Torres Strait Islander COVID-19 working party was convened through the Transforming Indigenous Mental Health and Wellbeing Project at the University of Western Australia to produce an independent report – A National COVID-19 Pandemic Issues Paper on Mental Health and Wellbeing For Aboriginal and Torres Strait Islander Peoples – to address the specific mental health, and social and emotional wellbeing needs of Aboriginal and Torres Strait Islander peoples in Australia.
Call for immediate action
The report calls for a coordinated response based on best practice research in Indigenous mental health and social and emotional wellbeing.
Indigenous governance must be prioritised to manage the COVID-19 recovery in communities through equitable, needs-based funding to support strengths-based, place-based, Indigenous-led, and community-led initiatives that address the social and cultural determinants of health and wellbeing.
The report has five recommendations:
- Self-determination – Support Aboriginal and Torres Strait Islander leaders and organisations to lead the pandemic mental health responses for their peoples and communities. This calls for direct funding to Indigenous organisations to fund Indigenous-led actions which will best meet the needs of Indigenous peoples, families, and communities.
- Health and mental health workforce – Improve the accessibility of culturally safe care that meets the needs of families and communities. It is critical to support and appropriately utilise the existing local workforce, and to create and grow a longer-term, place-based, multidisciplinary Indigenous social and emotional wellbeing (SEWB) workforce.
- Social and cultural determinants – Implement the National Strategic Framework for Aboriginal and Torres Strait Islander Peoples’ Mental Health and Social and Emotional Wellbeing 2017-2023 to enable culturally safe and sustainable approaches to improved mental health. Social determinants of health must be addressed and SEWB programs that are designed, delivered and culturally informed by Indigenous peoples must be supported.
- Digital and telehealth – Provide accessible and affordable Internet access and ensure digital and telehealth services to Indigenous communities are culturally safe and trauma-informed. An Indigenous-led helpline to be made available immediately.
- Evaluation – Implement a comprehensive quantitative and qualitative national research and evaluation program that covers urban, regional, and remote communities, promotes accountability of funding models, and enables Indigenous data sovereignty.
Lessons from pandemic response
At the time of writing the report, fewer than 60 cases of COVID-19 had been notified among Aboriginal and Torres Strait Islander peoples, representing 0.8% of all Australian cases.
Our communities have been kept physically safe through a highly successful COVID-19 health response due to the innovation, leadership, and management of the Aboriginal community-controlled health sector (ACCHO), led by National Aboriginal Community Controlled Health Organisation (NAACHO) and peak organisations that were prepared to respond independently and early in the pandemic. This was highlighted in the Go8 Report.
Other factors contributing to this success were: the united response of diverse sectors, including health, education, land councils, and government agencies: communities were protected and prepared for lockdown; and effective local communication strategies were developed.
A case study* included in the report outlines a successful communication initiative in which elders, cultural educators, former politicians and health professionals from Darwin, Barunga, Lajamanu, Wurrumiyanga and Galiwinku created five short videos in English, Kriol, Warlpiri, Tiwi and Djambarrpuyngu catering to the largest language groups across the Top End of the NT.
In addition to the medical messages, which were workshopped with leaders (not delivered as a script), community concerns were addressed. Smart phones were used to film messages in selfie mode, by grandkids, via video conference and by a dialysis nurse in Lajamanu, 900km southwest of Darwin.
Messages were back translated to the non-Indigenous English-speaking video producers by other language speakers.
To rapidly disseminate the messages, videos were freely shared with government departments, clinicians, Aboriginal community-controlled health organisations, chronic illness peak bodies, local radio and TV networks, and Facebook (including remote community noticeboards), Twitter and health professionals WhatsApp groups (with a message encouraging clinicians to show patients videos). One month after posting, the videos reached 20,000 views.
Another case study in the report details the RunRona initiative. In the face of COVID-19, the Victorian Aboriginal organisation Clothing the Gap launched a virtual event designed to combat the rising physical inactivity, social isolation, and disconnection throughout Australia.
RunRona is an example of an independent and un-funded self-determination initiative supporting community health and wellbeing through engaging and meaningful health promotion.
The organising team behind RunRona was made up of a collective of Aboriginal health promotion practitioners, personal trainers and communication professionals from Clothing The Gap and Spark Health Australia.
In total, 4,114 people registered to participate in the event and got active with their friends and family over the weekend of 30-31 May. The team are proud that Aboriginal and Torres Strait Islander people made up at least 20 percent of registrations.
Innovative models of care
COVID-19 provides an opportunity to establish innovative and effective models of health care. The COVID-19 response by the Aboriginal and Torres Strait Islander COVID-19 Health Advisory Group, working with Indigenous communities and organisations has shown that the ACCHO network is extremely effective and agile, capable of planning, developing, and implementing early intervention, prevention, and response services for Indigenous communities.
This health response has demonstrated the importance and impact of self-determination in promoting the health and wellbeing of Indigenous peoples in contemporary Australia.
A successful mental health pandemic response for Aboriginal and Torres Strait Islander peoples requires a consistent and open acknowledgement of self-determination as a central factor needed to address the inadequacy of mainstream services for Indigenous peoples and the local workforce shortages.
* Excerpt used with permission from the author and taken from Kerrigan, V., Lee, A., Ralph, A, & Lawton, P. (2020) Stay Strong: Aboriginal Leaders Deliver COVID‐19 Health Messages.
Pat Dudgeon (Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention; Poche Centre for Indigenous Health; University of Western Australia); Kate Derry (University of Western Australia); Kerry Arabena (Thirrili; University of Melbourne); Tom Brideson (Gayaa Dhuwi Proud Spirit Australia); Sheree Cairney (Flinders University; Interplay Project); Tom Calma (Poche Indigenous Health Network; University of Canberra; University of Queensland; University of Sydney); Tania Dalton (Australian Indigenous Psychologists Association); Leilani Darwin (Black Dog Institute); Belinda Duarte (Culture Is Life); Danielle Dyall (Aboriginal Medical Services Alliance Northern Territory); Graham Gee (Murdoch Children’s Research Institute; University of Melbourne); Paul Gibson (Indigenous Allied Health Australia); Paul Gray (Australian Indigenous Psychologists Association, Jumbunna Institute, University of Technology Sydney); Allan Groth (Indigenous Allied Health Australia); Tanja Hirvonen (Australian Indigenous Psychologists Association; Flinders University); Chris Holland (Gayaa Dhuwi Proud Spirit Australia); Carolyn Mascall (Langford Aboriginal Association; Relationships Australia); Rob McPhee (Kimberley Aboriginal Medical Services); Helen Milroy (Gayaa Dhuwi Proud Spirit Australia; University of Western Australia); Jill Milroy (Poche Centre for Indigenous Health; University of Western Australia); Janine Mohamed (The Lowitja Institute); Justin Mohamed (Commissioner for Aboriginal Children and Young People, VIC); Donna Murray (Indigenous Allied Health Australia); Kristen Orazi (Kimberley Aboriginal Medical Services); Angela Ryder (Langford Aboriginal Association; Relationships Australia); Rachael Schmerl (Thirrili); Gracelyn Smallwood (James Cook University); Stewart Sutherland (Australian National University); Richard Weston (Secretariat of National Aboriginal and Islander Child Care); Michael Wright (Curtin University).