The quality of care provided to Aboriginal and Torres Strait Islander people in custodial and forensic systems needs improving, according to Dayna Veraguth, a Diversional Therapist with extensive work experience in juvenile justice and hospital settings.
Below, she explains the rationale for a new resource that aims to help increase awareness of culturally safe and effective, evidence-based wellbeing programs in these settings.
You can download the resource at this website: Challenge Yourself to Reduce Aboriginal incarceration.
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Dayna Veraguth writes:
Health professionals working in custodial and forensic systems have a responsibility to improve the care they provide to Aboriginal and Torres Strait Islander people.
This will require a significant shift for many health professionals working within these systems, to ensure their practice is culturally safe and that their clients have access to effective, evidence-based programs.
It is also important that these staff become more familiar with Aboriginal and Torres Strait Islander concepts of healing and social and emotional wellbeing, so that these holistic approaches can be integrated within frontline services.
In particular, it is important to incorporate more cultural and spiritual elements into the daily lives of Aboriginal and Torres Strait Islander people in these settings.
As well, these settings also need to make conscious efforts to increase the employment and presence of Indigenous health workers.
In NSW, the Justice Health and Forensic Mental Health Network (JHFMHN) annual report, ‘Year in Review 2013/14’ makes clear that there is a desire at an organisational level for practice to reflect current policy and guiding frameworks.
The JHFMHN annual report outlines the strong partnerships that exist, and highlights the various services that are linked to Aboriginal Community Controlled Organisations, both upon a person being detained or admitted and upon release.
However, in my experience, Aboriginal and Torres Strait Islander people admitted to high secure acute wards have limited access to “high quality and culturally appropriate mental health services and supports”, although the importance of this is recognised in the Council of Australian Governments (COAG) Roadmap for National Mental Health Reform.
Ensuring there are cultural connections for people who are held in such wards, often for long periods of time, even years, is important for improving their health and wellbeing.
Frontline clinicians can help drive change in program delivery, through being empowered themselves, through improving their attitudes and everyday practices with individual patients, the programs they deliver or the programs and issues for which they stand as advocates.
It is well known that there is a workforce shortage of Aboriginal and Torres Strait Islander health workers, while research shows that many non-Indigenous health workers that feel overwhelmingly challenged when working with Aboriginal and Torres Strait Islander patients and their families (clustered into the following common themes, ‘don’t know how’, ‘too scared’, ‘too hard’, and learning to practise regardless).
It is thus crucial that efforts are made to improve the competence of non-Indigenous health workers in these settings.
I have developed a resource to help increase awareness of culturally safe and effective, evidence-based wellbeing programs specifically for Aboriginal and Torres Strait Islander people in custodial and forensic systems.
It is a self-paced, evidence-based learning kit, called ‘Challenge Yourself ’ and is available at this website.
It is anticipated that this resource will enhance individual health workers’ personal practice through self-reflective activities and increased cultural understanding.
It will help non-Aboriginal health workers to reflect on whether their clinical practice may in fact be a hindrance to social and emotional wellbeing through emphasising ill health. Or they may be diverting resources away from service provision and programs that have been proven to be effective for Aboriginal and Torres Strait Islander people.
We need to build up a community of health workers who are leading change collaboratively from the ground up, in line with policy.
Frontline health professionals are in an ideal position to scrutinise existing and proposed programs and enact change by advocating with Aboriginal and Torres Strait Islander people in line with what does work.
While most health professionals want to do the right thing by the patients in their care, as Dr Ernest Hunter highlights, ‘good intentions’ alone are not enough.
The literature reflects that there is huge space for improvement in the current attitudes and views of non-Aboriginal health workers towards issues of health equity, including but not limited to eliminating racism and understanding the strength of Indigenous culture and self determination.
Also needed are culturally appropriate rehabilitation programs as well as the need for an increase in connections to culture through the local community and increased links to patient’s own communities.
I would also like to acknowledge ‘Respecting the Difference’, an Aboriginal cultural awareness training framework.
This training was to have been completed by all staff by the end of 2015 as part of the ‘Good Health Great Jobs – NSW Health Aboriginal Workforce Strategic Framework 2011-2015’.
While it is unlikely that all staff have completed it and the policy is set for review late in 2016, the training is well-designed. It is comprised of a two-hour online course and a one-day face-to-face training and is extremely valuable.
• Dayna Veraguth is a Diversional Therapist with extensive work experience in juvenile justice and hospital settings. This is an edited version of a paper she submitted as a UNSW Master of Forensic Mental Health student.
• Many thanks to Dr Megan Williams, a Senior Research Fellow with the Muru Marri Collaboration in the Centre for Health Research at Western Sydney University, for facilitating this publication, and to Dayna for sharing the resource with Croakey readers.
(Further references for this article are available upon request)
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