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First Nations’ healing practices critical for cultural safety in mental healthcare

Highlighting the importance of embodying First Nations’ healing practices in mental healthcare, Dr Amy Coopes reports on an eloquent keynote by psychiatrist Dr Loyola McLean at the recent Royal Australian and New Zealand College of Psychiatrists Congress.

In addition, Coopes discusses an Aboriginal-led program in Western Australia bringing cultural safety into mental healthcare.

Bookmark this link for ongoing reports from the Croakey Conference News Service.


Amy Coopes writes:

The importance of learning from First Nations paradigms and knowledges was beautifully and eloquently described in an acclaimed address on trauma, attachment and healing to a peak meeting of trans-Tasman psychiatrists.

Psychiatrist and psychotherapist Dr Loyola McLean, identifying as a Yamatji woman, is an associate professor at the University of Sydney’s Brain and Mind Centre. She drew on wisdom and ways of knowing, both from the rich bio-psycho-socio-cultural-spiritual model in psychiatry and notions of the Dreaming, in a captivating keynote that drew a standing ovation at last month’s annual congress of the Royal Australian and New Zealand College of Psychiatrists in Sydney.

McLean, an expert in trauma-informed care and attachment, spoke to an Aboriginal paradigm where, instead of connecting stars to sketch constellations, it was the spaces between that were joined to form the whole, an “ecological matrix” where we sought coherence and understanding.

Describing herself as a woman with a “stolen story”, due to family disconnection from kin and Country as a result of Stolen laws and practices, she is still on a journey to reconnect, McLean reflected at length on the power of relationships to shape and heal, with “distrust and disgust” corrosive to connection in ways that could become pathological.

Dr Loyola McLean at RANZCP2022. Photo by Dr Usama Munir.

Connections

“Dissociation, disconnection, discoordination are at the heart of the disorders we see,” she told a packed session, describing the “co-regulation” of human contact, where “bodyminds” could be nurtured, as well as broken.

In a lyrical, often elegiac address McLean invoked the motifs of the coolamon (thaga in Wajarri) – a symbol of being both “held and held together” – and the rainbow serpent, and the “womb of the world”, a generative shared space that allowed us to imagine and deeply connect with what was possible, even and especially when, it appeared to be out of reach.

She referred to the bodymind interface as an “enchanted loom” weaving a meaningful but ever-shifting pattern from connections, whether neural, interpersonal, to cultural or country, or at a global level.

The question at the heart of it all was how – in a world where so many of us are torn – we bring the “past and present together in a way that changes the future”.

“We must co-create if we want to survive on this planet into the future,” McLean said. “We have to meet before we can move, and plenty of stuff gets in the way of the meeting.”

In Wajarri language, which McLean is learning, she said there was a concept known as nganhu wanarayimanha nurragi which, roughly translated, meant ‘we are walking home together’. Central to this notion was nganggurnmanha, a word that captured listening, thinking and remembering.

Deep listening

For psychiatrists, McLean said there was a duty of deep listening, which she described as a form of sacred custodianship and relatedness; a space for patients to be held and empathically resonated with around experiences of loss and estrangement, in a process of shared meaning-making.

Indeed, she said interpersonal co-regulation – a dynamic which the therapeutic alliance strove to emulate – was, though “not the whole story, where it begins”, a “proto-conversation” involving gaze, voice, position, arousal, shared activity on a “secure-based template” of honesty and authenticity.

Truly mutual connection offered the chance for repair and coherence of self, and for the clinician was proven to be protective against vicarious trauma.

“Health happens between us,” she said, arguing that relationality at every level needed to come into focus. “If we really want to recreate, repair and re-story this world, it’s going to take two or more.”

She described the “task of self” as something that took time and said a lot of energy went towards the organisation of our internal world, with insecure templates of self coming at great cost and trauma freezing us in “fight, flight or fawning” responses that prevented us from “going into others to heal”.

Conversely, a period of reconciliation and relational repair offered up a new narrative and chance to experience joy, which McLean said was the “fruit of deep human connection and delight” and gave life meaning and hope.

“May we be becoming the kinds of humans in fellowship that will reach out to each other with curiosity, love and compassion,” she concluded.

Cultural safety

Cultural safety in mental health was highlighted in a separate session at the Congress featuring Professor Helen Milroy from the National Mental Health Commission, a celebrated Palyku psychiatrist, author and academic.

Presenting at the session, University of Western Australia researcher Dr Jemma Collova noted the significant and ongoing disadvantage, trauma and mental health concerns in Aboriginal and Torres Strait Islander communities as a result of colonisation, genocide and discriminatory policies. This extended to and included the mental health space itself, Collova said.

Instead of recognising that Aboriginal and Torres Strait Islander cultures and complex kinship systems had allowed wellbeing to flourish over many tens of thousands of years, Indigenous knowledge and conceptualisations of health and wellbeing had been excluded and devalued, with research being ‘on’ rather than ‘with’ First Nations peoples.

She said the key to cultural safety lay in its acknowledgement of power, and the fact that it could only ever be determined by the user of a service, not the provider.

Milroy said it was also important to appreciate the nuances of cultural safety in mental healthcare as opposed to physical healthcare.

In the latter, she said, it was often an overlay to largely homogenised approaches, whereas in the former, culture shaped how the nature and cause of distress was understood, it significantly influenced readiness or ability to seek help, and was directly linked to the discrimination faced.

Instead of imposing Western-style ideas and approaches on Aboriginal and Torres Strait Islander communities, Milroy called for a greater understanding of Indigenous phenomenology – the witnessed presence of ancestors and other spirits – and appreciation of Indigenous experiences of stigma in mental health care.

Yarning circles

Dr Shraddha Kashyap presented findings from a number of yarning circles, on country, with Indigenous people on cultural safety in research.

It identified a number of important features, including Indigenous leadership, co-design and integration into methodology (for example, using art, stories or songs as data points).

In addition, the building and maintaining of community partnerships and their involvement in decision-making, and reflection on privilege and bias by those not identifying as First Nations who were involved were also identified as important.

The research found that cultural safety as understood by Indigenous people in a mental health setting would involve an “understanding and acknowledgement of Aboriginal cultural knowledge, life experience, issues and protocols” and appreciated the primacy of cultural identity.

It also revealed that there was more concern about stigma, privacy, and a greater expectation of engaging with family, community and culture in the mental health space compared with provision of physical healthcare.

Trust was fundamental and often where the relationship broke down with mainstream providers, Kashyap said. Instead of treating the illness, it was important to treat the person, with a respect for cultural protocols and healing practices.

This was echoed by Associate Professor Mat Coleman, who described mainstream service models as reductionist, diagnostic, temporary and deficit-based, with an emphasis on safety over quality of care, based on paternalistic, custodial policies and transactional incentives.

Instead, cultural safety called for a long-term investment and long-range thinking, where approaches were Indigenous-led and driven, Coleman said.

From Twitter

View Coopes’ Twitter thread on Dr Loyola McLean’s keynote presentation here.

View Croakey News Twitter thread on the cultural safety discussion here.


Dr Amy Coopes was in virtual attendance at the RANZCP Congress for the Croakey Conference News Service. Bookmark this link to see all our conf