This Thursday, November 19, is your last chance to tune in live to one of the virtual symposia currently being run by the Centre of Research Excellence: Indigenous Health + Alcohol (CRE).
The final webinar of the series will feature presentations by two CRE researchers, Lynette Bullen and Liz Dale, on the topic, How Mainstream Approaches Work for Aboriginal People.
You can join in via the link below or, if you’d like to follow on Twitter, Dr Tess Ryan will live-tweet the event from 11am-12pm AEDT. Follow @TessRyan1. You can also follow the hashtag #2020ResearchExcellence and this Twitter list.
In the lead-up to her presentation, Croakey spoke to Lynette Bullen, a Wiradjuri woman living and working on country, in the challenging setting of involuntary drug and alcohol treatment.
Ruth Armstrong writes:
A few years ago, Lynette Bullen asked herself a question.
Bullen, a Wiradjuri woman with more than 25 years of experience working in drug and alcohol care and education, had seen first hand the disproportionate harms inflicted by alcohol, on the health of Indigenous Australians. And she’d seen the hospitalisation statistics that backed this up.
Yet in her role as a Senior Clinician for NSW Health’s Involuntary Drug and Alcohol Treatment (IDAT) Unit in the NSW town of Orange, she had encountered very few Aboriginal or Torres Strait Islander patients. She wondered why.
The question has drawn Bullen out of her comfort zone to become lead researcher on a study that delves into the minds of drug and alcohol clinicians to better understand the barriers and enablers to referring Indigenous clients for life-saving involuntary care.
She will present some insights from her ongoing research this Thursday, at the final symposium of the Centre of Research Excellence: Indigenous Health + Alcohol (CRE) #2020ResearchExcellence series.
From Mothercraft to Murdi Paaki
Born and bred in Orange NSW, Bullen packed her bags for Sydney in the late 1980’s to study as an enrolled nurse. Being away from family and home was brutal, but she stayed the course and was able to get work closer to home in Bathurst when she finished her studies.
The decision to complete her Mothercraft Certificate at Karitane led her reluctantly back to the city where, after qualifying, she stumbled upon a role that would shape her career – working as a Mothercraft nurse at Jarrah House, a women’s residential substance use rehabilitation service.
She was there for the “mums and bubs” aspect of the program, but Bullen grew into the role, and undertook a certificate in drug and alcohol at TAFE to better prepare her to assist her clients.
Four years later, when a position in Orange came up at the Drug and alcohol NGO, the Lyndon community, Bullen jumped at the chance to move back home, and fully into the drug and alcohol sector, supplementing her on-the-job training with a Bachelor of Counselling from the University of New England.
She held various roles at Lyndon for 11 years, working in detox, drug and alcohol counselling and education, and community roles, before taking on a position in Lyndon’s Clinical Leadership Program, based all around the Western NSW Murdi Paaki region.
In this role, Bullen provided group education to clinicians, and saw complex clients across the vast region, encompassing the towns of Broken Hill, Wilcannia, Menindee, Bourke, Brewarrina, Walgett and beyond. When an opportunity arose to continue this work via NSW Health, she moved across to work for government.
Traversing the Murdi Paaki region by road and with the Royal Flying Doctor Service, Bullen felt immediately comfortable working in Aboriginal communities and health services.
It was during this time that she came to know about her Aboriginal heritage.
I didn’t know about my Aboriginal background. I always felt comfortable out in those services and then my Dad was doing a lot of family history and he started looking at my mother’s history.”
Via social media Bullen saw that she had Aboriginal family members on her mother’s side, but it was people she met through work who sealed the deal.
I had people out in places like Wilcannia saying, who’s your mob? And so I started going down this path of, well who is my family? I think when my mum was growing up there was a lot of shame. She was of that era when people were taken away… and in Orange there wasn’t a large population of Aboriginal people when I was growing up.
I was talking to one fellow out at Wilcannia one day and he was asking me about ‘who’s your family’ and I was telling him my grandad’s name and he looked at me and he said, ‘Do you know Myrtle’, and I said, ‘Aunty Myrtle?’ And he looked at me, and he said, ‘you got colour in you, girl’.”
Bullen says she has embraced all of her heritage.
The research question
When NSW Health’s Involuntary Drug and Alcohol Treatment (IDAT) program was being set up in Orange, Bullen joined the team, where she remains as a senior drug and alcohol clinician today.
The Orange program houses eight of the twelve involuntary beds in NSW and is a mainstream service reserved for the most complex and most unwell drug and alcohol patients.
Bullen was used to working with clients who were required by legal arrangements to engage in rehabilitation but the health needs of the IDAT patients were next level. She says:
Because their health has deteriorated quite significantly from their substance use or alcohol use, they’re frequenting the hospitals a lot more. It’s not unusual for someone to have maybe 90 ambulance callouts or hospital presentations within a three or six-month period…
The people we see have a range of medical issues – end stage liver failure, cognitive impairment, pancreatitis. You might see a 40-year-old coming in using a wheely walker because of the mobility issues due to their alcohol use. They’re malnourished. They’re really unwell.”
Admission to IDAT requires an accredited medical practitioner to sign a dependency certificate with strict criteria, and a magistrate to review the order within seven days.
It’s common for referrers to note that clients need IDAT admission because otherwise they are going to die, and it was this assertion that led Bullen to her research question.
If admission to IDAT was seen as a life saving intervention, why wasn’t she seeing more Aboriginal and Torres Strait Islander people passing through the service?
When I was working out west I was seeing so many people dying young.
And I thought we’re supposed to be closing the gap but no one’s looking at why aren’t we helping Aboriginal people to get drug and alcohol support and to improve their health outcomes.”
Becoming a researcher
Bullen had never planned to go down the research path, but did have an existing connection with the CRE’s Associate Professor Kylie Lee and Professor Kate Conigrave, having worked with them on the Handbook for Aboriginal Alcohol and Drug Work and helped voice the CRE’s Grog Survey App.
The idea of jumping into an academic stream was overwhelming but an opportunity arose via the NSW Health Education and Training Institute’s Rural Research Capacity Building Program, to which Bullen successfully applied. The program has provided her with education and support to pursue her research while working full time, as well as study days and a cohort of 17 other researchers.
It also mandates that participants have a research mentor, so Bullen approached Kylie Lee, with whom she now meets at least weekly. Once the project began, she was delighted to be invited to join the CRE as a student.
For the CRE to take me on as a student is really amazing. I feel very honoured.
That extra, intense mentorship and training and education and peer support from other Aboriginal people and students…
The education sessions that they provide us with – grammar, writing, lit reviews. I feel very fortunate. I’ve got two supports: NSW Health and the CRE.”
Bullen says cost is a major barrier to drug and alcohol clinicians turning their questions and observations into research projects and is grateful that she has been able to access both these supports cost free.
Her project has so far involved semi-structured interviews with drug and alcohol clinicians who have referred clients to IDAT. Most are “very senior and skilled” and have been open in discussing the concerns they hold when referring Aboriginal and Torres Strait Islander people.
These conversations with referrers reveal that they are often anxious about taking people off country and away from their family to undergo involuntary care, with concerns about traumatisation or re-traumatisation. This is despite recognition of significant benefits such as access to comprehensive assessment, complete health checks, and connectivity with other agencies such as NDIS.
Bullen says it’s been a worthwhile challenge to throw away her preconceived ideas when approaching this piece of work.
I’m wanting to honour the voices who are sharing their stories with me and to really think about what they’re saying, and how can we help our referrers out there who are working in difficult circumstances, to feel more comfortable and supported when they’re referring.”
The future of mainstream
Having spent most of her career in mainstream services, Bullen has some thoughts about what needs to improve.
Importantly, she wants to see more training for drug and alcohol counsellors who identify as Aboriginal, and more collaboration between mainstream and Aboriginal Controlled services.
Some Aboriginal patients don’t want to go to an AMS and some people don’t want to go to mainstream so we need to cover both – and how can we make it more accessible for people to come in?”
She would like to interview patients and their families as the next step in understanding how IDAT works or doesn’t work for Aboriginal people, “because you’ve always got to ask that question: well why? Why do we need to have people coming to an IDAT program? An involuntary program. Why do we need it?”
Working with drug and alcohol clients has its challenges, and the research has added a layer of pressure to Bullen’s already overcommitted life. There have been some curve balls, such as a gruelling bout of treatment for breast cancer a few years ago.
Chief among the many things that sustain her is “fun and a good laugh” with family, some of whom are in Orange and others further afield.
She has loved spending time in and around Bourke, Warren and Nyngan where her Aboriginal grandfather worked as a drover on sheep stations.
Stopping to notice nature anywhere will bring her joy.
People say, oh you’ve got to stop and smell the roses. I actually do. It’s so important to sit outside and look at nature.”
Spending time with her mum, who has lived with her since her father’s death, with her two dogs, and participating in Rotary gatherings and projects is enriching and stimulating.
Importantly, Bullen understands that she doesn’t carry the weight of the world on her shoulders.
The people she works with need the agency to forge their own paths. She says:
I’m not here to change the world. I’m purely here to help guide and support those who need some assistance.
Helping them back along the path. To honour where they are and to help them.”
Photographs courtesy Lynette Bullen
Lynette Bullen will present on the topic, How Mainstream approaches work for Aboriginal People, as part of the the 2020 Symposium Series for the Centre of Research Excellence: Indigenous Health + Alcohol.
Register here to join this Thursday, November 19 at 11am AEDT.
Also presenting at the webinar, is Worimi Woman and PhD candidate Liz Dale, a psychologist with over 15 years of experience working in non-government and clinical settings, including youth and adult homelessness, addiction, eating disorders and intergenerational trauma.