(This post has been updated with more details of winners from the Deadlys).
Some of the high achievers in Aboriginal and Torres Strait Islander health were recognised at a stunning ceremony at the Deadlys in Sydney last night, including psychologist Professor Pat Dudgeon, the Rewrite Your Story campaign, Aboriginal Health Worker Leonie Morcome from the Biripi Aboriginal Medical Service, and this publication from Magabala Books, Traditional Healers of Central Australia: Ngangkari.
(Thanks to the Healing Foundation for allowing publication of some of their photos from the Deadlys – see the bottom of this post).
Below is a lengthy interview that I did some weeks ago with Professor Dudgeon and Dr Tom Calma, co-chairs of the Aboriginal and Torres Strait Islander Mental Health and Suicide Prevention Advisory Group. It is also timely to publish it now, in the wake of World Suicide Prevention Day.
In discussing the new National Aboriginal and Torres Strait Islander Suicide Prevention Strategy, Professor Dudgeon and Dr Calma encourage Croakey readers to get involved in its implementation – by tackling racism, by becoming culturally competent, and by developing respectful working partnerships with Aboriginal and Torres Strait Islander communities and peoples.
Tom Calma also suggests that health professionals and academics could do much more to challenge the “mindless discussions” that so often are fanned by shock jocks and sensational media headlines, and he stresses the need for a consistent, long-term policy focus.
The Strategy follows community consultations that highlighted the need to focus on:
• Developing the capacity of Aboriginal and Torres Strait Islander controlled services and communities to lead and sustain strengths-based preventive activities and culturally specific approaches to healing and recovery from trauma and
• Building the capacity of mainstream services and agencies to be more inclusive and responsive to the needs and circumstances of Aboriginal and Torres Strait Islander peoples in all cities, towns and communities.
The Strategy identifies six areas for action:
1. Building strengths and capacity in Aboriginal and Torres Strait Islander communities (both community and service development).
2: Building strengths and resilience in individuals and families, through work with the universal child and family services, schools, health services, recognising that suicide risk is associated with adversity in early childhood.
3. Culturally appropriate targeted suicide prevention services for individuals and families at a higher level of risk including those with mental illness, who are in or discharged from custody, with histories of alcohol and drug abuse or of domestic violence, and some people with histories of neglect and abuse.
4: Coordinating approaches to prevention by Commonwealth, state and territory governments, between different departments, and with the community sector to ensure there is capacity within local Aboriginal and Torres Strait Islander organisations to provide preventive services.
5. Building the evidence base and disseminating information.
6: Consistent standards and quality in suicide prevention.
Q and A
Tom Calma: Some efforts have been made, but it came to a head in 2011/12 when the NT provided a report about youth suicides, that was very revealing and called for a national effort in suicide prevention.
Several years ago, I got involved at Narrogin in WA, where there had been a spate of suicides and there was a total lack of services. I was invited to convene a community meeting with about 150 people there.
It became very obvious there were no mental health services and no social and emotional wellbeing services provided. There were issues of racism talked about, taking place at high school and in the local council.
One of the outcomes was that the meeting was an opportunity to bring all the parties together, to hear about the issues from an Aboriginal perspective and to identify activities in the community that were not conducive to good community relations. For example, people felt excluded from the swimming pool and felt poorly treated there in comparison to others; and people felt isolated at the school and weren’t attending because of behaviours there.
The Council developed a Reconciliation Action Plan, which gave them the opportunity to reflect upon their practices and to address them.
Oxfam provided support to engage an Aboriginal psychologist to work within the community on a part time basis while waiting for government to respond. In other words, the response has to be whole of community development, taking a human rights approach, and informing and engaging with the community.
That community meeting did not resolve why people were taking their lives but it was an opportunity for people to understand more about some of the issues that might drive people in that direction – the impacts of exclusion and racism, and how that affects peoples’ mental state and anxiety, particularly if there is no way to get counselling. One of the big things that Sir Michael Marmot talks about is when people lose control, that has a fairly significant impact on their mental health, when they feel they are not in position to control their own being.
Pat Dudgeon: Aboriginal Torres Strait Islander suicide rates are increasing. We have undertaken work with communities to address this, such as in the Kimberley. We found that:
• Aboriginal people have particular conceptions and understanding of healing, empowerment and leadership based on their historical, political and social experiences and cultural values.
• There is a high level of need in the Aboriginal communities for a range of culturally appropriate and locally responsive healing, empowerment and leadership programs and strategies.
• Programs need to address empowerment in different ways, for different groups and in multiple settings, to accommodate differing levels of need and community, family and individual readiness.
• The content, design and delivery of empowerment programs need to have legitimate community support and engagement, and be culturally appropriate, locally based and relevant to people’s needs.
• Empowerment programs are an effective strategy for enhancing social and emotional wellbeing and addressing suicide risk factors, especially among young people.
• Programs that empower individuals to change their lives, their communities’ lives and the systems that are barriers to good social and emotional well being can have an impact on a number of key policy areas.
We are now undertaking work with national sites and similar messages are forthcoming.
Even though there has been concern about suicide and Indigenous issues, it’s worth noting that at the national level, we do not have a national Aboriginal and Torres Strait Islander Mental Health Plan, unlike the rest of the population. Indigenous mental health and social and emotional wellbeing is a complicated area and it is unacceptable for this to be assimilated or overlooked by being made part of mainstream plans.
Q: Or, to put it another way, why now? What were the factors (whether political, advocacy, evidentiary or other) that led to action?
Tom Calma: It came as quite a surprise to many people that there has never been an Aboriginal and Torres Strait Islander Suicide Prevention Strategy before. Developing this strategy had support from government, the bureaucracy and community. While there are programs out there responding to suicides in the community, we found there was not a lot of coordination or community awareness.
Pat Dudgeon: Why now? I just think it was about time. It is unacceptable that there was not a national strategy until now given the rates of suicide.
Q: What is the main message you would like to get across about the strategy to Aboriginal and Torres Strait Islander people and communities?
Tom Calma: We have a strategy, the Government has allocated $17.8 million towards the management of the strategy and towards projects that might be funded. The role of the new committee is to provide advice to the government on issues they need to consider in the allocation of this money.
Funding principles have been developed to guide the allocation of the funding, and we are encouraging government to consider applying those principles across other government agencies. They are all about community empowerment, respecting community and fully engaging with community; making sure the recipients of the money have an enduring relationship with community and Aboriginal and Torres Strait Islander people.
In the past, governments have given non-Indigenous providers money to deliver services and they haven’t always done that in a way that is going to achieve sustainable outcomes. What we’re saying is, if you’re a non-Indigenous party, you show us that you have an enduring relationship with the community and then you have a better chance of succeeding.
What we also said, which is very important, is that the money wouldn’t be one off grants but should be over a number of years so that if someone starts a project they can see it through and bed it down.
Too often in Aboriginal and Torres Strait Islander affairs we see the one off or stop-start policy – the Minister or bureaucrat gets a good idea at the time and throws a bit of money out there and then priorities change and so does the money. The impact of inconsistent program and policy advice and funding is harmful. Engaging participants in a service takes more than one year or a political cycle.
Pat Dudgeon: The main message that I’d like to get across is that the strategy is good. Maybe that’s why it didn’t happen until now – because now we have got more of a platform about what is right for Indigenous people. The principles in the strategy are very strong about community ownership, universalist approaches, and looking at colonisation, racism and a whole range of other social determinants.
If there had been such a strategy previously, the risk might have been that there might have been a more clinical individualistic, approach. When that’s applied to us, there is danger that it might ‘blame the victims’ and might not account for significant contributing factors such as the history of colonisation, ongoing poverty and racism, and the need for local community ownership and partnerships. So some approaches might have been harmful.
Q: What is the main message you would like to get across about the strategy to community organisations and services?
Tom Calma: It’s very early stage and we have to disperse the funding in a way that’s fair and equitable and will have the necessary impacts. We are now at a time of getting the community informed about what the strategies are about. We will be going through a process of seeking interest from parties to run programs, that the money is over four years.
When we previously had $4.5 million to disperse, we received bids for 150 different programs seeking almost $150 million dollars. The demand was overwhelming.
Pat Dudgeon: My main message is use whatever you need to do to prevent suicide. Ultimately, however, the local communities have the answers; they know what the issues are and they know what the solutions are so we need to help support them to come up with their own programs and services to prevent suicide.
Q: What is the main message you would like to get across about the strategy to mainstream services?
Tom Calma: Our advisory group has an MOU with the National Mental Health Commission on how we can work more closely together and particularly the way we can inform the national agenda that they’re pushing on Contributing Life Strategy.
That resonates with what we want to do, which is the whole of life approach. We are establishing good working relationships with the Mental Health Council of Australia and that will grow over time, as it will with other bodies that are working in this area.
As an example, we want to engage more with the First Peoples Disability Network Australia to ensure that they are able to recognise people with mental health issues and with federal agencies like Disability Care Australia, making sure that out of all their funding there are specific targets for Aboriginal and Torres Strait Islander people and that they do recognise in their funding that people with psychological, psychiatric and disability issues are recognised. That’s still a work in progress – too often we think only of physical disability and not the other.
I’m an ambassador for Suicide Prevention Australia, so we have a good working relationship with them. Our new committee only had our first meeting in mid June. The calibre of the people of this committee is very high level.
One of the key observations is there is no central coordinating body for Aboriginal and Torres Strait Islander mental health and social and emotional wellbeing, and suicide prevention. The Healing Foundation is dealing with social and emotional wellbeing. We don’t have a collective body – nothing like the model of the Close The Gap steering committee which has all major Indigenous and non Indigenous peak bodies coming together every quarter and strategising and is very potent. As a ministerial advisory group, we can’t go and do advocacy as a group. For example, which body is talking to political parties about Aboriginal and Torres Strait Islander mental health issues?
Pat Dudgeon: The message for mainstream services is that if people come seeking help – help them. But also look at ways of building relationships into the Aboriginal community and into Aboriginal community controlled organisations and ensure that you are culturally competent. This is not a new message, Aboriginal people have been calling for the need to be heard for some time. In the Hear Our Voices report we quoted June Oscar:
It is a story of colonisation; the threat of losing our cultural authority to manage our societies; and the despair that has come from that disempowerment. It is a story of grief and trauma and the continued pain of living with grog, drug and violence. It is a story that academics and journalists write about us as though we are victims of history that we can do nothing about. And within their stories about us is an acceptance that the paternal hand of government will determine the nature of our welfare and even the nature of our rights. I want to tell a different story. It is about how Aboriginal people can be the authors of our stories and not passive and powerless subjects in stories told and written by others (Oscar, 2009).
Q: What is the main message you would like to get across about the strategy to the wider Australian community?
Tom Calma: This strategy has been developed after widespread national consultations and inputs from bodies with written submissions and workshops. So it’s a considered strategy but it’s not set in stone, and it will evolve as we go out.
We want people to know and particularly family to know there is support out there. There is a lot of support through Headstart. We have programs now through the ATAPs, through Medicare Locals and Aboriginal Medical Services.
What we’ve seen so far in a lot of the programs is that it’s about empowerment, community education and information, helping people understand where services are available, developing resources people can use, making sure there is community education to address issues like inclusion and to address racism.
Separately we’re working on issues related to justice and justice reinvestment. Most of those incarcerated have a mental health issue, whether or not it’s diagnosed before they get to prison. We have to make sure there is support in post release programs. It takes a lot of awareness raising.
Pat Dudgeon: The main message for the wider community is that it is appalling that the Aboriginal suicide is twice the rate of other Australians; I don’t think everyone is aware of this. I think there is an ignorance about that. What I’d say to the broader community is that we’ve got a long way to go.
Despite all our great achievements in Reconciliation (she points to the Aboriginal flag flying outside the Canberra hotel where we are chatting) we have a way to go to understand Aboriginal culture and history and to own the oppression that colonisation has impacted on Aboriginal people and to work towards a society where all cultures and particularly Indigenous culture is recognised and valued.
Q: What is the main message you would like to get across about the strategy to Governments?
Tom Calma: It’s about responding to community driven programs and solutions. People want to get engaged, they need the support, sometimes moral support, sometimes financial support to address these issues.
Government needs to understand that there is not a single issue why people suicide; there could be a whole range of different reasons. We have to look at multiple strategies and approaches. We need to have a consistent approach that has to evolve and it has to have funding support over a generation for some of these issues.
To address issues of mental health and suicide you have to address some of the other determinants – housing, inclusion and racism are big contributors, and the loss of control that occurs when government policies take control away from people with policies like income management and the alcohol controls in the NT, Qld, WA and SA.
Pat Dudgeon: The main message for governments is to fund Aboriginal programs that support Aboriginal people to develop good funding models and submissions and then walk with them and assist them to deal with their own issues.
Q. The document notes that implementation of the Strategy is everyone’s business. How might Croakey readers contribute – whether at a personal or professional level – to the strategy’s implementation?
Tom Calma: The mantra that the Australian Human Rights Commission is championing – that racism stops with me. That campaign is about self-reflection, are we perpetrators as individuals and as organisations? We can all take on roles of being champions within their organisations of this issue?
It’s about trying to create opportunities through employment programs.
For me a really big one – and I throw this challenge out to health professionals and academics – challenge the newspapers, challenge the shock jocks. We are the ones who have got that respectability. If you are an academic you have the mantra of academic freedom, you are a specialist in a discipline you can talk with authority. We let a whole lot of mindless discussion take place out there unchallenged. I say this to academics – You’re the ones who’ve got to get active, the Indigenous and non-Indigenous academics.
Pat Dudgeon: Croakey readers can contribute by being aware of Aboriginal Torres Strait Islander history and culture in the first instance and the current disadvantage and why our statistics are as they are. They can also help by becoming culturally competent, and working with Aboriginal people in partnerships at an individual level, and at a professional level. Our history is of a struggle for equality and to have our rights recognised and to be recognised as human beings – and that struggle is still with us. Our struggle is about us doing it ourselves with support. Often people rush in and take over and that compounds disempowerment. I’d encourage readers be mindful of how you deal with and work with people.
Q: Media coverage of suicide is a controversial topic. How would you like to see the media cover the issue of suicide among Aboriginal and Torres Strait Islander communities?
Tom Calma: Dan Harrison at the SMH did a story about suicide and changed what had been an overly sensational headline after checking back with me. It was a fantastic story. This is what journalism should be about. Every bloody statistic is a family member and that’s what we have to understand about this: families feel bad enough about this, they’ve lost somebody, they often don’t know why, they will continue questioning themselves as to whether they could have done something differently. We don’t want media coverage making them feel guilty. Suicide Prevention Australia has some good examples of how to report on suicide, and to avoid guilt-laden language.
Pat Dudgeon: The media either sensationalises it or steers clear because it’s too sensitive. We need to have more stories that are done in an humane and empowering way.
Q: What sort of media stories are not helpful (and why)?
Tom Calma: SANE Australia put out some good guidelines for media and I’d encourage all journalists to consider those, and always let people know who might be reading that there is help available.
Pat Dudgeon: In the NMHC Report Card, there are two narratives by Indigenous consumers and I thought they were very well done. Those two people felt really empowered by the way that they were treated so that is probably a good example.
Q. The Strategy emphasises the diversity of communities and the need for locally responsive and appropriate plans. How can communities get the right balance between “reinventing the wheel” and “local ownership and reality”?
Pat Dudgeon: There will be a centre for best practice in Aboriginal and Torres Strait Islander suicide prevention, and this will to ensure that we get knowledge transfer happening across different groups. We also need to encourage their own creativity and local knowledge. The Healing Foundation has an approach that encourages local ownership, yet also brings people together so that their knowledges are shared.
Q. The Strategy follows Marmot’s take on “proportionate universalism”, saying that activities should, where possible, be implemented for the widest possible benefit for the Aboriginal and Torres Strait Islander population, but with proportionate additional effort for those at greater risk or disadvantage. Do we know how many and which communities are at greater risk and so need more help?
Pat Dudgeon: I agree with proportionate universalism. A good approach is to facilitate peoples’ empowerment and wellbeing and change the circumstances in which they live. Suicide is not an event on its own; it is the end result of a whole lot of psychological distress. We can’t undo the past, but if we can change peoples’ circumstances and build on their resilience and ensure there are good support networks and make sure they are empowered, that will overcome a lot of issues. And there also needs to be direct intervention/services put in place. There needs to be a range of different options, not only one in itself.
Q. Are there any communities or projects whose work has been effective in reducing suicide rates (or some other measurable impact) that you are able to mention or point readers to?
Q: What are the major barriers to the strategy’s effective implementation?
Tom Calma: If the new government wants to change the existing strategy for their own approach. It is only just starting, should there be a change of direction, it would undermine all this work. We need a non-partisan approach; the same steady hand approach is needed for Indigenous tobacco control.
Pat Dudgeon: Funding, funding. There needs to be more funds available for people to do things. I know so many local Aboriginal community people who are really working hard, often on very little money for the community and that is a common story.
Q: What are the major enablers for the strategy’s effective implementation?
Tom Calma: Time. Time to get it understood and to get good programs out there. One of the discussions we’re having is to establish a national centre of best practices so we can collectively look at what is happening in Indigenous mental health and suicide prevention, both nationally and internationally.
Pat: The principles of the strategy are the big enablers. It’s very much valuing local knowledge, community-driven, and based on strengths and resilience.
Q: In ten years time, how should we judge the success of the strategy and its implementation? What are some concrete measurable objectives you would like to see achieved by then?
Tom Calma: That consistent funding continues and we have strategies up until 2030.
Another measure is that in ten years we will see an elimination of cluster suicides, and greater presentation to mental health services by Aboriginal and Torres Strait Islander people and that people, even in the most remote areas, can get access to services.
I don’t think we will ever eliminate suicide, but we will have a community where it occurs less often and that understands more about early identification of some of the behaviours that might lead to self-harm and suicide.
Pat Dudgeon: In ten years time, the strategy has been successful if the community in its broad sense has been well resourced to implement it. And that it’s been properly implemented and we see a reduction of suicides and other psychological and mental health problems. One thing I’ve noticed lately is that governments are accepting that with Indigenous policy that culture is a key element – which I find very inspiring.
Q: In May, the Government announced $17.8 million in funding over four years for the strategy. Is this enough? What amount is needed?
Tom Calma: What we don’t want governments to do is to abrogate on their responsibilities by offloading responsibility to other parties. This is about a partnership; if we look at it from a social determinants of health perspective, it’s got to be a whole range of other agencies engaged in this and working collaboratively. It’s also about making sure that funding approaches – the two major funders are DoHA and FAHCSIA – that there is a level of coordination to eliminate duplication and competition.
Pat Dudgeon: It’s a good start but there needs to be more coordinated commitment. There needs to be more coordination amongst other expenditure. Some communities want to do cultural activities and are not able to get funding for that. I would consider these as working towards strengthening culture and therefore resilience.
Q: Do you have any stories to share about what you’ve learnt out of being part of this process?
Tom Calma: I’ve been really impressed by how committed people are to want to work in this space. I’ve really gained an empathy with people who have lost somebody, and to try and understand a little from their perspective. It’s a very hard place to be because many people don’t know why people have taken their lives. That’s an ongoing issue, I know there are a lot of hurt people because they still feel there’s not enough provision of services or support out there.
There are a lot of committed people out there who want to make a difference, who need a bit of support and guidance to be able to do that. The peak bodies are all very keen to work with Aboriginal and Torres Strait Islander people and we very much encourage that. We want to foster and develop and grow collaboration and partnership with all parties – government, non-government, and community sector organisations.
Pat Dudgeon: I think the strategy is good but our job – and that includes the Aboriginal leadership too – is to make sure it’s meaningful on the ground because Canberra is a long way from those communities out there.
Lifeline 13 11 14
Suicide Call Back Service 1300 659 467
Kids Helpline 1800 55 1800
Note: The Deadlys will air on SBS ONE on Sunday 14 September at 9.30pm and will be repeated on NITV on Wednesday 18 September at 9.30pm.
Declaration: Professor Pat Dudgeon is one of Melissa Sweet’s PhD supervisors.