Volume 2 | Issue 2 | Article 1 – Dudgeon et al.

The context and causes of the of Indigenous people in Australia

Volume 2 | Issue 2 mental health and services and programs. Although there is a degree of Article 1, September 2017 commonality between the specific causes Pat Dudgeon associated with the suicide of Indigenous and University of non-Indigenous individuals, the burden and the accumulation of underlying trauma, risk factors Tom Calma and specific causes in the case of Indigenous Chancellor, individuals results in higher rates of suicide. The Christopher Holland increasing Indigenous suicide rate suggests that Consultant the overall current approach to Indigenous suicide prevention is not working. Innovative Indigenous community-led, strengths based Abstract approaches should be supported in the context of When comparing suicide in the Aboriginal and a different national approach. This includes, in Torres Strait Islander (Indigenous) population to addition to targeted responses to Indigenous that in the non-Indigenous populations of individuals and population groups at risk of Australia, there are significant differences in the suicide, empowering communities to address rates of suicide and the age groups at risk of their challenges, including those associated with suicide. The etiology of these differences includes suicide. It includes empowering communities to a history of colonisation and its aftermath heal intergenerational trauma at the individual, including a burden of intergenerational trauma in family, community-level. It includes the Indigenous population. It also includes strengthening culture and sources of resilience to contemporary disadvantage and discrimination. protect against suicide at the community level. These not only impact on Indigenous family and Keywords: Aboriginal, Torres Strait Islander, community life but also on potential sources of Australia, Indigenous, suicide, causes of suicide, social and emotional wellbeing and resilience that suicide prevention, protective factors. help protect Indigenous individuals against suicide. They also result in the greater exposure Acknowledgements. The authors acknowledge of Indigenous families and individuals to trauma, the contribution of the Aboriginal and Torres and other risk factors associated with suicide. Strait Islander Suicide Prevention Evaluation Further, they underpin those families and Project to this paper. individual’s lower access to culturally appropriate

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Introduction particular, experiences of colonization which occurred within only three to eight generations of Prior to the 1960s there are few reports of Indigenous people living today, have a collective Indigenous suicide (Hunter & Milroy, 2006). Yet dimension and can be connected to the suicide of in contemporary Australia, the Indigenous Indigenous people today. suicide rate is currently twice that of the non- Indigenous (Steering Committee for the Review Although there is a degree of commonality of Government Service Provision [SCRGSP], between the specific causes associated with the 2016). In particular, Indigenous young people suicide of Indigenous and non-Indigenous under 18 years of age are significantly over- individuals, the broader historical, cultural, represented in suicide cases of that age group political, social and economic context and the (National Children’s Commissioner, 2014). accumulation of the associated burden of underlying intergenerational trauma, risk factors Indigenous Australia is made up of two distinct and the specific causes that impact on individuals cultural groups. Mainland Aboriginal peoples, contribute to the higher rates of suicide in the who were hunter-gatherers, have inhabited the Indigenous population. continent for at least 50,000 years and have different languages and cultures. Torres Strait Understanding the causes of Indigenous suicide, Islander peoples are a different cultural group and the differences between suicide in the who make up around 10 per cent of the Indigenous and non-Indigenous population, is Indigenous population and practiced agriculture critically important to developing effective in addition to hunting and gathering. Both Indigenous suicide prevention activity. This is groups suffer similar challenges as peoples particularly so given the increases in the number recovering form colonisation. A range of cultural of Indigenous suicide deaths over the past five differences, particularly a greater collective years suggesting things are getting worse, not dimension in the culture and life of Indigenous better, and underscoring the need for different peoples, is recognised as a key difference between approaches to Indigenous suicide prevention them and the non-Indigenous population in (Dudgeon et al., 2016). Australia (Gee, Dudgeon, Schultz, Hart & Kelly, In particular, strengths based responses that work 2014). As well as the consequences of to empower communities to strengthen their colonisation, these cultural differences have cultures, address their challenges, restore implications for Indigenous suicide prevention community functioning and heal activity. intergenerational trauma at the individual, family, With reference to the Australian Indigenous community and population level are required in social and emotional wellbeing concept, culturally addition to targeted responses to individuals and defined family and kin relationships; community groups at higher risk of suicide within the relationships; the role of Elders, cultural practice; Indigenous population. Because of the greater connection to country; and spirituality and collective dimensions of Indigenous life, it is ancestors are considered among important proposed that such community-level responses collective elements of the health and mental will also support individual resilience and thereby health of individuals. Critically, they are have the potential to protect against suicide. considered to be sources of resilience and (Dudgeon et al., 2016). protective factors against mental health problems and suicide (Gee et al., 2014). Colonisation and its Conversely, as proposed by Hunter and Milroy Contemporary Impacts (2006), some Indigenous people’s self-destructive Intergenerational Trauma (including suicidal) behaviours reflect During colonisation, following an initial wave of vulnerability stemming from internal states frontier warfare, massacres and dispossession, a informed by both individual experience and the second wave (from the mid to late nineteenth potential internalisation of collective historical, century onwards) involved the dispossession of socio-economic and community factors. In Indigenous people onto reserves and their

6 Volume 2 | Issue 2 | Article 1 – Dudgeon et al. subjection to legal regimes that controlled all Hunter and Milroy (2006) associate the relatively aspects of their lives (Gee et al., 2014). This recent emergence of suicide as an Indigenous included the forcible removal of thousands of population health issue to with the closing of Aboriginal children to be assimilated into non- reserves and the end of formal legally encoded Indigenous society, a practice that has been racial discrimination. In practice, the lifting of characterised as genocidal (Human Rights and legal discrimination did nothing to address the Equal Opportunity Commission, 1997). These underlying trauma associated with Indigenous events are not only historical memories but have peoples’ experience of colonisation to that point consequences in the lives of contemporary in time. Further, while Indigenous individuals Indigenous individuals and families. A 2008 were formally made equal before the law and Indigenous population survey reported 12 per suddenly able to access both welfare and alcohol cent of respondents aged 45 years and over (i.e. without restriction, they remained socially born before 1963) had personally experienced excluded from the benefits of political, social and separation from their family (Australian Bureau economic life, including from accessing the of Statistics [ABS], 2010). health and mental health services of the time. This led to a period of what has been referred to The longer-term consequences of such removals as ‘normative instability’ that persists in some include mental health and health impacts on communities. It is proposed that this community those directly involved (ABS, 2010). More dysfunction and further disempowerment and broadly, the intergenerational transmission of loss of control within an ongoing context of trauma in the contemporary Indigenous unresolved legacies of colonisation forms the population is an ongoing effect of forcible background to high Indigenous suicide rates and removals and indeed the wider colonisation other characteristics of Indigenous suicide as a process. By this, unacknowledged or unresolved population health issue today (Hunter and trauma in previous generations is linked to Milroy, 2006). dysfunction within an extended family in later generations (Atkinson, 2002). The mechanisms The work of Chandler and Lalonde’s studies by which trauma is transmitted down generations (1998, 2008) among almost 200 British could include impacts on children resulting from Columbian (Canadian) ’ weakened attachment relationships with care communities is important in viewing the givers, challenged parenting skills and family relationship between the collective functioning of functioning, parental physical and mental illness, contemporary Indigenous communities and the and disconnection and alienation from the suicide rates among their young people. The extended family, culture and society (Milroy, studies focused on community-level protective 2005). These effects are compounded by factors against suicidal behaviours: in particular exposure to high levels of traumatic incidents and self- determination defined according to key stressors in the present (Milroy, 2005). markers:

Community Functioning  a measure of self-government; Atkinson (2012) associates intergenerational  have litigated for Aboriginal title to trauma with compounding Indigenous traditional lands; community dysfunction characterised by violence  a measure of local control over health; between community members, anti-social  a measure of local control over education; behaviours and forms of abuse that might in  a measure of local control over policing themselves contribute to suicide. However, the services; and association between intergenerational trauma and  suicide, including by such mediating factors, is yet community facilities for the preservation of to be significantly explored. The devastating culture. impacts of intergenerational trauma on  a measure of local control over child welfare Indigenous community functioning should be services; and the subject of further research including in the  elected band councils composed of more context of suicide prevention. than 50 percent women (Chandler & Lalonde, 1998, 2008).

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The studies found that communities where all of in a 2012-2013 Indigenous population health these markers of self-determination were present survey (2012 – 13 Indigenous Survey) were the had no cases of suicide. Conversely, where death of a family member or friend (reported by communities had none of these markers, youth 37 per cent of respondents); serious illness (23 suicide rates were many times the national per cent); inability to get a job (23 per cent); and average (Chandler & Lalonde, 1998, 2008). Such mental illness (16 per cent) (ABS, 2013). studies suggest the importance of community empowerment, self-determination and cultural Such life stressors are shared experiences reclamation in Indigenous community between the Indigenous and the non-Indigenous functioning and this has important implications populations. However, there is evidence for for suicide prevention in Australia. Indigenous peoples’ greater and simultaneous exposure to multiple life stressors. In the 2012- 2013 Indigenous Survey, 73 per cent of Social Determinants and respondents aged 15 years and over reported that Indigenous Suicide they, their family or friends had experienced one or more life stressor in the previous year. That Despite the achievement of legal equality by the rate is 1.4 times that reported by non-Indigenous 1960s, part of the aftermath of colonisation in people (ABS, 2013). contemporary Australia is the persistence of institutional racism and discrimination against Researchers report that 1.9 – 2.6 overlapping Indigenous people and the related concept of stressful life events are associated with low or social exclusion. McLachlan, Gilfillan, and moderate psychological distress, with between Gordon (2013) classified Australian population 3.2 and 3.6 events associated with high or very groups using a Social Exclusion Monitor high psychological distress (Australian Institute comprising 29 indicators across seven key life of Health and Welfare [AIHW], 2009). Further, domains. With this, they assessed that people at Chamberlain, Goldney, Delfabbro, Gill and Dal highest risk of experiencing deeper or multiple Grande (2009) reported that those with high and forms of disadvantage included not only very high psychological distress measured by the Indigenous people as a group, but also Kessler K-10 scale were 21 and 77 times more population groups among whom Indigenous likely, respectively, to be experiencing suicidal people are over-represented when compared to ideation. non-Indigenous people. These include groups In the 2012-2013 Indigenous Survey, 30 per cent who are also often socially excluded in their own of respondents over 18 years of age were assessed right including those dependent on income with having high or very high psychological support, those living in public housing, distress levels in the four weeks before the survey: unemployed people, people with a long-term nearly three times the non-Indigenous rate (ABS, health condition or disability, and people with 2013a). low educational attainment. Current literature suggests that, suicide might be While the associations between these social associated with chronic depression (Harris & determinants of health and mental health and Barraclough, 1997). Also in the 2012-2013 Indigenous suicide rates needs to be the subject Indigenous Survey, 12 per cent of Indigenous of further research, it is proposed that Indigenous respondents reported feeling depressed or having peoples’ greater exposure to stressors and depression as a long-term condition; compared traumatic incidents, their experiences of 9.6 per cent in the total population (AIHW, interpersonal racism; and associated use of 2015). Further, over 2008 – 2013, depression was alcohol and drugs and other factors are relevant the most frequently reported mental health mediating factors - as discussed below. related problem managed by GPs among Exposure to Life Stressors Indigenous clients (AHMAC, 2015). Associated with social exclusion and While in an Indigenous context, the associations disadvantage is greater exposure to life stressors. between exposure to stressful and traumatic The most frequently reported stressors reported incidents, psychological distress and trauma and

8 Volume 2 | Issue 2 | Article 1 – Dudgeon et al. suicide requires further research, particular causes sexual assault by Indigenous children status is not of Indigenous suicide, with significant impacts on known, data from incidents that are recorded by younger Indigenous people as indicated, have police suggest it is a significant problem been identified as: (SCRGSP, 2016).

 Relationship problems (either conflict with a There is also strong association between high partner or relationship rates of suicide among young people after leaving breakdown/separation). care (LAWA, 2016).  Broader familial and interpersonal conflict. The association between the experience of  Bereavement. Younger males were interpersonal and other forms of racism and significantly at risk. suicide requires further research to be  A criminal history and pending legal matters. understood and particularly in the Australian Younger males were significantly at risk. Indigenous population. However, from United  Unemployment and the inability to get a job. States studies with African American Again, younger males were significantly at populations, it is proposed that experiences of risk. (De Leo, Sveticic, Milner, & Mackay, racism and the vicarious experience of racism can 2011). reinforce a perceived need for constant vigilance that can become traumatisation (Carter, 2007; Exposure to Traumatic Incidents And Chou, Asnaani & Hofmann, 2012; Williams, Childhood Abuse 2015). Research also indicates an association between situational trauma and suicidal behaviors at least Alcohol and Drug Use in the general population. For example, higher In Australia, it has been reported that rates of suicide have been observed among impulsiveness is a “distinct feature of Aboriginal Vietnam veterans who have been wounded suicide which is commonly linked to excessive and/or exposed to traumatic incidents, with alcohol consumption” (LAWA, 2016, p.6). higher risk associated with higher exposure to However, impulsivity and its relationship to combat trauma (Bullman & Kang, 1996). Nadew suicidal behaviour is a complex issue that cannot (2012) assessed the exposure to traumatic be simply attributed to alcohol and drug use. incidents, prevalence of Post-Traumatic Stress Impulsivity has also been associated with an Disorder (PTSD) and alcohol use among 221 individual’s lack of ability to self-manage their individuals in remote Western Australian untreated trauma (LAWA, 2016). Trauma among Indigenous communities. Of the sample, it was Indigenous people in Australia has itself been assessed that 97 per cent of participants had been associated with alcohol and drug use (Nadew, exposed to traumatic incidents over the course of 2012). their lifetimes. Of these, about 55 per cent were In the report of the inquiry into Aboriginal youth assessed with PTSD and 20 per cent for major suicide in remote areas, the Legislative Assembly recurrent depression. Further, about 74 per cent of Western Australia (2016) reported suicide is of participants overall, and 91 per cent of those the most common cause of alcohol-related with PTSD, met diagnostic criteria for alcohol deaths among Aboriginal men and the fourth use related disorders, abuse and dependence. most common cause amongst Aboriginal All forms of childhood abuse significantly women. Further, it reported high levels of alcohol increase the lifetime risk of and and drug misuse have been noted in almost all suicide attempts. Research further suggests that documented Aboriginal suicide clusters, with the link is strongest in cases of sexual abuse many of the affected individuals being either (Legislative Assembly, Parliament of Western intoxicated or in severe withdrawal. Australia [LAWA], 2016). Cashmore and Shackel (2013) also report that sexual victimisation, both Exposure to Suicide in childhood and beyond, is a significant risk A recent Australian study reported that factor for suicide attempts among both men and by Indigenous people were significantly more women. Whilst the actual prevalence of child likely to occur in a cluster than suicides by non- Indigenous people and this was the case among

9 Published by Te Rau Matatini, 2017 both Indigenous young people and adults Overall, there is evidence that because of lack of (Robinson, Too, Pirkis & Spittal, 2016). It has access to, or use of, primary mental health care also been noted that exposure to suicidal threats, according to need, Indigenous peoples with attempts and suicide within the family or by close mental health problems are significantly associates was a common factor in suicide overrepresented in other parts of the health and clusters (Hanssens, 2010). Further, that cultural mental health system (AIHW, 2015a). and family obligations to participate in relatively high numbers of funerals and grieving rituals may Aboriginal Community Controlled also magnify the cumulative impact of these Health Services distressing events and perhaps overwhelm Critical to improving access to health and mental normal recovery processes (Silburn et al., 2014). health services is the development of trauma- informed, culturally safe general population Indigenous Peoples’ Lower services with culturally competent staff and, in particular, the expansion of Aboriginal Access to Mental Health Community Controlled Health Services Services and Programs (ACCHSs) (that are based in communities and governed by communities through a majority Lower Access of People at Risk Of Indigenous elected board) to deliver mental Suicide To Services health services to Indigenous peoples. In general population suicide research, people Where ACCHSs exist, studies suggest the who have already attempted suicide are community prefers to, and does, use them considered to be at the highest risk of suicide (at (Panaretto, Wenitong, Button & Ring, 2014). forty times increased risk) than any other population group. Further increased risk was With appropriate resources, an ACCHS is able to related to the recency of a previous attempt, the implement a culturally competent and frequency of previous attempts, and isolation comprehensive primary health care model based (Harris & Barraclough, 1997). Yet an Indigenous on the culturally shaped, holistic concepts of person who has recently attempted suicide or health understood by the communities they serve who is at risk of suicide is less likely to be able to (Gee et al., 2014). Ideally, these will include access the services they need than a non- integrated health, mental health and alcohol and indigenous person in the same position. other drug services, as well as social supports. However, significant service gaps in these areas Some researchers have suggested that the are reported (AIHW, 2015b). evidence shows that a significant number of Indigenous suicides are pre-meditated and in Apart from ACCHSs, for general population many cases intent had been communicated prior services to better support their Indigenous clients to death. As such, not only were these people to at risk of suicide, culturally safe service some degree identifiable to friends but also environments must be established. These have potentially to family and mental health and been defined as “environments that are suicide prevention service providers (De Leo et spiritually, socially and emotionally safe, as well as al., 2011). Yet in their analysis of over 400 physically safe for people; where there is no Indigenous suicide deaths in Queensland over assault challenge or denial of their identity, of 1994 and 2006, De Leo and colleagues (2016) who they are and what they need” (Williams, found that only 23.3 per cent of Indigenous cases 1999, p. 213). Further, non-Indigenous had received treatment from a mental health practitioners should not only be clinically but also professional in their lifetime, compared to 42.3 culturally competent. To that end, practitioners per cent of a non-Indigenous sample; and only should consider local Indigenous cultural 10.1 per cent of Indigenous cases were seen by a competence training as a starting point. mental health professional in last three months prior to suicide, compared to 25.6 per cent of The Aboriginal and Torres Strait Islander Suicide non-Indigenous cases. Prevention Evaluation Project’s (ATSISPEP) Solutions that Work report included examples of success factors identified in indicated service

10 Volume 2 | Issue 2 | Article 1 – Dudgeon et al. responses to Indigenous people at immediate risk cultural renewal, healing activities and support to of suicide or who have attempted suicide. In address community challenges should be a part addition to ideally being located in, or working of a different national approach as set out in the through, an ACCHS, and being trauma- 2013 National Aboriginal and Torres Strait informed, culturally safe and providing culturally Islander Suicide Prevention Strategy that is yet to competent practitioners, success factors for be fully implemented (Department of Health and indicated services included: Ageing, 2012).

 24-hours-a-day, seven-days-a-week services Culture including that operate during identified Indigenous Elders have expressed concerns critical risk periods such as Christmas time. about and see that reasons for the  Time protocols whereby a person at risk of high rates of suicide among Indigenous youth suicide should be able to see someone within could be due to a lack of cultural education that a minimum standard time. directly affects their connection to culture,  Follow up. It is critical that services assertively community and country. This is in part because follow up and provide continuing care to of an overemphasis on efforts to provide a people at risk or attempted suicide. western education and to learn English,  Clear referral pathways – between health sometimes at the expense of traditional cultural services, support services and other knowledge and learning language (Culture is Life, providers (Dudgeon et al., 2016). 2013). Access to cultural healers and the involvement of Further, a range of culturally focused responses Elders and cultural activities as a part of ongoing to suicide supported by Elders suggests that individual treatment should also be included as cultural education for young people (including important potential elements in individual spending time with Elders, and on country) and, treatment (Dudgeon et al., 2016). more broadly, cultural reclamation activities in communities has a significant role to play in Postvention support where a person has died by Indigenous suicide prevention. The Elders suicide or in a traumatic way, should be available propose that a foundation of cultural education to provide support to the family members and kin will help protect young people from feelings of of the deceased at a time of great need, but also hopelessness, isolation, and being ‘lost between to prevent imitative suicidal behaviours two worlds’ that could lead to suicidal behaviours (Dudgeon et al., 2016). (Culture is Life, 2013). In a similar vein, from Chandler and Lalonde’s Conclusion – a different and other studies, ‘cultural continuity’ theory has approach to Indigenous developed that proposes that Indigenous people (and particularly young people) that have a sense suicide prevention of their past and their cultures will draw If it is accepted that the increasing Indigenous resilience-building pride and identity from these, suicide rate shows that the current overall as well as this awareness strengthening their sense approach to Indigenous suicide prevention is not of connectedness with family and community working, then it is time for a different national (Chandler & Lalonde, 1998, 2008; Niezen, 2009). approach to Indigenous suicide prevention that Further, by extension, potentially vulnerable responds at the community level and ensures younger people will also conceive of themselves Indigenous community level control - in addition as having a future as bearers of that culture to targeted responses. Only in this way can the (Chandler & Lalonde, 1998, 2008). underlying causes of Indigenous suicide be properly addressed and protective factors from Healing culture, family and community restored. Examples of Indigenous-led emerging models, healing centres and hubs for healing Indigenous- led, strengths based approaches to intergenerational trauma and that focus on suicide prevention that include community-level culture include: (Western Australia);

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Yarrabah Aboriginal Medical Service Research (Queensland); Gallang Place (Brisbane); Yorgum The potential of cultural education and cultural (Perth); We Al-li (northern NSW); Red Dust continuity as a protective factor against suicide, Healing (central NSW), and Marumali (Sydney), particularly among Indigenous young people, among others. Further, the National Aboriginal should be explored in Australian Indigenous and Torres Strait Islander Healing Foundation settings as a highly productive line of research has developed a number of publications, and policy development. Overall, there is a need resources and programs that address for significant new investment in research into intergenerational trauma and healing and that the causes of Indigenous suicide and in particular could inform a different approach to Indigenous the potential association between suicide prevention at the community, family and intergenerational trauma and trauma, life individual level. stressors, racism and suicide within the context of a different national approach to Indigenous Empowerment suicide prevention. Further, research building on The ATSISPEP Solutions That Work report the work of ATSISPEP to expand the evidence highlighted the importance of strengths- and base for Indigenous suicide prevention activity community empowerment- based approaches to should also take place. Indigenous suicide prevention through community developed, community controlled, ------and community located suicide prevention programs that work with whole communities. High Indigenous suicide rates in Australia arise That is, in addition to targeted responses to from a complex web of interacting personal and individuals and population groups at risk of social circumstances. While some of the ‘causes’ suicide. Success factors at this level included: associated with suicide among Indigenous individuals might be the same as that in the  addressing community challenges; general population, the prevalence and  strengthening culture and building identity; interrelationships among these factors can differ  alcohol and drug use reduction programs; because of wider contextual factors: colonisation, intergenerational trauma, social determinants and  community tailored gatekeeper training and their impacts on contemporary Indigenous awareness-raising programs about suicide communities. Suicide is just one indicator of risk; distress in communities that calls for healing at  peer-to-peer mentoring, and education and collective-levels, and particularly at the leadership on suicide prevention; community level, in addition to the focus on  programs to engage young people including targeted responses for individuals and groups at sport and connecting young people to risk of suicide. culture, their country and their Elders; and  the employment of community members as References a peer workforce in suicide prevention activity (Dudgeon et al., 2016). Atkinson, J. (2002). Trauma trails, recreating songlines: The transgenerational effects of trauma in The ongoing National Empowerment Project Indigenous Australia. Melbourne, Australia: provides an example of responses that aim to Spinifex Press. empower communities by education in identifying and addressing the challenges they Atkinson, J. (2012). Educaring a trauma informed face (including those associated with suicide) and approach to healing generational trauma for Aboriginal supporting their capacity for self-governance and Australians, Goolmangar, Australia: We-Al-Li. organisation to address those challenges Retrieved from: http://fwtdp.org.au/wp- (Dudgeon et al., 2014). In 2016, the Yawuru content/uploads/2013/08/Judy-Atkinson- Corporation in Broome published a report on Healing-From-Generational-Trauma- measuring community wellbeing that could Workbook.pdf further inform community empowerment-based approaches (Yap and Yu, 2016).

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Australian Bureau of Statistics. (2010). Removal Carter, R. (2007). Racism and psychological and from natural family: The health and welfare of Australia's emotional injury: Recognizing and assessing race- Aboriginal and Torres Strait Islander Peoples [Cat. no. based traumatic stress. The Counselling Psychologist, 4704.0]. Retrieved from 35(1), 13-105. doi: 10.1177/0011000006292033 http://www.abs.gov.au/AUSSTATS/[email protected] /lookup/4704.0Chapter470Oct+2010 Cashmore, J., & Shackel, R. (2013). The long-term effects of child sexual abuse. Melbourne, Australia: Australian Bureau of Statistics. (2013). Family Australian Institute of Family Studies. stressors: Australian Aboriginal and Torres Strait Islander health survey, first results, Australia, 2012-13 Chamberlain, P., Goldney. R., Delfabbro, P., Gill, [cat. no. 4727.0.55.001]. Retrieved from T. & Dal Grande, L. (2009) Suicide ideation: The http://www.abs.gov.au/ausstats/[email protected]/Late clinical utility of the K10. Crisis, 30(1), 39–42. doi: 10.1027/0227-5910.30.1.39 stproducts/C0E1AC36B1E28917CA257C2F00 1456E3?opendocument Chandler, M. J. & Lalonde, C. E. (1998). Cultural Australian Bureau of Statistics. (2013a). continuity as a hedge against suicide in ’s Psychological Distress: Australian Aboriginal and Torres First Nations. Transcultural Psychiatry, 35(2):191– Strait Islander health survey, first results, 2012 [cat. no. 219. Retrieved from 4727.0.55.001]. Retrieved from http://firstnationcitizenship.afn.ca/uploads/A1 www.abs.gov.au/ausstats/[email protected]/Lookup/9 2_Cultural_Continuity_as_a_Hedge_against_Sui cide.pdf F3C9BDE98B3C5F1CA257C2F00145721?open document Chandler, M. J. & Lalonde, C. E. (2008). Cultural Australian Health Ministers’ Advisory Council. continuity as a protective factor against suicide in (2015). Aboriginal and Torres Strait Islander health First Nations Youth. Horizons --A Special Issue on performance framework 2014 report, Canberra, Aboriginal Youth, Hope or Heartbreak: Aboriginal Australia: AHMAC. Youth and Canada’s Future. 10(1), 68-72. Retrieved from Australian Institute of Health and Welfare. https://www.researchgate.net/publication/2399 (2009). Measuring the social and emotional wellbeing of 21354_Cultural_Continuity_as_a_Protective_Fa Aboriginal and Torres Strait Islander Peoples [Cat. No. ctor_Against_Suicide_in_First_Nations_Youth IHW 24].Canberra, Australia: AIHW. Chou, T., Asnaani, A. & Hofmann, S. (2012). Australian Institute of Health and Welfare (2015). Perception of racial discrimination and The health and welfare of Australia’s Aboriginal and psychopathology across three U.S. ethnic Torres Strait Islander peoples 2015 [Cat. no. IHW minority groups. Cultural Diversity and Ethnic 147] Canberra, Australia: AIHW. Minority Psychology, 18(1), 74-81. doi: 10.1037/a0025432 Australian Institute of Health and Welfare, (2015a). Characteristics of people who use community Culture is Life. (2013). The Elders’ report into mental health care services: Mental Health Services in preventing Indigenous self-harm and youth Australia. Retrieved from suicide. Retrieved from https://mhsa.aihw.gov.au/services/community- http://www.cultureislife.org/wp- care/client-characteristics/ content/uploads/2015/10/Elders-Report.pdf Australian Institute of Health and Welfare De Leo, D., Sveticic, J., Milner, A. & Mackay, K. (2015b). Aboriginal and Torres Strait Islander health (2011). Suicide in indigenous populations of Queensland, organisations: Online services report—key results 2013– Australian Institute for Suicide Research and 14. Canberra, Australia: AIHW. Retrieved from Prevention National Centre of Excellence in http://www.aihw.gov.au/WorkArea/Download Suicide Prevention and WHO Collaborating Asset.aspx?id=60129550815 Centre for Research and Training in Suicide Prevention. Brisbane, Australia: Australian Bullman, T., & Kang, H. (1996). The risk of Academic Press. suicide among wounded Vietnam veterans. American Journal of Public Health, 86(5).

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14 Volume 2 | Issue 2 | Article 1 – Dudgeon et al. health and wellbeing principles and practice – revised focussing on rural and remote Australia, edition. Canberra: Commonwealth of Australia. Indigenous health, education, justice reinvestment, research, leadership, reconciliation, Steering Committee for the Review of and economic development. Government Service Provision. (2016). Overcoming Indigenous disadvantage: Key indicators Professor Calma was the Aboriginal and Torres 2016. Canberra, Australia: Productivity Strait Islander Social Justice Commissioner at the Commission. Australian Human Rights Commission from 2004 to 2010 and the Race Discrimination Williams, M. (2015). The link between racism and Commissioner from 2004 until 2009. PTSD, Psychology Today. Retrieved from https://www.psychologytoday.com/blog/cultur In his 2005 Social Justice Report, Professor ally-speaking/201509/the-link-between-racism- Calma called for the life expectancy gap between and-ptsd Indigenous and non-Indigenous people in Australia to be closed within a generation, and Williams, R. (1999). Cultural safety; What does it advocated embedding a social determinants- mean for our work practice? Australian and New based approach to public policy around Zealand Journal of Public Health, 23(2), 213-214. doi: improving Indigenous health, education and 10.1111/j.1467-842X.1999.tb01240.x employment and in order to address inequality Yap, M. and Yu, E. (2016). Community wellbeing gaps. This call spearheaded the from the ground up: a Yawuru example. Bankwest Campaign for Indigenous Health Equality Curtin Economics Centre Research Report 3/16 resulting in COAG’s Closing the Gap response in August. Retrieved from December 2007. http://www.curtin.edu.au/local/docs/bcec- Professor Calma has worked for over a decade community-wellbeing-from-the-ground-up-a- with the co-authors on Indigenous mental health, yawuru-example.pdf. social and emotional wellbeing and suicide Professor Pat Dudgeon, BAppSc. GDip prevention. (Psych). PhD is an Aboriginal psychologist of the Mr Christopher Holland, LLB (Hons); GDLP Bardi people of the Kimberley, Western is a private consultant. He worked as human Australia. She is based in the School of rights lawyer before becoming an Indigenous Indigenous Studies at the University of Western health advocate in 2003. He has written Australia. Professor Dudgeon has significant extensively including on human rights, involvement in Indigenous psychology research Indigenous health, mental health and social and and mental health policy. Recently she has led emotional wellbeing, and suicide prevention the Aboriginal and Torres Strait Islander Suicide including for the Aboriginal and Torres Strait Prevention Evaluation Project that evaluated the Islander Suicide Prevention Evaluation Project. effectiveness of existing Indigenous community- [email protected] based suicide prevention services and programs. The Project report identified success factors in Indigenous suicide prevention and recommended evidenced-based service and program delivery models. [email protected] Professor Tom Calma AO is an Aboriginal Elder from the Kungarakan tribal group and a member of the Iwaidja tribal group in the of Australia. He has been involved in Indigenous affairs at a community, state, national and international level and worked in the public sector for over 40 years. He is currently on a number of boards and committees

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