Ways Forward National Aboriginal and Torres Strait Islander Mental Health Policy National Consultancy Report by P. Swan and B. Raphael © Commonwealth of Australia 1995 ISBN 0 644 35759 2 (set) ISBN 0 644 35760 6 (volume 1) This work is copyright. Apart from any use as permitted under the CopyrightAct 1968, no part may be reproduced by any process without prior written permission from the Australian Government Publishing Service and the authors. Requests and inquiries concerning reproduction rights should be directed to the Manager, Commonwealth Information Services, Australian Government Publishing Service, GPO Box 84, Canberra ACT2601 Produced by the Australian Government Publishing Service 20 February 1995 Ms Mary Scott Director of the Office of Aboriginal and Torres Strait Islander Health Sirius Building CANBERRA ACT 2600 Dear Ms Scott The National Aboriginal and Torres Strait Islander Mental Health Policy and Plan represents a national overview of the mental health needs and problems of the Aboriginal and Torres Strait Islander people around Australia. The policy and its guiding Principles, Strategies and Targets clearly outlines ‘Ways Forward’ to improve the mental health and wellbeing of the Aboriginal and Torres Strait Islander population. All provision of these services is through Aboriginal Community Controlled Health Services and/or management. This significant report has been fully endorsed by the National Aboriginal Community Controlled Health Organisation and is submitted by the two principal investigators, Sr Pat Swan and Professor Beverley Raphael. Sr Pat Swan Professor Beverley Raphael Acknowledgements The Consultants wish to thank: • Directors and Staff of the Aboriginal Medical Service, Redfern • National Aboriginal Community Controlled Health Organisation (NACCHO) • All Aboriginal community groups and individuals who assisted in providing information for the development of this National Aboriginal and Torres Strait Islander Mental Health Policy • Nada Martinek (Research Support), Trish Buckley (Secretarial Support) and staff of the Department of Psychiatry, University of Queensland. Foreword The consultancy process This report follows the National Aboriginal Mental Health Conference, and incorporates many of the insights and recommendations supported by Aboriginal people at that meeting. It is built upon Aboriginal views of health and mental health as holistic, involving spiritual, social, emotional, cultural, physical and mental wellbeing and issues related to land and way of life. It supports the view that Aboriginal mental health inevitably relates to colonisation, history, racism and social factors. The consultants believe that it is essential that Aboriginal people are given charge of their own mental health program development, because of the close relationship of mental health to wellbeing and the concerns that exist about genocide and assimilation, as well as the very adverse record of history. The consultants therefore support absolutely, the view of Aboriginal people that self-determination is central to mental health, and central in the provision of mental health services. This report was developed on the basis of views and recommendations made to the consultants by Aboriginal people consulted around Australia. The consultants met Aboriginal people from Aboriginal Controlled Health Services, communities and those working in health departments in their visits to capital cities of all States, to a number of rural centres, Alice Springs and Broome. Resources provided did not enable the consultants to travel to all communities, nor to as many remote communities as they wished. They are very grateful to those Aboriginal people who travelled to meet them at other sites and who gave so generously of their time. They also met with Aboriginal people at Conferences, seminars and meetings, to seek their views. As well as Aboriginal Community Controlled Health Services were contacted and surveyed as to what they saw to be major mental health issues, the most critical needs and what they believed would be helpful. The consultants contacted Aboriginal and Torres Strait Islander Commission and at their suggestion, contacted all Regional Councils for their views and concerns. The consultants sought information on, and where possible, visited and sought the views of those providing mental health services for Aboriginal people, and those planning or proposing new initiatives in this field. The consultants also met with Aboriginal consumers and sought their views. State Mental Health Services were also contacted as to State program and contributions for Aboriginal Mental Health. Their response indicated a great shortage of support and services. Other agencies such as those potentially providing education relevant to Aboriginal Mental Health, Mental Health Workers are Mental Health Professionals were also contacted for information and contributions of relevance. While the consultants were unable to visit the Torres Strait Islands they consulted with Torres Strait Islander people and have included in the report, statements and submissions relevant to their views. All Government policies and reports addressing Aboriginal mental health related issues were examined and documented. All studies, research and reports relevant to Aboriginal Mental Health were reviewed and summarised. Drafts of the report and recommendations were discussed with many Aboriginal groups and are fully endorsed by the National Aboriginal Community Controlled Health Organisation. The proposals included in this report represent the views from many different Aboriginal people, settings and communities, as conveyed to the consultants. The consultants recognise that no consultancy process can be absolutely complete. Views were sought very widely and what is included represents these views. Nevertheless, the issues documented were repeatedly identified as the priorities for and by Aboriginal people. The recommendations in this report are for Aboriginal people to take forward as they see fit and for adaptation and use in their own communities, according to priority and need. No recommendations are prescriptive, but rather reflect a range of programs that Aboriginal people had identified as needed for their communities. It was repeatedly stressed that mainstream mental health services were inappropriate and it was seen as critical that mainstream providers be educated in Aboriginal culture and mental health to respond appropriately when Aboriginal people used such services. The consultants consider that considerable resources must be found to develop mental health services for Aboriginal people, in view of: the dearth of services; the need to redress long-standing neglect; the close inter-relationship with physical health with mental health and wellbeing; and the increasing inequities of Aboriginal health generally; and the impact on mental health, of past and present policies, such as the forced removal of children, and of people from their land, and the loss of culture. The consultants believe the most important next step is to constitute a group of Aboriginal people to oversight the next stages of consultation, program development, resource determination and co-ordination, as is suggested by the proposed National Aboriginal Mental Health Advisory Committee. This policy should be taken forward, adapted and implemented by Aboriginal people to meet the needs of their communities. They should be adequately resourced to do this, and backed by all relevant Governments, organisations and other bodies to achieve appropriate and equitable mental health programs for Aboriginal people. Professor Beverley Raphael Ms Pat Swan Executive summary The National Aboriginal Mental Health Policy and Plan have been developed after extensive consultation with Aboriginal and Torres Strait Islander people around Australia and with relevant groups and organisations. (note: The word Aboriginal is used throughout this report to cover Aboriginal and Torres Strait Islander people as Indigenous Australians) The consultation process revealed extensive problems of Aboriginal mental health and high levels of unmet need. Evidence was presented that mental health problems were a major difficulty for most communities, and that there were few health and mental health resources available to deal with them. While data was generally inadequate, available evidence of a systematic kind indicated that Aboriginal people suffered mental health problems such as depression at a very high rate, compared to non-Aboriginal people, that rates of self-harm and suicide are higher, and that substance abuse, domestic violence, child abuse and disadvantage contribute additional risk factors. Trauma and Grief were seen as overwhelming problems, both related to past history of loss and traumatisation and current frequent losses with excess mortality in family and kinship networks. Evidence from the many Aboriginal people and organisations presenting to the consultancy highlighted the extent and severity of these problems and their strong relationship to mental and physical health problems. State reports highlighted the limited data available and shortage of services. Aboriginal people perceived mainstream mental health services as failing them, both in terms of cultural understanding and response, and repeatedly identified the need for Aboriginal mental health services, which took into account their concepts of the holistic value of health and their spiritual and cultural beliefs, as well as the contexts