Aboriginal people have made it clear they do not want non-Aboriginal people telling them what they need. Aboriginal people want to decide and build their own destinies, but recognise this cannot be achieved in isolation.
Read Jason's story - about his journey towards social and emotional wellbeing
Respect, knowledge and understanding
Aboriginal health workers - more please
Keeping our promises
Services designed for people
Follow the money
What success means
The Commission believes
Special strengths exist in Aboriginal culture, which considers mental health to be part of a continuum that applies not only to individual people but to extended families and entire communities and is not separate from physical health and spirituality.
This perspective, which is sometimes described as social and emotional wellbeing, has much to teach all of us as we increasingly recognise the intimate connections between our mental health and our backgrounds, cultures, beliefs and experiences.
Aboriginal people also have particular mental health needs as disadvantage and discrimination combine with the devastating grief and trauma that are a consequence of the past systematic removal of children and destruction of communities, and the continuing experience of loss from incarceration, illness and premature deaths of family members.
Even when Aboriginal people appear valued and successful by the measures of our wider society, they may still feel marginalised by the power imbalance between Aboriginal and non-Aboriginal Australia and by the dominance of non-Aboriginal voices in all our public agendas.
Aboriginal people have made it clear they do not want non-Aboriginal people telling them what they need. Aboriginal people want to decide and build their own destinies, but they recognise this cannot be achieved in isolation. A delicate balance between self-determination and support, separateness and mainstream involvement needs to be found.
Through the Commission’s consultations and continuing engagement with Aboriginal people and communities and with the help of our own Aboriginal colleagues and advisers, we have identified the following areas for urgent action. We have also begun to develop approaches to implementation that aim to honour Aboriginal people’s autonomy while offering support on their terms.
- 1/3 of Australia's Aboriginal population lives in NSW (208,500) people
- 8.5 - 9.3 years life expectancy gap between Aboriginal and non-Aboriginal people in NSW
- Mental illness problems account for 10% of the gap
- In 2013, Aboriginal and Torres Strait Islander prisoners made up for 23% of the NSW prison population
- Aboriginal people are twice as likely as non-Aboriginal people to experience high or very high levels of distress
- Aboriginal people are 3 times as likely as non-Aboriginal people to be hospitalised for intentional self-harm
- Suicide rate of Aboriginal people is 1.4 times that of non-Indigenous people in NSW
Many of the Aboriginal people of NSW do not feel they have the respect or understanding of the mainstream community, including its mental health professionals. This is clearly a poor foundation for mental health generally and it bodes poorly for interactions with the mental health system in particular.
Many Aboriginal people also feel that the mainstream community still has little knowledge or understanding of Aboriginal culture and history as first Australians and as traditional owners of the land.
People describe feeling worn down by the repeated need to educate doctors, front-line emergency service workers and health workers in basic Aboriginal history, which should be well known in the entire community. This includes the impact of the Stolen Generations and the effects of grief on the mental health of their loved ones.
They describe the stigma they experience on the basis of their Aboriginality, and its effect on the type of support they are offered – in particular a common assumption that drug and alcohol use must be involved when an Aboriginal person experiences mental illness. They report a general cultural insensitivity, including a lack of awareness that many Aboriginal families fear their children will be taken from them, which can make them wary and reluctant to seek help for a mental health problem.
It is already NSW Government policy that departments and agencies should work in formal partnership with Aboriginal communities to plan, design and implement health services, including the provision of mental health support.
This is the first strategic direction under the NSW Aboriginal Health Plan 2013-2023, which recognises the NSW Aboriginal Health Partnership Agreement between the NSW Government and the Aboriginal Health & Medical Research Council of NSW and recommends the replication of this partnership – intended to bring Aboriginal expertise and experience into the heart of the health system – at a local level within communities.
The central challenge now is to ensure partnerships – among wider community groups and government agencies and Aboriginal organisations such as regional Aboriginal Medical services, Aboriginal land councils, Elders and Aboriginal-controlled community organisations – are strong enough to deliver all they can in terms of improved mental health and social and emotional wellbeing for Aboriginal people.
When Aboriginal people encounter the health system they want to be able to talk to Aboriginal health workers, but there simply are not enough of them to meet demand. The desire to speak to someone from one’s own cultural background has clear links to the need to be understood and respected. Having more Aboriginal health workers in the system would foster cross-cultural understanding – everyone learns, everyone benefits.
But there are challenges for Aboriginal people already working in the health system such as Aboriginal liaison officers (ALO) and Aboriginal mental health workers.
They can feel isolated and over-stretched; they feel there are pay inequities, and roles can be too generic, resulting in staff feeling they are spread too thinly and not supported in developing specialist expertise.
Aboriginal people also need to feel safe working in the system and in their individual roles; people can feel discouraged and vulnerable if their position is not explicitly valued and integrated in service provision.
Ensuring safety extends to supporting the mental health of Aboriginal workers, who may be traumatised by their continuing exposure to problems and tragedies in their communities, and to ensuring roles are culturally appropriate – for example in matters of men’s business and women’s business.
There has been no shortage of goodwill towards Aboriginal people and communities, expressed in reports, plans and inquiry findings. But the action has generally failed to live up to the words.
Aboriginal people have told us they are tired of reform that runs out of steam, of grand commitments that lapse from lack of energy or follow-through.
As we seek to move further in supporting Aboriginal people to achieve better mental health and social and emotional wellbeing, we must at the same time acknowledge and revisit the commitments that have already been made, and ensure we either redouble our efforts to keep earlier promises or else identify more meaningful aims. It is not acceptable simply to ignore the past and move on.
We must also recognise the time and expertise generously given by Aboriginal people who have been extensively consulted in the development of those previous commitments. By doing this we will honour Aboriginal people and show them that we are serious in our intentions.
Many Aboriginal people living in NSW find the state’s health, mental health and social services provision confusing, fragmented and inflexible. They want services that can respond effectively to the nuances and complexities of their individual circumstances. This becomes particularly important when a mental illness is part of the picture and an individual or family is dealing with more than one department or agency.
Aboriginal people are calling for greater transparency about funding arrangements for Aboriginal health and mental health services. There is a concern that money is not allocated where need is greatest, and a desire to know how spending decisions are made.
This is linked to a perception that money is being subtly diverted away from Aboriginal-specific or community-controlled programs, towards large mainstream services that do not understand the needs of Aboriginal people.
Competitive tender processes must be designed in ways that complement government commitments to Aboriginal self-determination.
When communities identify that a service needs to be co-designed or delivered by Aboriginal people, the tender specifications must reflect this.
We must also build the capacity of Aboriginal community-controlled organisations to respond to tenders and be partners within consortiums.
The need for healing centres, places and programs was raised by Aboriginal communities and organisations as a way to increase focus on appropriate mental health services for Aboriginal people in rural and remote NSW.
The NSW Government’s OCHRE (Opportunity, Choice, Healing, Responsibility, Empowerment) plan recognises that healing is a key step towards any reconciliation, especially as many previous government programs and policies contributed significantly to the trauma, loss and pain felt by many Aboriginal people.
Healing includes promotion of self-determination, leadership and ownership of healing by Aboriginal people.
The Commission believes the OCHRE initiatives – which emphasise education, opportunity, self-determination and strong governance – can have a positive impact on the mental health and social and emotional wellbeing of Aboriginal people in NSW, and are essential in adopting a whole-of-life, whole-of-community, and whole-of-government approach to individual and community wellbeing.
In working with NSW Aboriginal communities and NSW Aboriginal Affairs in supporting the implementation of the OCHRE plan, the Commission will advocate for:
- improving the access of Aboriginal people to culturally appropriate mental health services provided by mainstream and Aboriginal community-controlled health organisations
- Aboriginal community-managed healing services that embed Aboriginal cultural perspectives within mental health recovery and peer-managed support services
- the need for culturally appropriate mental health first aid and mental health literacy training in Aboriginal communities.
Many people seek mental health support without telling the service provider that they are Aboriginal. Sometimes they are not asked, although it is generally policy that everyone should be asked whether they are Aboriginal or Torres Strait Islander. On other occasions people feel inhibited from mentioning their Aboriginality by the fear of stigma or discrimination; it is a common experience that professionals may attribute mental health problems in Aboriginal people to drug and alcohol use or take their distress less seriously. Because of their recent history, people may also fear adverse consequences if their Aboriginality is linked to their mental distress – for example the fear that their children might be removed from their care.
The Commission supports concerted efforts to establish the Aboriginal status of anyone who seeks mental health support. Only then will we be able to gauge the real patterns of mental distress among Aboriginal people, and provide services that are adequately funded and truly aligned to people’s needs.
The connectedness that characterises Aboriginal communities, and their perspectives on health and mental wellbeing, mean it may be difficult to break change down into simple, clear performance scores. We need to find new ways both to insist on reform that is meaningful to Aboriginal people, and to measure the progress we make across many domains of social and emotional wellbeing. We need Aboriginal people to take a central role in describing what successful reform looks like for their communities.
- efforts to support Aboriginal mental health and social and emotional wellbeing should always be grounded in respect for Aboriginal self-determination, and programs must be co-designed, implemented and managed in partnership with Aboriginal people and communities. It should not be assumed one person or group speaks for others
- Aboriginal communities should be empowered to develop ground-up approaches, owned and driven by the communities themselves – including by Aboriginal people with a lived experience of mental illness
- the Aboriginal community is best placed to advise on the provision of culturally appropriate services
- all service providers need to be accountable for the results of the work they do for Aboriginal people and communities, and should be required regularly to show how they support improved mental health and social and emotional wellbeing.
Source material for content on this page is from the Living Well Report