President speech: Australian Psychological Society (Sydney Branch) AGM

Australian Psychological Society (Sydney Branch) AGM

The Hon Catherine Branson QC

22 October 2009

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I would like to begin by acknowledging the traditional owners of the land on which we meet, the Gadigal people of the Eora nation, and pay my respects to their elders, past and present.

As psychologists or aspiring psychologists, you may be wondering why the President of the Australian Human Rights Commission is here? You may be wondering: what does human rights have to do with psychology?

What I would like to explore, over the next half an hour or so, is just how closely your work as psychologists and my work as an advocate for human rights, are related.

I hope to do this by providing a brief overview of what human rights actually are, how human rights relate to health and, in particular, how the right to culture and to be socially included impact upon health – especially mental health.

Human rights

I’d like to start by talking about human rights. 

There is an interesting parallel between human rights and mental health. They are both, simultaneously, enormously complex yet rather simple; they are issues of fundamental importance about being human, yet they are issues about which most people know little.

Mental health reform in Australia is a continuing and fraught process – as you will be well aware. And I am sure that you feel frustrated, at times, about what must seem to be a glacially slow process of change. 

Perhaps you sometimes have a strong urge to shout out to everybody: individuals, governments, businesses, society-at-large, help them to better understand what mental health is all about.

So too with human rights in Australia. Yes, Australia is a free, democratic country. But we are the only democracy in the world without comprehensive human rights protection; our Constitutional protections are limited; we do not have a strong culture of human rights and most Australians do not even have a clear idea of what they are.

So, with apologies for those of you who may already be familiar with human rights, here is a brief outline of what they are.

Human rights are integral to who we are and to our everyday lives, as humans, as free agents. The Commission’s slogan reflects this: human rights are for everyone, everywhere, everyday.

Human rights are about values; the values inherent in concepts like dignity, freedom and equality. They are rights we all have simply by virtue of being human. They are our birth right.

They include rights such as the right to life, the right to liberty and to be free from torture, arbitrary arrest or detention (so here is an important issue relating to the constraint of people with mental illness!) the right to a basic education, the right to access appropriate health care (including mental health care) and the right to maintain a cultural identity and language, amongst many other rights. 

Human rights have a history spanning back to the Enlightenment, possibly to classical times, but the Universal Declaration of Human Rights, adopted by the UN General Assembly in 1948, was the first comprehensive statement by the international community of the human rights and freedoms of all people.

The Universal Declaration, as well as listing all the key human rights in their broadest terms, explains that all rights are inalienable and indivisible. That means humans cannot just ‘give away’ their human rights (inalienability), nor should they just enjoy some of them - you get them all if you are human! (indivisibility).

Aside from being critical to living a life in dignity, these basic values are essential for promoting inclusive societies in which people can freely participate. Human rights are, therefore, about creating and maintaining an environment of mutual respect and understanding.

Indeed, such an environment of mutual respect and understanding is critical to being able to live a life in dignity. As I am speaking, I hope that many of you are thinking that these are essential conditions in which good mental health may be protected and promoted.

So human rights are not just a complex system of notional protections that only the student of arcane international law can understand; they are an ethical framework that should be comprehensible to just about everybody in our society.

Human rights and health

Health, in and of itself, is a human right. However, the World Health Organisation (or the WHO) – which is, of course, a United Nations agency and therefore automatically has strong links to the UN’s human rights mandate – has also explicitly recognised the critical links between the right to health and other human rights.  

For example,

• violations of an individual’s human rights can have serious health impacts – such as violence against women (eg: female genital mutilation) and children (eg: child labour)

• risk of poor or declining health among some groups (such as Aboriginal and Torres Strait Islander peoples) may be reduced by taking steps to respect, protect and fulfil human rights (for example, freedom from discrimination on the grounds of race, faith or gender)

• health policies and programs can either promote or violate human rights in their design or implementation (for example, services and individual service providers may unintentionally exclude, or may be culturally inappropriate for, some clients).

The WHO argues that many factors – such as the social and economic context, the physical environment, and an individual’s personal characteristics and behaviours – impact on their health.1

The WHO also recognises that the social determinants of health are mostly responsible for health inequalities. These determinants include those conditions in which people are born, grow, live, work and age, and include the health system itself.  

Social conditions such as racism, discrimination, stigmatisation, and unemployment, also, can lead to social exclusion. These processes prevent people from participating in education and gaining equitable access to services. They are all human rights breaches. They also have social and psychological impacts upon health.

You are all probably familiar with the landmark Whitehall studies which were first conducted in the mid 1980s and are so widely discussed by Sir Michael Marmot. These studies provide definitive proof of these links: that health is not always a linear, cause-and-effect process; that it must often be contextualised holistically. 

As psychologists, you will understand that these factors, which so often press themselves upon the lives of individuals, are critical determinants of their mental health.2

Culture

I would now like to talk a little about one of the most complex words in the English language: culture.

Often racism, discrimination, stigmatisation and hostility towards a person or a group will be related to their cultural identity.  

When I speak of culture, broadly, I am referring to the values, customs, traditions and norms of behaviour shared by a community.

Cultural values shape the way we think about and interpret the world around us.3 When we see culture as integral to self-identity, we can begin to see how it relates to our daily lives – in the school and education we choose for our children; in the food we eat; in the housing we live in, and in the health care we try to access.

The right to cultural identity (often described as cultural liberty) is a human right and, like all human rights, it is inter-related and inter-dependent on other human rights.

Cecil Helman, in the classic text Health, Culture and Mental Health provides an important explanation about the importance of culture; indeed, this explanation is perhaps the most important one for those of us who are concerned with human rights. 

Helman describes three levels of culture. The first (the tertiary level) is the visible and manifest culture – the kind of things we think about as actually being tangible culture: cuisine, dress, music, festivals and the like. This is the façade that is presented to the rest of the world by a culture.

The secondary level is the underlying assumptions and beliefs that are shared within a culture.

The primary level Helman describes as: “the deepest level of culture ‘in which the rules are known to all, obeyed by all, but seldom if ever stated. Its rules are implicit, taken for granted, almost impossible for the average person to state as a system, and generally out of awareness’…”

Culture, in this sense, is deeply psychologically embedded in both the individual’s conscious and unconscious. It is the lens through which the world is viewed; it is a critical definer of the individual, shaping their morals, their responses, thoughts and actions.  

It makes the notion of ‘assimilation’, so beloved by many political populists, both facile and unrealistic. Cultural assimilationism is not only a violation of human rights; it is also an impossible expectation. Culture is too important, too ingrained, too ubiquitous to be so easily discarded.

I would like to look at some examples of the way in which culture can affect peoples’ human rights and health simultaneously. 

Take, for example, a homeless person. Their right to shelter is being violated on a daily basis. However, people who are homeless are also likely to experience a number of human rights breaches including the right to the highest attainable standard of physical and mental health.

When we start to look at the causes of homelessness, we can see how culture may also be related. If housing is not culturally appropriate, or if there is discrimination in access to housing on the basis of race, religion or ethnicity, this can lead to homelessness, which, in turn, impacts on the mental health and wellbeing of the individual.

Culture – particularly if this includes language – may also be a barrier to information. If culture limits access to knowledge, then the individual is at an instant disadvantage, restricted in their ability to be empowered by even those things that are free.

Again, I am sure I don’t need to spell out to you the failures of so-called universal health cover. Well-intentioned though it may be, as always, it is the educated (and therefore the relatively privileged) who are more likely to know their rights, know what is free, know how to access resources, and make sure they enjoy them!

Similarly, if education and schooling is not culturally appropriate, or there is bullying or exclusion on ‘cultural’ grounds (and this includes racial and religious grounds) this may lead to school failure, withdrawal or resistance.  What follows of course is the cycle of disadvantage which, again, leaves the individual more vulnerable to mental health problems.

For example, in one of the Commission’s inquiries, we found that Indigenous “… children with disabilities are often culturally isolated in their schooling, whether in a regular classroom, special class or special school….The resultant cultural isolation can adversely affect the child’s social and psychological development as well as their educational learning.”4

Recognising the importance of culture and the right to cultural liberty is now – more than ever – critically important in Australian society.

Let me paint you all a picture of what Australia looks like now and what it is likely to look like in the not-too-distant future.

On the first of this month, Australia’s population hit 22 million.5  According to the 2008 report on population flows, natural increase (that is, births and deaths) accounted for only 41% of this population growth. Migration accounted for the majority of the growth (59%).6

As Australia’s population ages, net overseas migration will be increasingly important for our labour force. In fact, it is predicted that, “within four years, as the baby boom generation retires, net overseas migration will become the only source of net labour force growth.”7 This is something we cannot ignore. 

The population growth we are experiencing from overseas is not just from the old source countries of the post-second world war era: the English-speaking British or the northern Mediterranean rim, virtually all of whom were Christian and, if we must use the old eugenic descriptor, ‘Caucasian’.

In the 2006 census, the UK was the largest overseas-born group (23.5%); however this is declining. The second largest group are the New Zealand born. However, this data does not show that the ethnicity of many New Zealanders are Samoan, Tongan, or other Pacific Islander origins.

What is changing dramatically is the enormous growth patterns from Africa. The number of people from Liberia increased by 1,239% since the last census, Sierra Leone up 437%, and Sudan up by 288%.8 These growths, of course, reflect low base figures.

But these figures demonstrate that global demographics cannot just be ignored. Let me illustrate why.

In 1900 approximately 25% of the world’s population lived in Europe. At the same time 8% lived in Africa, and 57.4% lived in Asia. By 2020, it has been estimated, Europe’s share will be down to 7%, Asia will be relatively stable at 59.1% and Africa will rapidly expand to nearly 20%.

Australia, since the late 1940s, has been drawn incrementally into this vortex of global demographic change.

What does this mean? It is often claimed that Australians speak over 200 languages. That’s 3.2 million Australians who speak another language, with over 500,000 Australians speaking Cantonese, Mandarin or another Chinese language. However, languages such as Shona (up 530%) and Swahili (up 120%) are increasing significantly.

Indeed, Australians speak many more languages than this when we consider that Indigenous Australians alone have over 140 languages9 – this means the REAL total of languages spoken in Australia is more like 350!

In terms of our religious diversity, things are also changing. While we are a predominately Christian nation, and will remain so for the foreseeable future, the number of Australians who reported themselves as Christian is down 7% from 10 years earlier.

Looking, however, at the smaller faith communities: the number of Australian Hindus increased by 700%, Buddhists by over 400% and Muslims by 250% in the last 20 years.

The very clear result is that Australia, while very diverse now, will be even more so in the future. If we don’t start taking culture into account in our daily lives and in our work, this could have enormous impacts – especially on the mental health sector.  

We only have to look to our Indigenous communities to see the impact of assimilation and social exclusion.

In the Commission’s 2008 report on ‘Preventing crime and promoting rights for Indigenous young people with cognitive disabilities and mental health issues’, we found that Indigenous young people experience high levels of mental health issues.

This high incidence rate was attributable to the social determinants of health and the social exclusion of Indigenous young people.

The broad social environment in which children and young people live are linked to their cognitive and mental health outcomes.10

“We know that Indigenous young people can face racism and discrimination in a number of areas; from peers, school, interactions with police and broader society. These interactions can decrease sense of self worth and generate anger, leading to both internalising and externalising mental health issues.”11

Indeed, international studies have demonstrated the link between lower socio-economic status and increased risk of mild to moderate intellectual disability.12

Through the Commission’s work, we are beginning to hear similar stories from Australia’s growing Muslim communities. Over the past few years, the Commission has conducted several inquiries into issues facing the Australian Muslim population.  

Reports from these have demonstrated that Australian Muslim community members experience feelings of alienation, isolation and powerlessness as a result of discrimination.13

One of the impacts identified as a result of such discrimination and exclusion is the rise in mental health issues including chronic depression and suicidal behaviour. A community-based counsellor reportedly found that a growing number of Muslim girls are experiencing psychological problems as a result of discrimination. “She talked to 13 girls in the last few months and six are suicidal due to their exposure to discrimination.”14

There are many other examples I could draw on that relate to culture, human rights and mental health. Another that springs to mind are foreign fee paying students and the often dire circumstances in which they find themselves.

You may argue that such students are not Australian citizens; however, as I have just described in the globalised, mobile, intellectually and technologically integrated future we are now entering, many of them will be. And if they’re not, we do not want a critical source of skilled migration cut off through neglect. Nor do we want our nation’s relationships with their home countries damaged.

These are not just economic issues. For all the impact upon our economy, and the arguments that justify our investment in protecting international students, Australia, clearly, has a duty of care and moral responsibility to these guests in our country. 

The discrimination and exploitation that many have experienced will be having significant impacts upon their mental health. This is simply unacceptable.

I would also like to mention the effects that discrimination may have upon community harmony and public safety. Governments around the world have been understandably concerned about these issues, particularly since the terrorist attacks of 9/11.

However, global responses have tended to be similar; they are reactive and draconian (often threatening human rights in many countries). While governments have reacted with tough new security laws, increased border protection, investments into new military hardware and the like, social researchers (including those who work for intelligence agencies) have been furiously hypothesizing about the roots and causes of terrorism.

The subject of terrorism, however, is outside the scope of my speech this evening.

It is well understood that social exclusion on the grounds of discrimination (probably based on race, ethnicity or faith) will lead to isolation; this can lead to resentment, withdrawal and, ultimately, a desire for revenge.

Culture, mental dysfunction, social alienation and security – clearly, there is a matrix of interconnection here. An interconnection that is poorly understood, researched or discussed. I would argue that, if we asserted a human rights approach to primary prevention (of the whole cycle of alienation commencing in the first place), this would clearly have significant benefits – benefits to individual well-being, public safety, financial efficiencies, and social justice.

Conclusion

When we see health as a state of complete physical, mental and social well-being, we can see how health is integrally related to culture in numerous ways:

• a person’s place in his or her culture is an essential part of his or her self-identity. If cultural integrity is threatened, that person’s psychological and emotional health is at risk

• likewise, if a cultural group is discriminated against in terms of access to services, this has a compounding effect on the psychological and emotional health of members of that group

• culture can impact on how people label and communicate distress

• culture can affect how people interpret and understand their mental illness and mental illness in their family and friends

• culture can impact on access to health services.

The complexity of the causes of mental health problems for our Indigenous Australians and their entrenched nature need to be recognised in the development of responses and treatments.

The history of colonisation has had a profound effect on Indigenous Australians. As a group they have experienced dispossession of land, removal of children, family separation and displacement and loss of culture.

In the present day, many Indigenous Australians continue to live in conditions of social and economic disadvantage compared with the population as a whole, they have, on average, a lower life expectancy and higher levels of morbidity and experience high levels of unemployment and poor access to appropriate housing and other basic services.

Likewise, immigrant and migrant communities have often come from traumatic backgrounds.

In 2008-2009, Australia issued 13,000 refugee and humanitarian visas. These were for people who have fled their home country and cannot return due to a well-founded fear of persecution because of their race, religion, nationality, membership of a particular social group, or political opinion.

Often, asylum seekers share similar pre-arrival experiences.  

They may have been confronted with impossible choices such as deciding who should die or be left behind; they may have faced loss of family and friends; they may have faced deliberate erosion of their personal integrity in refugee camps; and they may have witnessed many atrocities such as murder and torture. And, as some of the research has sadly demonstrated: if you are a woman, and have an asylum experience, you are likely to have raped. Possibly repeatedly.

In order to prevent social exclusion, which we know can lead to mental health issues, innovative, culturally respectful approaches to prevention, early intervention, clinical and community services are essential.15

In genuinely socially inclusive communities, members of Indigenous, immigrant and migrant communities’ religious, cultural, ethnic and racial beliefs and backgrounds will be, at an absolute minimum, respected.

In Australia’s rapidly changing environment, a multi-disciplinary and culturally appropriate approach to mental health is critical. Recognising cultural identity as a human right, integral to each and everyone of us, should shape policy and practices which are appropriate and effective in today’s increasingly multicultural society.

For those of you with long memories you may recall the critical role that the Australian Human Rights Commission, then known as HREOC, played in changing the way that mental illness was understood and treated in Australia. 

It has been a long time since Brian Burdekin helped prepare that seminal report which was called Human Rights and Mental Illness: report of the National Inquiry into the Human Rights of People with Mental Illness and was published in 1993.  Yes, many things have changed since then, and many things have not. The human rights issues that relate to mental health and mental illness have not gone away – even if many of them have changed. 

I leave you with a question: is it time for the human rights lens, once again, to be held over the mental health sector, and for all of us to reflect more deeply on the cultural and social inclusion dimensions?

Thank you.

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