Indigenous Forum, National Mental Health Services
Conference

Mick Gooda

Aboriginal and Torres Strait Islander Social
Justice Commissioner

Australian Human Rights Commission

Darling Harbour Convention
Centre

Tuesday 14 September 2010

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

I welcome Gatherings such as this one because it shines light on the issue of
Aboriginal and Torres Strait Islander mental ill health; an issue that is often
overlooked in discussions around Indigenous disadvantage and in relation to some
of the headline issues associated, often unfortunately, with Indigenous
Australians in the media.

Yet, without addressing mental ill-health as an issue in its own right,
efforts to improve life in many Indigenous communities, both urban and remote,
are likely to come undone. Poor mental health contributes to the crisis of
family violence, anti-social behaviour, substance misuse, confrontation with the
legal system, and low participation in schooling and employment that is evident
in a significant number of Aboriginal and Torres Strait Islander communities.
And it is vital that policy-makers start viewing these things through the lens
of mental health rather than, in the case of family violence for example,
exclusively that of the criminal justice system.

Mental health is a BIG issue for us.

In terms of our emotional and social well-being, the 2004-2005 National
Aboriginal Torres Strait Islander Health Survey found that Indigenous people
aged 18 years or older were twice as likely as their non-Indigenous counterparts
to feel high or very high levels of psychological distress.

And I’m sure I don’t need to set out in too much detail why we
may collectively suffer poorer mental health: at broadest, dispossession,
removals from family and community, the erosion of cultures, and our ongoing
exclusion from the economy and the political system by dint of systemic racism
being a burden we all share.

And on an individual level this can manifest as high rates of exposure to
significant personal stressors. The health survey mentioned above, for example,
reported 77% of respondents experiencing (and I use the descriptors from the
survey) 'death of a family member or friend', 'alcohol or drug related problem',
'trouble with police', and 'witness to violence' in the previous 12 months to
the survey.

In addition, other factors, such as the outrageously disproportionate rates
of Indigenous incarceration are not considered by policy-makers in terms of
their mental health impacts. The health survey found that almost one in five
Indigenous respondents had a family member that had been sent to jail in the
previous 12 months. In very practical ways this can have a dramatic impact on a
family – the loss of an income or a provider of child care for example
– let alone the harder to quantify impacts: the stress and expense of
dealing with police, courts and legal services; the loss of friends and partners
to custodial settings; and the increasing perception that everything is out of
control, and another reminder of the racism we face.

With such a significantly higher level of stressors and the correspondingly
high levels of psychological distress reported among us, it is perhaps –
tragically- not surprising that Indigenous people were almost twice as likely to
be hospitalised for mental and behavioural disorders than were other Australians
in 2008-09.

Further, as reported by the Australian Bureau of Statistics in its excellent
publication The Health and Welfare of Australia’s Aboriginal and Torres
Strait Islander Peoples, records indicate that Indigenous males were 5.8
times more likely and Indigenous females 3.1 times more likely to die from these
disorders in 2001-2005 than were their non-Indigenous counterparts.

And drug and alcohol abuse clearly is a part of the picture: for example, the
death rate for 'mental and behavioural disorders due to psychoactive substance
use' was 14 times higher for Indigenous males aged 35-44 years than for
non-Indigenous males in that age group. The rate for Indigenous females in this
age group was 12 times higher than their non-Indigenous counterparts.

And as has so often been reported, suicide rates are much higher among our
people, and particularly rates among our young people are tragically high. Over
2003-2007 death rates from intentional self-harm were generally between 1.5 and
3.5 times higher for Indigenous males and females living in NSW Qld, WA, SA and
the NT than for their non-Indigenous counterparts.

And I am reminded of the Coronial Inquiry into the recent 22 suicides in the
Kimberley of some of the further impacts such high rates of suicide have on
entire communities. In many cases, as the Coroner noted, young children have
been the ones to find the dead bodies of their parents, brothers and community
members. These kids are scarred for life. More broadly, the coroner also noted
the enormous burden of grief, and unresolved grief, in particular in these
communities and how it fed a vicious cycle of substance abuse and lateral
violence.

Against this sobering background, the Australian Human Rights Commission,
including my predecessors and I, have been actively involved in addressing the
mental health of Indigenous Australians. For example:

In 1993, the landmark Report of the National Inquiry into the Human Rights of
People with Mental Illness , known as the Burdekin report was published. This
inquiry helped to highlight the issues confronting Indigenous people with a
mental illness including many of the issues I will raise today. Many of the
findings are still current 12 years later.

In 1997, the Australian nation was shocked by the findings of the well known
Bringing them home report. This report also highlighted mental health issues,
particularly in relation to Aboriginal people forcibly and unnecessarily removed
from their families as children. And despite the moves forward to healing
facilitated by the National Apology delivered in 2008 by Prime Minister Rudd
(which was a recommendation in the Bringing them home report) the
intergenerational impacts of these policies are still with us. For example, the
Western Australian Aboriginal Child Health Survey, 2004, found the children of
Indigenous carers who had been forcibly separated from their families were more
than twice as likely to be at high risk of incurring clinically significant
emotional and behavioural difficulties, and had twice the rates of alcohol and
other drug use than other Australians.

And in 2005, following a national inquiry, the Australian Human Rights
Commission (then known as the Human Rights and Equal Opportunity Commission)
published Not for Service - Experiences of Injustice and despair in mental
health care in Australia. And my predecessor, Dr Tom Calma, took part in
community consultations with the Mental Health Council of Australia to ensure
that Indigenous voices and experiences were heard in its pages and that
Indigenous mental health got the attention it deserved. The report highlighted,
among other things, the lack of sufficient development of culturally appropriate
treatment services for Indigenous persons, particularly within remote
communities; and the lack of attention to the close relationships between poor
physical health and mental health problems in many of our people. It recommended
a significant increase in funds for Indigenous mental health services.

My predecessor and I have also used the Close the Gap Campaign for Indigenous
Health Equality to try to raise the profile of Indigenous mental health within
the health sector.

For those of you who don’t know, the Close the Gap Campaign has
mobilised behind a right to health based approach to achieving Indigenous health
equality. Its membership comprises the peak Indigenous and non-Indigenous health
and health professional bodies, NGOs and human rights organizations. And
prominent among the members who form the Indigenous leadership group of the
Campaign are the National Aboriginal Community Controlled Health Organisation
and the Australian Indigenous Psychologists Association whose members are
obviously on the front line, so to speak, in terms of dealing with much of the
burden of mental health in our communities.

In brief then, the Campaign’s goal is to close the health and life
expectancy gap between Aboriginal and Torres Strait Islander and non- Indigenous
Australians within a generation. It aims to do this is (a) through the adoption
by Australian governments of a comprehensive national plan of action that is
properly resourced and that has the goal of achieving health equality by 2030.
Importantly, (b), this would be developed and implemented in partnership with
Aboriginal and Torres Strait Islander peoples and their representatives. 
And it would encapsulate a targeted approach, focusing on a wide range of health
conditions and health determinants.

The Campaign advocates a comprehensive and holistic address to emotional and
social well being and mental health issues as a vital part of any overall effort
to achieve Indigenous health equality. And while work in this area is not
complete, what the Campaign is trying to do in particular is to link the
importance of our cultures and identity back to our mental, and indeed physical
health, and the flipside, the impact of cultural factors like racism on our
health. We are calling all these together the ‘cultural
determinants’ of Indigenous health, both positive in terms of providing
resilience, and negative. This work should be completed within the next six
months or so.

The Campaign has achieved considerable public and political support, changing
the discourse in Australia in relation to our health and in particular our
health inequality. In August 2007, the then Federal Opposition signalled its
support for the Campaign’s approach in its Indigenous affairs election
platform. As a result, ‘closing the gap’ entered the policy
lexicon. Following the election of the Labor Government in 2007, many
aspects of the Campaign became official government policy. Since then,
Australian governments through a number of commitments have adopted elements of
the Campaign’s approach; notably, the adoption by COAG of a target to
achieve Indigenous health equality within a generation, and to halve the under
5’s mortality rate by 2018.

The Close the Gap Statement of Intent is the touchstone of the Campaign, and
has received the bipartisan support of the Prime Minister and Opposition Leader
in March 2008. It has since been signed by the Governments and Oppositions of
Western Australia, Queensland, Victoria, the Australian Capital Territory, and
New South Wales. The South Australian Premier has also written to the CTG
Steering Committee indicating his Government’s committed to sign. The CTG
anticipate that the Statement of Intent will soon achieve national status.

This commits the parties to developing a national plan for Indigenous health
equality by 2030, with the establishment of the health services needed to meet
that goal by 2018. It also commits to a national partnership to support that
planning and implementation process.

In response to the adoption of the COAG targets, the Campaign developed a
range of supporting sub-targets - the Close the Gap National Indigenous
Health Equality Targets - with a range of Aboriginal and Torres Strait
Islander health experts and stakeholders over 6 months in 2007-08. This includes
a number of targets in relation to mental health services and the training of an
Indigenous mental health workforce.

And as I’ve said, a partnership between Aboriginal and Torres Strait
Islander peoples and their representatives and Australian governments is a vital
part of the Campaign’s approach: vital if we are to achieve Indigenous
health equality. Government must listen to us across a range of areas, but
particularly in relation to mental health if they are to hope to understand why
we become mentally ill, and what can heal us; or – framing it positively
– what gives us mental and spiritual resilience in the face of
adversity.

Very few studies have been undertaken to model Aboriginal and Torres Strait
Islander mental health or what determines ill-health. The only common conclusion
among commentators seems to be that non-Indigenous models of mental health and
ill-health have only limited application for Indigenous peoples.

Only Indigenous people know what those factors are. Yet has anybody really
bothered to ask us? Or listened when we give our answers?

Listening to us is vital. For how long have we shouted from the rooftops, so
to speak, that our mental and physical health cannot be treated as discrete
issues but must be considered in a broader context and in relation to our
cultural lives and political position. As the National Aboriginal Health
Strategy, over twenty years old now, so aptly put it:

Health to Aboriginal peoples is a matter of determining all aspects of their
life, including control over their physical environment, of dignity, of
community self-esteem, and of justice. It is not merely a matter of the
provision of doctors, hospitals, medicines or the absence of disease and
incapacity.

In linking mental and physical health with self determination, the National
Aboriginal Health Strategy was ahead of its time. Since then of course it has
become widely accepted that the stress caused by perceived lack of control of
one's environment operates as a physical and mental health determinant in all
population groups.

The role self-determination and empowerment can play in Aboriginal and Torres
Strait Islander mental ill-health and health has many levels.

At the individual level, ensuring Aboriginal and Torres Strait Islander
peoples can access education and employment could be seen as a mental health
measure; after all, study after study has shown that an increased perception of
control comes with increased income and understanding of one's environment, both
in terms of ones own culture and language and traditions, but also in terms of
being able to navigate the non-Indigenous world.

At a community level, as agents of empowerment community-controlled services
and self-governance might also be considered as mental health measures.

More broadly, protecting the right of self-determination of Aboriginal and
Torres Strait Islander peoples at the national level by implementing the United Nations Declaration on the Rights of Indigenous Peoples, and
constitutional reform that recognises and protects the rights of Aboriginal and
Torres Strait Islander peoples, also requires serious consideration in terms of
their impact on mental health and achieving reconciliation. In that regard, I
also note that the landmark Ways Forward report into Aboriginal and
Torres Strait Islander mental health in 1996 linked the mental health of
Aboriginal and Torres Strait Islander peoples with the recognition of their
rights. This is a finding I fully support.

Many people that I spoke to, after the National Apology to the Stolen
Generations indicated that for the first time, they felt a part of this country.
Constitutional recognition of Aboriginal and Torres Strait Islander people as a
special part our nation – feeling as though we belong here - will
contribute to overcoming some of the underlying causes of mental health amongst
our people.

And of course, I welcome both federal parties indications that they will look
at the constitutional recognition of Indigenous Australians over the next term
of new government.

Treating the problem - mental health services

I’d like to finish by making some brief points in relation to the
provision of mental health services to Aboriginal and Torres Strait Islander
peoples and communities: pointers, if you like, to further discussion today.

The first point is, as evident in the statistics I cited earlier, that a
greater investment in mental health services are needed in communities. We need
greater capacity and with a growing youth cohort we need it sooner rather than
later.

Second, these services must be culturally sensitive; and, as I’ve said,
to this end governments need to deal directly with Aboriginal and Torres Strait
Islander peoples and communities as well as collaborate with primary health care
providers in order to develop and deliver culturally appropriate services.

Other avenues to that end include:

• increasing resources to Aboriginal Community Controlled Health Services to
  meet the increasing mental health and social and emotional well being needs
  placed upon the Aboriginal and Torres Strait Islander primary health care
  sector. These services are also best placed as providers of traditional mental
  health healing and other ways of addressing mental ill-health.
  

• reforming mainstream and private provider community based mental health care
  to better meet the needs of Aboriginal and Torres Strait Islander consumers.
  This could be through cultural awareness training of staff working in these
  agencies.
  

• training an Indigenous mental health workforce - psychiatrists,
  psychologists and so on is also vital. And I’ve mentioned the Australian
  Indigenous Psychologist’s Association already in the context of the Close
  the Gap Campaign, and I know that they are doing a lot of pioneering work in
  this area.
  

Third , breaking down mental 'health silos' in the health sector.
My predecessor for example called for all medical and para-professionals working
with Aboriginal and Torres Strait Islander peoples – not just mental
health workers - to have a basic knowledge of possible mental health issues so
to facilitate the prevention or early address of mental health problems before
they become a crisis. Prevention is – as always – preferable to
having to cure.

Other silos that must be broken down are those that separate out mental
health, family violence and substance abuse services. These should be integrated
within comprehensive primary health care services to reflect the fact that these
issues are often linked and I note the great job that many of the community
controlled health services are already doing in that regard.

Fourth, beyond services, we also need to acknowledge the burden of mental
health of people living in our communities and our families. Programs must be
put in place to address the needs of Indigenous carers of the long-term mentally
ill living in our communities.

And finally, education of the broader community and Aboriginal and Torres
Strait Islander communities about mental health issues must occur. The stigma
about mental ill-health must be broken down and communities affected by mental
health issues should be informed so they can be as actively involved as possible
in relation to addressing mental health issues. Community members who act as
carers too need support from other community members as well as from special
programs.

The challenges of mental health in our communities are complex but not
insurmountable. I hope in the brief time I have had here I have triggered some
thoughts as to ways forward including about the potential of the Close the Gap
Campaign to ensure Indigenous mental health gets the attention it deserves at
the national level. (And I have some information here on the Campaign if anyone
would like to take it with them today.)

I wish you all the best and thank you for the invitation to speak.