Transcript of Working with Aboriginal People: Enhancing Clinical Practice in Mental Health Care.
Aunty Loretta Parsley, Traditional Custodian of Walbunja, Yuin. Aboriginal Social Health Mentor: Walawaani njindiwan (Welcome everyone). I'd like to welcome you all to the traditional lands of the Walbunja people and to where my ancestors lived for thousands of generations, here at beautiful Cullendulla.
Kristen Ella, Yuin. Aboriginal CAMHS Priority Advisor, MH-Children and Young People: Aboriginal people have one of the richest surviving cultures in the world. Through their resilience and their connection to culture they've successfully continued to thrive for thousands of years, by adapting to many different environments and circumstances.
Professor Judy Atkinson, Jiman/Bundjalung. Intergenerational Violence, Trauma and Healing Expert: We're facing a crisis, a major crisis, and it's not just a crisis for Aboriginal people, it's a crisis for Australia as a whole. Our prisons and juvenile detention centres are becoming full of people with childhood histories of trauma. Every stat we have, closing the gap, everything, is saying we're failing.
Kristen: The staggering issues with mental health and wellbeing for Aboriginal youth is one of our biggest concerns. Young Aboriginal people have been hospitalised for mental and behavioral disorders at more than twice the rate of other Australians. The suicide rate for Aboriginal youth is also two times as high.
Professor Judy: In the generational complexity of trauma, out of colonisation on Aboriginal people, there are outcomes in families, in communities.
Young Aboriginal man 1: I was going through a very hard stage in life and didn't really know which way to go, bouncing between different clinics, different psychiatrists and different helpers.
Young Aboriginal man 2: I found it very difficult to go to a clinic as it's a foreign place, you know I was scared. I didn't know where to look for help. Also you know it's very intimidating, going straight into the clinic. It's a very scary thing to do for a kid suffering mental illness.
Professor Judy: If there are young people growing up, grow up feeling that they're not part of this country and they have undiagnosed trauma which can be linked to diagnosis of mental illlness, that's what I'm talking about trauma, the rage, the anger, the grief, then they're more likely to have children who are going to repeat that. And that's where we are now, we're in a generational pattern.
Corina Kemp, Dieri/Paakintji. Child and Adolescent Mental Health Team Leader: There's so many factors, I guess, driving these at-risk kids that I don't, I don't even know where to start. It's hard. Those kids that are at-risk are at risk of homelessness, losing their connection to their people. They need connection to their family. They don't need to be taken away from their family and placed in a rehabilitation centre because they're at risk of suicide or because they've just self-harmed or they're threatening self-harm. They don't need to be taken away from their family. They don't need to be taken away from their community.
Professor Judy: You start to hear the stories when you're on the ground, in a community, or you're sitting around a fire with a family who feel they are hopeless, disengaged, because their kids have dropped out of school, their kids are not making it and the kids are choosing what we know now is a symptom of trauma - addictions.
Kristen: Evidence shows that Aboriginal people are more likely to access health services where service providers communicate respectfully, build good relationships, have an awareness of the underlying social issues as well as some understanding of culture, and where Aboriginal people are part of the health care team.
Aunty Loretta: Now I have a very firm belief in the partnership of two minds: the Western and the Aboriginal. If they're brought together as a best practice, for all people, then the healing can begin.
[Music]
Text overlay: The NSW Mental Health Reform (2014-2024) focuses on:
Dr Robert Redwin, Child and Adolescent Psychiatrist: I think we're nervous about Aboriginal clients because we don't know lots of areas, we don't have the knowledge in that area. We're worried that we're going to offend people and then in offending them we're going to turn them away, then we're not going to be able to help them. We want to help people and if we can't even engage properly, we're not going to get a good treatment.
Aunty Loretta: We know culturally our people are not good closed-in. You know, you look at the rate of suicide when our people go to jail. So that's why I say out on Country with the energy around you, is so much better than the clinician sitting in a room, four walls and doing the face-to-face.
Young Aboriginal man 2: I come from a Yaegl and Widjabul tribe which resides here today where I stand in Lismore. I suffered from like many mental illnesses, a lot of sickness, depression, anxiety. I found myself in you know walking down a lot of bad roads. I had a cousin Cody who picked me up one day and he took me down to the beach and let's go, where we going. I was in a really bad shape and he took me down there and I seen my Uncle, Uncle Dhinawan and a lot of the Elders there and they were doing dance practice for Splendour in the Grass. They were doing the open ceremony.
[Young Aboriginal man 2 adds paint to his face. He joins three other young Aboriginal men in traditional paint. They dance, while Dhinawan, also painted, plays clapping sticks and sings in language.]
Young Aboriginal man 2: It's four years later and I feel completely healed, like I know who I am. I know who my people are.
Kirsten: Many Aboriginal young people suffering from mental health issues feel lost and don't know why. Reconnecting to culture builds a sense of belonging. Engaging in cultural activities is an indicator of positive cultural identity that is associated with better mental health and well-being.
Text overlay: Amendments to the Mental Health Act (2007)
Kirsten: The changes to the Mental Health Act places more focus on recovery and supporting the individual. There is also an emphasis on recognising the cultural and spiritual beliefs and practices of Aboriginal people.
Young Aboriginal man 2: You know, losing your culture for an Indigenous man is like losing your fishing rod if you're a fisherman, you know, you don't have. You're looking for something and you can't find it.
Dr Robert: The advice I'd give a non-Indigenous clinician, is first of all to be open to the questions and to be open to how much you don't know. And then you're looking out for ways of learning from it. We know lots about mental health, but we don't know as much about Aboriginality, but when you're treating someone it's a partnership. We're bringing together different forms of knowledge and so if we can use our knowledge for mental health and our clients knowledge about their Aboriginality and put that together we can get a better outcome.
Young Aboriginal man 1: In my eyes culture's one of the most important things because it builds identity. Without that and without understanding who you are, you can't really move forward in life if you don't know where you came from.
Joe Brierly, Traditional Custodian of Walbunja/Brinja, Yuin. Aboriginal Outreach Worker: They need to know who they are, they need to like have their identity back. And I think through listening, yarning with elders, old people that gives them a lot of self esteem and self identity and self respect.
Professor Judy: So we need to understand when we say culture, what does culture mean? And we are in the process, as Aboriginal people of reclaiming culture as it was and it is now and we're starting to see what is good and not so good about this westernised culture and we need to bring it together and create another world, that says no to violence, no to harm of children, no to addictions and all the things that are symptoms of generational patterns of trauma.
Dhinawan Baker, Bigambul. Cultual Ambassador: But something I would recommend to clinicians and people who are dealing you know with Indigenous mental health, it's when you're in a community, is to find the champions in your community, the people who are you know practicing or who are helping with the revival of the culture in those communities. There's always someone who wants to teach the young kids whether it's about the language, the songs, the dances, painting, or even going out hunting, just being on the land. Because then with the combination of both the clinician's knowledge and the cultural knowledge then we can find you know a happy place and a safe place for these people to come to.
Young Aboriginal man 3: I put myself in a position where I didn't want to talk to anyone I just wanted to be left alone and then that loneliness started trying to take over me and I felt like I had no one around than that and then the support really helps. It builds everything basically. You need that family support straight from the get-go. And then having the community support with you just makes it, tops it off even more.
Joe: The best thing that mainstream clinicians can do is get out into the community, and rather than sitting in a, sitting in a room, because our Mob don't work like that, we work like this, out inside, that's how we were brought up and this is, out, this is where we feel more comfortable, is ask the question and listen and the people will tell you. And your Mob, there might be only one or two that stand up and talk to you, but they're the ones you really want to get to because they'll get back to their Mob, back to their mates and their brothers and sisters and you know, they'll be their voice really.
Kirsten: Policies of assimilation and forced removal of Aboriginal children from their families and communities has meant that many Aboriginal people do not trust Government agencies. Research shows that Aboriginal people are often reluctant to access health services because of discrimination, misunderstanding, fear, poor communication, and lack of trust in service providers. Youth will not voluntarily come in. We know what works: providing outreach services, using holistic approaches, being recovery focused and involving the family of the young person will go a long way in gaining trust and respect.
Professor Judy: So the issue is more about how we, in our expertise as clinicians, are willing to be where the person feels the safest. We can't name ourselves as being culturally competent, unless we can open the space for safety.
Dhinawan: There's a lot more different issues that our our youth face. A lot of it is transgenerational of oppression and that's been handed down through, whether their families were part of the stolen generation, they're dealing with that even they did not aware that has been an inherited mental you know situation or issue for them.
A lot of people think that you know like if you meet one Aboriginal person then they can speak for every single other Aboriginal person and this is not the case. For Aboriginal Australia or tribal Australia, with each different environment we had a different clan. So for thousands of years, we kept our identity strong in our clans or in our tribes, by speaking the language of that area, by dancing and singing and painting and storytelling of that area. And so you have this in-depth knowledge of what your environment is about.
Joe: My family's got a massive connection to Country, we live from it, we eat from it. I come here pretty regularly just it get myself together really.
Uncle Glen Rhodes, Teacher, Bundjalung Language and Culture Nest, Goonellabah Public School: I think all doctors, interns, any health professional needs to understand that the community they're working in. They need to know the community background, they need to know the significant people and places in that community. Without that they, I think it'll be difficult for any health professional to engage successfully with youth, or particularly around mental health issues.
Aunty Loretta: Our heritage is so important to us, our family connections, because we have been so fractured in our lives with the Stolen Generation, the White Australia Policy. So we hang on to keeping our culture alive, and we do this in a way that we bring back old practices of possum skin cloaks, men do the spears and also language plays a huge part in who we are.
Professor Judy: And everybody will have a different story, even in a family. Every community and every part of Australia has a different story, a different history and that history might be happening right now. But the bottom line is that Indigenous people have always known how to heal trauma and it's quite simple. We do the things that we've always done, embedded within the depth of culture, which is getting together, sharing stories, dance, culture, music.
Young Aboriginal man 3: If I'm painted up I feel like a completely different person. I feel like myself and that's what I want to feel. And basically dancing is just me releasing raw emotions, of being the person I am, letting that scream out, letting that brrrr, going for it. And it's one of the best feelings I could ever have.
Dr Robert: I think one of the things that you come to learn is that there are so many different Aboriginal cultures, that you're not going to have great knowledge of all of them, and the best thing to do is to ask someone which tribe, which mob, which clan do you come from and where does that mean your people come from, is what I tend to do to try to learn a little bit more for myself and to understand that person in their context.
Joe: I suppose what heals me is being able to I suppose sit down by the ocean and just smell it and hear it, don't need to say nothing, just, I go away from there feeling better anyway.
Kirsten: And sometimes you just need to brush up on knowing what are the songlines of the community you work in and try and speak to the Elders to understand the important stories of the Aboriginal people of that area.
Dhinawan: Songlines are all about connection, you can walk across your Country and know exactly where you are you can sing about the hills being nice and sharp and have a lot of movement, so then the song is fast. Or you can sing about the movement of the birds as it flies from tree to tree and within that there's going to be the stories of where the food is, what the bird is eating, the flowers that are blooming at this time, so it's essentially a map of your environment and it's telling you everything that you need in which to survive. So if you know your songs, you know your Country. If you know your Country, you're never hungry, and you're never lost.
Kirsten: And it is important to understand how Aboriginal people have got to this place, why we have so many Indigenous young people who have lost track of their identity and how this has contributed to their mental health and well-being.
Casey Ralph, Yuin. Chief Executive Officer, KARI - The largest Australian Aboriginal Foster Care Provider: The reality is Aboriginal kids are being removed and placed into out of home care at a rate ten times higher than than any other background, cultural background. The impact of kids from rural/remote areas being taken off Country and then moved into urban populations and then that impact on their mental health and well-being. It's significant, because the sad reality is as quickly as removing kids, the reality is we're actually taking them off their Countries a lot of the time and you know moving into a different Country where there's been a complete disconnect. And you know every Mob's different and so when you remove a child from all that they've known for a long period of time and moved them somewhere else without that connection, impact on well-being is huge.
Dhinawan: And when the kids are placed with non-Indigenous foster carers and they're, it's great that they put their hands up you know to help these kids, but they don't have that greater understanding of cultural protocols and practice. So it's not just a physical thing, it's very much a spiritual thing, which leads to a mental thing. And that's what we want to get people to acknowledge, that people who understand that if we practice culture then you're practicing a lot of your own inner healing.
Aunty Loretta: And to come through that process where they're saying Who am I? You know they've lost their identity. Am I Aboriginal or am I not Aboriginal?
Kirsten: But then we have an added barrier to treating Aboriginal youth because they are not presenting in clinics and not trying to access the care that is available.
Uncle Glen: If you've got a mental health issue who are you going to talk to? You don't want to talk to anyone, so I think it's about service provision going to them and going out to the communities and engaging the communities.
Aunty Loretta: So walking into a clinician where there's all white faces, they go oh no this place is not for me.
Dhinawan: Environment plays a lot and in four walls in a you know clinical environment it's really difficult for Indigenous people to open up, but they will go out and sit on the riverbank and they will pour out tears for you because it's a natural environment.
Professor Judy: One of the major problems I see is that many clinicians look for a psychiatric diagnosis and if we're stay with the story then we go into the trauma story, which is the story that drives the behavior that excludes the psychiatric diagnosis, that has a different clinical approach totally, and that then allows us to sit in a safe way or come to a way with the child, with the young adolescent, to get them to look at themselves in this process. The question is always not what is wrong with this young person, this child, this adolescent, a young man or a young woman, but what has happened to them? And that will change our response to their needs totally.
Corina: An Aboriginal person is not being disrespectful to you as a clinician by not making eye contact with you, it's just that it's not in their nature to you know make that eye contact with you. It's not a shame thing, it's just who they are and who they were brought up to be.
Dhinawan: With the eyes, people from different communities have a different way of responding. We didn't look someone in the eye when they were talking, we actually used our ear, because our ears are the most important. So we would point our ear to the person's mouth, now doesn't mean that we're ignoring you, we're actually looking at you with our ear. And this way we're taking in the information. So what is perceived as shy, oh I've lost their attention, they're looking out the window, could be just I am using my binungs, my ears, the best way I can and I'm directing them straight to you.
Aunty Loretta: They're not accessing the care because they're afraid that they'll be judged too, that we're all you know, every Aboriginal person comes through the door they're all drinkers, they're all smokers, they're all, you know they must be. If they're black, they're you know, they must be drinkers or smokers.
Kirsten: Another misconception is that kids are not being taken care of because they are often seen running around without adult supervision. To fully understand Aboriginal people you need to understand the Aboriginal family kinship structures.
Dhinawan: With the kinship, it allows us to have a closer relationship with more people. With my father, all of his brothers are my father. So I see them as my father. So they're children, who would you would say in Western Way, my uncles, their children now are my brothers and sisters, so we're closer. Now with my mother's brothers, they're my uncles, but my mother's sisters are my mum's, so all of their children are my brothers and sisters. So instead of saying now that I've got like 10 cousins on either side, I've got 10 brothers and sisters. And hence the reason why we all come together and in bigger groups, in larger groups, and as kids we are you know, we've adopted these people and they are closer than that. So this misconception of people letting their children run wild and free, you gotta remember we are a nomadic people. Our spirit, our freedom, is by letting our kids go. If you teach the kids how to go out, be comfortable with themselves, go out into their environment, they got more of a freer spirit.
Kirsten: In Aboriginal culture certain customs and practices are performed by men and women separately. Often referred to as men and women's business. Where possible it is preferable for men to speak to men and for women to speak to women especially in circumstances where you are not known by the person or community. It is important to ask if you're the only person available and of the opposite gender, if they are okay to proceed.
Laura Ross, Wamba-Wamba/Muthi Muthi. District Coordinator Aboriginal MHDA: So rather than being worried that a question that you're asking could be making somebody feel culturally unsafe because of men's or women's business, I'd be more concerned about stuff that a missing out on, because your opposite gendered to the person that you're treating.
Kirsten: For a clinician a great way to gain trust is ask your client who they are and where they are from. Some strategies to help successfully work with Aboriginal people include listening without being judgmental, incorporate healing therapies into your treatment such as sand play and art therapy, don't just use traditional talk therapies, find the strength within the individual, Aboriginal people have strong resilience, working with Aboriginal community controlled services such as your local AMS and any other health services including Aboriginal health within your local health district, using interdisciplinary approaches that provide outreach services and transport, if a community is dealing with sorry business, it is respectful not to make any requests for a community meeting or consultation, work with them to arrange the best possible times to meet, and most importantly always ask if you are unsure of something. It is okay to ask.
Aunty Loretta: Even having an Aboriginal painting up in a building, aesthetically that can be a friendly gesture to say we welcome Aboriginal people here.
Corina: Yes the first contact is vital with our Aboriginal people. If you don't have that first connection with them and you say to them I'll see in a month's time, you've lost them. Word of mouth is big here in town as well, and not just here, I guess it it's everywhere. If you get a bad doctor in town or you're gonna be mistreated or treated you know disrespectfully, you're gonna get bad feedback especially from our Elders.
Uncle Glen: Of course if they've got a mental health issue they have difficulty expressing themselves, so you've got to have a service provision that is open and comfortable and a setting where these people young people feel like they are respected as who they are, otherwise there's a lot of shame talking about their mental health condition, otherwise it gets held within for a long time.
Dr Robert: We absolutely continue to use our professional skills, but we have to add to it. We have to try to add the knowledge of the Aboriginal community. We try to understand all communities, in all races. The Aboriginal community is one that I think we grew up thinking we knew something about, but as the longer we interact with the community, the more we realize we're just lacking in that knowledge. But if you ask people they tend to give it to you.
Kirsten: The reason for this video is to highlight the importance of incorporating culture into your therapy and service delivery. It is our responsibility to do everything we can to help close the gap for Aboriginal people.
Young Aboriginal man 3: It brings that concept where as long as you stay healthy you're staying alive. Everlasting life.
Useful tools and resources: www.health.nsw.gov.au
A True Pictures Production.