THE WHAT, WHY AND HOW OF KOORIE WELL-BEING

1. THE WHAT, WHY AND HOW OF KOORIE WELL-BEING DEVELOPING CULTURAL SAFETY AND CULTURAL EASE TO STRENGTHEN FAMILIES MURU MARRI INDIGENOUS HEALTH UNIT

3. THE WHAT, WHY AND HOW … • What do we know of the effects of mental distress on Koorie families? • Why is it so hard to lighten the burden of community distress … to break the inter-generational cycle? • How can service providers and organisations make a difference?

4. HOW, IN PARTICULAR … • Can cultural safety and cultural ease bring about sustainable change in the way both people and organisations work? • Do you effectively engage Koorie communities? • Can all this help strengthen Koorie families?

5. THE WHAT … What do we know of the effects of mental distress on Koorie families?

6. INDIGENOUS MENTAL DISTRESS • Vic: 2 x Non-Koori rate of ‘Higher Mental and Behavioural Disorders’* • NSW: self-reported ‘mental distress’ almost 2 x Non-Koori rate** • WA children: High risk of significant emotional/behavioural difficulties - Nyoongah 24% > Wajella 15% *** * Aboriginal Affairs Victoria ** NSW Health *** WAACHS

7. ‘NOISE’ IN THE SYSTEM • Reports show a high level of generalised, or non-specific mental distress* • Clear Indigenous mental distress diagnoses, or ‘signals’, hard to assess owing to background‘noise’ • Example of Post-Natal Depression * Gavin Stuart, former epidemiologist for NSW Health

8. JUST WHAT IS THIS ‘NOISE’? • Dispossession – land, language, culture, economic base → grief and loss • ‘Stolen Generations’ • Trans-Generational Trauma • Racism/discrimination and ‘Clayton’s’ apartheid

9. INDIGENOUS MENTAL DISTRESS: A LAYER MODEL

10. “PSYCHOLOGY DOESN’T HAVE THE TOOLS … ” to deal with • catastrophe* • complex Post-Traumatic Stress Disorder** • complicated grief - “People with complicated grief are basically stuck in a state of chronic grieving”*** * Erika Apfelbaum ** Derek Silove *** Paul Boelen

11. THE WHY …? Why is it so hard to lighten the burden of community distress … to break the inter-generational cycle?

12. GRIEF AND LOSS • The losses from colonisation are multiple • Loss is an on-going Koorie experience • It’s both profound and pervasive

13. ‘STOLEN GENERATIONS’

14. ‘STOLEN GENERATIONS’

15. INCARCERATION AND ‘STOLEN GENERATIONS’ • One third of all Aboriginal inmates in NSW had been removed from their parents as children • 31% of female Aboriginal inmates in NSW, and 21% of male, reported that their parents had been forcibly removed from their families as children*

16. TRANS-GENERATIONAL TRAUMA • Holocaust literature – Yael Danieli • Koorie research - Pat Swan / Beverley Raphael, Jane McKendrick • Critical Psychology – Erika Apfelbaum • Critiques of Bio-Psychiatry – Peter Breggin

17. T-G TRAUMA RECOGNISED DVA programme* for children - criteria: • Both parents experiencing a mental illness and /or alcohol /drug abuse problem • One parent (particularly a mother) experiencing a mental illness and/or alcohol/drug abuse problem • A father who has identified his health as ‘very poor’ * Vietnam Veterans Counselling Service Vietnam Veterans Sons and Daughters Project Plan

18. T-G TRAUMA - NOT ‘MENTAL’ • Psychobiology / Body memory of trauma – Bessel van der Kolk • Psychoneurobiology / Developing brain & trauma – Bruce Perry, Alan Schore • Trauma and Psychosis – John Read

19. STATES BECOME TRAITS Dissociation (‘freeze’) • If a child dissociates in response to severe trauma and stays in that … state for … sufficient … time, [they] will alter the homeostasis of the systems [involved]… • ↑ dissociative/somatoform disorders, anxiety, major depression * Bruce Perry, 2001

20. STATES BECOME TRAITS Hyper-arousal (‘fight’ or ‘flight’) • If the child exposed to violence uses a … hyper-arousal response, the altered homeostasis will be in different neuro-chemical systems • ↑ persisting hyper-arousal symptoms / disorders: PTSD, ADHD, conduct disorder * Bruce Perry, 2001

21. PREGY. / EARLY YEARS - SUPPORT CRITICAL • Exposure to violence or trauma alters the developing brain • Consistent, moderate stress → resilience • Unpredictable or chronic stress → deficits in function / vulnerability to future stressors*: ‘Living barefoot … surrounded by broken glass’ * Bruce Perry, 2001

22. EFFECTS OF RACISM • Racism is a major determinant of health and a driver of inequalities in health* * Ricci Harris et al, 2006

23. EFFECTS OF RACISM • Consistent relationships [have been found] between self-reported discrimination and … poorer mental health outcomes* • The literature suggests a robust link between self-perceived discrimination and mental health** * Ricci Harris et al, 2006 ** Gee, 2002

25. EFFECTS OF RACISM

26. COMBATTING RACISM

27. ‘CLAYTON’S’ APARTHEID What are the contemporary effects of keeping Aboriginal Australia side-lined for generations?

28. EFFECTS ON IDENTITY

29. PERMISSION TO MARRY

30. CEASE TO BE AN ABORIGINE

32. THE HOW … How can service providers and organisations make a difference?

33. AN INTEGRATED APPROACH

34. UNSAFE CULTURAL PRACTICE … comprises any action that diminishes, demeans or disempowers the cultural identity or well-being of an individual.* * Nursing Council of New Zealand, 2005

35. CULTURAL SAFETY • More than simply having some cultural awareness/sensitivity* • Requires the service provider to let go some ‘power’ in the relationship with the client** * New Zealand Psychologists Registration Board, 2006 ** Aekins, 2006

36. CULTURAL SAFETY • The client determines what’s comfortable – the service provider looks for guidance as to how to provide the service • The service provider professional is encouraged to reflect on their own cultural identity and how this plays out in the way they work with the client

37. CULTURAL EASE

38. NOT CULTURAL EASE

39. HOW TO MAKE A DIFFERENCE • Strengthen resilience – personal and cultural • Keep a de-Othering perspective • Cultural safety – make it a service priority • Cultural ease - use Aboriginal protocols/ways • Build environments for change – develop real engagement with local community • Extended advocacy – Political is the Clinical

40. STRENGTHEN RESILIENCE Culture and health • Connection to culture, language, land ‘protective’ of well-being* • Notion of cultural resilience** * Jane McKendrick ** Iris HeavyRunner and Kathy Marshall / Tracy Westerman

41. STRENGTHEN RESILIENCE • Enculturation is a resiliency factor in development … • Spirituality reported by adolescent students was related to competence … • [Other studies show] links between spirituality and/or enculturation and wellness and/or resilience * Joyce Strand and Thomas Peacock, 2002

42. Being other

43. Being Other

44. BEYOND THE PALE

45. INDIGENOUS AUSTRALIAN APPROACHES TO LISTENING Dadirri “Inner, deep listening and quiet, still awareness … something like what you call contemplation.” (Miriam-Rose Ungunmerr-Baumann)

46. Indigenous Australian Approaches to Listening Dadirri Listening with your ears and heart* * Judy Atkinson, after Miriam-Rose Ungunmerr-Baumann

47. INDIGENOUS AUSTRALIAN APPROACHES TO LISTENING Ngara “Listen, hear, think … (Eora, the Sydney language) to listen is simultaneously to reflect and become self-aware.”* * Paul Carter

48. Indigenous Australian Approaches to Listening Ngara Listening requires something of you … you need to complete the circle. Hearing should lead to action.* * Koori Peak Organisation Board Member

49. INDIGENOUS AUSTRALIAN APPROACHES TO LISTENING Binang Goonj “They hear, but they don’t listen.” (Bidjara language, south-west Queensland)

50. INDIGENOUS AUSTRALIAN APPROACHES TO LISTENING The Role of Silence "If you cannot understand an Aboriginal person's silence, then you will never understand their words" (Uncle George Tongerie, Elder from South Australia)