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Well good afternoon everyone. Look, firstly, as it is our custom, I would like to begin
by paying my respects to the Māori elders, both past and present. I also want to give
special recognition and acknowledgement to the youth that are here today as well.
I’d like to thank the conference organisers for giving me the honour and privilege to
come to your mob's country and to come and talk about the issues across the ocean in terms
of suicide, but also not to talk about it, but what we can practically do about it.
So part of my talk is speaking from the point of view of a Health Service provider.
The first thing I wanted to do was give an outline to everyone about the Central Australian
Aboriginal Congress. We grew out of a people movement in 1974, where the local aboriginal
people at that time were in a paradigm of segregation. And so the local leaders took
action to make sure that aboriginal people got the appropriate access to healthcare and
a whole range of social welfare services at that time.
I want to then talk a little bit about the epidemiology of suicide, both within a national
context, but also from within a context of the impact in our community, and the level
of suicide. And then I’ll talk about Alice Springs where we live.
I then want to focus on some of the key determinants of suicide, with particular emphasis on interventions
that have a strong evidence base, and can make a big difference in reducing the terrible
suicide rate in Aboriginal communities in Australia, especially among our young people.
So much more could be done than is being done, and we need to implement the types of programmes
that I’m going to talk about, in key areas, as a matter of urgency.
Suicide is preventable, and even one death from suicide is one death too many.
Much of what I’m going to say is in a policy platform paper that our organisation has developed
which is called ‘Rebuilding Family Life in Alice Springs in Central Australia -
the social and community dimensions of change for our people’.
The next part is just an organisational chart, we started in 1974. At the moment we have
three hundred staff, full-time, that work for us. And we do that in across what we
call Aboriginal Community Controlled Comprehensive Primary Healthcare,
which is providing a holistic approach to Aboriginal health.
We have a range of services and programmes, and a lot of it’s outreach community-based.
We provide support to five remote communities; some of those communities are within three
hundred kilometres of where we live, others are within seventy-five to a hundred, so we
provide a... like a big brother support role to those broader communities around their
own development, their aspirations and the needs for their people.
The next slide is just letting you know that part of what we do tries to follow the principle
of equity and access, and reducing barriers for people across the whole health spectrum.
I just want to talk briefly about what’s happening in Australia in the Northern Territory
around suicide. In this graph here, it just shows you that nationally, suicide rates are
declining, including for youth. As you can see, suicide is much more common... is a much
more common cause of death in men, and this is true for Aboriginal communities as well.
The next graph shows you, in the Northern Territory where we live, that we have got
the highest suicides rate of any other state and territory. And that’s where we live
and work. In the Northern Territory there’s a total of fifty-five thousand Aboriginal
people who live there, and fifty percent of that fifty-five thousand are under the age
of twenty-five. The challenge is quite enormous.
The next graph here shows that the suicide rate is increasing in the Northern Territory,
especially young youth, and this is in contrast to what is going on nationally
where the suicide rates are declining.
As you can see from this graph, it is more likely to affect a younger person in an Aboriginal
community than in the broader Australian community, so that just shows you the Northern Territory
Aboriginal population, and the Australian population, and the age group.
The increasing trend amongst indigenous males is very clear, and when you compare the number
of deaths per year for two decades with the first two years of this decade, the N...
the Northern Territory has continued with the very high rate over that decade.
This data here is a more of an indication within the region that we live, where between
the year 2001 and 2011 we had a total suicide deaths of 108, and it shows you the age group
within them, and which were youth and which was over 25 years of age.
The next graph shows you the comparative difference between non-indigenous and indigenous, and
the gender is on the next column, and down in the lower corner it shows you the three
main town areas within which we live, where those resident communities sit.
In the community of those three regions up there we have a population of about forty-five
thousand people, and there’s twenty-one thousand of those which are Aboriginal.
Even though we make up less than half the population, seventy-five percent of the suicides
are Aboriginal people. Alice Springs has a... where we live is a population of
twenty-seven thousand people. Tennant Creek has three thousand people,
which is five hundred kilometres from where we are, and the rest of the population,
about fifteen thousand, live in dispersed geographical bush locations,
and a lot of those communities live in very poor infrastructure, no housing,
most of them would probably only have a doctor visit them once a month, and
they fly in, so people are living in really extreme circumstances.
And as I’ve said that in the last twelve months,
nearly all of the suicides have been by youth under twenty-five.
This next slide is to demonstrate that our government, as here, has taken note of the
number of people under the age of twenty-five taking their own lives, and has set up an
inquiry in terms of what the government response,
but also, importantly, a community response to what needs to happen.
The next part of what I want to talk about is what we’re focusing on in our own community,
is that I think on the basis of the evidence and what we know across the globe –
this is a global issue – that we think the issues of early childhood
need to be seen as an essential plank of how to address suicide.
Where I think the calling even from the Royal Colleges of Psychiatrists are all saying that
there’s got to be a better focus on early childhood in order to reduce a whole range
of health issues including self-harm and suicide, and that tackling mental health early in life
will improve educational attainment, employment opportunities and physical health,
and reduce the level of substance misuse, self-harm and suicide
as well as family conflict and social deprivation.
There’s a number of strategies, programmes and services that we need to do, and we’ve
got to take a bottom up and a top down approach, and we’ve got to do that in collaboration.
I think the science without the community is nothing. It’s the same with medical
care and medical models, that one without the other is not going to assist us to close
the gap, and in fact it’s making the gap wider. And so I think that’s an important
message about where we’re coming from, and we’ve got to get integration,
and we’ve got to focus on primary prevention.
I want to just reference, because I’m in your mob's country, I thought that there’s a study
that you might have... that came out recently which revealed the extent of the correlation
between impulsivity and self-control identified in early childhood, and the longterm health
and well-being. Impulsivity itself is an important character trait that probably places
young people at an increased risk of suicide.
The scientific evidence, and what we all hear about in terms of a medical clinical approach
I think is necessary, but it’s only a framework that allows us to have a dialogue, and the
key challenge I think for all of us is the implementation of that knowledge, and defining
best practice in an indigenous context. They’re the challenges, because I think
evidence is something that we don’t lack, intellect, we all have a knowledge, but one
without the other is not going to assist.
There’s an Australian Early Development Index that we use in Australia that comes
out regularly, reporting on the extent of children in terms of language and cognitive
domains and development, and that, really, it’s sending a message that we’ve got
to get in much earlier, and get in the front end rather than trying to plug all these holes
with massive interventions at the wrong end of the system, which is where the medical
model and that paradigm sort of disempowers us. And I think even though we can all recognise
it’s got a role, it singularly cannot address the social issues for us as Aboriginal people,
and we need both tools. And the indigenous paradigm seems to get left off the train,
and I think that’s a struggle that we’re all in, to try and assert our authority and
our knowledge in a system that ignores it.
The next thing I wanted to talk about was to let people know about what we’re trying
to do in our community about primary prevention, getting in the front end. And this programme
has come out of a University in Colorado, by a guy named Professor David Aules where
he’s trialled this programme over a thirty year period. And it’s a licensed programme
which has got a whole lot of integrity and requirements that you have to fulfil when
you’re implementing it, and what it’s demonstrated over its thirty year pilot is
that if you provide a home visitation programme to young mothers in early pregnancy, up until
they’re two years old, it has a lifetime effect on both the mother and the child.
And it has, and it reduces a whole range, has better improved pregnancy outcomes, it
improves child health and development, and it improves the parent’s economic self-sufficiency.
And for us, we see this as making an investment. It’s a non-clinical programme and it works
on the parameters of the social cultural context of that mother and that family’s life.
And it doesn’t mean their health doesn’t get addressed, but it just doesn’t dominate,
and it puts the social cultural context of that family at the front of everything.
He’s done this study in a number of communities, and the reason our community got selected
in Australia is because in Alice Springs we have one of the highest births of Aboriginal
families in Australia, besides Victoria and in another town called Cairns, so those three
communities are where the most Aboriginal births take effect. So we have three hundred
births a year in our region, and at the moment we’ve got a hundred and one mothers that
have enrolled on the programme, and it’s really having good impacts.
Next week we’re having the first anniversary of a mother who’s graduated in the two year
programme, and it’s completely home visitation. And a lot of the environments and the areas
that our young mums that are on this programme, they live in an environment which we call
back home ‘town camps’, so they’re pretty equivalent to the shanty towns you see in
South Africa. So that’s where a lot of our young mums live in those type of environments
– very tough, and there’s a few criterias, like you’ve got to be twenty-eight weeks
pregnant as a part of being eligible, but you get
a whole range of support before the baby’s born.
And I think our staff are quite hesitant, and felt that because we’re going to have
all these non-Aboriginal nurses that work with our Aboriginal family support workers,
that the acceptance of them going into those environments would have a negative impact.
But it’s actually worked quite well for both the mothers and the dads, so we’ve
had lots of men who have engaged, and over time the men... and we’re talking about
men who are... who live quite traditional lifestyles, and, you know, the social status
issue that is a part of all of that, and it’s really allowing them to engage in a programme
that’s... we’ve had lots of the young men saying look, I need to do something about
my behaviour, I shouldn’t be like this, and it’s... and then because we have a whole
range of services and programmes that’s all under the one roof, the men can then come
and be introduced to our male health programme, or they go to where they can get some treatment
for alcohol or whatever they want, and it’s working in a way that it’s almost like a
family, and so they shop around and get the assistance that they need.
So when he did this study he did a predominantly white community in Elmira, New York,
which is one of the low income socio-disadvantaged population outside of New York,
so most of the women in there were single, they were into prostitution,
they were heavy into drugs, in and out of prison, and what he’s done
with each of these family groups he’s gone back and followed them up fifteen years later.
And so when he went to Memphis he did a predominantly Afro-American community, and then he did a
study in Denver which was predominantly on the Hispanic community, and so it’s out
of all of those programmes where he’s refined the way this programme functions, and, as
I said for us, I think we’re taking a risk, but I think given the environment and the
situations that we’re confronting, we’re actually compelled to act,
and we’re to do something and to see if it will have the kind of outcomes
that he’s had in other communities.
And I think at the moment our community, and the young women of today that are having children,
are responding quite positively. We can’t be completely certain whether the evidence
of those three communities is actually transferrable for Aboriginal population,
but that’s part of the journey of reflecting on our own services and programmes,
and whether it’s working. We can’t keep delivering services if they’re not having the outcome.
And it’s shown as a part of that outcome that most of the young children that he... that
got two years of a complete home visitation, it took a two year programme, that a lot of
the young children ended up with better education attainment, their risky behaviours were reduced,
and their mothers got reintroduced into the workforce.
So at the moment with our hundred and one mums that we’ve got on the programme
at the moment, we’ve identified thirty of them which can’t... they... those thirty
young women who have got their first-time babies, none of them can read and write, and
part of the programme is introducing them back into, and they’re attending sort of
TAFE College, literacy and numeracy programme, and they’re turning up every day.
And they’re just... they’re enjoying it, so it’s giving them a sense of achievement,
and a journey of change for themselves.
So this is where the programme, from our perspective’s really having the outcome, and it, as I said,
it’s a non-clinical medical approach, it’s actually the social cultural context of supporting
young mums with the challenges of today.
The programme’s prescribed, so I mean it’s sort of... it’s got a ratio where the home-nurse
visitor has to case manage twenty families. We found that that was going to be quite extreme
because some of the mums that are on the programme have already got three or four children.
Trying to implement these type of programmes in a family environment where someone’s
got three other children has been quite challenging, because the importance of working with the
mum is giving her the... empowering her to make better decisions about what she needs
to do in terms of her family and the future.
These are just slides which talk about the economic benefits and gains that this programme
makes just on the premise of two years of home visitation. This little snippet that
I’ve put up here is really a snippet that’s come out of a monthly journal that talked
about the level of suicide, and how young people in the top end of where we live are
suiciding. We all need to recognise, I guess, that alcohol is one of the many
causes of suicide - certainly in our community –
and that needs to be addressed as an underlying cause.
The causation of suicide is complex, it’s multi-faceted, and it does include alcohol.
Impulsivity is being seen as a contributing factor, that it might be things that it’s
already instilled in our children before they get to a point. And we need to think about
that, and what that means, and I guess what we’re trying to do is look at addressing
that from within a preventative lens, and get in early and see primary prevention in
early childhood as a way of eradicating some of the symptoms and signs later on.
I wanted to talk just a little bit about cultural continuity, because I think that’s something
that’s come up here quite a lot today. I’ve referenced a study that’s been done
in Canada which I think we all understand what it means, and I think we’ve got to
renew that. And it came up in the indigenous session earlier, that we’ve got to find
that pathway and journey back about strengthening our community and who we are, if we want to
have, you know, the issue of suicide and our young people to be our leaders in the future.
In spite of the need to focus on early childhood, it’s also necessary to provide programmes
that work for young people who already have a range of issues and problems that they’re
experiencing. And the key that we think, to all of these approaches, is the need to
work with family, parents and community, as well as teachers and schools, peer groups,
as a way of then achieving those four planks that we can which give young people
the support they require at that particular time where they are.
The other thing I’ll just roughly talk about is an approach that we’ve been looking at
in terms of multi-systemic therapy. It’s an intensive family and community-based treatment
programme which focuses on the entire world of chronic and violent juvenile offenders,
their homes and families, schools, teachers, neighbourhoods and friends.
And it works with the toughest offenders.
There are adolescent males and females between the ages twelve and seventeen who have longterm
arrest histories, and this multi-systemic therapy approach allows the integration and
the kind of support that young people need to work through the issues that creates those
kind of behaviours and outcomes that we see currently. It’s a very expensive model,
it’s worked in a couple of communities in Australia, it’s got a lot of evidence base,
and it seems to have the outcome and effect that you want in terms of young people.
I know that was very quick, and I hope that I was able to provide a snapshot to you about
where we’re coming from in the Northern Territory, the challenges that we have in
Australia which I think are global, and I think that coming here and sharing what we’re
doing, and what we see as the future for our children and families, to deal with these
issues as they arise, is really what we’re on about.
So I hope some of the key interventions, and the trials and tribulations that we’re attempting
to address, gives a window of opportunity for people to think about. And as I said,
the paper that we’ve developed, and if people want to obtain a copy, just come and see me.
So, thank you.