Balit Murrup Aboriginal social and emotional wellbeing framework 2017-2027 - health.vic
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Balit Murrup Aboriginal social and emotional wellbeing framework 2017–2027
Balit Murrup
Acknowledgement of
Aboriginal Victoria
The Victorian Government proudly acknowledges Victoria’s
Aboriginal community and its rich culture and pays respect
to its Elders past and present. We acknowledge Aboriginal
people as Australia’s First Peoples and the Traditional Owners
and custodians of the land and water on which we live, work
and play. We recognise and value the ongoing contribution of
Aboriginal people and communities to Victorian life and how
this enriches our society more broadly. We embrace the spirit
of self-determination and reconciliation, working towards
equality of outcomes and ensuring equitable voice.
Victorian Aboriginal communities and peoples are culturally diverse,
with rich and varied heritages and histories pre- and post-invasion.
The impacts of colonisation, while having devastating effects on
traditional life of Aboriginal nations, have not diminished Aboriginal
peoples’ connection to country, culture and community. Aboriginal
Nations continue to strengthen and grow with the resurgence of
language, lore and cultural knowledge. These rich and varied histories
need to be understood and acknowledged by all Victorians, to truly
understand the resilience and strength of previous generations, as well
as the history of the fight for survival, justice and country that has taken
place across and around Australia.
As we work together to ensure Victorian Aboriginal communities continue
to thrive, the Victorian Government acknowledges the invaluable
contributions of generations of Aboriginal warriors that have come
before us, who have fought tirelessly for the rights of their people and
communities towards Aboriginal self-determination, and we are now
honoured to be part of that vision.
To receive this publication in an accessible format email Aboriginal
Health and Wellbeing
Authorised and published by the Victorian Government,
1 Treasury Place, Melbourne.
© State of Victoria, Department of Health and Human Services,
October 2017.
Except where otherwise indicated, the images in this publication show
models and illustrative settings only, and do not necessarily depict actual
services, facilities or recipients of services. This publication may contain
images of deceased Aboriginal and Torres Strait Islander peoples.
In this document, ‘Aboriginal’ refers to both Aboriginal and Torres Strait
Islander people. ‘Indigenous’ or ‘Koori/Koorie’ is retained when it is part of
the title of a report, program or quotation.
ISBN 978-1-76069-025-0 (print) ISBN 978-1-76069-026-7 (pdf/online)
Available at Balit Murrup
(1705012)
2
Aboriginal social and emotional wellbeing framework
Balit Murrup
Balit Murrup means Korin Korin Balit-Djak Artwork
‘Strong Spirit’ in the
Woi-wurrung language.
This is spoken by members
of four Koorie clans that
lived in adjoining estates
in the Port Phillip region.
Permission to use Balit Murrup
for this policy was provided by
the Wurundjeri Tribe Land Council.
Artist – Dixon Patten
The artwork for Balit Murrup uses a section of the artwork from Korin
Korin Balit-Djak, the Aboriginal health, wellbeing and safety strategic
plan (2017-2027). It has been adapted with the artists permission and
depicts the Aboriginal community and our connection to culture
and each other.
Within the detailed circles, Department of Health and Human Services
and community work together to help with system reform across the
health and human services sector with the ultimate goal of physical,
social and emotional wellbeing for all Aboriginal people. The ripples
represent the positive impact on community that this work will have
and that Aboriginal culture and community is a priority.
The hands represent individuals, couples and families. The white circles
represent various tribes/families/ regions. The various paths with the
footprints depict our life journeys and transference of knowledge,
history and culture.
Dixon Patten was commissioned by the Department of Health and
Human Services to produce the artwork for Korin Korin Balit-Djak.
3
Balit Murrup
Aunty Louise
– my story
Mental illness, alcohol and drugs, and a
stretched and culturally unsafe service
system unable to help my daughter have
left me heartbroken.
As carer for my granddaughters, ‘case manager’
and service system navigator and volunteer
advocate for other members of my community,
I know all about mental illness and its impact.
With the exception of the police however, I feel no
Aunty one hears or responds to my concerns or provides
Louise
the appropriate assistance to my daughter – from
urgent psychiatric responses, to ongoing therapy
and support, including any form of daytime
activities that might enable my daughter to recover
and make meaning in her life … and there is never
any respite for me … not ever.
Rarely do I see a black face or an Aboriginal service
where past and present trauma, and the need to
My beautiful heal and connect with culture and community, is
recognised. My daughter, family and community
daughter will never need an Aboriginal and mainstream mental health
be the person she system that listens, engages and responds to our
needs and works together with us to find what works
once was. best over the long term.
4
Aboriginal social and emotional wellbeing framework
Contents
Acknowledgement of Aboriginal Victoria 2
Balit Murrup 3
Aunty Louise – my story 4
Minister’s foreword 6
The Aboriginal Social and Emotional Wellbeing Reference Group 7
The framework 8
Executive summary 10
New investments supporting Balit Murrup 13
Key facts about Aboriginal social and emotional wellbeing 16
The case f or change 17
Policy and reform context 22
The social and emotional wellbeing model 24
Dimensions of social emotional wellbeing 26
Bringing the social and emotional wellbeing model to life 28
The importance of healing 31
Our Commitments to enable reform 34
Domain 1: Improving access to culturally responsive services 36
Domain 2: Supporting resilience, healing and trauma recovery 39
Domain 3: Building a strong, skilled and supported workforce 43
Domain 4: Integrated and seamless service delivery 46
Partners in change 48
Appendix 1: Key concepts 50
Appendix 2: Gayaa Dhuwi (Proud Spirit) Declaration 51
References 52
5
Balit Murrup
Minister’s foreword
Closing the gap in life expectancy between
Aboriginal and non-Aboriginal Victorians
is as much about improving the social and
emotional wellbeing, resilience and mental
health of Aboriginal people, families and
communities as it is about addressing the
physical health factors.
Balit Murrup: Aboriginal Social I thank them for their invaluable innovative demonstration
and Emotional Wellbeing contribution, leadership and projects – Improving mental
Framework is part of the Victorian guidance. I would like to thank health treatment outcomes for
Government’s commitment to in particular the Aboriginal Aboriginal and Torres Strait
doing just that – providing a Social and Emotional Wellbeing Islander people with moderate
long-term vision to improve the Reference Group, established to severe mental illness – that
social and emotional wellbeing in August 2016. focus on reducing the impacts
and mental health outcomes for of unaddressed mental
Aboriginal communities. It aligns Although many Aboriginal health conditions.
with Victoria’s 10-year mental people living in Victoria enjoy
health plan (2015), which aims to excellent social and emotional Further investment has been
support all Victorians to achieve wellbeing, many do not. The made in trials of suicide prevention
their best mental health; and Korin impacts of colonisation, trans- initiatives to improve care following
Korin Balit-Djak: Aboriginal Health, generational trauma, racism, a suicide attempt and to help local
Wellbeing and Safety Strategic discrimination, marginalisation communities prevent suicide, with
Plan 2017–2027, which articulates and disadvantage have resulted Aboriginal people a priority target
a vision for self-determining in poor mental health outcomes. group. The Victorian Government
Aboriginal communities supported Because of this, we need whole- is also expanding the number
by an integrated culturally of-system reform; informed by of Aboriginal mental health and
responsive service system. Aboriginal-led solutions based drug and alcohol positions as a
on the concept of social and key investment in workforce and
Balit Murrup has been developed emotional wellbeing. service system reform to support
with the shared knowledge services to be more culturally
and wisdom of leaders and The integration of healing, responsive.
experts in Aboriginal social and trauma-informed care and
emotional wellbeing and mental recovery-oriented approaches We will continue to work closely
illness, Aboriginal community- across the spectrum of prevention with Aboriginal organisations and
controlled organisations and other and intervention strategies is the communities to build on existing
service providers. cornerstone of Balit Murrup – knowledge and best practice
along with the aim of intervening in order to implement a whole-
early before serious mental illness of-government approach to
occurs. And, where Aboriginal Aboriginal social and emotional
Victorians experience ongoing wellbeing that works.
and severe mental illness, we will
build the capacity of the system
to support recovery and prevent
relapse. The First People of
Australia deserve nothing less.
The Victorian Government is
providing investment into a
Martin Foley MP
number of strategic priorities
Minister for Mental Health
including the funding of three
6
Aboriginal social and emotional wellbeing framework
The Aboriginal Social
and Emotional Wellbeing
Reference Group
Balit Murrup: Aboriginal We would like to acknowledge
Social and Emotional
Reference the inspiring contribution made
Wellbeing Framework has group members by Michelle Hannon who worked
every day with Aboriginal people
been built through the
leadership, experience,
2016–2017 at the Northern Area Mental
Health Service to improve their
Belinda Stevens, Chairperson
expertise and wisdom of social and emotional wellbeing
(Victorian Aboriginal Community and mental health. Michelle
the Aboriginal Social and Controlled Organisation), Annette was passionate about the need
Emotional Reference Group. Vickery (Victorian Aboriginal for workforce expansion and a
Legal Service), Daphne Yarram ‘different way’ to support healing
The reference group is made up of (Yoowinna Wurnalung Healing
Aboriginal people with support from and recovery. Michelle passed
Service), Gary Hamen (Barwon away suddenly in April 2017.
non-Aboriginal representatives Health), Gillie Freeman (Ngwala
from across local and statewide Drug and Alcohol Service), Indi
Aboriginal community-controlled Clarke (Koori Youth Council),
organisations, mental health Michael Bell (Winda Mara
services and government. They Aboriginal Corporation), Salina
have supported, challenged Bernard and Joanne Dwyer Belinda Stevens
and worked with the Victorian (Victorian Aboriginal Health Chairperson, Aboriginal Social
Government to shape a shared Service), Sue Anne Hunter Emotional Wellbeing
vision and approach for working (Victorian Aboriginal Child Care Reference Group
together to improve the social and Agency), Tania Dalton (Australian
emotional wellbeing and mental Indigenous Psychologists
health outcomes for Aboriginal Association), Jamie Waring
people, families and communities (Wadamba Wilam), Alasdair
across Victoria. Vance (Royal Children’s Hospital)
Improving the social and and the late Michelle Hannon
emotional wellbeing and mental (Northern Hospital).
health outcomes for Aboriginal Department of Health and Human
people cannot be achieved Service representatives: Helen
by any one agency or sector, Kennedy, Sally Rose, Michelle
or by Aboriginal people alone. Smith, Christian Coulahan, Anne
It will need to be shaped and Frost, Robyn Humphries and
led through Aboriginal self- Lorraine Langley.
determination with support from
government and the mainstream
service system, in particular
mental health and other services.
The leadership, co-design and
collaborative process fostered
through the Aboriginal Social
and Emotional Wellbeing
Reference Group in shaping
Balit Murrup is an important first
step in the journey. It establishes
an important foundation for
the critical partnership and
collaboration required to achieve
the vision and aspirations set out
in Balit Murrup.
7
Balit Murrup
The framework
Vision: Victorian Aboriginal people, Objective: The health gap between
families and communities achieve and Aboriginal Victorians and the general
sustain the highest attainable standards population attributable to suicide,
of social emotional wellbeing and mental illness and psychological distress
mental health. is reduced.
Principles
Strong
communities, Self-determination and community control
strong culture Self-determination is recognised as essential to overcome the
disadvantage that Aboriginal people experience. Government and
Victoria’s First Peoples services will support the leadership role of Aboriginal communities
and organisations in the planning, delivery, evaluation and
draw on a shared culture measurement of services delivered to Aboriginal people, including
that extends tens of social and emotional wellbeing, mental health and healing and
thousands of years into recovery services.
the past, and continues
to be practised now, Embedding healing and protective factors
despite disruptions since Connection to culture, family, community and country are built into all
colonisation. The history approaches across the promotion, early prevention, early intervention,
of Aboriginal Victorians treatment and recovery continuum.
is also a history of
resistance, reclamation Culturally capable services
of rights, and community Cultural perspectives are embedded into clinical and therapeutic
and personal resilience. practice and services respect the rights, views and expectations of
It is a history that individuals and families.
seeks to re-establish
self-determination in all Person-centred care
aspects of community Mental health and alcohol and other drug services for Aboriginal
including the ways Victorians are designed around the needs and expectations of
in which Aboriginal individuals, families and communities rather than service providers.
people and communities
access and interact with Community engagement
government. Victoria’s Aboriginal communities self-determine and participate in the co-
First Peoples also design and delivery of social and emotional wellbeing and mental
share a more recent health services and programs.
history of colonisation,
dispossession and Partnerships
cultural dislocation and Integrated partnerships between all health service providers and
separation from family Aboriginal communities will provide the best opportunity to improve
mental health outcomes and optimise social and emotional wellbeing
and community through
and will foster trust, connectivity, and appropriate care.
removal and denial of
political power. Supporting and investing in evidence-based
interventions and service models that
achieve sustainable health outcomes and
contribute to closing the health gap.
8
Aboriginal social and emotional wellbeing framework
Healing Social and Holistic health
Healing is one of the emotional The concept of Aboriginal
health and wellbeing is different
most common ways of wellbeing to the universal concept as it is
understanding Aboriginal regarded and recognised as a
• Connection to spirit,
peoples’ experience of more holistic and whole-of-life
spirituality and ancestors view. It encompasses the social,
recovery from trauma
• Connection to land emotional and cultural wellbeing
and other mental health of not only the individual, but
• Connection to culture
and social and emotional the wider community thereby
• Connection to community
wellbeing difficulties, bringing about the total wellbeing
• Connection to family and kinship
including unresolved grief of community.’ ACCO submission
• Connection to mind and emotions Korin Korin Balit-Djak.
and loss.
• Connection to body.
Domains
Improving access to culturally Supporting resilience, healing
responsive services and trauma recovery
Strengthening access to culturally Aboriginal-led health promotion and
responsive social and emotional wellbeing prevention initiatives
and mental health services Recognition of the integral importance of
More Aboriginal people accessing culturally traditional and contemporary healing approaches
appropriate treatment and care Promotion of trauma-informed services models
and clinical practice
Building a strong, skilled and Integrated and seamless
supported workforce service delivery
New Aboriginal social and emotional wellbeing Exploration of new services models and
and mental health workforce training program integrated continuity of care
Expansion of Aboriginal social and emotional Promotion of partnerships for prevention
wellbeing, mental health and alcohol and drug and recovery
workforce in Aboriginal and mainstream services
Supporting new multi-disciplinary social
and emotional wellbeing teams
9
Balit Murrup
Executive summary
Many Victorian Aboriginal people and communities are thriving and
enjoy excellent social and emotional wellbeing and mental health.
Through connections to culture, community, country and family they
are resilient and able to deal successfully with life’s difficulties and
challenges. But too many are not.
The impacts of colonisation, The development of Balit Murrup:
trans-generational trauma, Aboriginal Social and Emotional
What is social
racism, discrimination, Wellbeing Framework is a key and emotional
marginalisation and commitment under Victoria’s 10- wellbeing?
disadvantage have resulted in year mental health plan. It is also
poor mental health outcomes. a companion document to Korin The Aboriginal concept
Korin Balit-Djak: Aboriginal Health, of social and emotional
Aboriginal people and Wellbeing and Safety Strategic
communities are more likely wellbeing is an inclusive
Plan 2017–2027. Korin Korin Balit-
than the general population Djak provides an overarching term that enables
to face risk factors for poor framework for action to improve concepts of mental
mental health and barriers to the health, wellbeing and safety health to be recognised
emotional and social wellbeing.
This includes mental illness;
of Aboriginal Victorians by as part of a holistic
providing high-level strategic and interconnected
drug and alcohol abuse; family actions to reform the health and
violence; self-harm and suicide; human services sector in order
Aboriginal view of health
all of which are experienced to advance Aboriginal self- which embraces social,
by Aboriginal Victorians at determination in health, wellbeing emotional, physical,
significantly higher rates than and safety. cultural and spiritual
non-Aboriginal Victorians. For
Aboriginal Victorians with a Balit Murrup is underpinned by
dimensions of wellbeing.
disability – physical, intellectual a comprehensive analysis of the
While acknowledging mental
or cognitive – the challenges to case for change.
health as a critical area of
social and emotional wellbeing
wellbeing, social and emotional
can be multiplied.
wellbeing emphasises the
By improving the social and importance of individual, family
emotional wellbeing and mental and community strengths and
health of Aboriginal people, resilience, feelings of cultural
families and communities, we can safety and connection to
make a significant contribution to culture, and the importance
reducing the incidence, severity of realising aspirations, and
and duration of mental illness experiencing satisfaction and
and suicide. purpose in life. Importantly,
social and emotional wellbeing
is a source of resilience which
can help protect against the
worst impacts of stressful life
events for Aboriginal people
and provide a buffer to mitigate
risks of poor mental health.
10Aboriginal social and emotional wellbeing framework
In Balit Murrup, mental health and • Improved treatment and
related services for Aboriginal recovery responses for
people need to be designed and Aboriginal people and
delivered incorporating Aboriginal their families living with
concepts of social and emotional acute, episodic and chronic
wellbeing, and supported by
mental illness.
Aboriginal leadership.
• Recognition and investment in
The strategic directions of Balit best practice approaches and
Murrup have been informed and research, including the sharing
underpinned by a consultation and expansion of programs
process. Aboriginal people have
delivering effective outcomes.
emphasised that improving
resilience, wellbeing and mental • An increased focus on suicide Key aims of Balit Murrup include:
health requires: prevention.
• Building the resilience,
• All Aboriginal community-
• Action across the health engagement, skills and
controlled organisations
promotion, early intervention, self-determination of
to inform or deliver mental
treatment and recovery Aboriginal people.
health services and social and
continuum. • Enabling Aboriginal people to
emotional wellbeing solutions
• Aboriginal experiences of and initiatives. be heard, to make decisions,
trauma and concepts of social and to plan and shape their
and emotional wellbeing, The key focus of Balit Murrup is to own journeys of care, recovery
healing and resilience to inform improve the social and emotional and healing.
wellbeing and mental health of
all service models. • Supporting the planning
Aboriginal people, families and
• Improved access to timely, communities. This includes carers. and delivery of culturally
integrated, local and culturally Balit Murrup commits to action appropriate care for the
responsive mental health and on delivering locally-designed clinical, cultural and social and
alcohol and drug services community responses that emotional wellbeing needs of
with a skilled and expanded underpin and inform the building Aboriginal people across all
Aboriginal workforce across of a more culturally responsive service systems.
mainstream and Aboriginal service system with an expanded
• Supporting and investing in
community-controlled skilled Aboriginal workforce.
local Aboriginal community-led
organisations (ACCOs). initiatives and strategies.
• Concentrated effort on
Balit Murrup identifies four key
improving mental health
domain areas as set out on the
outcomes for individuals, following page . Each domain has
families and population a number of strategic priorities
groups who may be at risk which are underpinned by a
and vulnerable. set of immediate actions and
longer-term deliverables. Taken
together, they are the building
blocks for improving the social
and emotional wellbeing of
Aboriginal Victorians.
11Balit Murrup
Key domains
We will develop mental health
Improving access literacy, acknowledge past, current Integrated
to culturally and intergenerational trauma,
enable opportunities for people
and seamless
responsive to heal and recover, and adopt
approaches that include whole-of-
service delivery
services person and whole-of-community We will explore new service models
with Aboriginal communities
We will work with health services strategies. This includes traditional
and contemporary Aboriginal and mental health consumers
to build their capacity to provide that facilitate access, focuses
culturally safe and appropriate healing approaches as well as the
importance of trauma-informed, on outcomes and provides
mental health care and treatment clear pathways and transition
free of racism for Aboriginal family-centred therapeutic
practices that build on protective support to ensure continuity
people of all ages. We will work and service integration. We will
to ensure that more Aboriginal factors and supports recovery,
resilience and healing. work collaboratively across
people with a mental illness who governments to support the
need support are engaged in development of joined-up
appropriate treatment and care
and that Aboriginal people, families Building a approaches to social and
emotional wellbeing support,
and communities are engaged in
service design and review.
strong, skilled mental health, suicide prevention,
and alcohol and drug services.
and supported This will be underpinned by
Supporting workforce recognising the importance of
holistic and integrated services
resilience, We will grow and sustain
Aboriginal mental health and
to Aboriginal people. Particular
emphasis will be placed on
healing and social and emotional wellbeing
workforces across Aboriginal
building partnerships between
mainstream clinical mental
trauma recovery community-controlled health services, Aboriginal
organisations and mainstream community controlled health
Aboriginal people will lead and
mental health services. Planning organisations and other primary
co-design health promotion
and supporting the development and community health providers
and prevention focused on
of this workforce will respond to to support the continuity of care
building resilience and wellbeing.
the growing Aboriginal population for Aboriginal people entering
This includes:
and impacts of trauma within and leaving hospital.
• safe and secure housing the Aboriginal community.
• individual and community safety Multidisciplinary mental health
• family and community and social and emotional
connections wellbeing teams will be supported
across Victoria.
• connecting with country
• access to information, services
and resources.
12Aboriginal social and emotional wellbeing framework
New investments
supporting
Balit Murrup
New investments have been made to ensure that the
strategic priorities linked with each of the four Balit Murrup
domains are translated into initiatives that will make a
tangible difference to the social and emotional wellbeing
outcomes of Aboriginal people.
• An additional 24 Aboriginal
Improving Mental Expanded drug and alcohol positions will
Health Treatment workforce – provide specialist counselling
and treatment for Aboriginal
Outcomes for Aboriginal social Victorians facing alcohol and
Aboriginal and and emotional other drug addiction.
Torres Strait wellbeing, Victorian suicide
Islander People mental health prevention
with Moderate and alcohol and The Victorian Budget 2016–17
to Severe drug treatment provided $27 million over four
years to deliver the Victorian
Mental Illness The Victorian Budget 2017–18 suicide prevention framework.
A key initiative is underway, in
provided an additional $22
demonstrations million as initial investment in partnership with Primary Health
Networks, to support twelve local
sites an expanded Aboriginal mental
health and drug and alcohol communities to develop proactive
Funding of $7.7 million has workforce: suicide prevention strategies
been allocated across three through place-based pilots. An
demonstration projects to test • Ten Aboriginal-specific important focus of this work is
new service models for Aboriginal clinical and therapeutic seeking Aboriginal input into
Victorians with moderate to positions will be established in culturally appropriate and safe
severe mental illness, trauma ACCOs to ensure that ACCOs suicide prevention approaches for
and other complex health Aboriginal communities.
can respond to increased
and social support needs who demand for social and
often fall through the gap emotional wellbeing and
between primary and tertiary mental health services.
mental health services. Each
site will provide culturally • An Aboriginal Mental Health
responsive mental health care, Workforce Training Program
treatment, counselling and care will be established to address
coordination. Evidence emerging entry barriers. This program
on successful practices will be will help build a workforce that
used to inform the development can respond to the needs of
of future Aboriginal social and Aboriginal Victorians. Fifteen
emotional wellbeing and mental initial trainee positions will be
health models and resources. created with pathways into a
bachelor degree.
13Balit Murrup
Initiatives to
support Marrung:
Aboriginal
Aboriginal youth education
mentoring plan 2016–26 –
The government will provide
$1.8 million to extend the Aboriginal establishing the
youth mentoring program,
delivered by Aboriginal community
foundations for
controlled organisations. This better outcomes
program will be continued to
ensure that young Aboriginal The Victorian
people are connected to protective Government will
factors including culture, family
provide funding to
and social support systems.
support the delivery
of Marrung: Aboriginal
Growing strong Self- education plan
2016– 2026.
in culture, Victorian
Aboriginal Child determination
Care Agency
and treaty Initiatives include:
• Koorie Families as First
The Victorian Budget 2017–18
Educators
includes $68 million to support
self-determination and to create • Koorie Supported Playgroups
a better relationship between to provide high-quality and
government and Aboriginal culturally-responsive parenting
Victorians so that both can support
deliver better outcomes, empower • the piloting of an accredited
communities and develop a strong
Aboriginal languages program
culture. This allocation will fund
for Aboriginal community
treaty negotiations and make
sure that Aboriginal communities members to support the
remain at the heart of these delivery of language programs
discussions. It will also be used to in schools and kindergartens.
create an Aboriginal Community
These initiatives are in addition to
Infrastructure Fund for
the 2016–17 Marrung investment
significant innovative community
which includes:
infrastructure projects.
• Children’s Koori Court Liaison
Officers: to support young
Aboriginal people appearing
before the Children’s Koori
Court and the Children’s Court
in selected regional locations to
re-engage or remain engaged
in education
• delivery of cultural understanding
and safety training to all
government schools
• expanding the Koorie Academy
of Excellence from one to
four locations: this will build
secondary students’ aspirations
to complete year 12 and pursue
further pathways through a
focus on culture, leadership
and academia.
14Aboriginal social and emotional wellbeing framework
More support
for Aboriginal
prisoners – This commitment is a response to
a landmark report examining the
Six new forensic mental health
programs will be supported
strengthening circumstances of 1,000 Aboriginal
children and young people in out-
to provide culturally safe
partnerships between the
cultural of-home care. A key government programs and Aboriginal
connections response is to implement Section
18 of the Children, Youth and
community-controlled
organisations for those on
and reducing Families Act 2005 which provides
for Aboriginal organisations
community corrections orders
with a mental health illness.
recidivism to assume responsibility for
Aboriginal children on child
The Victorian Budget 2016–17
has committed $2.5 million to
protection orders. Supporting
support the development of
culturally appropriate Aboriginal
This support includes a focus on Healing Models
promoting healing and culturally
rehabilitation programs that have responsive counselling and wrap- and Therapeutic
a focus on cultural strengthening,
healing, family violence, parenting
around services for the growing
number of children, their families Responses
and women’s programs. and carers who have been victims • The Victorian Government has
of trauma, family violence and allocated $22.87 million to work
An additional $710,000 has
sexual abuse. in partnership with Aboriginal
also been allocated to support
a ‘Continuity of Aboriginal communities to develop and
Health Care’ pilot, led by
Justice Health to ensure post-
Better support provide holistic and healing
therapeutic responses for
release access to healthcare
services in the community,
for youth justice survivors of family violence
including child survivors.
including mental health. The and forensic • A further $17 million has been
Continuity of Aboriginal Health
Care pilot will be delivered by mental health allocated for specialist family
three Aboriginal community violence advisors in major
The Victorian Government
controlled organisations. has committed $83 million to mental health and alcohol and
implement priority initiatives other drug services to identify
as part of the Forensic mental and respond to alcohol, drug
More support for health implementation plan, and mental health issues.
Koori kids and under Victoria’s 10-year mental
health plan. The Forensic mental
families health implementation plan is a
framework to reform Victoria’s
The government is committed to forensic mental health system
implementing recommendations over the next ten years and
aimed at improving the cultural delivers on the commitment to
connections of Koori children address the over-representation
and young people who are of people with a mental illness in
unable to live with their families Victoria’s criminal justice system,
– and providing better help for including Aboriginal and Torres
families earlier. Strait Islander people.
The Forensic mental health
implementation plan will expand
mental health support for those
who are in (or at risk of entering)
the criminal justice system with
a focus on preventing offending
in the first place. The funding will
mean more forensic mental health
beds, more specialist treatment
and create a range of community,
prison and court programs.
15Balit Murrup
Key facts about Aboriginal social
and emotional wellbeing
32% 55% 34.8%
One in three Aboriginal people The number of ABORIGINAL 34.8 per cent of Aboriginal
experience high or very high MENTAL HEALTH-RELATED Victorians experience
levels of PSYCHOLOGICAL PRESENTATIONS to Victorian medically-diagnosed
DISTRESS. That is nearly three Hospital Emergency DEPRESSION AND ANXIETY
times the non-Aboriginal rate. departments had increased compared with 19.6 per cent
(AATSIHS 2012-13) by 55 per cent between 2012-13 of non-Aboriginal Victorians.
and 2015-16 (VEMD) (VPHS 2008)
47.1% 22%
Over 47 per cent of Aboriginal MENTAL HEALTH AND RELATED
people HAVE A RELATIVE WHO CONDITIONS have been estimated to
WAS FORCIBLY REMOVED from account for as much as 22 per cent of the
their family due to STOLEN HEALTH GAP (12 per cent mental health
GENERATIONS POLICIES in Victoria. conditions, 6 per cent alcohol and substance
Transgenerational trauma continues abuse and 4 per cent suicide). Mental health
to affect Aboriginal people in problems, self-harm and suicide have been
Victoria. (DHHS 2015) reported at double the rate of non-Aboriginal
people for at least a decade. (Burden of
Disease 2003 p.2)
As a result of the level of social and emotional wellbeing and
mental health problems in Victorian Aboriginal communities;
the following impacts are apparent:
12x
more likely 60%
In Victoria, the average Family violence, parental mental illness
placement rate into OUT-OF- and alcohol and drug issues are the most
HOME CARE for Aboriginal significant contributing factors in the
children in care is 87.4 per placement of Aboriginal children in out-of-
thousand, which greatly exceeds home care. MENTAL HEALTH WAS A DRIVER
the placement rate of six per INTO CARE in more than 60 per cent of
thousand for non-Aboriginal cases, and was also the reason many
children. (ROGS 2017) children could not be returned (Commission
for Children and Young People 2016)
16Aboriginal social and emotional wellbeing framework
The case f or change
Despite having greater need, Aboriginal people experience barriers in
accessing mental health services and professionals. Aboriginal people
have historically not accessed mainstream mental health services at
levels appropriate to their needs. Contact is mostly limited to acute
episodes of illness, and often following presentation at an Aboriginal
community controlled health organisation.
In 2012–2013, the most common
Closing the Gap service Suicide Aboriginal
deficits reported by Aboriginal
community controlled health Suicides were the fifth leading children and
organisations were around mental
health and social and emotional
cause of death among
Indigenous Australians in 2014,
young people
wellbeing services. approximately twice as high as Childhood experiences of social
and emotional wellbeing issues
the non-Indigenous rate. The
Aboriginal people with high or are also more extreme for
most vulnerable age group of
very high levels of psychological Aboriginal children than non-
distress have poorer general Indigenous Australians is 15–24 Aboriginal children:
health outcomes and are more years where suicide is over five
likely to: times more prevalent than in • The average placement rate
non-Indigenous Australians into out-of-home care for
• self-report poor or fair health of the same age (Dudgeon, Aboriginal children in Victoria
• smoke et al. 2016). is 87.4 per thousand children,
• drink at chronic or risky levels far greater than the 6.1 per
With suicide rates among
• use illicit substances thousand children in non-
Aboriginal people rising,
Aboriginal family situations.
• be a victim of violence. Victorian Aboriginal families
• Family violence, parental
and community members are
This is compounded by mental illness and alcohol and
experiences of racism across
experiencing greater distress
other drug issues are the most
health and human service and profound grief. Aboriginal
significant factors leading to the
settings and the broader young people, lesbian, gay,
placement of Aboriginal children
community. Racism continues bisexual, trans and gender
in out-of-home care with two-
to have a significant impact on diverse and intersex (LGBTI)
thirds (60 per cent) of children
Aboriginal peoples’ decisions people are particularly at
about when and why they unable return to their families.
risk of suicide and self-harm,
seek health services, their as are prisoners immediately • There is continued
acceptance of and adherence following release. overrepresentation of Victorian
to treatment (DOH 2015). Stigma Aboriginal young people
and discrimination are strongly subject to youth justice
correlated with poorer health supervision and detention,
and wellbeing outcomes (ABS
with Aboriginal young people
2016; Ferdinand, Paradies &
more likely to offend earlier
Kelaher 2012).
(age 14 for Aboriginal people
compared with age 19 for
non-Aboriginal people).
17Balit Murrup
children, discrimination, racism
High levels The current and negative staff attitudes
of trauma service system • relatively few Aboriginal people
working in the mental health
Research conducted by the is unable to system resulting in Aboriginal
Victorian Aboriginal Health
Service investigated the extent
meet the needs people being less likely to
access health services or
of trauma exposure among of Aboriginal ‘return’ for follow-up treatment
Aboriginal clients attending
family counselling services. The Victorians • inflexible models of service
delivery, including the use of
number of traumatic events About half of the Aboriginal inappropriate assessment and
clients reported experiencing in a population in Australia uses
lifetime was very high, with levels diagnostic tools
mainstream services because
of trauma exposure comparable an Aboriginal service they need • lack of service coordination
to that of refugee populations is not available or accessible, and integration between
who had experienced large-scale or they prefer mainstream primary mental health and
collective trauma (Mollica, et al. services. Although culturally safe specialist clinical services
2014; Sabin, et al. 2002). Of further mainstream services are important, (NMHC 2014)
concern, 91 per cent of the clients we know from community feedback • poor investment in Aboriginal
interviewed reported having that many people would use
experienced family violence, with mental health and Aboriginal-
Aboriginal services if a more
40 per cent reporting trauma led mainstream models
extensive suite of services were
symptoms consistent with available, including counsellors • the relative poverty of
post-traumatic stress disorder and clinicians. Aboriginal people affecting their
(Gee 2016). capacity to access services
Overall, the mental health and
primary health service systems • limited ‘mental health literacy’
have been largely ineffective in and awareness identifying
responding to the high rates of and responding to social and
psychological distress experienced emotional wellbeing problems
within Aboriginal communities. in Aboriginal communities
Much of the service system has (NSW Government 2007).
been unable to embrace Aboriginal
concepts of health and wellbeing These barriers result in infrequent
and has failed to understand contact with primary health and
the historical context and early intervention services, leading
pervasiveness of racial oppression to increased engagement with
and social disadvantage. This can more complex tertiary services. If
contribute to poorer outcomes not treated early, acute, episodic
for clients and increasing client and chronic mental illness can
dissatisfaction and distrust, which lead to major disruption for
then discourages future access and individuals and their families
perpetuates the cycle. across all areas of their lives.
Although Aboriginal people Improving access to mental health
experience greater levels of services and treatment outcomes
psycho-social problems compared for clients requires addressing:
with the general population, they
• the barriers of entry to
are under-represented in the
mainstream services
service system because of:
• ensuring Aboriginal community
• historical fear and distrust of controlled health organisations
mainstream and government are appropriately resourced and
services due to past policies trained to respond to increased
and practices of removing demand to provide primary
mental health care.
18Priority groups
Children and Young people in the
young people justice system
While many Aboriginal children A snapshot of the characteristics
and young people live in loving of young offenders in custody,
connected families, others inclusive of Aboriginal young
do not. Too many Aboriginal people, showed 33 per cent
children experience stressful, presented with mental health
traumatic life events. Social issues, and 23 percent had a
and economic disadvantage history of self-harm or suicidal
(often intergenerational) places ideation. Further to this, 22 Building resilience,
Aboriginal children at greater risk per cent were registered with Victorian Aboriginal
Child Care Agency
of behavioural and environmental Disability Services; 19 per cent
harm including exposure to had a current child protection
racism, family violence, or order, with 62 per cent being
poor-quality parenting. The victims of abuse, trauma or
impact of this is an often neglect; and 60 per cent of young
undetected, underestimated and people presenting with a history
misunderstood determinant of of alcohol and drug misuse.
mental health. According to the Victorian Youth
Parole Board, ‘effective treatment
Because of under-recognition of mental health concerns is
of mental health impacts, only crucial to improve recovery, health
one in four Aboriginal children and social outcomes, and reduce
experiencing traumatic life the likelihood of further offending’.
events are accessing appropriate (DHHS Youth Parole Board Annual
services – compounding Report 2014).
displacement and trauma
impacts (Sawyer et al. 2000).
Culturally safe, Aboriginal-led,
social and emotional wellbeing Our experience has
approaches and programs
targeted across education, health, shown us that identity,
housing, child welfare and the
youth justice system are necessary
culture and being
to prevent the escalation of social connected to community
and emotional wellbeing and
mental health issues immediately and culture are powerful
and in later years. underpinnings of
resilience for children
in their development,
especially those who
have experienced
trauma in their lives.
(Victorian Aboriginal Child Care Agency,
Healing Centre Report)
19Balit Murrup
of the stolen generations were
Elders and psychologically, physically and
Lesbian, gay,
older people sexually abused while in care bisexual, transgender
Many older people, community or with their adoptive families. and intersex
This trauma impacts their lives
Elders and members of the Stolen
directly as well as those of their community (LGBTI)
Generations are burdened with
grief, loss and trauma. Removal of children, grandchildren, great- Aboriginal LGBTI Victorians
children, the erosion of family and grandchildren and beyond. are more likely to experience
community structures, high rates poorer physical and mental
of incarceration and frequent Aboriginal prisoners health outcomes due to
deaths affect all members of the compounding effects
Increased rates of incarceration, of marginalisation and
extended kinship structures. Older
harsh prison environments, discrimination. Better
Aboriginal people are often also
marginalisation, poor health understanding the experience
carers for their extended families,
outcomes and lost employment of Aboriginal people who belong
particularly grandchildren where
opportunities have profound to LGBTI communities is critical
parents are unable to care for
negative impacts for individuals, to reducing the impacts of
their children. Mental health
families and communities. A depression, alcohol and drug use,
services need to recognise the
study into Victorian Aboriginal self-harm and suicidal behaviour.
diversity of roles and burdens on
prisoner mental health and Discrimination on the basis of
Elders as well as the importance
cognitive function found that sexual orientation or gender
of engaging with Elders to inform
across their lives Aboriginal identity and reduced access to
and co-design effective mental
prisoners, particularly female culturally responsive healthcare
health responses for their families
prisoners, are exposed to high can affect these poorer health
and communities.
rates of social adversity, trauma and wellbeing outcomes.
and health problems. The study
The Stolen found that 72 per cent of men
Aboriginal people
Generations and 92 per cent of women had
received a lifetime diagnosis of misusing alcohol
Many Aboriginal children were
forcibly removed from their
mental illness, compared with and other drugs
a lifetime prevalence of 45 per
families as a result of various cent in the general population Alcohol use alone causes eight
government policies between (Ogloff, Patterson, Cutajar, Adams, per cent of the preventable
1910–1970. The generations of Thomas and Halacas, 2013). For burden of disease for Aboriginal
children removed under these both males and females, the most people. This high need is reflected
policies became known as the prevalent illnesses included major in the over-representation of
Stolen Generations. These policies depressive episodes and post- Aboriginal people as clients in
of child removal have left a legacy traumatic stress disorder. Victoria’s alcohol and other drug
of trauma and loss that continues treatment system, and in further
to affect Aboriginal communities, unmet need highlighted by the
families and individuals. Many Aboriginal community. In 2015–16,
seven per cent (or 2,056 clients) of
alcohol and drug service clients
were Aboriginal. This rose to nine
Sistagirl Brotherboy percent (699 clients) of clients
aged 25 years or under and 10
per cent (590 clients) of forensic
clients, who access treatment as a
result of contact with the criminal
justice system.
20Long-term People who
unemployed experienced childhood
Aboriginal people have an sexual assault Joe’s story –
unemployment rate three times
higher than non-Aboriginal
Psychological and emotional
trauma as an impact of early
Thomas
people. The resulting low
socioeconomic status is
childhood sexual assault is Embling
experienced by many Aboriginal
associated with poor health and people. Sexual assault is often Joe* is a proud Yorta
increased exposure to health risk the reason for the removal
factors (ABS 2009). Continuing Yorta man who
and placement of Aboriginal
anxiety, insecurity, low self- children in out-of-home care.
identifies strongly with
esteem, social isolation and The intergenerational impacts his culture, mob, and
lack of control create social and of sexual assault in institutions family.
emotional wellbeing risks that can or foster family placements
lead to poor mental health and for the Stolen Generation are Joe is on a community
premature death (Wilkinson & documented in the Bringing treatment order. At his
Marmot 2003). them home report (HREOC first meeting with his
1997) and the Royal Commission case manager Will, he
People who have into Institutional Responses appeared disinterested and
to Sexual Abuse (Australian disengaged. Will wondered
experienced Government 2017). if Joe might be feeling
family violence uncomfortable and shamed.
He invited Joe to walk to the
Family violence can be both a People who are hospital courtyard and yarn
cause and outcome of mental homeless or living in under a spreading gumtree.
illness. Aboriginal women are
25 times more likely to be killed insecure housing Joe began to engage. Will
asked Joe about his culture,
or injured than non-Aboriginal Aboriginal people experience family and community,
women as a result of family homelessness at four times the sharing some of his own story.
violence. Eighty-eight per cent of rate of non-Aboriginal Australians
children in out-of-home care have (AIHW 2011). Homelessness and At their second meeting,
experienced family violence. housing instability are outcomes Joe began talking about his
and causes of poor mental health. mental health issues and
For many victim-survivors
profound fears of talking
speaking through the Victorian Coordinating culturally safe with ‘mainstream’ health
Royal Commission into Family responses across housing, providers because of their
Violence ‘navigating ... confusing homelessness and mental health past lack of understanding
systems’ was a major barrier. New sectors is critical. The Victorian of him and his culture.
Support and Safety Hubs with Government recognises the As a result, Joe’s cultural
skilled case managers and service successful outcomes being needs were recognised in
navigators will ‘support women achieved by Wadamba Wilam his planning and clinical
and children from crisis through to in inner city Melbourne, which setting – also linking him to
recovery working in collaboration provides a model of care that Aboriginal-specific supports
across Aboriginal, primary is culturally responsive, with and services. With his cultural
and mental services’. (State integrated support for Aboriginal connection and identity
Government of Victoria 2016) people who are homeless and recognised and respected,
have poor mental health. Joe was able to positively
engage with treatment
and support.
Their forced removal led to psychological
*not his real name
and emotional damage which has been
inherited by today’s Aboriginal and Torres
Strait Islander children.
Justice McClellan 2016
21Balit Murrup
Policy and reform context
Balit Murrup: Aboriginal Social and Emotional Wellbeing Framework is one
of the first three priorities in Victoria’s 10-year mental health plan, which
outlines a long-term vision to improve mental health services and outcomes for
Victorians with a mental illness. Victoria’s 10-year mental health plan is also
supported by the Victorian suicide prevention framework 2016–25, the Mental
Health Workforce Strategy and new initiatives to strengthen and expand
clinical mental health services and undertake reforms under the Forensic
mental health implementation plan. Importantly, it is a companion document to
Korin Korin Balit-Djak: Aboriginal Health, Wellbeing and Safety Strategic Plan.
Key plans and frameworks that support this framework are provided below.
Korin Korin Balit-Djak: Aboriginal Another corresponding critical
Victorian health, wellbeing and safety document under development
Government strategic plan - provides an
overarching framework for
is the Aboriginal children and
families agreement and strategic
Victorian Aboriginal affairs action to advance Aboriginal action plan – designed to improve
framework 2013–2018 – the self-determination and improve outcomes for Aboriginal children
Victorian Government’s the health, wellbeing and safety and families in Victoria. Balit
overarching framework that of Aboriginal Victorians now Murrup is also informed by Always
defines the narrative for a long- and over the next 10 years. was, always will be Koori children:
term approach to Aboriginal Coordinating efforts across Systemic inquiry into services
affairs. The Victorian Aboriginal the department, the plan sets provided to Aboriginal children
Affairs Framework commits to strategic directions for reform and young people in out-of-home
improving outcomes for Victorian across the health and human care in Victoria (2016).
Aboriginal people though focused services system to achieve the
vision of ‘self-determining, healthy Victorian public health and
and integrated strategic action wellbeing plan 2015–2019 –
areas, headline indicators and and safe Aboriginal people and
communities’. outlines the government’s key
targets which are measured on an priorities to improve the health
ongoing basis through the annual Aboriginal governance and and wellbeing of Victorians, with
Victorian Aboriginal affairs report. accountability framework – will a particular focus on addressing
Ending family violence: strengthen the department’s inequities in health outcomes.
Victoria’s plan for change – accountability to community The release of the Victorian
the Indigenous Family Violence through planning, policy public health and wellbeing
Partnership Forum is working development, service outcomes framework provides a
with the Victorian Government implementation and decision- new approach to monitoring and
to strengthen family violence making in consultation with reporting on our collective efforts
reforms in an Aboriginal context. the Aboriginal community and to improve health and wellbeing
This includes the development Aboriginal community-controlled over the long term.
of a complementary Aboriginal organisations.
Absolutely everyone: State
10-year plan. This work is framed Roadmap for Reform: Strong disability plan 2017–2020 – is the
by the Victorian Government’s families, safe children – focuses way the government is taking a
response to the Royal Commission on prevention, early intervention, lead on promoting the inclusion of
into Family Violence. and creating services that are Victorians with a disability.
coordinated and work together
to meet the needs of vulnerable
families and children.
22Aboriginal social and emotional wellbeing framework
Marrung: Aboriginal education National Strategic Framework
plan 2016–2026 – sets out a Local for Aboriginal and Torres Strait
10-year vision for delivering on
the ‘Education State’ to Aboriginal
government Islander Peoples’ Mental Health
and Social and Emotional
Victorians. It is underpinned by Victorian Aboriginal local Wellbeing 2017–2023 (draft) –
the principle of self-determination government action plan – will guide and inform Aboriginal
and delivers on Victoria’s emphasises the central role that and Torres Strait Islander mental
commitment to ensuring local government has as planner health and wellbeing reforms.
Aboriginal people, at every stage and service provider in closing the
of their learning and development gap in disadvantage experienced Closing the Gap – In February
journey, achieve their potential, by Aboriginal people within their 2011, the Council of Australian
succeed in life, and feel strong in local communities. Governments agreed that
their cultural identity. Aboriginal reform and ‘Closing
the Gap’ was one of five national
Aboriginal Justice Agreement –
a formal agreement between the
National priorities for governments.
Victorian Government and the National framework on recovery-
Koori community to work together oriented mental health services
to improve Koori justice outcomes. (2013) – provides a national
It is currently in its third phase, understanding and consistent
which will be implemented from approach to support recovery-
2013–2018. oriented mental health practices
and service delivery that is
Aboriginal Social and Emotional ‘responsive to Aboriginal and
Wellbeing Plan (Justice Health Torres Strait Islander people,
and Corrections Victoria 2015) – families and communities’.
focuses on improving the mental
health and wellbeing of Aboriginal Recognising that consumers’
people while incarcerated and self-determination is a vital
upon their release. The plan part of successful treatment
aims to prevent, stabilise and and recovery, the principles of
effectively manage mental illness recovery emphasise choice and
while in prison, as well as improve self-determination within clinical
the transition processes to ensure requirements and duty of care.
improvements are maintained Australia’s Fifth National
upon release. Mental Health Plan (draft) –
Priority Area 4: Aboriginal and
Torres Strait Islander mental
health and suicide prevention
emphasises the importance
of culturally responsive care
through integrating social and
emotional wellbeing services
within a range of mental health,
drug and alcohol, and suicide
prevention services.
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