Twenty years ago tomorrow, the landmark Burdekin report on mental health was launched. Among indigenous Australians it identified high rates of mental health conditions and dreadful impacts in our communities. It recommended providing indigenous Australians with the training, power and resources needed to determine and deliver our own mental health strategies, within our terms of cultural reference and understandings of mental health.
Some things have improved in the past 20 years. Since 1993, the training of a critical mass of indigenous psychologists and other mental health workers, the establishment of the Healing Foundation, the rollout of the Aboriginal Community Controlled Health Services and the emergence of an indigenous mental health movement mean we are ready to both develop and implement our own mental health strategies.
Yet we have also seen little improvement in the statistics and a mental health gap has become apparent. At present, the rates of suicide and hospitalisation for mental health conditions among indigenous Australians are double those of other Australians. Further, poor mental health continues to exacerbate many other disadvantage gaps we suffer.
Today, one in four prisoners is indigenous, even though we comprise only one in 33 of the total population. Among them, the incidence of mental health conditions and substance abuse problems is shockingly high. The associations between poor mental health and high imprisonment rates are clear.
So, 20 years on, while we take great pride in the emergence of an indigenous mental health leadership, we are also frustrated that little on the ground has apparently changed.
How then do we understand our mental health, and what might an indigenous response to the mental health gap look like?
Indigenous Australians describe their physical and mental health as having a foundation of “social and emotional wellbeing” originating in strong and positive connections to family and community, traditional lands, ancestors and the spiritual dimension of existence. This can be understood as a protective factor against the high rates of stressors and negative social determinants (including sickness, poverty, disability, racism, unemployment and so on) that we suffer and that can lead to depression, anxiety, substance abuse and, sometimes, severe mental illness.
In the spirit of “prevention rather than cure”, then, building on culture and social and emotional wellbeing would be at the heart of any overall response to our mental health and suicide rates. We are particularly excited by research in Canadian indigenous communities that reports those with strong cultural foundations who are working to maintain and develop their culture into the future as having significantly lower rates of suicide among their young people than communities under cultural stress.
It is thought that young people from a strong cultural background have a sense of their past and their traditions and are able to draw pride and identity from them. By extension, they also conceive of themselves as having a future: a strong disincentive to suicide.
Research in our communities, too, supports the idea that there is a high level of need for programs that support culture, and also those that draw on culture to ground healing, suicide prevention and mental health programs.
Cultural and social and emotional wellbeing-based policy and program development to address the mental health gap is something that indigenous Australians must lead at both the national and community level. Even with the best will in the world, Australian governments are ill-equipped to work in this profoundly cultural indigenous space. The proper thing here is for Australian governments and others to partner and work with us. Partnership means listening to indigenous Australians and sharing power. For too long the capital in indigenous knowledge, leadership and lived experience has been marginalised and undervalued in all areas, including this one.
Such a partnership at the national level is critical because there is currently no overarching, dedicated strategic response to closing the mental health gap that both pulls together all the causal threads and recognises mental health as a potential circuit breaker in so many areas of disadvantage. In fact, five overlapping strategies jostle in the space. An overarching plan, or policy framework, being developed under Aboriginal and Torres Strait Islander leadership is critical if these strategies are to work together towards a common goal and avoid wasteful duplication.
Such a plan would place mental health at the centre of the Council of Australian Governments’ Closing the Gap agenda. It would have a goal to close the indigenous mental health gap and inform a nationally consistent whole-of-government response that includes recognition of, and respect for, our human rights, addresses racism on a national level, and that works to complement the strategies to address disadvantage and social exclusion that already comprise much of the Closing the Gap agenda.
Placing mental health in the Closing the Gap agenda has the added benefit of harnessing the contribution closing the mental health gap could make to closing many other disadvantage gaps. In fact it is our belief that the contribution mental health conditions make to many areas of disadvantage is often underestimated – particularly in many areas that are deemed intractable. This includes lower life expectancy. Mental health conditions, substance abuse and suicide have been estimated to account for as much as 22 per cent of the health gap.
Investing in our mental health services should also be considered as a justice re-investment measure, diverting money that would have been spent on imprisonment into services that address the underlying causes of crime in our communities. This is one possible source of the additional investment needed, and it could also help to fund the training of the required numbers of indigenous Australians to work at all levels of the mental health system, and to ensure all mental health workers are able to work competently across the cultural divide.
We call on Australian governments to support indigenous Australians to develop and deliver a national plan to close the mental health gap, and to partner with us to advance the solutions identified in the Burdekin report that have stood the test of time.
Tom Calma is a former Aboriginal and Torres Strait Islander social justice commissioner and race discrimination commissioner; Pat Dudgeon, acknowledged as Australia’s first indigenous psychologist, is a member of the National Mental Health Commission.
This article first appeared on The Australian on 19 October, 2013.