Submission to the National Anti-Racism
Strategy 2012
Australian Human Rights Commission
This submission was prepared for the Australian Indigenous Psychologists
Association by Dr Pat Dudgeon, Mr Glenn Williams and Liz Orr.
May 2012
1
Brief Summary
`a strong and confident national identity is one that begins with its First
Nations peoples, their knowledge, heritage, and spiritual connection to the
land and seas’ Racism Roundtable 2009.
The Australian Indigenous Psychologists Association (AIPA) applauds the Human
Rights Commission intention to develop a National Anti-Racism Strategy. This
submission focuses on the impact of racism evident through the lack of culturally
appropriate and culturally safe mental health services. AIPA calls on the Human
Rights Commission to include social and emotional wellbeing/mental health and
institutional racism in the scope of the National Anti-Racism strategy.
The
delivery of Indigenous-specific safe, high quality social and emotional wellbeing
services are needed to work at the many levels required to prevent the impact of
racism and to support community and institutional change. A national AntiRacism Strategy must address systemic racism and advocate for change at the
institutional and cultural level as well as the individual and personal level. Social
and emotional wellbeing services for Indigenous Australians are urgently
required. Prevention programs and campaigns to raise awareness and encourage
social activism against racism are also required
2
Table of Contents
1.
2.
3.
4.
Australian Indigenous Psychological Association (AIPA) ................................... 5
Recommendations ............................................................................................................. 7
Focus .................................................................................................................................... 10
Addressing Social and Emotional Wellbeing issues............................................ 10
4.1 Distinguishing Social and Emotional Well Being from Mental Health............... 12
4.2 Social and Emotional Well Being assessment tools ................................................. 15
4.3 Action about health inequalities ...................................................................................... 19
5. Psychology and Racism .................................................................................................. 20
5.1 The roundtable on racism and Durban Declaration ................................................. 21
6. Indigenous mental health movement and culturally appropriate paradigms
......................................................................................................................................................... 24
6.1. Self-determination and meaningful ongoing consultation ........................................ 25
6.2. Psychology: current & proposed AIPA actions to combat racism .......................... 26
6.3. Anti Racism, responsible media and using media as strategy ................................. 27
6.4 Anti- racism education and resources ............................................................................ 28
6.5 Research & evaluation .......................................................................................................... 30
References ................................................................................................................................... 33
3
4
1.
Australian Indigenous Psychological Association (AIPA)
AIPA is the national body that represents Aboriginal and Torres Strait Islander
psychologists in Australia.
AIPA is an unincorporated Association and the
Australian Psychological Society (APS) provides organisational and financial
support to AIPA, including the auspicing of contracts from the Australian
Government
AIPA is committed to improving the social and emotional well-being and mental
health of Aboriginal and Torres Strait Islander people by increasing the number
of Indigenous psychologists and by leading the change required to deliver
equitable, accessible, sustainable, timely and culturally safe primary mental
health care to Aboriginal and Torres Strait Islander peoples in urban, regional
and remote Australia.
Furthermore, AIPA is committed to supporting
indigenous psychologists through undergraduate and post graduate courses;
and providing professional development to Indigenous and non-Indigenous
psychologists to increase the cultural safety of indigenous clients and expanding
the skills of psychologists to work with indigenous clients. By maintaining a
high standard of practice and engaging in Indigenous psychological research,
AIPA is committed to being on the forefront of Indigenous psychology in
Australia. AIPA is supported in its functioning by the Australian Psychological
Society.
For more information about AIPA and its members, please refer to AIPA’s
website: http:/ /www.indigenouspsychology.com.au/
The Australian Indigenous Psychologists Association (AIPA) applauds the
Human Rights Commission steps to develop a National Anti-Racism Strategy.
AIPA, together with the host, the Australian Psychological Society (APS),
contributed to a roundtable about research concerning racism at the University
of Western Australia in June 2009. Key organizations including the Human
Rights Commission, the Australian Indigenous Doctors Association, the Telethon
Institute for Child Health Research, WA, the School of Indigenous Studies UWA,
and the University of Notre Dame Australia attended. The Roundtable was
5
initiated by AIPA Chair and APS Fellow Dr Pat Dudgeon, who saw it as one way
to renew the momentum for combating racism that was generated a decade ago
by the APS Position Paper Racism and prejudice: Psychological perspectives
(1997).
6
2.
Recommendations
Recommendation 1: That the National Anti-Racism Strategy encompasses a
broad definition of racism, including individual, institutional and cultural racism.
The strategy should also seek to broaden the communities understanding of
racism, from individual incidents or attacks, to policies and procedures that
unfairly disadvantage Indigenous people
Recommendation 2: That AIPA endorses close collaboration with Indigenous
people that involves meaningful and ongoing input and appropriate resourcing
for actions that emerge from the strategy.
Recommendation 3: That the National Anti-Racism Strategy find ways to
address the needs of individuals and work to change systemic, institutional and
cultural racism. This may include:

Indigenous access to the Better access Program

Resourcing Aboriginal Community Controlled Health Organisations to
provide Social and Emotional Well Being programs

Changes to current Mental Health Systems and services and appropriate
resourcing for actions that emerge from the SEWB strategy. This is a key
action and may be a quantifiable measure against systemic racism.
Recommendation 4: That the Principles of the UN Declaration on the Rights of
Indigenous peoples, in particular the right to free, prior and informed consent
are incorporated into the strategy.
Recommendation 5: That the National Anti-Racism Strategy supports the call
to acknowledge Indigenous Australians as the first custodians of the land and
recognise the role Indigenous Australians continue to play in contemporary
multicultural society within the Australian Constitution. Working with the
National Congress of Australia’s first peoples, along with other Indigenous
specific organisations, the strategy should promote this recognition among all
government
departments,
educational
institutions
and
community
organisations, as well as the general public.
7
Recommendation 6: That the strategy promotes positive stories of survival
and strength about Indigenous Australians and highlights our ongoing
contribution to the broader community and country.
Recommendation 7:
That the National Anti-Racism Strategy investigate
accountability mechanisms for media representation of Aboriginal and Torres
Strait Islander peoples that the strategy:

prioritise media campaigns to reduce racism.

get the media to develop strategies to take responsibility for
representations of Aboriginal and Torres Strait people in ways which
highlight the diversity within groups and similarities across groups,
thereby discouraging negative stereotyping.

Investigate how to ensure media compliance with accountability
mechanisms for media representation of Aboriginal and Torres Strait
Islander peoples. For example perhaps there could be a media watch
officer with statutory powers.

support cultural awareness training to be made available for all people
involved in the media
Recommendation 8: AIPA recommends that anti-racism training be developed
based on multiple mechanisms, be adjusted to the local context, and be age
appropriate.
Recommendation 9: AIPA recommends that the Australian Government
support accurate qualitative and quantitative data on racism against Aboriginal
and Torres Strait Islander peoples and that this data collection be done within
an Indigenous framework with Indigenous people involved in all stages of the
design, collection and knowledge transfer stages.
This suggestion is in
accordance with Recommendation 103 of the Durban Review Conference
outcomes document.
Recommendation 10: AIPA urge the HRC to ensure that the national AntiRacism Strategy works to change the health system. A key element in the
prevention of serious psychological distress from yielding a high burden of
8
mental illness among Indigenous peoples, particularly high-prevalence
disorders such as anxiety disorders, depression and substance abuse disorders,
is universal access to culturally appropriate SEWB and primary mental health
care.
9
3.
Focus
In light of the urgent need to address the impact of racism on the social and
emotional wellbeing of Aboriginal and Torres Strait Islander people, AIPA calls
on the Human Rights Commission to put forward the recommendations outlined
in this paper to the government of the day, and to all future governments. These
recommendations will assist governments address the individual, institutional,
and cultural racism evident in the mental health systems in Australia. This
submission focuses on ensuring that ‘Close the Gap’ initiatives develop Social
and Emotional Wellbeing frameworks to assist Indigenous Australians deal with
the forms of racism they experience and to assist those charged with making
systemic and cultural change to eradicate racism.
4.
Addressing Social and Emotional Wellbeing issues
The direct and indirect racism and inequality experienced by Aboriginal and
Torres Strait Islander people and communities is one of the most pressing issues
facing Australia today (APS 2012). The human rights of Aboriginal and Torres
Strait Islander peoples are not sufficiently protected or promoted and the
insidious effects of racism continue to impact their lives and scar our nation.
Indigenous people are confronted with racism on a daily basis -to the point
where they sometimes think this is normal and they may accommodate the
situation in what is described as internalized racism (Dudgeon 2012, Paradies et
al 2008). The effects of racism on Aboriginal and Torres Strait Islander people
are being named and documented in an increasingly thorough and meaningful
manner (Paradies 2012).
Paradies, Harris and Anderson (2008) note the challenges in measuring the
impact of racism on health. However, they identify that this is due to the
complexity and subtlety of racism:
…racism can be subtle, unintentional, unwitting and even unconscious, it
is rarely possible to definitively attribute a particular event to racism. A
subjective experience of racism may, in fact, be caused by other forms of
oppression (e.g. sexism), while an individual may erroneously attribute
an objectively racist experience to another form of oppression or to
10
his/her own limitations. Moreover, internalised racism and systemic
racism can be invisible …
Racism creates physical ill health, a greater propensity to disease and a range of
social and emotion and psychological distress such as low self-esteem, mistrust
of the dominant culture, anxiety, substance misuse, depression, internalised
racism, confusion, and disengagement. Atkinson 2002; and Atkinson, Nelson
and Atkinson, (2010) point to the trauma of racism, its intergenerational impact
and the ongoing difficult task of healing from colonisation. With regard to the
impact of colonisation:
`There is little doubt that in real and symbolic terms, Australian
Aboriginal culture has been traumatized by the European invasion’
Halloran (2004):
The impact of colonisation and ongoing racism inflicted upon Aboriginal and
Torres Strait Islander people is starkly demonstrated by poor outcomes in
relation to health, education, incarceration, child protection, morbidity and
mortality with the average life expectancy gap between Indigenous and nonIndigenous Australians of around 11 years (ABS, 2009).
Furthermore,
Aboriginal and Torres Strait Islander peoples do not have access to justice.
Extensive data indicates that Aboriginal and Torres Strait Islander peoples
experience race discrimination at every stage of the justice system. For example,
in Western Australia 43% of prisoners are Indigenous from 3.5% of the
population (Kelly, Gee, Dudgeon, & Glaskin, 2009). Aboriginal and Torres Strait
Islander children lack access to safe, culturally appropriate, resourced, and
accessible quality education. Along with significant improvements to the quality
of education, the right to language needs to be realized through the education
system. Teaching in language is an important protective factor and this is widely
evidenced (Kelly et al., 2009).
11
4.1
Distinguishing Social and Emotional Well Being from Mental Health
Social and emotional wellbeing includes a plethora of issues such as; issues
relating to suicide, family violence, removal of children and young people,
incarceration of family members, drug and alcohol issues, witnessing or being
subject to violence, grief and loss, anger management, low self-esteem and high
prevalence disorders such as anxiety and depression.
The Social Health
Reference Group describes social and emotional wellbeing as recognising:
the important connection to land, culture, spirituality, ancestry, family
and community and how these affect the individual. Social and
emotional wellbeing problems cover a broad range of problems that
can result from unresolved grief and loss, trauma and abuse, domestic
violence, removal form family, substance misuse, family breakdown,
cultural dislocation, racism and discrimination an social disadvantage
(Social Health Reference Group 2004).
AIPA purports that the racism strategy identifies ‘social and emotional
wellbeing’ in terms of an Indigenous cultural concept that differs in important
ways to mainstream concepts of mental health and illness. Rather than simply
adapting and delivering models designed for mainstream Australians, social and
emotional wellbeing and mental health services need to strongly engage with
the diversity of cultures and Indigenous language groups/nations and each
group’s understanding of social and emotional wellbeing and support their ways
of achieving it. As well as addressing factors that influence the ‘mental health’ of
all Australians, services need to specifically address the aftermath of
colonisation: unresolved grief, loss and trauma, removal from family, family
breakdown, cultural dislocation, racism and discrimination and ongoing
disadvantage (SHRG, 2004).
Aboriginal and Torres Strait Islander people are exposed to a disproportionate
number of stressful life events compared to other Australians, contributing to
high levels of serious psychological distress and suicide (Kelly, Dudgeon et al,
2010). Any program that works on one issue in isolation from the others may
12
alleviate some problems in the short term but will not achieve the ultimate goal
of restoring social and emotional wellbeing across each language group/nation.
The definitions and determinants for mainstream mental heath and Indigenous
SEWB suggest clear overlaps and important differences between the two
concepts, and as many Indigenous scholars have noted, the relationship between
the two continues to be discussed, debated and negotiated (Garvey 2008).
Consistent with the Social Health Reference Group, AIPA acknowledges and
recognises the importance of mental health, but positions it within the larger
framework of SEWB—a framework that includes the domains of wellbeing that
are unique and essential components of Aboriginal and Torres Strait Islander
health (Kelly et al. 2009).
There are big challenges to service delivery posed by small, dispersed Aboriginal
and Torres Strait Islander communities in remote Australia, where 92,960
Aboriginal people live on traditional lands. The lack of infrastructure to support
service delivery and the extreme poverty and disadvantage found in these
communities often make survival the main task. Rather than simply adapting
and delivering models designed for mainstream Australians, social and
emotional wellbeing and mental health services need to be able to engage with
each group’s understanding of social and emotional wellbeing and how best to
achieve it.
There is little capacity to offer choice for the majority (76%) of the Aboriginal
and Torres Strait Islander population who live as dispersed minorities within
mainstream populations in urban and regional Australia. A two way strategy to
increase both the Indigenous mental health workforce and improve the cultural
competence of mainstream service providers to meet the needs of Aboriginal
and Torres Strait Islander people in their client base, is urgently required.
Aboriginal and Torres Strait Islander peoples continue to experience high levels
of racism in Australia, across multiple settings. For example, the Challenging
Racism data released in March 2011 found that Aboriginal and Torres Strait
Islander respondents experienced four times the racism of non-Aboriginal
13
Australians in relation to contact with police and in seeking housing (AIHW
2011) .
Similarly, 2008 research found that 27% of Aboriginal and Torres Strait Islander
peoples over the age of 15 reported experiencing discrimination in the
preceding 12 months (AIHWP 2008). Other research has found that three out of
four Aboriginal and Torres Strait Islander peoples regularly experienced race
discrimination when accessing primary health care, contributing to some people
not being diagnosed and treated for disease in its early stages(Paradies 2008).
The destructive impact of racism on Aboriginal and Torres Strait Islander
peoples' social and emotional health and wellbeing reaches beyond its
immediate impact. See for example
Reconciliation Australia, Australian
Reconciliation Barometer 2010, Question and Answer Fact Sheet, At:
http://www.reconciliation.org.au/home/resources/factsheets/q-afactsheets/baromter-2010 (viewed 1 February 2012) which notes respondents’
belief that previous race-based policies continue to affect some Aboriginal and
Torres Strait Islander people today.
Evidence suggests the need for ongoing research to fully understand the
different impact of racism across the lifespan and in different geographical and
social settings (Purdie et al2010). However, there is compelling evidence of a
link between race-based discrimination and poor mental health and wellbeing
(Paradies, 2006).
It is also noted by Parker (2010) that `prior to European colonization of
Australia (mental illness) was, most likely a fairly rare occurrence. The much
greater prevalence of mental illness in the Aboriginal And Torre Strait islander
population currently is a reflection of the significant disruption to Aboriginal
and Torres Strait Islander society and has a strong context of social and
emotional deprivation’. He goes on to note that management of the issues
therefore …`requires a strong emphasis on cultural safety along with the
recognition of family, culture and community in any healing processes’.
14
As a measure of `walking the talk’, AIPA strongly endorses close and ongoing
collaboration with Indigenous people in the development and monitoring of a
National Anti-Racism Strategy. This will require meaningful and ongoing input
and appropriate resourcing for actions that emerge from the strategy along with
supporting research that will assist to continue build the evidence base about
culturally effective services and approaches.
We call on the HRC to consider racism against Indigenous peoples as a public
health and Human Rights issue that requires a whole of government and cross
sector response. In recognition of the unique place of Indigenous culture and
the specific nature of racism against Aboriginal and Torres Strait Islanders that
manifests in unparalleled bad health and mental health outcomes we urge the
HRC to ensure that the national Anti-Racism Strategy works to change the health
system. A key element in the prevention of serious psychological distress from
yielding a high burden of mental illness among Indigenous peoples, particularly
high-prevalence disorders such as anxiety disorders, depression and substance
abuse disorders, is universal access to culturally appropriate SEWB and primary
mental health care.
4.2
Social and Emotional Well Being assessment tools
Inappropriate social and emotional wellbeing assessment tools and the poor
outcomes in relation to individual, community, and social and emotional wellbeing amongst Indigenous populations are of particular concern to AIPA.
Literature about Indigenous psychology and Indigenous social and emotional
well being is replete about the need for culturally appropriate assessment tools
for working with Aboriginal and Torres Strait Islander people (Drew, Adams &
Walker, 2010; Sheldon, 2010; Gilies, 2012) and a recognition of historical and
cultural contexts for social and emotional well-being must be central to
psychological and psychiatric assessments.
In developing culturally appropriate tools greater attention must also be paid to
the context and characteristics of mental health morbidity indicators and
15
strategies. For example, the rate of suicide in the Indigenous population is
almost three times greater than that of the non-Indigenous population (3.7%
compared to 1.3%) and Indigenous Australians are three times more likely to be
hospitalised for intentional self-harm than other Australians (ABS & AIHW,
2008). Whilst these higher rates of suicide have long been acknowledged there
has not been a corresponding development of safe, culturally appropriate,
resourced and accessible services to support social and emotional well-being.
Furthermore, the work of researchers such as Hunter (1999, 2001) and Hunter
and Milroy (2006) alert us to the phenomena of suicide clustering, the fact that
suicidal behavior is fairly recent as a socio-cultural phenomenon and that there
are significant regional variations that need to be considered in strategies to
prevent suicide.
These issues have been documented by the Co-operative Research Centre on
Aboriginal and Torres Strait Islander Health (Kelly et al 2009; Paradies, Harris &
Anderson 2008) and in many major government reports including: the Social
Justice Reports, the Bringing Them Home Report, the Little Children are Sacred
Report and the Royal Commission Report into Aboriginal Deaths in Custody.
The following major national conferences, inquiries and reports have found a
high level of unmet need among Aboriginal and Torres Strait Islander people
and a perception that mainstream mental health services have failed them:
1992
The Royal Commission into Aboriginal Deaths in Custody Report
1993
National Aboriginal Mental Health Conference
1994
The Burdekin Report on Human Rights and Mental Illness
1996
The Ways Forward Report: National Aboriginal and Torres Strait
Islander Mental Health Policy: National Consultancy Report.
1997
Bringing Them Home: Report of the National Inquiry into the
Separation of Aboriginal and Torres Strait Islander Children from
their Families
There is a high level of consensus in the findings of these reports and enquiries
that non-Indigenous mental health practitioners have little understanding of
16
Indigenous concepts of social and emotional wellbeing, history, culture and
society, and that this has resulted in barriers to service provision, frequent
misdiagnosis and inappropriate treatment (Barrett 2011).
A local example is the Indigenous Community Response to Suicides in Mackay’
report which outlines the community’s need for prevention, intervention and
post-intervention strategies that are broad, flexible in scope and Indigenousspecific (Barnett et al., 2010). It was within this context that the ‘Call-a-Cuz’
help-line was suggested - a tool for Indigenous people to access Indigenous
mental and social health professionals for assistance to address their emotional
and psychological distress within a social and emotional wellbeing context,
underpinned by a strengths-based model of service provision which draws upon
protective factors that are unique to Indigenous Australians, such as connections
to land, culture, spirituality, ancestry, family and community (Kelly, Dudgeon,
Gee & Glaskin, 2009).
The understanding that Indigenous Australians
experience emotional and psychological distress associated with feelings of
hopelessness, disconnectedness and grief - rather than mental illness - is
associated with the unique Indigenous experience of such losses as
dispossession, marginalisation, loss of culture and tradition as a result of past
governmental policies (Barnett et. al., 2010).
From these fundamental
experiences stem the cumulative effects of an almost inexhaustible list of serious
psychological distress factors experienced at a higher rate than that of other
Australians, which requires sensitive management (Kelly et al., 2009).
Institutional racism is also evidenced as an unintentional consequence of the
design and delivery of existing services. The location and style of services to
address emotional and psychological distress make them accessible to other
Australians whereas the many remote Indigenous communities that require
such services have little if any access to them. In addition, while the need for
after hours counselling and support has been met through 24 hour telephone
services such as Lifeline, Relationships Australia and the Kids Helpline, uptake of
these services by Indigenous Australians has not been proportional (2.5%) and
the evidence of unmet need is reflected in Indigenous rates of psychological
17
distress twice that of the general population (30% compared to 16%). Many
government departments and agencies throughout the country (e.g., Australian
Taxation Office, Medicare) recognise Indigenous people have specific needs and
have addressed this by providing Indigenous-specific access lines to facilitate
culturally competent service delivery (Barrett 2011).
AIPA supported a proposal by the APS to develop a national Indigenous social
and emotional wellbeing help-line with culturally competent and highly skilled
Indigenous mental health practitioners. Such a service would have the capacity
to identify and manage Indigenous-specific risk factors using strength-based
approaches which draw upon Indigenous-specific protective factors found at
individual, family and community levels in order to address the range of social
determinants which impact negatively on Indigenous social and emotional
wellbeing and stimulate high levels of psychological distress. When considering
the high level of unmet need for social and emotional wellbeing and mental
health support, the challenges posed by the demographics of the Aboriginal and
Torres Strait Islander population, and the lack of parity of Indigenous people
within the five professions which constitute the mental health workforce
(psychiatrists, psychologists, mental health nurses, social workers and
counsellors) it is reasonable to propose that a national help-line would enable
accessibility on a larger scale and help overcome many of the existing barriers to
accessible, culturally appropriate crisis intervention and referral services.
This proposal identified the need to deliver mental health care within
Indigenous frameworks of social and emotional wellbeing, as advocated in the
Ways Forward Report and the Social and Emotional Wellbeing Framework 2004
– 2009 (Swan & Raphael, 1995; Social Health Reference Group, 2004)
Additional strategies for providing culturally appropriate services for those
disabled by serious and recurring mental illnesses such as schizophrenia, major
depressive and bipolar disorders, are also required.
Support and training to
state mental health service crisis intervention teams and recruitment and
training of more Indigenous mental health around the nation is part of the
APS/AIPA reconciliation action plan but this is a longer term objective and more
18
immediate goals include the provision of cultural competence training and
ongoing skill and career development for the health and community services
workforce.
Further issues that need to be investigated to change institutional and cultural
racism within the health system include:

Recognition of the diversity of understandings of social and emotional
wellbeing which exist among the many language groups throughout
the country;

Communication issues for English speaking health providers working
with Indigenous patients for whom English is not their first language;

Unequal technological needs and resource availability in urban,
regional, rural and remote communities throughout the country;

Access to communication technology that is appropriate for use by
members of the Indigenous community nation wide;

Telephone help-line services currently provided by organisations need
to eradicate barriers to uptake and service provision- this may include
their support for an Indigenous-specific help-line;

Developing service delivery models, practice and operational
frameworks for an Indigenous help-line;

Working in collaboration with Indigenous health organisations to
investigate requirements for the recruitment, orientation, preparation,
on-going support needs, and retention of health service providers and
operational procedures for service providers.
The proposal to develop help line is one of many approaches to support victims
of racism and a national Anti-Racism Strategy should call for an updated and
specific Indigenous Social and Emotional Well Being (Mental Health) Strategy to
counter the racism of the current Mental Health Systems in Australia.
4.3
Action about health inequalities
Health inequalities between Aboriginal and Torres Strait Islander people and the
general Australian population are well documented and links between poor
19
health outcomes and racism are internationally recognized (WHO Determinants
of Health 2011 Marmot & Wilkinson 2006;). The social gradient of health and
psychosocial characteristics in the gradient such as depression, psychological
stress and associated health outcomes is also well documented (Wilkinson &
Marmot, 2003, Marmot 2004;) For example, higher mortality rates amongst
Indigenous Australians compared to other Australians relate to: accidents,
homicide and suicide (16% compared to 6% of non-Indigenous deaths);
maternal (five times higher) and infant mortality (three times higher) factors;
chronic diseases; poor living conditions; reduced access to healthcare, education
and employment opportunities in remote, regional and urban areas; and the
continued fragmentation of family networks due to Indigenous people being
removed from families through the child welfare, youth justice and incarceration
systems (Barnett et. al., 2010).
The lack of Indigenous mental health service professionals and providers and
the under-resourcing of the Aboriginal Community Controlled Health
Organisations (ACCHOs) are additional area that, if addressed as part of a
strategy , could reduce the impact and strengthen the response to racism. The
Co-operative Research Centre for Aboriginal and Torres Strait Islander Health,
now called the Lowitja Institute, has identified the further development of the
Indigenous health workforce as another
key strategy to address health
inequalities (Lowitja Roundtable 2011).
5.
Psychology and Racism
The discipline of psychology has been part of the colonising process and has
contributed to cultural and institutionalized racism as it presents in Australia.
The links between the newly emerging sciences of psychology at the turn of the
century with the salience of biological theories of race were documented in the
APS Racism Position Paper 1997. This notes ` …the tendency to loosely equate
biogenetic designations of race with social categorizations and popular
understandings’ thus contributing to negative stereotypes and confusion about
cultural practices and beliefs’. There are also a number of papers that provide
20
critiques of psychology and provide overviews of useful ideas about the
construction of prejudice and strategies to reduce racism (Sanson et al 1997;
Rickwood, Dudgeon & Gridley 2010; Gilies 2012, Penderson 2008).
As a discipline, psychology has taken some steps forward and in recent years
there have been some important paradigm shifts that move towards
understanding the social determinants of mental health and an acceptance of
Indigenous ways of describing and experiencing mental health. As noted earlier,
in Australia, this includes concepts such as social and emotional well-being and
the importance of self determination, which are being embraced by mainstream
mental
health
providers
and
practitioners
led
by
psychologists.
(Purdie,Dudgeon & Walker 2010).
AIPA acknowledge the underlying racism evident in the use of biogenetic
theories of psychosocial development and note that the APS- through its
Reconciliation Action Plan (RAP) Working Group and AIPA- will be updating its
critique of psychological literature and work to ensure appropriate Indigenous
content in psychology courses. This action and the RAP, will contribute to
creating appropriate curricula and resources and the mentoring and support of
more Indigenous psychologists.
5.1
The roundtable on racism and Durban Declaration
Psychologists regard people as intrinsically valuable and respect their rights,
including the right to autonomy and justice. Psychologists engage in conduct,
which promotes equity and the protection of people’s human rights, legal rights,
and moral rights. The APS Code of Ethics (APS 2007) reflects psychologists’
responsibilities, which include principles of respect for the rights and dignity of
people and peoples, propriety, and integrity. The Code is complemented by sets
of ethical guidelines, including guidelines on the provision of psychological
services to Aboriginal and Torres Strait Islander people.
declaration
of
ethical
principles
for
The Universal
psychologists
(2008)
www.am.org/iupsys/resources/ethics/univdecl2008.pdf explicitly recognizes
21
that Psychology as a science and a profession functions within the context of
human society, and as such has responsibilities to society that include using
psychological knowledge to improve the condition of individuals, families,
groups, communities, and society.
Psychologists work to understand important issues facing society and to
enhance community wellbeing by improving the social and environmental
conditions that impact on wellbeing. Through the APS, AIPA specifically raises
concerns and contributes to actions to address racism. This includes advocacy
for the rights of clients to receive culturally appropriate psychological services,
the need for psychologists to access cultural competence training, to facilitate
the profession and discipline of psychology to contribute to the prevention of
racism and to work towards alleviating the impact of institutional and cultural
racism on the social and emotional well being of Indigenous people.
Indigenous psychologists and others within in the APS have been tireless
advocates for the rights of Aboriginal and Torres Strait Islander peoples. This
has included supporting an Aboriginal and Torres Strait Islander Peoples and
Psychology interest group, co-facilitating a Racism Roundtable attended by over
40 researchers and public figures from across Australia in 2009, and developing
Reconciliation Action Plan for theAPS (www.psychology.org.au/reconciliation).
AIPA endorses the contribution of the APS 1997 ‘Position Paper on Racism’ and
the Racism Roundtable Boatshed Declaration (2009). The Boatshed Declaration
called upon the Prime Minister and the First Ministers of Australia to initiate a
plan
of
action
that
embeds
constitutional
protection
against
racial
discrimination and formally recognizes the capacity and rights of Aboriginal and
Torres Strait Islander peoples to self-determine their future.
The Boatshed
declaration also noted that the happiness and wellbeing of all Australians and
their future generations will be enhanced by valuing and taking pride in
Australian Aboriginal and Torres Strait Islander peoples – the oldest living
cultures of humanity. Furthermore, the Declaration noted four key areas for
action to counter racism against Indigenous Australians:
22
·Constitutional - that there be a preamble to the Constitution that
recognizes the rights of First Nations peoples, followed immediately by
the establishment of a treaty that details a formal agreement between the
Australian Government and Aboriginal and Torres Strait Islander
peoples, and a framework for national action.
·Policy - that policies that affect and impact on Australian Aboriginal and
Torres Strait Islander peoples must be based on their full involvement
and engagement to ensure appropriate agendas and appropriate levels of
resourcing are applied.
·Practice - that effective and genuine partnerships with governments and
capacity building agendas be recognized as essential pathways to
improving the outcomes for Aboriginal and Torres Strait Islander
peoples' education, health and wellbeing
·Standards - that all actions must be based on, and be an expression of,
the articles in the UN Declaration of the Rights of Indigenous Peoples,
particularly Article 3 (the Right to Self Determination) and Article 42
(calling on the states and agencies of the United Nations to implement the
Declaration).
AIPA supports the call made at the International Action Against Racism: Durban
Declaration and Program of Action. Furthermore, we emphasise that without
culturally appropriate screening and assessment tools and the development of
culturally competent health and mental health systems, there is a high risk that
serious psychological distress will be misdiagnosed, and inappropriate
treatments will be provided in response to help-seeking on the part of
Indigenous people. Cultural competence is directly linked to producing positive
outcomes, as it can only be said to have been achieved when there is a
demonstrated improvement in Indigenous SEWB and mental health outcomes at
an organisational, regional, system and population level (Kelly, Dudgeon Glaskin
2009) .
As already noted AIPA’s unique contribution and expertise is about the impact of
23
racism evident through the lack of culturally appropriate and culturally safe
mental health services. We propose that the National Anti-Racism Strategy seek
to address the need for change in this area and propose that appropriate
resourcing for actions that emerge from the SEWB strategy we acknowledged at
a key action in the Anti-Racism strategy as a measure against systemic racism.
AIPA also recommends that the HRC promote the celebration of diversity as part
of its strategy.
6. Indigenous mental health movement and culturally appropriate
paradigms
Considerable changes have come as a result of the actions of many over the last
four decades. For example, the formation of the National Aboriginal Mental
Health Association (NAMHA) in 1979 was a founding voice about Indigenous
mental health. They successfully advocated for the inclusion of mental health in
the training of Aboriginal health workers (reference?). There have been many
years of collaboration between Indigenous and non-Indigenous mental health
workers and a philosophical approach of empowerment and self-determination
in the provision of mental health services for Indigenous people (Purdie et al:
2010:21; Tsey and Whiteside 2009, Whiteside 2011). Aboriginal and Torres
Strait Islander people have used their own medicines and healing practices for
centuries. This is sometimes acknowledged and more recently has become a
respected and sometimes collaborative practice.
See for example, stories of
Aboriginal healers in Central Australia and their work in collaboration with
mainstream health services (NPY Women’s Council2003; see also Peters 2010).
Culturally appropriate assessment tools require paradigms that acknowledge
the diversity of Aboriginal and Torres Strait cultures and diverse colonization
experiences in Australia. A recognition of historical and cultural contexts for
social and emotional well-being must be understood and included in
psychological and psychiatric assessments. These issues have been documented
in many major Government reports including: the Social Justice Reports, the
Bringing Them Home Report, the Little Children are Sacred Report and the Royal
Commission Report into Aboriginal Deaths in Custody. Psychological issues may
be a result of physiology or trauma, or it may be linked to transgressions of the
24
law- even unknowingly. What matters most importantly is for workers to find
effective communication processes to determine the ‘patients view of their
situation’.
Gilies: (2012 ) notes that the promotion of self-determination is also critical in
the discipline of psychology and identifies that it this is underway within the APS
through the reconciliation process and the Bendi Lango Scholarship. However,
she goes on to state
`… we have a long way to go. Based on population estimates there should
be 624 trained Indigenous psychologists in the country to contribute to this
process, but currently there are only 45. ‘
6.1. Self-determination and meaningful ongoing consultation
Central to individual and community wellbeing is the concept of selfdetermination. A person’s right to determine their own destiny impacts directly
on happiness and health, and is particularly significant for Indigenous
communities because of the denial of this right in the past. Self-determination
must go beyond consultation to active engagement and partnership with ATSI
communities to be fully realized. AIPA endorses the plan’s actions to work with
the National Congress of Australia’s First people, as well as support by the
Government to recognize Indigenous people in the National constitution. But
these should be starting points within a broader commitment to recognition,
reconciliation and respect.
Land and connection to land and water are at the core of Aboriginal spirituality
and well-being. Aboriginal people have a right to their lands and the resources,
which they have traditionally owned. AIPA supports the strengthening of native
title arrangements and notes that further action is needed to address the
watering down of the Native Title Act as a result of the 1998 amendments
having weakened the position of Aboriginal and Torres Strait Islander peoples
within native title law. The native title system is unnecessarily lengthy and
complex and this process has been divisive for many Aboriginal and Torres
Strait Islander peoples, impacting significantly on their wellbeing. (APS 1997)
25
The suspension of the Racial Discrimination Act (1975) with little or no
consultation was a disrespectful and colonizing action against Aboriginal and
Torres Strait Islander people in the Northern Territory. Although the Act has
now been reinstated, there remain concerns that this has not been done fully or
unconditionally. Serious issues remain with the current legislation, Stronger
Futures, due to be put before the Senate which is built upon a paternalistic and
discriminatory rationale. (i.e., compulsory welfare quarantining based on race).
It is imperative that the Principles of the Declaration on the Rights of Indigenous
Peoples, in particular the right to free, prior and informed consent are realized.
AIPA calls for implementation of the constitutional protection against racial
discrimination; for example, this would mean ensuring that initiatives like the
Stronger Futures (NT) better reflect the aspirations of Aboriginal and Torres
Strait Islander peoples for themselves and acknowledgement of the capacity and
the right of Aboriginal and Torres Strait Islander peoples to self-determine their
futures.
6.2. Psychology: current & proposed AIPA actions to combat racism
This submission calls for sound research in endeavors to combat racism as a
threat to Indigenous social and emotional wellbeing in Australia. Paradies et al
(2008) argue that establishing the forms of systemic racism that are the easiest
and most beneficial to address, and developing interventions to foster
sustainable anti-racist cultures and environments are important principles in
anti-racism work. They go on to note that improving health system performance
is a key objective to address the systemic racism in the health sector. Enhancing
and tightening health system practices, policies and processes leaves less leeway
for systemic or interpersonal bias to influence clinical decision-making. Better
treatment and health outcomes for Indigenous patients have been demonstrated
via improvements in service provider practices. Research from the United States
describes a range of effective approaches to reducing racial bias among health
care providers that should be explored in Australia (Burgess et al. 2007).
The racism identified in the general health system is also present in the Mental
26
health system. A national Anti-racism strategy must address systemic racism
and advocate for change at the institutional and cultural level as well as the
individual and personal level.
Social and emotional wellbeing services for
Indigenous Australians are urgently required.
Prevention programs and
campaigns to raise awareness and encourage social activism against racism are
also required.
6.3. Anti Racism, responsible media and using media as strategy
There is anecdotal evidence from many Aboriginal and Torres Strait Islander
people that the perpetuation of inaccurate and negative portrayals of Indigenous
Australians is itself a form of racism and feeds racist attitudes. The recent (May
6th 2012) description in the media- ABC news and National print media- of a
man being `scalped’ at a remote Indigenous community is one such offensive
example. Similar injuries against non-Indigenous people are generally reported
as `serious head injuries’. This example is a clear negative stereotype that is
weighted with negative cultural baggage and from another first nation country
at that!
Media campaigns have been shown to be effective in encouraging attitude and
behaviour change. Compared to health issues that have been associated with
numerous media advertising campaigns over the last two decades, media
advertising has been under-utilised in marketing social issues such as racism.
Media campaigns linked to raised awareness about the impact of Family
Violence, Smoking and AIDS are examples of the successful use of media.
Research on the effectiveness of media advertising campaigns that are
specifically designed to combat racism in the community are few and far
between. One such study, however, is reported by Donovan and Leivers (1993)
who, together with government agencies and local Aboriginal groups, designed a
two-week media campaign challenging negative stereotypical beliefs about
Aboriginal people in employment found that the campaign had significantly
shifted community perceptions about the proportion of employed Aboriginal
people and their length of time in employment.
27
Engaging the media to ensure training is provided to journalists, media policies
and procedures, guidelines, ethical codes designed to promote fair reporting on
issues relating to indigenous communities and the inclusion of antidiscrimination messages in entertainment media are important elements to
consider..
AIPA recommend that the national Anti-Racism strategy prioritizes media
campaigns to reduce racism, as well as working collaboratively with the media
to develop strategies to take responsibility for representing Indigenous
Australians in ways that discourage negative stereotyping. We also recommend
that cultural awareness training be made available for all people involved in the
media.
6.4
Anti- racism education and resources
The series First Australians which premiered on SBS in 2009 is an excellent
resource that could rotationally screened on all free to air television stations
several times a year and at advertised times for schools.
Given that early childhood is the time when stereotypes and attitudes are first
being formed, there is an emphasis in the anti-racism literature on early
childhood interventions. However, the importance of cross-cultural awareness
and education for adolescents and young adults should not be underestimated.
Some young adults, especially those who attended predominantly monocultural
schools in their formative years, may have had little contact with people of
different backgrounds. AIPA support the APS recommendation that education
for intercultural understanding, antiracism training and effective conflict
resolution, in age appropriate forms, be integral parts of school and preschool
curricula. Schools and other organisations should make use of the research
literature and resources to ensure such programs are as effective as possible.
One aspect of this education should be an examination of history which
illustrates the changing boundaries between groups. Members of local
Indigenous groups should be involved in the development and teaching of these
programs.
28
In light of the potential of legislation to change community attitudes in the long
term, historic legislation such as The Native Title Act (1993) may in future be
viewed as a milestone in shaping Australian race relations. The symbolic
significance of abandoning the doctrine of ‘terra nullius’, which had for 200
years been embodied in Australian law, cannot be over-estimated. The national
Apology 2007 is also an important milestone to include in anti-racism programs.
Whilst it is important to change individual attitudes, this is only one strategy
that should be used. We need to look at the wider picture; governments (as
noted above) can influence public attitudes. While changing individuals’ racist
attitudes is important, so is changing racist structures.
Effective anti-racism education involves processes whereby members or groups
of the dominant culture take responsibility for working in partnership with
indigenous groups to: tell the true history of colonisation; address structural
change in institutions; embed policies of cultural safety in programs and
intervention strategies; and share power and resources in ways which require
the dominant culture to transform itself.
The APS summary of the anti-Racism literature suggests that the best possible
strategy for combating racism is multi-faceted, and developed in accordance
with the specific and local circumstances of the community for which it is
intended. Specifically, a dynamic, iterative and consultative approach, using both
‘top-down’ strategies (e.g., community or institutionally instigated action, such
as advertising campaigns targeting specific actions or behaviours — as in the
successful HIV/AIDS prevention Grim Reaper campaign) and ‘bottom-up’
strategies (e.g., addressing specific racist behaviours), is more likely to succeed
than are replications of ‘one-size fits all’ programs, without due regard for local
community concerns and political sensitivities around the issues of entitlement,
dispossession, racism and prejudice(APS 1997). More recent programs such as
the LEAD program in Whittlesea agree that in the design and implementation of
any strategy, it is advisable to work collaboratively with other community
agencies, in order to avoid the duplication of initiatives, and — in future — to
29
evaluate the success of each strategy with reference to empirically rigorous
process, interim and longer-term outcome criteria (Paradies 2012).
APS also identifies that the lessons learned regarding what works to address or
reduce racism include;

Involving groups who have and continue to experience racism in the
development, delivery and evaluation of anti-racism initiatives

No strategy for change will be successful without significant political will,
as not everyone wants to reduce racism, as arguably sections of the
general community currently benefit from prevailing intergroup tensions

Moral exhortation to be nice to one another does not work

Attempts to portray groups as ‘different but nice’ do not work

Attempts to reduce prejudice and racism are unlikely to have generic
effects (need to be locally targeted)

Any strategy must not expect instant results, change takes time

Strategies must target different aspects of prejudice and racism at
different times in a sequenced program

Attitudes are important to target as precursors for introducing more
structural or legislative change.
This research points to a need for continuous interventions at all levels. If the
benefits are eroded by day-to-day experiences, organisational culture, media
portrayals and by government action and lack of action, we cannot expect even
the best designed but time-limited and localised programs to have a strong,
lasting impact.
6.5
Research & evaluation
High quality research and evaluation should inform public policy and everyday
practice and as such it must be at the heart of our endeavours to understand and
combat racism in all its forms (Racism Roundtable, 2009).
Research about racism in Australia is not given the central role it warrants and
deserves despite recognised scholarship in this field (Paradies, Dudgeon,
30
Purdies, Walker). The Racism Roundtable gathering proposed combating racism
as an interdisciplinary undertaking and AIPA is a strong advocate for such
collaborative work.
It is also important that mechanisms to collect, compile, analyze, disseminate
and publish, reliable statistical data are supported at state and national level.
This would contribute to informed assessments of the situation of all victims of
racism, racial discrimination, xenophobia and related intolerance, in accordance
with the Durban Declaration and Program of Action.
Strong cultural identity on the part of those subjected to racism has been
associated with positive self-conceptions and greater resilience (Paradies 2008
Dudgeon 2010;Zubrick et al 2005; Paradies 2011) Programs that support
cultural identity need to be put in place for many reasons but high amongst them
are that they build resilience and assist to combat the effects of racism.
AIPA, and Psychology as a discipline, are committed to contributing to the
evidence base about what works to improve Social and Emotional Wellbeing/
Indigenous mental health. Research to develop and evaluate Indigenous specific
assessment tools, empowerment programs and crisis support are urgently
required. AIPA has developed a cultural competence training program that is
oversubscribed.
Support to continue and perhaps expand this mainstream
program could be linked to requirement for all health professionals to regularly
undertake cultural competence training. We also support the proposal by APS
for an Indigenous specific 24hr crisis telephone support service and the
development and trail of Indigenous specific psychological assessment toolsparticularly for use in the forensic, health and school systems.
In conjunction with the APS, AIPA has developed a Reconciliation Action Plan
that advocates for Indigenous curriculum in all psychology courses; an increase
in the number of Indigenous psychologists; the continuation of mentoring and
scholarship programs for Indigenous psychology students, partnership and
collaboration in health research, review of APS governance and policies and
cultural competence training for the APS board and members. These are some
31
of the concrete steps being taken to challenge racism in our discipline and
profession.
32
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