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Effectiveness of state, territory and Commonwealth government policies on regional and remote Indigenous communities

CHAIR —Welcome. Information on parliamentary privilege and the protection of witnesses and evidence has previously been provided to you. I now invite you to make a short opening statement, and at the conclusion of your remarks I will invite members of the committee to put questions to you.

Dr Bowers —I would like to thank you for the opportunity to talk a bit more about what we do and how we do it. Since we made our submission, we have undertaken a range of new initiatives which I think provide some more ideas about how we approach mental health in Indigenous communities not only in Queensland but across Australia. Although our centre is a little one, we are into our fourth year of operations. We have learnt a lot in that time about how we work with people in rural and remote communities generally and also Indigenous communities. Our centre is not entirely research based; we have a very applied approach to how we work with communities because people really want to see something—and often with research it is a matter of trying to collect information without actually doing something within the community.

In summary, our role is to look at consultation and engagement: how do we work with that community? We clearly do not have links because we are a small organisation. However, what we do have is a terrific participant base and a terrific network. Of course, the previous group of witnesses are part of our network, so we can call on them as part of our consultation and engagement process, as part of an intervention process, if that is identified by the community, if that is what they want. Finally, how do we measure and evaluate what we do and how do we make that sustainable? These are our key issues about what we do and how we do it.

We take a whole person, whole community approach. We try to strengthen individuals. However, we also try to build collective resilience within a community. We do not actually deliver a service. What we do have unique expertise in is looking at how we can best use our partnerships to make things work on the ground. For example, we might be offered a grant by somebody—and it is generally a government department that wants to do something. So we have the inevitable project cycle. How do we work with the community to do something that is worth while? That has to be embedded within the community or else, at the end of the day, it is not sustainable. So we specialise in trying to work out how to consult. To do that we engage people on the ground in that community. It might be one of the people trained in the family wellbeing processes, but it might be somebody else; it might be somebody within the education system. It depends on what is identified by that community as a priority. If youth suicide is an issue, we would be talking to somebody specifically about that. It is really a matter of trying to understand what is required, what are the issues in that community and what we will do about it.

We have got some more recent examples than those in our submission, and I am happy to elaborate if you have questions. First of all, we have a program called ‘Pathways to Resilience’ which has been funded by the department of communities in Queensland. That project has gone to several communities in Queensland with high suicide rates. The first part of that project was to talk with the communities and try and understand what the issues were and then try and get them to help us decide what they would like to do about it, where the stress points were, where the flashpoints were—and often they are around youth or school children—and what information they need. For example, in St George we were able to build on the NAIDOC Week celebrations that engaged youth, so we got young people in that community involved. That has turned out to be the most fabulous response in St George. They have actually formed a pathways to resilience group and put our logo on it. We were just the broker for that, but they realised something worth while was happening there. In Mount Isa, where there was a range of issues, there was some documentation about services and how that could be disseminated in a user-friendly way. So a whole lot more has gone on—and these are just quick snapshots of what has gone on. On Mornington Island they have been able to work with young people to build a song around issues that are affecting them. They wrote it, recorded it and then launched it. So now the whole community has a song about it. It is about education and raising awareness in a particular group. It is really about trying to do something that the community wants that is really different, and we are really working in the realm of promotion and prevention.

One of the other projects that has emerged independently that we have been able to incorporate and extend—and I mentioned that one of the issue is sustainability—is what we initially called ‘Creative Recovery’. That targeted people in Lockhart River who had a mental illness or were at risk of getting one. There is a level of stigma with ‘recovery’ because it assumes you have a problem.

What we have been able to do, through the pathways to resilience initiatives—and there is some level of competition, as you might gather, between communities—is to commence a similar initiative in Aurukun. We are in the process of negotiating that for Mornington Island and Doomadgee. This is creative recovery, using art initially. What we did in Aurukun was identify that the young children had nothing to do over the school holidays. So the local shop donated the paint and local artists donated their time and they have painted a mural on the shop wall, which previously had graffiti on it. It is fabulous. There is a photo of it in that newsletter. Now the girls have decided that they would like to do that. There is another, bigger wall on the side of the shop, and that is in the planning.

So there are a range of initiatives where there is an ability for us to transfer resources and opportunities that we see that are community driven and involve them but also send a message. They are some of the examples of what we have been able to do in the last few months that have expanded on the sorts of ideas in the papers that we have written about in our submission. We have applied them. We have extended the education initiative and the creative component of that. We have also been fairly creative in applying to the Department of Education, Employment and Workplace Relations for an Innovation Fund grant to see if we can sustain and extend the art initiatives, which is not just about people drawing; it is about community engagement. It is looking at other forms of art, like weaving ghost nets and all sorts of other things, where there is an opportunity to build an enterprise and a livelihood. What we would like to do and what we have applied to do is get somebody to do a scoping exercise on the opportunity to make that an enterprise in the cape. That is just another example.

Finally, what we are really trying to do is share our information. At the end of the day we write reports for the people who have funded us. I have brought some examples of our suicide prevention projects. We give those to our funders so that there are opportunities not only to share our knowledge but for us to extend it and learn from other people. We really do not want to work in isolation in Queensland. We really do not want to be seen as parochial. We want to learn from what is happening in like situations in the Northern Territory, in Western Australia and in other parts of the world. There is absolutely no point in duplicating things. We really want to understand what is happening out there and try and do it. I have been approached by many people all over Australia, and indeed other parts of the world, so that we can share what we are doing. It is not just about the activities we are doing; it is about how we do it. It is about how we are structured. We are a tiny, little organisation but with a large reach. So we are agile, we are small and we are able to employ the right people—like JCU, like our other participants who have niche expertise in a range of areas—once that has been identified by communities. That model is really responsive to community needs and individual requirements. So it is a combination of what we do and how we do it.

Senator SIEWERT —They all sound really exciting projects. I am interested in a number of areas. First off, I want to know about your funding base and how you get your funding. What is your core funding and how reliable is that? Then I want to hear about the different projects and how many projects you coordinate.

Dr Bowers —First of all, our core funding, $500,000, comes from Queensland Health. Around $150,000 a year comes from OATSIH.

Senator SIEWERT —What sort of funding cycle is there for those two bits of funding?

Dr Bowers —The one from OATSIH, at this stage, is recurrent, based on reporting requirements. The funding from Queensland Health for the first three years—which has now completed—was based on an agreement. It is not based on anything other than us negotiating on annual basis now.

Senator SIEWERT —So it was three years and now it is gone to annual?

Dr Bowers —Yes. We now negotiate it on an annual basis. We have not been led to believe it is jeopardy or anything like that. In fact, I believe that because we are independent we actually provide a lot of good news and good opportunities for doing things that traditionally government departments would struggle to do. We do not carry baggage into communities and we employ or work with the right people.

We also take a small amount for auspicing fees, which helps us sustain ourselves on top of that. For example, universities now take 35 to 40 per cent for administration. The rationale for setting the centre up is that we do not need such a large amount, so we take a lesser amount but we do actually take some administrative fees just to keep us going.

Senator SIEWERT —From the projects?

Dr Bowers —Yes, from the projects themselves. So they are our three sources of funding.

Senator SIEWERT —So the core funding enables you to run—

Dr Bowers —A small office.

Senator SIEWERT —And staff?

Dr Bowers —Yes.

Senator SIEWERT —Do the staff run projects outside projects that you apply for funding for?

Dr Bowers —No. It comes under the umbrella of the centre.

Senator SIEWERT —How many projects would you be running at any one time?

Dr Bowers —It varies. We would have projects that are being completed or being written up. Then we would have projects running at any one time. At the moment, we have got one running in rural and remote Queensland called Me and My Community, which is building leadership and resilience in identified rural communities affected by drought and other pressures. We have got the Pathways to Resilience, which I mentioned, and an extension of Building Bridges, which is the major project that family wellbeing was involved with. That is now running in Dalby and St George. I am just trying to think of all of them. We have also got Creative Recovery. So we would probably have around five or six major projects with other things rolling off that.

On top of that, we then have our other core business like our conference in September. Part of our role is to disseminate and share information through what we call our master networking. We really pride ourselves on being transparent, open and engaging with people and trying to understand who would like to work with us. More and more we are just trying to collect people with expertise because in Cairns it is really quite difficult to recruit people who have got knowledge and are able to work in these different environments. Mostly they want full-time jobs but we can only give them jobs as and when things come up. So we only have a very small core staff.

Senator SIEWERT —I do want to go there but I will just park that issue for a minute because I want to finish the funding issue. It sounds like you have funding for projects from a variety of sources. Is that correct?

Dr Bowers —Yes. We are really quite creative about what we look for. Up until this year, we had really only tendered for one before that. For most of them we have been approached by Commonwealth and state departments like the Department of Communities, Queensland Health and DoHA to do work. So we do something, publish it and they say: ‘What would you like to do? To extend that, how would you do? We have got another $250,000 to do X,Y or Z.’ We will negotiate that. I really quite like that idea because part of our strategy is influencing the agenda and setting the agenda rather than being told by government, ‘This is our policy and this is what we want to do.’ We want to influence policy by doing what we are doing and I think that is a good way.

Senator SIEWERT —Tell me how you do that. So many times you do not see any learning from projects. You were here when we were talking to the previous witness about how we use evidence based planning and policy development. How do you do that? How do you capture your learning? How do you document it and how do you get it through to policy makers?

Dr Bowers —My background has been running mental health services for South Australia and I have worked for DoHA in Canberra for many, many years—I go back into the eighties. What I understand are Commonwealth processes. So we have really made a huge effort to not only report on time but to publish quality documents with meaningful outcomes so that we can then make conclusions about whether this is worthwhile, what we can do and what we can learn from this.

For example, the family wellbeing process was being rolled out not only in the Cape by the previous group but in Dalby. Dalby was problematic because it is a mixed community, it has an Indigenous population as well as a large white population. It took a long time for the engagement, the trust and the acceptance process to happen. We have somebody there and we did not want to lose them. We know it takes a long time, so when the second opportunity came along and they came back to me within a week, mind you, of publishing these documents and said, ‘We’ve got some more resources’, I jumped on it. We did not want to lose this good work with the family wellbeing and all of the connections that have been made. We thought: how can we extend it? We negotiated what is the next phase which we have shortened to Building Bridges 2. That is now in Dalby and St George because the same Aboriginal medical service services St George as well. Now we are looking at the differences between services.

As much as we might be looking at the gaps in health between Indigenous people and mainstream Australia, we are also now looking at what gaps in services there might be in these two rural communities. That is being done by a consultative process and we will equally write that up at the end of the day with an independent small evaluation. What is emerging from it again is that expectations will be built about the interventions. What needs to be done to reduce those gaps? How is it that we can improve that? That is what this next stage will come up with. Hopefully, we will find that the same department and the same group of people might be able to help us to find some resources to meet those expectations.

Senator SIEWERT —When you are working on a program in a community, obviously, each community is different.

Dr Bowers —That is exactly right.

Senator SIEWERT —You take a program, you have the philosophy and the approach and then you tailor that to meet each community’s needs, so it is not one size fits all?

Dr Bowers —That is exactly right. I have made a really useful slide that I use in every presentation that outlines the differences between communities. Every community that you will go to will say, ‘We’re unique and we’re different.’ You can acknowledge that they are because they have different cultural mixes, different sizes, different degrees of remoteness, different industries with different problems and there are more factors without mentioning environment or anything else. But there are common factors. The common factors are that they are all connected to country in some way. Indigenous people are connected, as are farmers in a different way, as are miners in a different way. They are related in some way to the country they are working on but, more than that, they are all coping with change. All of the rural and remote communities are including Indigenous communities—most of the Indigenous ones are growing, a lot of the other ones are declining for various reasons, so we have continuous change. We have different industries happening, we have people leaving communities and services leaving communities because they unable to recruit, so we have change. Our role is really about building resilience within communities to cope with change and how we sustain that. When it comes down to it and you look at the GDP of Australia, a high proportion of it, over 50 per cent, is dependent on agriculture and mining. In a sense we really need to value not only Indigenous communities but all people who work in rural and remote Australia because our productivity into the future is going to be dependent on it. Indigenous communities are equally important in that process.

Senator SIEWERT —I have two more questions. One is that you said you do not deliver clinical services. Do you work with clinicians where you need to?

Dr Bowers —Absolutely. Queensland Health is a participant in the centre. RFDS is a participant in the centre and there is so much interest coming from other areas. We are in the process of looking to see whether there might be an opportunity to broaden our brief. In some projects we have people in New South Wales wanting to participate. We have somebody in the wheat belt in Western Australia wanting to participate in some of our initiatives. I think we might be seen to be a bit parochial with Queensland in our name and we are not picking up national tenders.

Senator SIEWERT —Ignore the Queenslanders!

Dr Bowers —We really think we need to share what we do, and so in some of the initiatives we have we are trying to work with other like-minded organisations. We are trying to also reduce the stigma. The problem is that when we go into a rural or remote community Indigenous people use euphemisms for mental health, as do farmers and miners. So we do not actually try to go there. We try to use other language and relate to them within their own language and in ways that are acceptable to them.

Senator SIEWERT —The other issue that I said I was going to park earlier was staff. Wherever we go in Australia we encounter issues around staffing and the ability to get staff in this sector but also particularly where you have to work in rural and remote areas.

Dr Bowers —We need somebody with strategic vision. We have a different requirement because we really need people who can write—write reports, write tenders and do project management. This is not a clinical role. This is a role that can take on a strategic view of issues which are often very sensitive. We need clever writing. It needs a level of maturity. It is really quite challenging. We need different language for different initiatives. If we are writing for government tenders or government reports, that language needs to be different to when we are presenting to or working with a community. We need to change our language. But we also need to be clever and understand and interpret the language of people living in rural and remote conditions and environments and translate that into another language so that when we are talking to people like you we have credibility. We know what is happening out there. We know what the issues are. But we need to represent that in the most appropriate and articulate way we can.

Senator ADAMS —I was wondering about the remote area mental health service. Do you work with closely with them?

Dr Bowers —Of course we do. In fact, in the process of setting the centre up there was a three-year lead time and there were a lot of consultations. That involved not only a range of the organisations who are now participants in the centre but people from here, like the Royal Flying Doctor Service, Professor Ernest Hunter and a range of people who are clinicians working in the area. They saw that there was a need to do something more creatively and more innovatively around the sorts of things that we are doing. Probably in health terms we do really sit at the promotion and prevention end of things. Most of our work goes into that end, where most clinicians do not have time to go. They are so few and far between that they do not have the luxury of being able to do something like we can do. That is why we really do include them. It is because this is an opportunity to do something different and innovative that they can do that takes away, in some ways, the stresses of having to cope with such demands on their clinical time.

Senator ADAMS —Do you get a lot of feedback from their people on the ground?

Dr Bowers —They are included in the whole process—absolutely, yes.

Senator ADAMS —I am just a little bit curious about something. The people who were giving evidence before you said it was really a little confusing because there were a lot of things going on that because of their funding arrangements they were not able to tap into.

Dr Bowers —I think that is the beauty of our structure.

Senator ADAMS —You are pulling it altogether.

Dr Bowers —We pull it together. One of the psychiatrists is actually a key part of the creative recovery enterprise process because that is a particular interest. She is out in the communities. She knows what is going on. We go out together, because I do not have any credibility if I do not know what is going on either. So we actually go and encourage support and work with people out there as these initiatives are being developed.

Senator MOORE —I just want to talk about one area which has always been a bane for me. You actually referred to it briefly at the beginning of your presentation—the competitive nature. I am interested in your role in that. You said a lot of people came to you. But this area, amongst others, is bedevilled by competitive tendering. We heard from the previous witness about professional people spending ridiculous amounts of their time having to apply for different things and write submissions. Do you have any view on that? I know you are coordinating and seeing what is happening across rural and remote areas. Is there any way we can do this better?

Dr Bowers —That is a fabulous question. I agree. What we have tried to do is open it up so we engage the best of our participants or likeminded organisations. We are now not only including people out of Queensland but have found other people with other expertise who are actively coming to us. A lot of our activity is a one-way street. We are tiny. We cannot service all these people, write the tenders and then think we are going to share all the scarce resources. The issue is trying to be open and transparent so that we can then get the best people to be part of that tender. But the universities are competitive. We are in that environment, but what we are trying to do is say, ‘Okay, we can include you, you and you.’

I would have to say that quite a lot of my work with projects in the past has been to mend or broker relationships between competing organisations. That is an absolute waste of time and emotional energy. We could find a solution for doing things more cleverly and sharing them between states more actively. We have learned a lot from what we have done in Queensland, but I am also learning and travelling to other places to see how it is that we can share what we do. We can set the scene. I think we can only set an example. We have to tender and compete with other people who are saying they are experts. It might go to Sydney or Melbourne universities, whereas we are on the ground, know what is happening and frequently hear of those sorts of things happening. There is a level of frustration around that when we think that we are ideally placed, because we do have what I think is a good reputation amongst the communities that we work in and we could happily expand that and share that a little bit more broadly.

Senator MOORE —I am interested in whether there is any process that can be brokered between governments giving out and calling for tenders and organisations such as yours, which are wider. I do not think we enter a single community where there is not tension around an absolutely essential service, which is looking at what everyone needs and who won the tender. That is everywhere we go.

Dr Bowers —Absolutely—and I hear about it every day. You probably only need to talk about the wellbeing centres to hear all of it.

Senator MOORE —We have heard that.

Dr Bowers —I am sure you have. That is a good example. I think that to start to do that there has to be some probity around it; therefore, selective tendering does help. The other thing is to bring people together and say: ‘How do you work together? How do we combine all of your collective expertise to do something like this?’ But that requires quite a lot of knowledge from people who might be based in Canberra or who might not know who is ideally placed, so there is that issue. There is also preferential treatment. There is an opportunity to influence and have a say in how we do that. I try to speak to ministers and people in senior positions in Canberra about what we do and how we do it and to provide advice, but when you are in Cairns it is a huge effort. Many a time I will go to Canberra with meetings lined up and only end up with one of five.

Senator MOORE —They will all drop out.

Dr Bowers —They will all drop out. That is a huge commitment on the part of our centre, but I think it is important that we communicate and have an understanding where policy is being made, how to interpret that policy and how to influence the making of that policy. I like to think that we are doing that in a very practical way. That takes time, though. That is a level of frustration—how do we influence what is happening? Fortunately, one of my meetings was successful and Minister Snowdon is coming to our office next week. We will have a chance to have a dialogue with him for him to better understand what we do, because our role perfectly fits his portfolio.

Senator MOORE —It is it. If you added the word Indigenous to it, you shadow his portfolio. What is the difference between preferential treatment and selective tendering? It is a genuine question; I am not sure.

Dr Bowers —Preferential has a value added to it, whereas selective does not.

Senator MOORE —That is true. It is a big issue so I just wanted to get something. I know you work in that cooperative space.

Dr Bowers —I think we do but on the other hand we are a tiny organisation; we are not like university. We do not have processes—

Senator MOORE —Dr Bowers, we got the message about your tiny organisation. You have been very good. We know you are small.

Dr Bowers —That is a benefit in some ways because we are agile.

Senator MOORE —And you are regionally based, which I think is very useful. We will keep talking, so that is fine.

Dr Bowers —Terrific.

CHAIR —Dr Bowers, thank you very much for the evidence you have provided today. As you have seen from the nature of the questions, it is likely that there may be further questions which will be provided to you on notice through the secretariat. If you have any other information which you think may be of value, it would be very useful for you to provide that to the committee. I noted in your opening remarks that you said the submission you provided is now outdated—that is, since 2008, clearly. In the context of the original submission, you may like to provide the committee with an update on some of the areas which you think need to be refreshed in regard to your research over the last couple of years. That would be most appreciated.

Dr Bowers —Thank you.

[11.10 am]