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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 invite you to make some opening remarks or statements, at the conclusion of which I will ask the committee to go to questions.

Ms Wargent —We are a small research office with the University of Queensland based in Cairns. Our focus of work is on empowerment research with social and emotional well-being and mental health issues in North Queensland. The majority of our work has been focused in Aboriginal and Torres Strait Islander communities in regional Cairns and on Cape York.

Dr Laliberte —We work according to an ecological model, looking at the social determinants of how social and emotional well-being encompasses adverse behaviour such as alcohol and drug abuse, and at risk behaviour such as crimes and stuff like that. We have different projects in improving the health system and the journey of care, as well as a through-care project in the prison up at Lotus Glen at Mareeba. Those are the major recurrent projects we are working on.

Ms Wargent —The other major works we have been working on over the past five to six years are protocols and guidelines for working with Aboriginal and Torres Strait Islander consumers or mental health social and emotional well-being issues with people in remote communities in North Queensland. We have developed a guide on how to work with Aboriginal and Torres Strait Islander consumers, carers and their families within the primary setting, the communities. We have been working on that for the last five to six years. We have developed a set of tools and guides around the patient journey from when they come to the primary health clinic in their community through to tertiary, secondary level care—if they are evacuated to that care—and back to the community again. That is one of the focus points that we wanted to talk to you about today.

We have been working on that for the last five to six years. We have developed a set of tools and guides around the patient journey from the primary health clinic within their community through to tertiary, secondary level care—if they are evacuated to that care—and back to the community again. That is one of the focus points that we wanted to talk to you about today.

Dr Laliberte —We also work in collaboration with other organisations such as Queensland Health and the Centre for Rural and Remote Mental Health. The project that brought me here was actually the National Suicide Prevention Strategy. We are looking at using empowerment to prevent suicide and, specifically, the meaning of suicide within Aboriginal communities to get a better understanding of how the people on the ground view the problem, as opposed to just imposing in communities suicide prevention programs that have little chance of success because they are not tailored to the risk factors, the beliefs and the perspectives of the people they wish to serve. Those are a few of our current and past works, and we have all this information with us.

CHAIR —You could table that information. We much appreciate that; thank you very much.

Senator ADAMS —That was a very interesting presentation. There are probably going to be lots of questions. Ms Wargent, could you give us an outline of the remote communities that you are involved with?

Ms Wargent —At the moment we are involved with Hope Vale; we are doing some work with Pormpuraaw, up in Far North Queensland; we have done a lot of work with Yarrabah community, which is not so remote; and we are working with Kowanyama. Those are the most current ones.

Senator ADAMS —We have just visited Weipa and Bamaga—I was just wondering if those communities had been included. Coming to the issue of suicide, do you have a bereavement guide for the communities to use after someone has unfortunately committed suicide? Do you deal with that as well?

Dr Laliberte —In the beginning of the NSPS, we were invited, due to our expertise, to assist the community response team in Yarrabah, where there had been a series of suicides. The community responded very well—according to the specific guidelines—based on their experience. We have not developed a guide per se, but we do have tools that address that issue, particularly in the protocols. That could easily be pulled together based on the Yarrabah experience. There are a few mentions of it in the report of the NSPS project as well. So, when we say that we work in collaboration, we do bring expertise to different communities on different areas, but we also learn a lot from the community members. If they have that experience, we just act as a facilitator—we just take a back seat and let them lead.

—Senator, earlier you asked about Weipa and Bamaga. With our collaboration with Queensland Health, we are not that visible as yet. We have been working with the director of mental health and ATODS, Alanah O’Brien, who is leading some of our work for a pilot site, with protocols, in Hope Vale, with the long-term aim for it to go further than that specific community—to reach out to Pormpuraaw, Bamaga, Lockhart, Aurukun and as many other remote communities as possible.

Dr Laliberte —We also do a lot of evaluation work as well. A few of the projects that we have evaluated were involved in those communities, so we were able to get an overview of the issues there. Also, the Family Wellbeing Program guides a lot of the research that we do because it is an empowerment program, and we work from the principle that not only our actions but how we undertake them should be empowering. That has been delivered to Normanton, and we are looking at Doomadgee at the moment as well. So we have been in contact with those lower gulf regions.

Senator FURNER —Have you been working around foetal alcohol spectrum disorder at all, up on the cape?

Dr Laliberte —Not specifically, but we are trying to get funding for a project using the empowerment program Family Wellbeing to support the transition of young female Aboriginal people between the ages of 10 and 13 so they are supported in that developmental phase so that foetal alcohol syndrome and early pregnancy does not become a reality for them.

Senator FURNER —From your experience in the cape, what is your opinion on that particular disease?

Dr Laliberte —I think there are a lot of problems that are not necessarily apparent that could be linked to foetal alcohol syndrome or drug use—

Senator BOYCE —What sort of problems?

Dr Laliberte —All of the risk behaviour—impulsivity, acting before you think—

Senator BOYCE —The sort of thing that could be misdiagnosed as ADHD.

Dr Laliberte —Perhaps, yes.

Senator FURNER —So what needs to be done in this particular area?

Dr Laliberte —I think it is really about empowerment, early intervention, and guiding and supporting the communities and the people of the communities to help them to make better choices.

Senator FURNER —Should those communities become dry, in your opinion, based on that being a major problem?

Dr Laliberte —That is a very difficult question, obviously, because there is a lot of anecdotal evidence of communities that become dry having other problems like sly grogging and marijuana use, and there is some anecdotal evidence around hospitalisation data and the rising rates of, for example, psychosis. A lot of speculation is around the effects of marijuana use. That is what we are seeing in the hospitalisation data. So there is that data, but the rest is speculation.

Senator BOYCE —I just wanted to ask you about the journey of women having babies through primary care et cetera. It would seem that in Far North Queensland primarily people come to Cairns four weeks before their baby is due. Can you tell us what your research has shown, if anything, in that area and what might happen next.

Ms Wargent —Specifically, we have not done any research around the maternal child health area. I am from Cairns; I was brought up in Cairns. I am on the local Aboriginal medical service, the Wuchopperen Health Service, board of directors and my family has been heavily involved in Mookai Rosie Bi-Bayan, the hostel for Aboriginal women who come to Cairns early to have their babies. From my experience, yes, you are right—we are really seeing women come only when they are due to have their babies or when they are unwell during their pregnancy. As far as I am aware, that process has been working really well. Mookai has been a providing that service in Cairns for a number of years now—I think it is going on 20 years. Unfortunately, we have not been focused on the research area; we have been specifically focused on social and emotional wellbeing and mental health for people who have chronic, recurring mental illnesses. So, unfortunately, I cannot comment on that.

Senator BOYCE —It would seem to me that having to leave your family behind for a month or so might affect your social and emotional wellbeing.

Ms Wargent —Yes, absolutely.

Senator MOORE —I have two questions. One is about how people work together in the fields. We saw people from James Cook earlier. The work they are doing on family wellbeing seems, when you hear about it, to be extremely similar to some of the work you are doing. I would just like on record to have something about how people work together when you have a number of skilled professionals from universities working in community. The second question—you can answer these all in one go—how are the protocols that you have developed now being used? Are they now a standard tool for everyone who traipses in and out of community? We all know the stories about that. You finally have something that has taken you so much work. How are they being used?

Ms Wargent —I was really pleased to hear that JCU were here earlier. We are transitioning from the University of Queensland across to JCU at the moment with that particular team. We have actually been collaborating over the last 12 to 15 years with SIAS, the School of Indigenous Australian Studies, at James Cook University. Because of that close network and because we have been connecting with communities, we have been able to secure some community based researchers within the communities in, for example, Yarrabah and Hope Vale. With that network ongoing for that period of time, it has been working really well. We have participated in the family wellbeing program together—JCU, us at UQ and community members on the ground—and that has strengthened our relationship working together and continuing to collaborate.

Dr Laliberte —To add to what Rachael has mentioned, the empowerment research program has been ongoing for the past 10 or 12 years now between UQ and the JCU team. We are continuing, hopefully, to grow that network. As was mentioned earlier, the family wellbeing program gives a set of principles and we all work from those principles. That guides our work and the way we collaborate. We have, for example, community members who become seconded to local community organisations such as Gurriny. I guess we are actually employing them, but through the local organisation, so that is strengthening those partnerships as well.

Ms Wargent —In terms of implementation of the protocols, we currently have a minimal budget to do that, but we have set up an implementation steering committee, which is being chaired by Queensland Health, in collaboration with us and community. We are at the early stages of that. We are planning a pilot site in Hope Vale and we have been contacted more recently by another community about perhaps piloting it there as well, with two different models, one being driven by Queensland Health and the other being driven by community, so from the ground up as opposed to—

Senator MOORE —Do they meet?

Dr Laliberte —That is what we are hoping.

Ms Wargent —Absolutely. Because we have got this committee and because of our collaboration and the way that we communicate and stay in touch with each other, we are planning to ensure that that meeting, that coming together, does happen.

Dr Laliberte —And the implementation is actually being guided by work that was done with Yarrabah Gurriny medical health service. That is a community led medical health service and our primary clinic. We have trained the social and emotional wellbeing team with the protocols. We have the training manual and, from that, we are doing up an implementation guide which will inform the steering committee. The pilot is really to refine all of those tools before we roll it out in the cape. But that is the plan, Queensland Health’s plan.

Senator MOORE —The protocols are hopefully going to be able to be adapted to any community, so you have got the core principles and how you do it.

Dr Laliberte —Yes.

Senator MOORE —It still strikes me as difficult—and I will talk with you later and Health—because they actually funded the project, they are the people who go into the communities most for health issues and they have not said, ‘We are doing it.’ Am I missing something there?

Ms Wargent —Yes. The protocols were driven initially through an NHMRC grant through AIMHI, the Australian Integrated Mental Health Initiative, and then Queensland Health did come along later and ask us to develop some guidelines. So, yes, they have funded this process to the point where we have this document. We are now at the point where we are trying to get it implemented. Queensland Health are really supporting that. I guess the challenge now is how we get in and how we get the primary healthcare teams on board and support it as well.

Senator MOORE —Who are employed by Queensland Health mainly?

Ms Wargent —Yes.

Senator MOORE —What is the time frame? Do you have any idea? If you have not, that is fine.

Dr Laliberte —That is always difficult because, yes, Queensland Health are there now but there is also the transition to community control that is mainly led by Apunipima, and we are meeting with them as well. So we work in collaboration and in partnership with the different organisations and people who are responsible to try and get everyone on that same page and not impose, so that is about the time that it takes.

Senator BOYCE —You mentioned earlier some research on the topic of suicide and the implications or the way it was dealt with in Indigenous communities. Would you give us some more information on that research.

Dr Laliberte —I visited four different communities: Yarrabah, Hope Vale, Kowanyama and Dalby in southern Queensland, which gave a different perspective geographically with its proximity to urban centres. The thing that struck me the most in the research component that I was responsible for was the risk factors for suicide. If I asked someone, ‘What is suicide?’ they would respond in three different ways. They would respond in terms of risk factors, they would respond in terms of impact and they would respond in terms of the definition. The definition was the standard one—when someone wants to kill themselves. With risk factors there was a lot of anger, grief, humiliation, stigma, sadness, depression—

Senator BOYCE —Was this within the family?

Dr Laliberte —In the community, because then they would go on to explain that they are tight-knit communities and when something happens to one person it impacts on everyone, at different levels but it still impacts on most people. There is a lot of guilt as well—a lot of what we could qualify as difficult grieving processes that take much more time and compound other grief that has not yet been dealt with because of the time and things that keep happening.

In terms of the consequences, the same list of risk factors would come up again. When we think about suicide in Aboriginal communities, clusters are a big factor, but then in sheds light—’If this is why we commit suicide and this is how we feel after a suicide, it’s not surprising that there is that domino effect.’ So there is a lot of compounded, unresolved grief.

But interviews did not stop there and there was a lot of feedback around ways forward, most of which involved empowerment and taking responsibility but having the opportunities that come with that responsibility. It was seen that progress would come not through the imposition of restrictive measures but from the ground up, empowerment and building on strengths. It was about finding the strengths and building on them—individual, family and community strengths.

Senator BOYCE —Some of those issues go to general views around stigma and mental health anyway.

Dr Laliberte —Absolutely.

Senator BOYCE —Is there any potential for adapting mainstream policies on promotion and prevention of stigmatisation in communities?

Dr Laliberte —I do not know if this will answer your question, but we work a lot along the lines of two-way understanding. For example, in mental health diagnoses it is not about saying, ‘You’re schizophrenic,’ or, ‘This is what you suffer from;’ it is about listening to their perspective because within mental health—and suicide is a part of the question of social and emotional wellbeing—there is the holistic view that you can separate emotional, mental, spiritual and physical wellbeing. Listening to their perspective and, yes, adapting the model that you are working from—not forcing people to fit into your model but building your model around what you are hearing from them—is what I would recommend. Was that your question?

Senator BOYCE —Yes, thank you.

Senator MOORE —We met a couple of times with the Dr Edward Koch Foundation, and I know they have lots of experience on the ground. Have you worked with them? Also, on the discussion around protocols, have organisations like those been part of the development and the commitment to use them in future?

Dr Laliberte —I think there have been some discussions in the past, maybe not particularly on the protocols but for the Family Wellbeing program.

Senator MOORE —Yes, I know they use that.

Ms Wargent —In terms of working directly with the Dr Edward Coe Foundation, we have not had the opportunity and I suppose we have not connected with them more recently.

CHAIR —I think it is tremendous that we have actually produced a guide for government people, in fact anyone visiting communities and doing business with the communities. I know it has been sponsored and Queensland Health’s intimate involvement in it and no doubt ownership has been discussed. Has there been any move that you have heard of to expand this initiative to other visiting government departments, the other thousands of people who wander in and out every day?

Ms Wargent —It has actually gone further than Queensland Health. Because we are not Queensland Health, we are a university, we take any and every opportunity to talk about it. So we have presented it at various conferences at a state level and a national level. Our previous director, Dr Melissa Haswell-Elkins, has now moved to the University of New South Wales and she has actually been talking about it down there and I suppose getting it out. There have been really good responses and New South Wales collections have been interested in it. It is being peer reviewed at the moment by some people in Western Australia as well as Dr Ross Bailey, who is from the Northern Territory. It has been getting out there presented more than just Queensland.

CHAIR —What sort of impact do you think it will have on the people going into the communities in resources sense? Is it going to take more time, is it going to cost them more money? Apart from just having more information, have you done any analysis on those sorts of impacts?

Dr Laliberte —We have not analysed that at this point because, as I said, we are just starting to trial it in the pilot sites with Queensland Health. But we do have an instrument to measure empowerment that was also developed by the work around the Family Wellbeing, led by Dr Melissa Haswell-Elkins. From the feedback we are getting with this instrument, it is just the fact that it is culturally appropriate and it talks to the people more, so it does create that awareness and they do feel that they are listened to and that their voice is heard. So if we consider the tools that are in the protocols that have been trialled in the Northern Territory by Dr Trish Nagel, there have been positive reports to the use of those tools, but that is just the tools within clinical settings and it is not the whole protocol.

CHAIR —Perhaps my question would be better answered at the end of the trials.

Ms Wargent —Just an early example is that we have been working with the community in Pormpuraaw. One of the staff members there has recently visited us and was excited to share her experience around using the tools. She does not have an alcohol and drug background or a social work background but she was able to sit with the client who has drug and alcohol issues and use the tools to go through it step by step with the client and then take that person with the tools to the primary health care centre and sit with the DON and say, ‘This is what we have done with this person and I’ll hand over to you.’ The client’s experience through that process was really positive and they gave good feedback to say they have never done this before and it has really been useful that they have been heard. Then at the clinic level the DON had said, ‘Thank you very much, you have done a lot of work for us and now we can continue with this patient’s journey within the centre.’ That is one example we can give at this point.

CHAIR —You will be getting a whole lot of feedback. I know this is not a draft but is a document, but what sort of frequency do you think is reasonable to have a lot of this scientific and evidentiary feedback about what perhaps is not necessarily working on the first assumptions? Would you have a review of the document? Have you thought about how often you would do that?

Dr Laliberte —We are not too sure how often, at this point; but within our doing a formative and summative evaluation of its implementation. The goal of the formative evaluation is really to collect the information, to guide the implementation and to improve the document, improve the service. So it is not only rendering a judgment on critical aspects; it is actually to improve the whole endeavour. There will be a second edition of the document. We are already thinking about that.

CHAIR —Thank you very much. The fact that there are no more questions from the committee, and the fact that we are a little before time, does reflect on your collaborative approach with previous evidence today.

Dr Laliberte —Yes, we are impressed!

CHAIR —But there may well be some other questions on notice provided to you through the secretariat. If there are any issues or things that may be useful to the committee that you think you may have omitted, we would be delighted to receive those. I am not sure whether you have some spare copies of the book, but I know the secretariat is very loath to part with the one they have that has been tabled. I would certainly appreciate the provision of at least one other one.

Ms Wargent —We actually have it electronically, so we can email it to you. It is also on our website.

CHAIR —Terrific. It would be great if you could provide any evidence of that nature to the committee, through the secretariat. Thank you very much for your evidence today.

Ms Wargent —Thank you.

Dr Laliberte —Thank you.

 [11.47 am]