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Suicide in Australia

CHAIR —Welcome. I understand that you have been given information on parliamentary privilege and the protection of witnesses and evidence.

Mr Rajan —Yes.

CHAIR —We have your submission. I invite you to make an opening statement and then we will ask you some questions.

Mr Rajan —This continues on from the previous speakers who were talking about some of the issues concerning data collection on suicide prevention. One of the questions I asked them as they left was: ‘I understand you’ve got a very good database. Is there any ethnicity data relating to that?’ And they said no. That there is no ethnicity data is one of the issues that we are confronting. In Western Australia, just under 29 per cent of the population were born overseas; about 49 per cent of the population were either born overseas or one parent was born overseas. So we are talking about a significant proportion of our population. But I guess we have not really captured any data to allow us to analyse whether there are some issues or trends that are being discerned, because we cannot get the data. We obviously cannot get the data from WA Police because suicide is not a crime, so they do not get involved in the issue of a suicide. The health department indicates that they do not keep ethnicity data either. So we do not have a sense of what the issues are.

Senator ADAMS —What about the coroner’s office.

Mr Rajan —The coroner’s office have indicated that they can extract the data; however, when it came to my writing the submission they wanted five or six weeks to get the information to me as it was not readily available. I would hope that they would keep data of that nature, but we are not aware of it. We did ask them, and I did not get past the front reception.

Senator ADAMS —We have the coroner coming in this afternoon. That is something that we could ask them.

Mr Rajan —Yes. It would be very interesting to see whether he can shed any light on whether or not there is ethnic data, given that we have numbers of people coming in from refugee backgrounds who are particularly survivors of torture and trauma. They have gone through some major mental health challenges to get here, and we are not really providing anything. There is one transcultural mental health service in Western Australia. We used to fund another one but that no longer exists. One service is run by the Multicultural Services Centre of Western Australia called MAITRI and it provides counselling, mental health advice and referral services in a bicultural, bilingual way. That is a very heavily accessed service. ASeTTS provide some services in relation to torture and trauma survivors; but, again, from my discussions with them, it appears that there is something close to a six-month waiting list for a person to get to see a bicultural counsellor of any kind.

Touching on some of the issues that were discussed earlier, such as bullying and so on, we are getting a few reports from different schools—again, this is anecdotal; we do not have any hard data—indicating that they are having some issues with people from refugee backgrounds, usually, and certain parts of Africa, that are forming groups. They are getting together and bullying others, and the other way around as well. There are some issues there that lead to challenges in mental health for some of those young people. Dealing with this on a much more global basis, you are looking at getting down to understanding what settlement services are required for some of the humanitarian entrants and ensuring that those settlement services are provided adequately; otherwise, they are going to end up with mental health issues that may result in high levels of suicide.

The main submission that we were working around was that we need to get some concrete ethnicity data on this so that we can start discerning any trends. Anecdotally, we can certainly say that we are seeing increasing reports of suicide amongst culturally and linguistically diverse, or CALD, communities. We are being made aware of a lot more. In the last three or four years we have seen more and more each year. We can point to individual instances where we can clearly indicate that the overwhelming control of your life can be related to either religious or cultural beliefs. This is what leads people to have different views of the value of their life. Anecdotally, we can point to a number of instances in recent years where we have seen that manifest in either an increased suicide rate or the methods by which they have undertaken the suicide. I am happy to share anecdotal examples with you, if you would like.

If you are looking at that, I can point to a doctor friend of mine who was born a Hindu, converted to Catholicism on the date of his marriage and in 36 years never went into a temple again. A month or so before he died, he went to Malaysia, where he originally came from. He asked to go to the temple on his way to his sister’s house. He went there, said his prayers and came back to Perth a few weeks later. He contacted me and asked me to do various things in case something happened to him. That was on a Friday. On the Saturday and Sunday he did the same thing again—contacted me. On Monday he walked into a petrol station in Belmont, doused himself with fuel and dropped a match on himself. What he was doing was acting according to the Indian belief of self-immolation to remove your sins. So you can see that 30 years after giving up Hinduism it still was part of his life, part of his thinking and part of his culture. The way he undertook that suicide was so much based on that original culture and original religion.

We have seen a few of those. The issue of loss of face has manifested itself in probably three suicides in the last 12 months that I am aware of, among CALD communities. In touching on the settlement services aspect of it, I think one of the things that can lead to higher levels of concern amongst the CALD youth communities, and the refugee youth community in particular, is the fact that in Australia when people come into the country we place children in a classroom based on their age. Someone who is 15 and comes from the middle of the Sudan may have only had two years of schooling because the school was bombed. So they become the dunce of the class. They get no actualisation from the classroom. They look for it out in the streets and amongst like-minded people—people who come from a similar cultural background.

I think the mental health of children in CALD communities is a major issue that needs to be addressed. Some of them have endured enormous amounts of trauma and torture. Also, information from the Australian Institute of Criminology here in Western Australia indicates that the incarceration rate amongst the African communities is significantly increasing, so it demonstrates some issues related to the mental health challenges particularly faced by CALD and humanitarian refugee entrants.

CHAIR —Are you okay if we go to questions now?

Mr Rajan —Absolutely.

Senator ADAMS —Mr Rajan, within your organisation have you got counsellors or a team that has been set up to deal with any of these issues?

Mr Rajan —We are not a service provider. We are an advocacy organisation. But we have affiliations with a number of service providers who do provide mental health services in a culturally appropriately way, and I would mention MAITRI as being the main one that does that. We do have access to that.

Senator ADAMS —So you have got a referral pattern if somebody does come. Would they come to you first? Do you think so?

Mr Rajan —This touches on something that the previous people were saying about who they go to for advice. My sense is that they would go to their tribal elders, so they would go to the tribal elders in the first instance. They would seek advice from the elders in the community before they would go to a formalised service.

Senator ADAMS —As far as rural areas go, I am think about Katanning being such a multicultural community. Do you have any communication with the people in Katanning?

Mr Rajan —Yes. We were actually significantly responsible for the resettling of a number of Burmese refugee families in Katanning. We went down there and spent a lot of time with the various service providers to make them aware of the cultural issues involved with that particular group of refugees. So, yes, we do have contact and regular discussions. We have consultations in the regional areas. We have done Katanning, Bunbury, Geraldton and Manjimup. In recent times we have been out there talking to all those communities.

Senator ADAMS —Are they settling down fairly well? Are there problems there?

Mr Rajan —The Burmese refugees are settling in exceptionally well. We were very careful, in the movement of those refugees to Katanning, to see that they were moving from rural to rural, so they were moving from a rural background in Burma to a rural background here. We tried to minimise the disruption factor by trying to make sure that there was only one settlement, so it was not Burma to Perth and then from Perth a few months later to Katanning but it was going straight through to Katanning. That is important. I think you cannot have dual disruption. As for the answer to your question about if the Burmese are settling in, they are settling in exceptionally well. It is a very tight-knit community. We have very strong and fairly tireless workers, who are champions for them, here in Perth who go down on a regular basis to make sure that they all settle in.

Senator MOORE —Mr Rajan, you made a number of points in your submission about communication and services; they all seem to fall into those areas. Is your organisation linked to the new state suicide plan? We had information about the wide consultation and partnership basis of that plan. Was your group involved in that?

Mr Rajan —Yes. One of our committee members was certainly presenting. He is the executive director of the Multicultural Services Centre of WA, which provides some of the service areas. So, yes, he certainly had some input into that.

Senator MOORE —So from your understanding are the issues that you raised in your submission part of the discussions as to the new plan?

Mr Rajan —I would think so.

Senator MOORE —We had the ministerial council people talking to us. In their extraordinarily long submission they actually did mention some data by Kryios which was some attempt to look at estimating. They very clearly said this was an estimation process around what I think is quite a significant rate of suicide amongst people from non-English-speaking backgrounds. So it has been put on the agenda and what we do with it now is up to all of us, to make sure it works.

Mr Rajan —I gather that even in the National Suicide Prevention Strategy issues some of the multicultural community information was highlighted—that we need information about suicide data collection et cetera on an ethnicity basis. That raises a whole series of other issues as to how you identify ethnicity as well. People can identify as being African, as opposed to being Ugandan or Eritrean, so it raises a lot of different issues, because culturally people from South Africa are very different from those from Eritrea but they are just as much African as anybody else. Even within Indian communities people can identify different levels—state level as opposed to a national level—so there can be some enormous difficulties. How far down you want to drill is another issue—whether you need to drill down to that level of data or whether it is simply okay to get someone who is Indian as opposed to Gujarati or whatever it may be.

Senator MOORE —There seems to be an issue with people who use that only as a basis for other things. I have asked in other areas about their role of interpreter services, and you have mentioned specifically in your submission that a lot of the counselling and support for people and families is by phone. That is just the nature of the way the services operate.

Mr Rajan —Yes.

Senator MOORE —I asked in Victoria about that, and they said that they were relatively satisfied with the response of the interpreter service. They did not have their own; they used the state one. They said that it worked quite well. From your experience and from what people tell you—because I know you only gain information; you do not go beyond that—do you have any comment you want to put on record about the immediacy and effectiveness of interpreter services in quite a specialised area of counselling?

Mr Rajan —I certainly think that the language services that are available are inadequate. For example, NAATI does not have interpreters in certain languages because they are relatively new languages et cetera. There are four or five African languages that are not being picked up at the moment. We have had regular contact with the interpreters in this area. The difficulty in this area is that you are getting into such a specialised field of counselling and psychiatry et cetera that you are really trying to translate something into a language that is very complex, even in English. On the other thing we have had some issue with in regard to the availability of information in languages: we were producing a DVD introducing people to the law of the land in Australia, and our first approach was to do it in English and then caption it in 12 languages but we discovered that most of the people accessing it are illiterate in their own language so they cannot read the caption. So we then have to find someone who can do a voice-over in that language. The medium by which we communicate this information to the CALD community is also very important. I think we need to understand that there are people with literacy difficulties in their own language and therefore we need to look at other media by which we can communicate.

There are consumer protection issues that go to this area as well. Again, anecdotally we are seeing lots and lots of African community children who are finding themselves with incredibly difficult mobile phone contracts and getting themselves into debt which they do not want to be in and then contemplating suicide. You cannot just look at an issue and say: ‘How do we communicate these things?’  We have to look at it as almost every agency being responsible to ensure the mental health of the individual. How do you do that? By all sorts of different ways of communicating messages. The area of stigma reduction is another big area. I think that the recognition of mental health challenges is an issue. Depression is an issue—and the understanding of it. I never heard the word ‘Alzheimer’s’ until I came to Australia. We referred to at as ‘dotage’—‘He’s in his dotage. Don’t worry about it; he forgets things.’ Recognition that mental health is an illness, a challenge, and not a stigma to be borne by the family, is a big issue amongst a lot of CALD communities.

Senator MOORE —There are places and people to help.

Mr Rajan —That is right.

Senator MOORE —And then it gets into a circle—if you are offering that, it has got to be there.

Mr Rajan —Yes.

Senator ADAMS —We have had quite a lot of evidence on triage at emergency departments, especially in the area of self harm. Have you had any complaints or any problems in that area?

Mr Rajan —I cannot say we have had any complaints. I suspect that, if mental health issues were displayed by members of the CALD community at an emergency department, they would probably be missed. I think the triage people would not be sufficiently trained on cultural issues to try and pick up signals of any kind. So I would think that any issues there would be missed. I am speaking without any real issues or complaints having been brought to our attention.

Senator ADAMS —What about interpreter services at emergency departments?

Mr Rajan —I do a number of cross-cultural awareness training programs for a few government departments and, without a shadow of a doubt, in every agency where I have delivered that cultural awareness training program the people receiving the training have not been aware that they are not to use a child under the age of 18 as an interpreter. So, in other words, the interpreter services are quite inadequate and in many instances health issues are being discussed with children under the age of 18 because they happen to be there. There is a statewide language services policy that indicates that you are not to use a child under the age of 18 under any circumstances, including emergencies—

Senator MOORE —And everyone ignores it.

Mr Rajan —Yes, everyone promptly ignores it.

CHAIR —They would want to use any method of communication that they can and it would be an automatic response. I am not justifying it; I am just pointing that out.

Mr Rajan —That is right. Just think that you could be discussing a father’s sexual health issues with a girl under the age of 15. It is very hard to handle that.

CHAIR —I wanted to go back to the issue of data. When we had the ministerial council here, they said that when they were preparing the last strategy they asked the coroner for data and they were given cold cases and information on 5,000 people from 1986 onwards.

Mr Rajan —From 1986 to now?

Senator MOORE —1986 to 2006.

CHAIR —It was a 20-year time frame.

Mr Rajan —Can I put that in context? What were the total number of suicides in that time?

CHAIR —We did not then break it down. They were given 5,000 cases to look at and we did not break it down in that conversation. There is more data in the strategy. I was just wondering whether you have had any conversations with the ministerial council or its predecessor around the breakdown of that data.

Mr Rajan —No, we have not. I would be interested to get some of the data. Have they updated it since 2006?

CHAIR —No, not that I am aware of, and the data that they were using, which Senator Moore was talking about earlier, around the number of suicides in immigrant communities and the percentage with non-English-speaking backgrounds relies a lot on overseas data. They are looking into that a bit more, but I was just wondering whether there had been interaction between you when the strategy was being developed using the data that they had managed to get from the coroner.

Senator MOORE —The coroner determined that from 1982 to 2006 a total of 4,787 deaths in Western Australia occurred as a result of suicide.

Mr Rajan —That is the total?

Senator MOORE —Yes, 3,840 men and 947 women.

Mr Rajan —That is over the period of—

Senator MOORE —1982-2006.

CHAIR —That is interesting because they said it was 1986 data.

Mr Rajan —It is a 24-year period and there are about 5,000 suicide deaths—in total, not just CALD communities.

CHAIR —That is the total, but I was wondering whether you had had discussions with them about—you know when you were talking earlier about data.

Mr Rajan —Yes. We have not had that discussion with them. I would probably need to have the discussion around that.

CHAIR —We will ask the coroner because the recording of ethnicity may be—

Mr Rajan —Problematic.

CHAIR —Yes. We have had that discussion with coroners in other states around whether somebody was Aboriginal and Torres Strait Islander or non-Aboriginal and Torres Strait Islander. There are problems around recording that level of data, let alone then going down to African and where they come from in Africa.

The other issue I am keen on following up is the issue you were talking about of mental health for children because, particularly with refugees, it is highly likely that they would have been exposed to a significant amount of trauma. It sounds like there are not that many services for addressing mental health issues for children in CALD communities.

Mr Rajan —I do not think there are any; I am not aware of any that address children specifically. Certainly the MAITRI offers children some services. I think that recognition, even within CALD communities, by parents of their children’s mental health issues could be a problem. I do not think most of my humanitarian community members would fully appreciate what their children are going through, what they have gone through and what they are suffering from. I think a massive education program needs to be conducted at all levels with the CALD communities to make them aware of some of the signals that may be sent. Imagine that someone has come here after seven, eight, 18 years in a refugee camp where none of that was an issue; none of that was even considered to be something that would be looked at.

I want to touch quickly on this issue of mental health. I think one area that we have also fallen down on very badly is that we had some discussions with the Indian community around what is happening with Indian students around Australia. We felt that there was a necessity for subsided or free mental health services to be provided to international students. We are dealing with 500,000 international students in Australia: 106,000 of them from India and 110,000 from China. These are people who have come from rural and remote Haryana and Punjab in India to urban Perth and they are away from home. They are suffering all of the mental health issues of being lonely et cetera, and we have got one person in the immigration centre who is there because he is at pathological risk of suicide. He has tried to commit suicide three times. He is an Indian student. His visa has been cancelled.

CHAIR —Because of that?

Mr Rajan —No, his visa was cancelled because he overworked. So his visa has been cancelled and, under normal circumstances, Immigration would let him out into the community to wind up his things before he goes away but they have had to take him into detention because he is at risk—he has tried to commit suicide three times. Someone needs to attend to the mental health issues that have driven him to that point, but he cannot access any of the services that we provide to permanent residents of Australia because he is a temporary resident, so 457 visa holders are temporary residents. Why should they not be entitled to some subsidised mental health access?

We have got six instances of 457 women who have had domestic violence perpetrated against them. If they leave the marriage they will be deported because they have no status in this country. Why? They are paying taxes like the rest of us. I guess the availability of subsidised mental health care should be available. We are talking 500,000 international students who should be allowed access to that. It is a $17 billion industry that we have made a lot of money from, but we have not given them a lot. We have got some Indian students who have tried to commit suicide—a couple in Melbourne and a couple here.

CHAIR —What sort of support are they getting from outside the government sector?

Mr Rajan —They get a little bit of counselling from the institutions that they attend, but that would certainly be very inadequate. I do not think that there are high levels of counselling available at most of the institutions. I am not certain that it is an issue with the tertiary sector, but it is a huge issue with the vocational education sector.

CHAIR —That is what we were just commenting on. The universities would provide more services probably but there would not be many in the small institutions.

Mr Rajan —That is right. The small institutions have exploited the industry completely and they are not providing any of the pastoral care and services that are required. As I said to an Indian student the other day, ‘What are you studying?’ He said, ‘Holistic medicine,’ and I said, ‘Let me get this right in my mind: you have got a system of Ayurveda in India that is 5,000 years old and you come here to study that? You may as well have stayed home.’ So, yes, services need to be provided there.

CHAIR —In terms of the work of your advocacy organisation, how far are you getting with advocating to get better mental health services for the broader CALD community and particularly for kids?

Mr Rajan —I think I might give you a completely wrong impression of the level at which we are funded in terms of our advocacy. We are not getting very far because, basically, the council is funded to the tune of $100,000 a year—that is total funding.

Senator MOORE —State funding—

Mr Rajan —Yes, we do not get any federal funding. It is difficult to try to push these things forward. Since Dr Gallop’s departure as Premier, we have not seen the commitment to multiculturalism and service provision in the CALD communities that we did see in the past. We have not seen any commitment really to multiculturalism and the provision of services in a culturally and linguistically appropriate way. We have not seen a strong commitment from any government since Dr Gallop, so that is a difficulty.

CHAIR —The new strategy seems to say pretty good stuff overall—

Mr Rajan —Yes.

CHAIR —Are you engaged in any discussions with the ministerial council, or the Telethon Institute for Child Health Research that have now got the successful tender, in terms of getting more services for the CALD community under the strategy?

Mr Rajan —We have not been, and with the Telethon institute I will certainly rectify that fairly quickly and go to them and talk to them about some of the things that we should be doing.

Senator MOORE —Concerning the issue raised about students and people with 457s—it is definitely a national thing?

Mr Rajan —Yes.

Senator MOORE —Do you know whether the national body has raised this formally with the government?

Mr Rajan —As in our national body, the Federation of Ethnic Communities Councils?

Senator MOORE —Yes.

Mr Rajan —I do not think so. We have put together a discussion paper around Indian students in particular with some of those issues that have come up, and that is in the final process of being submitted to Andrew Metcalfe from Immigration. We will refer it to Laurie Ferguson and also Senator Evans—

Senator MOORE —It has not come before us before, but it is incredibly important and when you state it we think, yes, it is certainly important. So we will have a look at taking that one forward as well, because it is a much wider issue in terms of the international students and 457 people who are away from home and do not have access to services. It is critical and I had not considered it before.

Mr Rajan —Generally, government services have been restricted to people who are permanent residents. You do not have to be a citizen but you do have to be a permanent resident. Unfortunately, 457s are temporary residents and students are temporary residents and—

Senator MOORE —A Senate community affairs committee took up the issue of people in detention and it was a direct focus of that committee, but the wider issue was not taken up as strongly as it should have been. It is important that you raise that.

Mr Rajan —Thank you.

CHAIR —Thank you very much. Your time in coming to present to us and your submission are very much appreciated, and thank you for waiting.

[11.50 am]