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Community Affairs References Committee
05/07/2018
Accessibility and quality of mental health services in rural and remote Australia

KING, Ms Brenda, Sexual Assault Counsellor, Anglicare WA

[10:32]

CHAIR: Ms King, thank you very much for coming. We very much appreciate it. Can I just double-check, before we go any further, that you've been given information on parliamentary privilege and the protection of witnesses and evidence.

Ms King : Yes.

CHAIR: I invite you to make an opening statement if there's anything you want to tell us, and then we'll ask you some questions.

Ms King : I've written an opening statement, so I'll read it.

CHAIR: Thank you.

Ms King : I've been in the role of sexual assault counsellor for the East Kimberley, based in Kununurra, for over eight years. I worked for the Department for Communities in child protection in Kununurra for three years prior to that, and for New South Wales Health as a sexual assault counsellor for 13 years before moving to Kununurra. I'm the only sexual assault counsellor in the East Kimberley. My observation is that there are higher than average rates of sexual abuse for both adults and children in the Kimberley, and higher rates of sexual abuse experienced by Aboriginal people compared to other Australians.

Child sexual abuse can have a very significant impact on a person's mental health both as a child and later on when they become an adult. Child sexual abuse is often a factor in people experiencing mental illness. It is identified as a factor in suicide and often results in personality disorders. To my knowledge, there are no services for perpetrators of child sexual abuse, and the problem of convicted perpetrators returning to their community is a big one in the Kimberley. To my knowledge, there are no specialised services for children and young people who sexually abuse other children. Specialised intervention at this age can be effective.

There is a strong taboo against, and shame for, victims speaking about sexual abuse, and this is especially the case for Aboriginal people. There is a need for culturally appropriate education and resources to be rolled out by people who are adequately trained. It is my opinion that we need staff from both Aboriginal and non-Aboriginal backgrounds engaged in this work. Aboriginal workers may require training and mentoring to overcome the taboo associated with talking about sexual abuse.

While sexual abuse remains a secretive issue in the Kimberley, it will contribute to poor mental health for victims. While children who are sexually abused do not receive specialised counselling services at the point of disclosure, they are at risk of experiencing mental health problems in later life.

Senator O'NEILL: Were you here earlier this morning when we heard from Mr Morrison and Mr Dann, Ms King?

Ms King : No.

Senator O'NEILL: They raised this issue with us, and we're hearing it from witnesses more broadly. Our inquiry is about the quality of mental health services and their accessibility. You've described the level of need as quite significant, and you've identified some points where there is no access. What is actually happening, what's working and what needs to be expanded?

Ms King : What's actually happening is that I'm the only sexual assault counsellor in the East Kimberley, so I'm spread very thin. It puts a limitation on my ability to do community education, particularly with Aboriginal health services, to break down the taboo and providing information about sexual assault and child sexual assault. It limits my ability to do community education to break the seal of secrecy. And because of the cultural limitations—women's business and men's business—it's not comfortable or appropriate to talk about sexual things in mixed company, and probably uncomfortable for people to speak out about it. It limits my ability to really address the secrecy around child sexual abuse and sexual abuse in the hope of increasing reporting and empowering, and making links with, victims.

Senator O'NEILL: Yes. So how many more of you do we need, and how many 'Mr King's do we need so that we can deal with the women's business and men's business issue?

Ms King : I would say two of each.

Senator O'NEILL: Right.

Ms King : Yes. My area of expertise is in one-on-one counselling, from the extensive training I received with the NSW Health Sexual Assault Service, so I'm particularly confident about providing therapeutic counselling for victims of sexual abuse over a long time, particularly adult survivors of childhood sexual abuse, who can present with a very complex range of mental health issues. There needs to be somebody, probably from a younger generation, with expertise in community education and engaging young people. So there are two aspects to the role.

Senator O'NEILL: Thank you for the work that you do. I'm sure that it's very powerful for the people who are able to access the service you provide. But how do you manage the traumatic nature of the work that you have to undertake? How much supervision are you able to access, and what support do you get for doing the work that you currently undertake?

Ms King : My personality is that I thrive in an outback setting. And I have a home here, which I retreat to, and I have leisure pursuits

Senator O'NEILL: So you self-care?

Ms King : Yes.

Senator O'NEILL: How sustainable is that for people who might not be quite as resilient as you, and what sorts of structures do we need to put in place?

Ms King : It's not sustainable at all, and clinical supervision is a really big issue. Anglicare needs extra resources for expert clinical supervision, probably on a weekly basis.

CHAIR: How is your position funded?

Ms King : It's through the primary health network.

CHAIR: Okay. I wanted to have an understanding not only of the services but how they're funded. So that's through the PHN.

Ms King : Yes.

CHAIR: Okay. Thank you. Sorry to interrupt.

Senator O'NEILL: Not at all. Have you made clear your concerns about the level of staffing to the PHN or to Anglicare?

Ms King : I have to my regional manager and I have to the CEO when I see him, but my focus has remained on providing services.

Senator O'NEILL: Doing your job. So advocacy for additional support is a challenge with your own employer.

Ms King : Yes.

Senator O'NEILL: You know the nature-nurture conversation happens around the issue of mental health disorder. We've had the identification of drug and alcohol use as a driver of mental ill health and forms of abuse that might follow from that. We've also had discussions about borderline personality that you've raised here. I'm trying to understand the scale of the problem, which seems quite significant, and how much that is related to sexual assault, drug and alcohol, or just the natural incidence of mental ill health. What's going on here with regard to that?

Ms King : Child sexual abuse figures very prominently in the cases that I see. I may see people referred for depression, and there's nearly always an experience of child sexual assault that hasn't been disclosed or is sort of brushed off. That's amongst the non-Aboriginal population as well. In a place as far north as this, people often run from their problems, so I see in the non-Aboriginal population many people experiencing poor mental health present for counselling with a history of child sexual abuse and sexual abuse in adulthood as well. Child sexual abuse is present in many people using drugs and alcohol to find relief.

Senator O'NEILL: So you're telling me the scale of the problem of child sexual abuse is very significant.

Ms King : Yes.

Senator O'NEILL: I'm very appreciative of you putting on the record that it's across the entire population here in the north, not just the Indigenous population, which has been the focus of our conversation for most of the morning. If that's the case and you're dealing with people who are presenting a long time after the fact, my question now is: what's the reality of the lived experience of young people with regard to sexual assault at the moment in this region?

Ms King : The reality is that they are very vulnerable to sexual assault. The protective factors of family being able to provide safety are compromised due to the social conditions that young people experience.

Senator O'NEILL: What do you mean by social conditions? What are you talking about there?

Ms King : Overcrowding.

Senator O'NEILL: Housing is a big problem?

Ms King : Yes. There is the limited ability of adults to provide supervision for young people.

Senator O'NEILL: Why is that? They're there. They're in the environment, but they're inadequately providing supervision. Why? What's going on?

Ms King : The nature of parenting is different. A young person might have several mothers or fathers who may be in other households. The understanding isn't the same as from a European culture, where you've got one mum and dad or one mother. There are a variety of adults who may be supervising children, so there's not one person responsible. People move from house to house. There's not one locality, so it would be normal for young people to be sleeping somewhere else. No-one would know where they are. And there generally isn't a routine of school, coming home and going to bed. The routines are often disrupted.

Senator O'NEILL: And we're talking about the general population here or just the First Nations population in those comments?

Ms King : Probably more the First Nations population, but there are non-Aboriginal families who—no, I think it's mostly a First Australians population.

Senator O'NEILL: Okay. There's no easy solution to what's become established practice in a community. There's no easy way to puncture that. But you talk about the importance of social education. Are you advocating for the teaching of protective behaviours for young people to protect themselves from an environment which can't be changed, or do you have ideas about the way cultural change could happen to create safer environments, or both—or anything else—in terms of solutions?

Ms King : I'm not sure that protective behaviours are the answer. What I could see would work would be workers on the ground, comfortable in their relationships with people, talking about sexual assault, talking about safety and helping to provide safety. These are workers who are connected, have spent the time, are on the ground and are involved in the lived, day-to-day experience of families to be able to take a phone call and respond to requests for help or discuss danger that the young person may see or problems that they're experiencing. The answer is to have people on the ground with the flexibility to work out in the streets with the families to really get to know them and build that relationship of trust so the young people have got somewhere to go when they're unsafe.

CHAIR: It's sort of like what we were talking about before. I think you were here when we were talking to Dr Trust.

Ms King : Yes.

CHAIR: It is that sort of employing people in communities specifically to work on this particular issue, but those workers have to have a high degree of trust from the community and can't be flying in. It's got to be members of the community.

Senator O'NEILL: Someone who lives in community with support wrapped around them.

Ms King : Yes, someone who's got the time and who's here for long enough to build the trust and to get to know families. The families are interconnected. When you've gained the trust in the family that opens to a larger group of people, it increases the safety of young people because they can really open up about what's really going on.

Senator O'NEILL: Somewhat despairingly, I ask you to identify the scale of what the problem is. I wonder what happens when you get to a point where people are beginning to say, 'Okay, I need to talk about this,' and it's then, 'All these people in my community are perpetrating sexual assault on young people.' And they all end up in jail, which is an appropriate response, but what does that do the community, and how does it resolve the problems for the people who are left with having told the story? There's so much complexity here. How endemic is this problem, what is the scale and how do you deal with the reality that this would send people to jail who clearly have done the wrong thing but would lead to another level of disruption in the community? The complexity of it overwhelms me. I want some counselling around this, I think—your advice on what we could do.

Ms King : Begin with children and specialised child sexual assault counselling services. Begin with Aboriginal people working with non-Aboriginal people to be trained up and skilled in supporting families, in helping to make disclosures and in knowing what to do in disclosures. With case management, rather than agencies sitting around and talking about the families, the families should absolutely be included in the case management meetings.

Senator O'NEILL: That's very practical.

Ms King : Be guided to give responsibility back to the families and back to the communities in a real way. I'm speaking from the experience of one of our workers who works in the area of suicide. She is out of the office most of the time. She's got the trust of young women, nearly all of whom have experienced child sexual abuse and all of whom engage in self-harm behaviour and are at possible risk of suicide. She's got their ear and their trust. For her to attend a case management meeting where there's domestic violence without the person that's being talked about goes against her grain, and yet it's not the format of the meeting.

Senator O'NEILL: What happens if a young woman, such as Dr Trust was talking about who might have experienced child sexual assault, discloses to this care worker that you're talking about? What's the sequence of events that follows?

Ms King : For a person under 16 our care worker is a mandated reporter to report that to the department for child protection, who will then conduct an interview to see if there's a disclosure. That will go to the legal system, which will then see if there's enough evidence to press charges and for it to go through court.

Senator O'NEILL: In how many instances does that occur? Is it frequent or uncommon?

Ms King : It's infrequent.

Senator O'NEILL: Is that because the evidence is poor?

Ms King : Yes.

Senator O'NEILL: The evidentiary bar is too high for people?

Ms King : Usually the unwillingness of the person, the fear—

Senator O'NEILL: And shame?

Ms King : And shame, yes. There's one exception of a community where disclosures were made and an investigation has been carried out and there's a court case coming up—there is prosecution. A lot of support was put around people in that small community.

Senator O'NEILL: My fear that whole communities could fall apart as this comes forward is pretty misplaced by what you've just said, that people need to tell their story and they need their support. Evidence is hard to come by. People who might have perpetrated this will still be in community. The shame transfers from the person who has experienced the victimisation to the people who have perpetrated it, and the community knows about this and lives with it in some way, changing their protective behaviours, is that how it ends up?

Ms King : Not necessarily that the shame is transferred. Generally, there's a backlash to say that it didn't happen and there's further victimisation of the victim then being accused of making it up.

Senator O'NEILL: Now my hope has gone again. What I'm saying to you is that I can't see a path forward.

Ms King : Workers on the ground who are comfortable talking about sexual assault, who are confident that child sexual assault is never okay in any form and who give that message in their daily lives through their work at the clinic, through the work at the school and through their work as mothers, fathers and assistants at the school—people who know how much it happens; who are sure that it's never okay; who are going to speak out against it; who are going to be empowered themselves to report it, speak against it and empower others to speak up, so that—

CHAIR: Changing the culture in terms of—

Ms King : Changing the culture. Blowing the myth—

CHAIR: I mean that in terms of culture, in terms of the hiding of it—

Ms King : Yes, the secrecy and the shame—

CHAIR: The secrecy and the shame. Changing that sort of culture—

Ms King : And the culture of protecting family. The strength of family bonds here is wonderful, admirable—

Senator O'NEILL: When it's an asset that's positive it's powerful but when it's a framework that suppresses, silences and hides then it's dangerous.

Ms King : Yes.

CHAIR: I want to focus back on dealing with the mental health aspects. You were talking about the support services and what happens. Senator O'Neill asked about what happens when someone discloses. In terms of mental health support and counselling, it seems to me that if we're not making sure that services and counselling are available when someone discloses, as you've articulated—and our other witness have talked about that—a child is going to have lifelong consequences if there are no support services there. You're the only counsellor available in the East Kimberley?

Ms King : Yes.

Senator O'NEILL: How long is your wait list?

Ms King : I don't have a wait list because children aren't referred generally, and people don't come forward for sexual assault counselling because there's such a taboo about it.

CHAIR: You've said you're extremely busy. You're dealing with adults—

Ms King : Yes.

CHAIR: mainly because the children aren't being referred to you because they're not disclosing.

Ms King : Some children are referred, but not a lot—not as many as I believe could be.

CHAIR: You've also said that you think that you essentially need two more male and two more female counsellors?

Ms King : Probably three females and one male.

CHAIR: Okay—to address the caseload that you know is there?

Ms King : Yes—to come in when the barriers are broken down and when the connections in the community are made and when a specialised child sexual assault service is established in the East Kimberley that services are confident to refer to.

CHAIR: In your opinion there's a significant issue—I'm just trying to get it all clear—of non-disclosure, and the number of people that you are seeing indicates that there's an issue out there. You need a service established that's also doing community awareness and giving support and building trust so that people will disclose?

Ms King : Yes.

CHAIR: Not only are you then addressing the issue of adults who have the ongoing consequences but you're also actually enabling children to disclose in a supportive environment, making sure the services are there for when that occurs?

Ms King : That's correct, and linking with services: police, child protection and health. It's about awareness and facilitating that link. The sexual assault service needs funding and support for the two components: therapeutic and counselling. For a good service, survivors require years of support. I see people on general referrals, particularly in small places like Halls Creek. I'm easily identified, and if I'm the sexual assault counsellor and people are seeing me, it cuts it off. So I see anybody and that's how I know how much sexual assault there is. There is depression and stuff. There's always a sexual assault.

CHAIR: I understand what you're saying now. So you do general counselling services. There's still an issue associated with seeing somebody for mental health counselling, as we've heard, but at least they then feel safe to disclose when they're coming in for general support?

Ms King : Yes.

CHAIR: So there are two things. The service needs to do the therapeutic services, but you also talked about community education and awareness. That would be another critical role of the service—those two arms.

Ms King : Yes, particularly mentoring workers, both Aboriginal and non-Aboriginal, who are uncomfortable. Most people are really uncomfortable talking about sexual abuse. It's still a taboo subject here—it's very uncomfortable. We need to empower people to talk about it. We talk about road safety, but not sexual assault. We need a specialised service for children so that children as young as three who disclose can receive a service and can get support, to shift the blame from themselves and the damage—the boundaries and the things that make their ability to function in later life so difficult. Children from a young age need to be able to understand—shift the blame and understand the principles of sexual assault, that it's not their fault and they're not bad and dirty. That makes a huge difference, but we haven't got that.

CHAIR: That is on top of the child specialist? I'm trying to get my head around the scale of the sorts of services that we need. Would that be on top of the one male and three females?

Ms King : No. I think that, if there were therapists who were skilled in developing services for children and adults in an intense therapeutic setting and there were experts in community education, that would be okay.

CHAIR: So you're talking about a very skilled workforce, basically.

Ms King : Yes, and well supported, where there was specific sexual assault clinical supervision and there was specific training for sexual assault workers built into the funding.

CHAIR: Thank you very much for your time today—we really appreciate it. With every one of our witnesses we could have gone on for hours. If anything else occurs to you please don't hesitate to let us know.

Ms King : Thank you for listening.

Senator O'NEILL: Thank you.