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Community Affairs References Committee
10/07/2018
Accessibility and quality of mental health services in rural and remote Australia

ADAMS, Mr John, General Manager, Central Australia, Jesuit Social Services

CORBO, Ms Maree, Program Manager, Tangentyere Family Violence Prevention Program, Tangentyere Council

[17:02]

CHAIR: Sorry to keep you waiting, but we've been late everywhere we've gone, because we've been hearing so much information.

Ms Corbo : That's all right.

CHAIR: Can I just double-check that you've both been given information on parliamentary privilege and the protection of witnesses and evidence. Thank you for coming. I invite both of you to give us, if you want to, any opening comments, and then we'll ask you questions—or interrupt you as we did to our last witness.

Ms Corbo : I've brought these in so you can have a look at them. I would really like to thank this committee for the opportunity to present today. I'm not a mental health clinician. My expertise in this area is that of family and domestic violence, and I have an understanding of the impacts that family and domestic violence has on the mental health outcomes for Aboriginal men, women, children and communities.

Tangentyere Council is an Aboriginal community controlled organisation delivering both human services and social enterprise activities. I'm not going to go through all of those; you can have a look at those. Tangentyere has a large footprint, delivering services across the town camps in Alice Springs, in greater Alice Springs and throughout Central Australia. The family violence programs at Tangentyere offer support, referrals, resources, and group and individual sessions for men, women and young people impacted by family violence, as well as secondary consult and referral to agencies. The Tangentyere Family Violence Prevention Program is committed to working within an integrated response to family and domestic violence to prevent violence in the town camps and in the wider Alice Springs community. We aim to raise awareness that cultural and societal change is required to assist in moving towards a safer, healthier and stronger future for families and communities. In the Tangentyere Family Violence Prevention Program, our vision and strategy is to engage men, women and children to understand the drivers and contributors of family violence, which in turn empowers and educates people to pass on this knowledge for future generations and to have hope and healing.

Family and domestic violence, as you know, not only affects women and children physically but also comes with a huge emotional and mental health cost. Issues such as post-traumatic stress, anxiety and depression often have long-term impacts that often sit alongside substance use in an effort to block out or cope with traumatic feelings. Likewise, many of the men we work with experience similar issues. Without minimising the use of violence, they've often experienced sustained family and domestic violence as children, impacting on their ability to have healthy relationships in their adult life. Practically, we know that many of the men, women and children we work with require support around these issues. Sadly, except for very obvious mental health issues such as suicidal ideation, most of the people we work with are not linked into mental health services.

We understand that relationships are incredibly important, and we work with our community members in a relational way without judgement, recognising that trauma is a facet of the bigger story of those we engage with. We recognise that cultural safety is an important aspect of our work. A commonly used definition of cultural safety is that of Williams in 1999, who defined cultural safety as:

An environment that is spiritually, socially and emotionally safe, as well as physically safe for people, where there is no assault, challenge or denial of their identity, of who they are and what they need.

Stigma regarding mental health is not unusual, and my experience of working with men for a long time has shown that men in particular struggle to go to doctors for general health checks and, in particular, their struggle to address mental health issues. It's therefore imperative that cultural safety be at the core of the work that needs to be carried out regarding mental health issues. While I recognise the excellent and intense work that mental health services do in Alice Springs in the broader community, culturally safe work in this area needs to be enhanced. Some of the best examples of culturally safe prevention work come from the Mental Health Association of Central Australia's Suicide Story, which was created by Aboriginal people for Aboriginal people.

We recognise that the people we work beside feel safe at Tangentyere and often see our office as a drop-in space. Our office provides cups of tea, food and a place to sit down and feel safe. We are surrounded by Aboriginal artwork, and the atmosphere is welcoming and physically and emotionally safe. We understand that conducting outreach to people's homes assists them to feel more in control. Many conversations regarding challenging topics happen in the car.

Workers and the space they work in need to be predictable to achieve good outcomes for any client group and, in particular, Aboriginal community members. We welcome working with mainstream services and believe that silos in this area are not helpful to the people we work for. Co-location of mental health services into Aboriginal controlled services may assist people to feel safer, and it may be less medical in its approach, as fit-for-all services do not always work in this environment. This issue is particularly relevant for young people. The young people we work with are often labelled as troublesome or using antisocial behaviour. As such, the further stigmatising of mental health issues is yet another barrier they have to face.

Young people of many cultures can struggle to keep appointments, to be on time or to manage their health. This is not dissimilar to what occurs for the young people we work with. In situations like this, the medical model is not always helpful or engaging for young people, often placing further pressure on them. We believe that a culturally safe drop-in space may assist young people to engage with workers in a less formal and less structured setting that focuses on relationships as its core and as the beginning phase of informal assessment regarding a young person's mental health.

Infrastructure is often not recognised as an issue. However, town camp community members often do not have access to phones or cars in an emergency, making it challenging for people to get support or to go to appointments when required. Research undertaken by Tangentyere and the Baker Heart and Diabetes Institute demonstrated that only 25 per cent of town camp households have access to a car in an emergency situation. If support is required for an individual, ambulance and police are often the only options, and only if there is a phone available for them to ring from.

In this current day, people often come to an understanding about a range of issues via websites or through digital media. However, access to technology is a huge problem for town camp communities, who often do not have access to wi-fi, smartphones iPads or computers. Likewise, if these were available, digital and English literacy are huge barriers to seeking support via live-chat mental health websites, as they rely on literacy to communicate, which is often an issue for many community members who struggle in this area. This is particularly true of older members, who are not trained in using social media or digital technology and therefore do not have access to online pathways to gain education or support about issues such as mental health.

National mental health StandBy numbers are frequently not appropriate for people where English is a second or third language or where the people on the end of the phone do not understand the cultural context of the people they are speaking to. While we often give out numbers to people to access support via phone—examples include Lifeline, beyondblue and SuicideLine, I'm never confident that they will be used or, if used, that the person at the end of the phone will understand the complexity of who they may be speaking to.

In conclusion, I'd like to advocate for an increase in culturally safe environments, an increase in culturally safe group work and individual work, possible mainstream mental health services co-located in Aboriginal-controlled organisations, fewer silos between services, an increased understanding of the need for outreach mental health services, an increase in primary prevention to address the stigma surrounding mental health, culturally appropriate and accessible phone services, access to digital media and more work to be conducted to support men with accessing services that are non-shaming and culturally appropriate.

CHAIR: Thank you. Mr Adams?

Mr Adams : Thanks for this opportunity to present today. I'll try to be brief. Jesuit Social Services has been working for more than 40 years, delivering practical support and advocating for improved policies to achieve strong, cohesive and vibrant communities where every individual can play their role and flourish. We work with some of the most marginalised individuals and communities often experiencing multiple and complex challenges. We work where the need is acute and there is the greatest capacity for change. Our services span Victoria, New South Wales and the Northern Territory. Overall we support move than 57,000 individuals and families. We have consistently argued that public policy must pay greater attention to the role of structural factors and societal inequity as key determinants of health and wellbeing.

In 2015 Jesuit Social Services, along with Catholic Social Services Australia, released the findings of its fourth Dropping off the edge report, which found that complex and entrenched disadvantage continues to be experienced a small but persistent locations in each state and territory across Australia. These communities experience a weblike structure of disadvantage, with significant issues including underemployment, mental health problems, a lack of affordable and safe housing, low educational attainment and poor-quality infrastructure and services. In the NT, disadvantage is not uniform across communities. In our DOTE report we found that, unlike other locations around the country, disadvantage in the Northern Territory is more dispersed. It was common for locations within the NT to experience both high and low rankings on different indicators. As such, responses to disadvantage must be tabled and take a nuanced approach.

That is basically about collecting data about disadvantage. You need a postcode, for example, and postcode is the biggest drama for us when we do the DOTE research. For example, we might have a postcode that includes all of Alice Springs. It might include the golf course as well as town camps. The problem is that that can hide quite severe disadvantage, and we need to look at more nuanced indicators to try to pick that up.

Senator O'NEILL: And it's used for so many things. It's a problem for our SES model for schools et cetera. There's been an effort to expand the areas covered by postcodes for efficiencies for Australia Post.

Mr Adams : And for things like state high schools in the Territory it's a nightmare. You've got one secondary school in Alice Springs, and it has to cater for kids from town camps as well as my kids as well as other people's kids who might have an issue with the private school system. I've been on every school board that my kids have been to in the state system. It's a nightmare, especially since they have withdrawn mental health services in schools. They used to employ a clinical psychologist.

CHAIR: So what access—

Mr Adams : Now I think they've got one individual, when they used to have three or four who used to target all the schools in Alice Springs. I think the expectation is that they use health services.

Senator O'NEILL: Outside school hours and in a different context.

Mr Adams : Yes, and competing with the other issues for mental health providers outside. In 2003-2004 it was a good service. As child protection workers back then, we wouldn't have a meeting in school where Services South, we used to call them, would attend. You'd know there was a clinical psych who basically had been doing it for so long. I think they had two clinical psychs, actually. It was an excellent service. But that's been shrunk and shrunk.

On the whole, a number of Indigenous communities across Australia, including in the Northern Territory, experience persistent and entrenched disadvantage. The forced severing of healthy, familiar relationships with land clearly has a negative impact on the wellbeing of Aboriginal and Torres Strait Islander peoples, resulting in disadvantage and marginalisation that is reflected in disproportionately high incarceration rates, deaths in custody, low health indicators, low education rates, poverty and intergenerational trauma. There are also impacts on mental health outcomes.

Addressing the mental health needs of Aboriginal communities, particularly in rural and remote areas, demands a specific response. First, it is crucial to base any services, supports and responses on the unique conceptions of mental health within Aboriginal communities and cultures and the understanding of mental health as part of a continuum that applies to individual people, extended families and entire communities interconnected with physical health and spirituality.

Second, the most effective mechanism for improving the responsiveness of services and effectiveness of outcomes is to increase the involvement of and control by communities and locally based organisations in the planning, coordination and provision of services. This involves establishing cultural relationships with Aboriginal and Torres Strait Islander communities to support community decision-making. To cite one example in the mental health space: about five years ago, I was on the MHACA board, and the federal government funded the suicide response stuff to an agency that could deliver throughout the country because they wanted one service agreement with one agency. The local grassroots stuff that had been developed with Laurencia Grant and Suicide Story got pushed to the back. That was wrong and just a little bit offensive.

Senator O'NEILL: To say nothing of the impact of that.

Mr Adams : And just not the way to spend your dollars.

CHAIR: Crazy.

Mr Adams : It might look good from a departmental point of view in terms of—

Senator O'NEILL: efficiencies.

Mr Adams : efficiency. And not only that; you can also poor KPIs with good KPIs if it's big enough.

Jesuit Social Services would like to note that establishing cultural relationships with Aboriginal and Torres Strait Islander communities strengthens their engagement in the design, delivery and evaluation of human services but may not always result in expected outcomes, especially in the short term. Rather, time must be advocated for to enable Aboriginal and Torres Strait Islander people to strengthen their capacity so that in the long term they may develop the autonomy and skills required to manage these services.

Third, the social fabric of communities can play an influential role in buffering the worst effects of disadvantage. With the community factors being shown to influence mental health levels in children, education and levels of safety and crime, Jesuit Social Services's community-capacity-building approach provides a framework whereby cultural and cross-sector partnerships are fostered. Through these partnerships, the strengths of Aboriginal and Torres Strait Islander people can be harnessed to increase protective factors and prevent impacts of disadvantage, in turn improving the mental health and social and emotional wellbeing o Aboriginal and Torres Strait Islander peoples.

Finally, Jesuit Social Services supports the introduction of Aboriginal and Torres Strait Islander accountability mechanisms to ensure that Aboriginal and Torres Strait Islander voices are not just heard but actively play a role in shaping and implementing policies and programs and mentoring their ongoing progress. While there are various ways this could occur, Jesuit Social Services sees that it's imperative that a diversity of Aboriginal and Torres Strait Islander voices are engaged, which is reflective of the diversity among Aboriginal and Torres Strait Islander peoples across the country.

Senator O'NEILL: Could we have a copy of your opening statement, please?

Mr Adams : Absolutely. Can I just say, I've heard a lot about relationship today. I just cite two examples. I've got a colleague, an old fella, Phil Hasle. Phil's been doing this job for 20 years and has worked in the volatile substance misuse space for years. When we're out bush with people and we're trying to ascertain where there's a mental health situation which involves a psychosis, you've got to know the individual. You've got to have a relationship that's more than just a couple of hours. You've got to have a relationship where you've developed a rapport, where you understand when they're having a good day and when they're having a bad day. Sometimes they'll talk about things. You need this relationship so you know when to go: 'You know when you say you see that thing, does everybody else in your community see that thing or did just you see that thing?' I work for Jesuit Social Services, a Catholic organisation. My imaginary friend's mainstream. But if your imaginary friend's not mainstream, you need to have really good assessment skills to work out whether you're talking about someone who has got a cultural set of beliefs or a psychosis, because it gets overlooked. It gets overlooked because of how non-Aboriginal people get confused about the cultural context in which they work. It gets overlooked because of language.

I've got another colleague who was struggling to get a client to attend medical treatment. She twigged that something was wrong. She asked everybody, 'Is this behaviour because she is just angry or is it a psychosis?' And they went, 'No, no, no, that's just her. She just doesn't get the language; she doesn't speak English.' They got an interpreter in. After a five-minute conversation, my colleague went to the interpreter and said, 'Do you know this woman?' The interpreter said, 'Yes, I know her; I grew up with her.' My colleague went, 'Is she all right?' And the interpreter said, 'Oh no, she's always had a psychosis; she's always had a problem.' At this stage, she was 55 and had gone undiagnosed. We overlay those sorts of issues in a context where we still lock people up without trial for mental health issues. There are still people in the Alice Springs prison and there's no plan. There is no service that's going in there and saying, 'How do we get this person out of prison? Or how do we manage their transition to community?' People just end up going to prison and never getting released. There's some work to be done, I think.

CHAIR: Are you talking about people with severe psychosis, cognitive impairment, the indefinite detention?

Mr Adams : I am talking about the indefinite detention space.

CHAIR: My experience today is they're getting out on a case-by-case basis, where somebody spends years—literally—advocating to get them out.

Mr Adams : And then, when they get out, there is not the service wrap around. We have another program but, you know. So we need to be thinking that we've got high rates of foetal alcohol syndrome. We've got failure to thrive. We've got some cognitive impairment stuff going on which is at a higher rate than other places. We don't really have that service provision. We're rolling out the NDIS, which so far has not been spectacular. We talk about this need not to have silos but, if you look at the experience of the NDIS in the Territory so far, it's created silos, not got rid of them.

CHAIR: Can you expand on that a bit because it's an area—

Senator O'NEILL: Especially for mental health.

Mr Adams : When they rolled out the NDIS in the Barkly, one of the biggest issues for agencies, especially the remote clinics, was that if you weren't registered with the NDIS then you weren't within the practice group that could discuss things around the confidentiality stuff.

CHAIR: Sorry, it's just unclear. So we're talking the same language, do you mean services that were registered? Is that what you mean?

Mr Adams : Yes.

CHAIR: So the service providers with the NDIS. Is that correct?

Mr Adams : Yes. So if Maree was registered and I wasn't registered then she couldn't talk to me about things.

CHAIR: But the person may have been—

Mr Adams : They might have been my client for years but they might have just picked them up.

CHAIR: That is just damn well stupid—sorry.

Mr Adams : I don't know whether it's been resolved in the last 12 months, but 12 months ago in Utopia that was the biggest issue they had.

CHAIR: I'm gobsmacked. I'm sorry; I interrupted you. Keep going.

Mr Adams : No, that—

Senator O'NEILL: Can we go to the mental health part of the NDIS? We've heard that's a very significant problem because of the episodic nature of mental ill-health—that some people are in and out of the system and—

Mr Adams : The NDIS hasn't rolled out here yet, so we'd only be guessing.

CHAIR: It's not in Alice but it is in the Barkly. Are there any services there that you're working with?

Mr Adams : We do the training in the Barkly, but that's it. I have heard there's some service provision in the Barkly with an awfully large client list and very few workers, but that's going to happen in the remote areas just in terms of getting staff, I suppose.

Senator O'NEILL: I want to ask about a transition. This is a discussion that we had when we were in Darwin the other day. I'm pretty sure it was Jesuit services. I was just going to look through my notes to see. They were spoken of highly in terms of managing a transition out of the space to bring in Aboriginal people to lead. I think the Victoria health service was named.

Mr Adams : It was a program that we did in partnership with the Victoria Legal Aid and VACCA.

CHAIR: Yes, it was.

Mr Adams : We went into partnership. It wasn't necessarily a mental health program; it was a program that identified young people who'd become involved in the criminal justice system. That was flagged through, I suppose, SupportLink. Do they still use SupportLink in Victoria?

Ms Corbo : Yes. I know what you mean.

Mr Adams : Anyway, it was flagged and the young person was referred to us. We'd engage and ensure that there were case management services around that young person. We did that in partnership with VALS and VACCA. Originally we did it for two years, but it took us six years to transition it over. It's not just about working alongside Aboriginal organisations; it can also be about working alongside Aboriginal organisations and they're not taken aside. VALS and VACCA had to negotiate between each other over who picked up that program. Some things you can't do in two or three years; some things just take us as long as they take. In the Territory, our experience of that was probably the Atyenhenge-Atherre Aboriginal Corporation. We went to Santa Teresa for some five years and basically talked to people. We'd literally go out there three days a week and sit down and talk to people. They wanted to set up an organisation. It was just after the intervention and they were feeling very disempowered. We took people's country 200 years ago and then we came back through the intervention and did it all over again. People were quite angry about that and people felt very frustrated. Your tap would be leaking and you were told you couldn't change the washer in the tap, even though over years and years and years you'd done it multiple times. I've been to so many ceremonial burnings of cert IIIs in building certificates because people are so angry about not being able to fix their houses.

CHAIR: It still happens.

Mr Adams : Yes. We worked with those people and we talked to those people about what they wanted to do with that and they set up the Atyenhenge-Atherre Aboriginal Corporation and Santa Teresa Enterprises, which then took back control of the store. Then we worked with AAAC and we put in a joint application and Communities for Children contract. We've now transitioned that to Santa Teresa. Business-wise, that work is difficult because, when you're continually operating to put yourself out of business, you have to work out how you stay in business too. It's made more difficult by, ironically, the federal government's approach to international aid because, as the federal government's cut all that international aid, the large agencies that might fund Aboriginal services have found that their operational costs have had to be cut right back. Most of those international aid organisations have reduced their funding in Aboriginal affairs significantly, because they've got a business model as well that's not looking too flash. That's the issue. Government work is all about KPIs, and I haven't seen a federal government service agreement in years that hasn't needed an employment outcome. So, some of those KPI are too—how do Aboriginal people lead the work, if the government's leading the work? Rita Markwell—and I'm a dinosaur—when she was with Macklin came up with the communities for children model. It was all about taking those decisions about how money is spent on communities and putting it out in communities. In some ways, absolutely, communities have got more than they had before, but everybody's taken a piece on the way through, haven't they? I'd love to see the budget on communities for children across the country and see what bit stays with the federal government, what bit stays in—

Senator O'NEILL: The NGOs?

Mr Adams : I don't think the NDIS is part of that.

Senator O'NEILL: No, the NGOs.

Mr Adams : The NGOs that facilitate it—and we've just handed over a children's grant for communities for children at Harts Range.

CHAIR: Can you just go back a step to the employment outcomes.

Mr Adams : Maree might be able to answer that. Every federal government grant I've seen recently has got employment outcomes—it's got to make CDP work.

CHAIR: Instead of it just being about—say, we're talking about mental health—mental health outcomes, you've also got to bolt onto that employment outcomes, which may be complementary or maybe not.

Mr Adams : Not only that: if you look at the community mental health program that was rolled out a couple of years ago with the IFS, I'm sure you'd find that it was where there were significant CDP programs because they were concerned about the success of the CDP program. So they ended up funding in clusters in remote communities—for example, Santa Teresa, Titjikala and Finke got a mental health program and also got the IFS program because they needed the CDP program to thrive.

CHAIR: So that could provide outcomes for them.

Mr Adams : So it ended up that the federal government was more concerned with its KPI of having a successful program, and it started to drop those other programs where they could improve their CDP program rather than just—

CHAIR: Rather than where the greatest need—

Mr Adams : the actual need.

Senator O'NEILL: That's a pretty outrageous operational decision.

CHAIR: But it does not surprise me.

Mr Adams : It's the world.

Senator O'NEILL: It's the world; it's what we live in.

Ms Corbo : Before we finish, can I just emphasise the need for family violence support.

CHAIR: I wanted to come to that.

Ms Corbo : I know you're ready to go, but—

CHAIR: I wanted to ask you some questions, so go for it.

Ms Corbo : You talked about family violence and the impact of family violence. We know that it's such a huge thing and has such long-term impacts on people's mental and emotional health, especially for children. One of the things that I would like to advocate for is for more money to be put in by the federal government, in particular, around things like prevention. This year the Northern Territory government had a very, very tiny bucket of prevention money—I think it was $150,000. That's very hard to do anything with ; however, what we know about prevention is that it needs to be whole of community. It needs to go across the Northern Territory so that we're not just constantly putting bandaids on. Every time something happens, it's a crisis and we keep putting bandaids on. Family violence needs to be a holistic response, and prevention needs to be a huge part of that conversation.

One of the things that we'd like the federal government to do is think about the third action plan for family violence and look at spending some money, putting their hands in their pocket and pulling out some for a lot more support around, particularly, prevention. In saying that, I know that we've got Our Watch and we've got Change the Story and there's a new Indigenous framework that's coming out, but we also think that it needs to be done with community. We can develop some really good things but it needs to be across the Northern Territory, not just in tiny parts of the Northern Territory, including remote communities and a whole range of things. That's something I really want to push, that it's not just about crisis all the time. What we know about family violence is that the ripple effect of family violence is alcohol and drug use and mental health.

Senator O'NEILL: Or is it the other way round or a complex interplay of all of those things plus housing?

Ms Corbo : Definitely; it's a part of the intersect, family violence. We definitely need more support in that area. Aboriginal women are 35 times more likely to be hospitalised. There are huge impacts that children are witnessing.

CHAIR: I'll follow that up because it's exactly where I want to go to next. I don't know if you were here when the NPY—

Ms Corbo : No.

CHAIR: were talking about the strong connection between family and domestic violence and suicide either completed or attempted. They said, basically, that in 50 per cent of the suicides or attempted suicides there was direct involvement of family violence, and in the other 50 per cent it was indirect; they'd seen it as a child or some other—

Senator O'NEILL: Or an extended family.

CHAIR: Or an extended family. I want to ask you about your understanding and experiences.

Ms Corbo : It's not so big in the work that I'm doing. I know it's certainly happening a lot on the lands, but I can't speak for John's knowledge on this issue. I'm always torn by this idea that threat of suicide is a very high risk. It's a known high-risk factor, often, to control and in a range of different things. So when we talk about the high-risk factors, the threat of suicide is a huge one. I'm always torn because I also know that people are following through, and that sort of thing. And certainly we've had many in our program who've done that, time and time again, who've made threats of suicide, and we've had one or two that we've been seriously concerned about.

One of the things, I think, in this is that we do well as we build relationships. We have consistent relationships with people so we can check in with them and see how they're going, see how they're faring, and try to support them in getting into services. What I know about men is they're very reluctant. Once they've got a spot they feel safe in—I've worked with men for a very long time, not just here—they like to stay in that space. So I'm always trying to make sure that we get people to come in or that we support men to go out, but we're holding their hand at the same time because it takes awhile. I know for a lot of our men they don't necessarily feel safe going to a mainstream service. They're much more comfortable in an Aboriginal controlled service, such as congress or ourselves. I think there's always that play around it being quite a high-risk factor, but it's certainly not to the extent that's happening on the lands. But I would absolutely agree that often it's a huge problem, certainly the threats.

CHAIR: The association between a suicide, or threatening or attempts, and family violence.

Ms Corbo : Yes. So that's the tension we have when we're assessing a man: is it a threat to control or does he have genuine suicidal ideation? Sometimes they can intersect but it's always that tension, which is why we need to be very careful when we're assessing. We certainly take it seriously when they say it.

Senator O'NEILL: A few submissions have talked about impulse action, where suicide is another form of violence against the community rather than violence against themselves. As one woman said to me—not on the record—it is 'I'll show you now' in the ultimate way. So how do you record suicide attempts?

Ms Corbo : We would be assessing the man. We are working with the man, often after that has happened. We would always do an assessment and we would be writing that down. We would document that. We would also do the work we need to do to find out a little bit more about what has been happening. We would find out if he is connected into a psychologist or a psychiatrist and then try and connect him into an appropriate service. But it is always documented.

Senator O'NEILL: How many of the attempts with which you have had interactions are just an impulsive action rather than a planned, strategic action?

Ms Corbo : I wouldn't say that most of the men we have worked with have attempted suicide; I would say that most of them have threatened suicide.

Senator O'NEILL: Why?

Ms Corbo : They haven't gone to that next step, but they have certainly threatened—nearly all of them. Suicide is such a scary thing up here. You can bring someone to their knees by saying you're going to kill yourself if they leave you or don't do what you want. People carry a lot of shame and guilt. They often have known someone who has done it. We do know enough to know when someone—we can assess for that sort of thing.

Senator O'NEILL: In terms of alcohol and drugs, we as Australians are all ashamed of the lived reality that you are describing to us in the course of this inquiry. I want to again test an impression as I leave this series of hearings that we have had up here: do we have a tsunami of much worse things on the horizon because of FASD and other secondary problems that are the reality of this next generation? Are we still at the tip of the iceberg here?

Mr Adams : There are two issues. With the politicisation of the child protection system it looks like there will be more childhood removals without the work around the Aboriginal Child Placement Principle. If we remove more children from family I think we are going to have a significant problem when those children achieve adulthood. The problem we have in this country is that it is not a nuanced debate. Just because a child comes into care doesn't mean its relationship with its extended family and culture needs to end. The issue there is that it takes resources. I have been doing that stuff for a long time. In 2002 the federal government funded the ACCAs. They didn't have an ACCA in the Territory but they had two Aboriginal people in the department and all they did was look for kinship carers. The reality is that the kinship care system needs more resources and if we do one without the other we are going to have serious mental issues later on.

You were talking about the stuff with the NPY. I was doing a particular job for 12 months there. I was working for Tangentyere. I would agree with NPY that there was usually a domestic side to it—either a struggle around kids or a domestic argument. But it was also young people and there were substances involved in that. While we continue to criminalise marijuana use rather than take a public health approach we are going to struggle. I cite Phil Hassall again. He is obviously my sage!

Ms Corbo : Clearly.

Mr Adams : Clearly. He had no trouble getting clients who misused volatile substances because it wasn't illegal, but he never gets anybody presenting about their marijuana misuse. We're not talking about the marijuana of the 1970s and 1980s. We've got marijuana that has got quite a high level and it's quite—

Senator O'NEILL: THC.

Mr Adams : Yes. Because it's criminal we're not getting people presenting to agencies with issues around marijuana. I'm seen lots of young men hiding out on communities. You'll turn up to a house, open the door and it's like a Cheech and Chong movie with the smoke that comes out. They're playing on the Xbox. Those kids aren't attaching themselves to any services. We're probably not seeing them until they get married and they do something bad. I think that's coming as well. We need to address that. I don't think that's just an issue for Alice Springs, town camps and remote communities; I think we need to take a public health approach to marijuana. It's ridiculous.

Senator O'NEILL: I want to ask about chroming, which is something we heard about today, and ice.

Mr Adams : This is purely my experience, and it's a very small experience up here. I think ice currently in Alice Springs runs at about between $120 and $150 a point, so basically the only place you seem to see that in my client group is where someone is making money usually selling marijuana, because there's no way you can afford ice unless that's the case. So there is a bit of crossover. With some of those suicides there is always a rumour about ice.

Ms Corbo : It's very frightening too.

Mr Adams : I've got a mate who drove a car into a police station. They said, 'It was the ice.' I said, 'What about the last four times he drove a car into the police station?'

Ms Corbo : My sense is similar. My experience with ice and working with white men down in Melbourne is that it's often a tradie drug. My experience with ice here is the same. We don't just work with Aboriginal men in our program; we work with white men too. The small minority of white guys that we've had have used ice.

CHAIR: Did you say it was a training drug?

Ms Corbo : A tradie drug. Often it's a weekend type of thing. I'm not minimising it. I think there's quite a lot of hype and the community are terrified of ice. They're so scared of ice, but I haven't seen it being as big an issue up here as what I saw in Melbourne, where every second man was using ice.

Mr Adams : I think that's a cost point.

Ms Corbo : I think so too.

Senator O'NEILL: We have talked a lot about Aboriginal people this evening. In terms of services for local tradies, what's there in terms of mental health and drug and alcohol support?

Ms Corbo : We have the men's behaviour change, so we have men who come to us. I often say to the police, 'It's surprising that in Victoria there were 39 programs and white men were bashing down the doors literally to get in.' I would argue that the police perhaps aren't picking up white men in the same way. No?

Mr Adams : Yes.

Ms Corbo : I just think they're not picking it up. I don't think they pick up the nuanced nature of emotional abuse and verbal abuse. I think that the bar is quite high. I think they see it as physical abuse and they don't see the nuanced ways that family violence can be used in my experience by white men.

Senator O'NEILL: In a different cultural sense?

Ms Corbo : In a different cultural sense. We'll get there.

Mr Adams : DASA has got two ice workers and an ice program over there.

Senator O'NEILL: DASA?

Mr Adams : Drug and Alcohol Services Australia in Alice Springs.

Ms Corbo : There is also Relationships Australia for counselling. It's not that there are not services.

Senator O'NEILL: Except people don't know where to go. Are there waiting list?

Mr Adams : There is a cross agency thing on the ice stuff. Congress ran a parents group for a while. So we sort of know where to refer to. I tend to deal with Aboriginal people so it's not something that—

Senator O'NEILL: Can I be really blunt about the FASD crisis that we keep hearing about? If that is the case, and kids are unable to learn in schools—there are all these other things going on. They've got the not sleeping, they've got the observation of domestic violence, they've got the lack of preparation, they've got early onset use of ganja. There's all of that going on, and you've got FASD on top of that and funding getting withdrawn from schools. It sounds like a tsunami that's going to be coming down the line, but everybody seems to be a bit, 'No, no; it's not that bad.' So is FASD really bad, or is it just overreported in the media and I've got my facts completely out of whack?

Mr Adams : I don't think it is overreported. There's an issue at the moment where people are concerned about putting money into assessment services around FASD. It's good to know how much is there, but maybe a more cost-effective approach is to have that assessment stuff in the schools around learning difficulties, because maybe the response to FASD is the same as a response to other learning difficulties.

Senator O'NEILL: Yes.

CHAIR: And not labelling people.

Mr Adams : Yes, I think people are scared of getting into a diminishing pie debate around the funding, and they're worried that if they put too much money into the FASD assessment stuff—they're more concerned that the money needs to be around the actual response. One bugbear of mine has always—

Ms Corbo : You've got him on a roll!

CHAIR: I can see!

Mr Adams : I'm an old child protection worker. For years we were taking kids into care on neglect. We were basically taking kids into care on neglect based on the—what was it called?

Ms Corbo : Failure to thrive?

Mr Adams : The road to health chart. We didn't have a speech pathologist in town, so we couldn't go out and do that assessment about the swallowing reflex. Well, sometimes that was the issue. For me, child protection services are about parents who are not acting protectively. That's one of the biggest problems with the child protection system here: a lot of the kids that went into care, especially in the eighties and the nineties, went into care because it was a disability issue. We didn't have an advanced disability service, parents couldn't care for the kids out bush and so they'd give them to welfare. For years the child protection system became the pick-up for everything. We tried, on several occasions, to move those kids from the child protection system over to disability services, because they get better services from the disability services.

Senator O'NEILL: Because that's what their needs are.

Mr Adams : Yes, and they do things like respond to the child, whereas child protection tends to do the big stick stuff and, if you're lucky, you get to spend an amount of time with them to do something about some of the developmental delays. It's a bit like that all over again, isn't it, Maree? You do need the allied health professionals, here more so than anywhere else.

Ms Corbo : And there's so much focus here on 'crisis, crisis, crisis' that the prevention and early intervention stuff just get pushed to the side.

CHAIR: I just want to go back to children and crisis, and how it links in with prevention. We've heard in a number of places that there are a lot of children living in stress crisis, that their cortisol levels are high.

Senator O'NEILL: Like a war zone, we heard the other day.

Ms Corbo : Yes.

CHAIR: We were on a mental health delegation last year and heard evidence about mental health and its association with the number of crises in a child's life, particularly around family violence. So you've got the situation where we've got these kids that are being exposed to high levels of stress, and we know the trajectory if we don't make sure there is early intervention and prevention, such as the programs you were talking about. I don't know if you were here earlier, John, when Professor Boffa was talking, but it seems to me that we know all this stuff. We've also heard there aren't child psychologists out there; we're not doing early intervention.

Senator O'NEILL: Down the stream we're picking up the adults.

CHAIR: Yes, and at the moment it seems we're still on that same crises driven trajectory. I accept that we've got to deal with the crises, but we're always focused here and not there. It's the same with child protection. We'll spend a lot of money once the child goes into out-of-home care, though probably not enough.

Mr Adams : I actually think we spend even more money in out-of-home care when they don't have connection and they don't have kinship care, but it's a different sort of money.

CHAIR: Exactly.

Mr Adams : It's the sort of money they don't account with.

CHAIR: That's what I mean.

Mr Adams : They'll say, 'There's 800 kids in care; that's just what we spend for out-of-home care.' But they won't spend the money in kinship care.

CHAIR: That's exactly right.

Mr Adams : They don't get that opportunity cost.

CHAIR: And then, when there are going to be cuts, they'll cut any minimum amount of early intervention we've got. That's the funding that is typically cut first. You can't measure the outcomes if a child doesn't go into care—if you stop things.

Mr Adams : You can't measure what didn't happen.

Ms Corbo : I know it sounds so—we are hopeful, too; it's all not terrible. The community have lots of really good ideas about things.

Senator O'NEILL: They don't seem to get a hell of a lot of say about it, though.

Ms Corbo : That's right, this is the thing. That's another thing. If time is spent they will come up with lots of different really, really good ideas. I don't know if you know about the Women's Family Safety Group. You've met them, Rachel.

CHAIR: Yes.

Ms Corbo : They're doing a lot around family violence and they're doing a lot in their community. They're listened to much more than anyone else. They're much more influential than I'll ever be, coming up and being the program manager of the family violence program. I mean, it's important to hold onto hope. We can talk about a tsunami, but there are some amazing people up here doing amazing things. There are amazing communities pulling together. So I think, as you go, that's something that's important to remember. I think the people that work up here are generally hopeful. There are lots of things that perhaps aren't going well, but there are solutions and there are ways of working through those to make sure that we can. Often the communities do have lots of good ideas about things, so harnessing that is important.

Mr Adams : And they're good. It's a double-win isn't it? They're not only great advocates. There's the women's safety framework, Men's Four Corners, IAD Elders, the Justice Group—

Ms Corbo : Akeyulerre.

Mr Adams : and Akeyulerre. Not only are they great advocates but it improves connectedness and it gives those individuals power. It's the double-win.

Senator O'NEILL: Like the elders who were talking about their books today.

Mr Adams : It's bang for the buck, really. If you wanted to get the most traction for your money around mental health—we say that mental health is all about community connectedness, especially in the area of depression and things like that—they are the services that are a bit gritty and grassroots. They're the ones who get you mileage.

CHAIR: Would either of you be able to give us a list of some of those services and programs that are community based that are the gritty ones?

Ms Corbo : I can do that.

Mr Adams : If you look at NPY, that was always NPY's strength. NPY was talking about Aboriginal community involvement in the child protection system back in 2004. A woman from Western Australia came out—what was her name?

Ms Corbo : Western Australia?

Mr Adams : Yes, she came out from Western Australia—you probably know her, I reckon—and she did a piece of work with the NPY board about the role of the Aboriginal community organisations board in influencing the child protection system.

CHAIR: Yes, I do.

Mr Adams : There was a book that was put out at the time.

CHAIR: It'll come back to me at midnight or something.

Mr Adams : We just get a little bit. Then what happens is that the change isn't working fast enough for the mainstream, so they bring in interventions. What's the thing been in the last couple of years? Now it's all about a job. Well, that hasn't worked either, has it? In some ways it is all about a job—

CHAIR: It has if you want to get people off income support.

Ms Corbo : They're not on it anyway.

Mr Adams : But you need to look at economies around the satisfaction of needs, and their needs are not just economic; they're spiritual. It's connection to country. They're valuable things that we need to be able to support.

Ms Corbo : It's also capacity building, working with community. The women in the Women's Family Safety Group call it two-way learning.

Senator O'NEILL: We keep hearing that.

Ms Corbo : Did you hear that today? They're very big on that. My expertise and our expertise is as family violence specialists. I came up here to do that. Then with the women's expertise and the men's, we all just pull together. So it's important that money's just not given and no support. I really hate that. It's like, 'Yeah, yeah, you want to do some grassroots stuff. Here, we'll give you a bucket of money and we'll set you up to fail.'

Senator O'NEILL: That takes us back to the pairing and partnerships and the opportunity to plan for making yourself redundant ultimately so that the community is up and standing on its own. Does some sort of incentive need to be provided to organisations like Jesuit to, as you say, have a business model that enables an exit over time?

Mr Adams : I think I'm going for benefactors, folks. I'm not sure the federal government's up to that sort of stuff. I'm not sure the federal government is in a position to allow communities to lead. Sometimes, from my position, I know the money that I get from benefactors is more effective than the money I get from the feds.

Senator O'NEILL: Because?

Mr Adams : Because it's led by the community.

Senator O'NEILL: So it's more flexible?

Mr Adams : It can respond to what people want.

Senator O'NEILL: And is it effectively achieving outcomes because of that responsiveness?

Mr Adams : It is if it's making those Aboriginal leaders more muscular in the way they approach the issue. If they have that independence, if they can speak from the heart and if they don't feel confined by government KPIs, then, yes, absolutely.

Ms Corbo : And it's slow and it's steady. It's so important to just do that work slowly and—

Senator O'NEILL: That's a very important message to government, isn't it?

Ms Corbo : It's a very important message. It needs to be slow and steady with a community development framework that is just working. It doesn't mean that things won't get done. We started the children's specialist program, and I said to the government, 'Please, just let me do this the right way and your outcomes will be actually better.' And it's true, because most of our referrals come from within Tangentyere, from family members, because they feel invested in it. They feel supported and they feel like that's their program. So I think that's—

Senator O'NEILL: They're not driven to something.

Ms Corbo : Yes. But it is that two-way working together and, as I said, not just throwing out money and going, 'Here you go.'

Senator O'NEILL: Because you've got to have time to gather the cultural knowledge, haven't you, alongside sharing your professional white knowledge, so there's an intersection of knowledge growth for both sides.

Ms Corbo : Absolutely.

CHAIR: I'm going to have to wind us up, otherwise I think we could be still talking here in another hour. Thank you very much. That was enormously helpful for us.

Ms Corbo : Hold the hope. Don't let go of hope.

CHAIR: Yes. I really take that message on board. It would be really good in our report to feature it. What I like to do is case studies on positives, so it would be really helpful to have some of those really good hope stories.

Ms Corbo : Yes. There are always negatives, but there are a whole lot of positives.

CHAIR: Yes. Thank you very much for your time today. Thank you to all our witnesses today, and to broadcasting and Hansard. We'll adjourn for today. We recommence in Canberra on 19 July.

Committee adjourned at 18:03