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Community Affairs References Committee
06/07/2018
Accessibility and quality of mental health services in rural and remote Australia

HENDERSON, Ms Sharon, Administration Officer, Garl Garl Walbu Alcohol Association Aboriginal Corporation

HENDERSON-YATES, Dr Lynette, Chief Executive Officer, Derby Aboriginal Health Service

ROBERTS, Ms Jean, Manager, Garl Garl Walbu Alcohol Association Aboriginal Corporation

[11:01]

CHAIR: Welcome. Thank you very much for coming to talk to us today. Hopefully it won't be a painful experience. You've just seen us ask questions. Can I just double-check before we start that you've been given information on parliamentary privilege and the protection of witnesses and evidence.

Ms Henderson : Yes.

Ms Roberts : Yes.

CHAIR: Fantastic. Do you have anything to say about the capacity in which you appear?

Ms Roberts : I'm the manager of Garl Garl Walbu Alcohol Association Aboriginal Corporation. I'll refer to it as Garl Garl Walbu while I'm talking.

Ms Henderson : I'm the admin officer, and I fill in as manager for Jean when she's not available.

CHAIR: Thank you for coming. I invite both of you—whoever wants to—to make an opening statement, and then we'll ask you some questions.

Ms Roberts : Certainly. We've made some notes on things. I'll give you an overview of Garl Garl Walbu. We're actually next door. Garl Garl Walbu is, as I said, an alcohol association, but we are an Aboriginal corporation. We have a board of directors made up of local Aboriginal people in town, and they govern the running of the organisation.

I'll just let you know our programs. There are a few of them. There's the sober-up shelter and the night patrol, which both came out of the recommendations of the inquiry into Aboriginal deaths in custody. Basically they are what they are, which is not about any sort of preventative education type thing; it is more about ensuring people are removed in the community and put into a safe place—either taken home or taken into the sober-up shelter to recover. Our shelter allows them to have a wash and a sleep and have their clothes washed. In the morning they have a hot breakfast. We try to do opportunistic type care about AOD and things like that. Although people are often loud and noisy at night time, they're very quiet in the morning once they sober up, so we don't get too many intakes. But the point is we're there and they know the staff really well. The night patrol goes around, as with other night patrols, picking up people who are intoxicated. It's mainly by removing them away if they're in groups of people. It's removing them away to go home or to the sober-up shelter or somewhere safe so they don't harm themselves or other people. That was the main purpose of those two services.

Since then, a few years ago, the directors of Garl Garl Walbu really wanted to get into providing more preventative and education type programs. We applied for Prime Minister and Cabinet Indigenous Advancement Strategy. We realised the issues of AOD in the community for young people, as you discussed earlier with the DAHS mob. It's quite a sad position. We really wanted a program where we could train, because the whole point is that we and other agencies have tried to talk to young people over many years, but it just doesn't work—young people want to talk to other young people. So that was the whole idea of our program: training up young people in alcohol, drug and other issues. The point is they're not experts but they are sure about their knowledge base so they understand why people turn to alcohol and drugs. So they cover a whole lot of issues from the history and all the other social issues and so forth.

Also, they're supported. One good thing about Derby is that our agencies work very closely. Garl Garl has always been supported by many other agencies such as DAHS, Winun Ngari and Emama Nguda are all around. The thing about that is that people are willing to support each other and our young people are supported that way, which is really important. Their main thing is probably more of an advocacy role. If they're talking to a young person, they know they might have an issue, but they might say, 'Gee, I'd love to get a job.' They'll ask what the issues are, they'll talk about it and they'll go with the young person to Winun Ngari, which is the employment service here. It might be Centrelink: a lot of our young people don't get income—they're dependent on their parents: 'How do I get that?' It's like that. Sometimes it's a medical reason. A young person will want to talk to someone, so they'll go with the young person and take them to SEWB to talk to somebody there. So that's basically Garl Garl Walbu.

We weren't quite sure about what we were going to do. I thought, 'What will I present today and talk about.' Garl Garl Walbu is in the position—when you talk about mental health issues, not far away is AOD. With all our customers who come here—I'm talking about the ones who use both sober-up shelter and night patrol services—a lot of them are long-term users of alcohol, mainly alcohol. They have entrenched issues and things, and we try and support them. Some do all right. Some have even managed to get their own little flats and things, so eventually they do get out of that. Others might go home, back to community. So they do a few things. But you will have your core little group of people, I think as with anything you have a spectrum of people who use alcohol quite a lot and then there are those who are extreme and will be around town. We know who they are and so forth. At Garl Garl Walbu we talk about looking forward. People say, 'We must get a rehab in Derby. We must get a rehab and other things.' That is true, in many ways. Talking about that, we have rehab in Broome and Wyndham for Aboriginal people. One of the issues that Garl Garl Walbu is exploring is whether they are the best way. We've been looking at different things, and one of the things we're very interested in—I don't know if you know that Western Australia is exploring the concept of recovery colleges. I don't know if you know too much about them.

Senator O'NEILL: No, nothing.

Ms Roberts : They've got some in the eastern states; Broome has one.

Senator PRATT: The state government said at the election that they were going to introduce them in Western Australia as well.

Ms Roberts : The idea is that there's great stigma, as the DAHS staff mentioned, about mental health: 'Stay away from that person. They're a crazy person,' and it's the same thing with people, especially our young people, who have AOD issues. It seems that, once you take drugs, people label you as a druggie and things like that. It's the same if you drink: 'They're just a useless alcoholic.' They're really negative and they marginalise. People have that stigma on them, so they're always fighting that. That's why they stay together. That's a good thing about it: they'll stick together in terms of that. In many ways, they are their own support group and deal with issues. Having said that, there's a support group for regular users, but there are also the ones who carve boab nuts. They carve beautiful boab nuts, but of course they sell them to buy alcohol. At least they're doing it and they're supporting each other, and while they're doing it they're sober, having a chat and all of those things. In many ways, we recognise that they're doing something at least. It's contact.

We've raised recovery colleges. Garl Garl Walbu directors are very keen on this. First of all, if you don't know them, they're called colleges because people go to them to attend courses, workshops and programs on mental health, AOD and other related issues. The thing about them is that they've been co-designed, so when they're developed you have a consumer; people might be users; you have an educationalist; you might have a psychologist or a doctor; you might have a worker in that field; you might have family members. You have all people developing those workshops and programs with input from all those different voices and opinions. From that, they develop a program—a workshop thing. The thing about that is that people hear what other people are saying. No-one's an expert and everyone is valued. If you're a consumer, no-one considers you've got an opinion, but with these sorts of things your ideas and thoughts are actually welcomed. That's part of it.

Senator O'NEILL: Are they live-in?

Ms Roberts : No, they're not. That's an interesting thing. Broome has one. If you go to Broome, there's a small one, in Forrest Street, near Fong's. The whole idea is that you work with somebody, a support worker. The good thing about it is that the support worker then helps them select workshops that they think will help them. They're not told to do it. They're are complementary. You still go to your psychologist, AOD worker or whatever. This is complementary. The thing I like about it is that that's it, because people really want to learn a bit more about their conditions and what they need to do. They're non-judgmental. People participate. Other people who attend the workshops can be users, family members or workers. You get a cross-section of people coming to the workshops. We were talking about this with the directors: it allows people to have input. When you're talking about mental health and alcohol and drug issues, it has to be a community thing. It can't be just an organisational thing. We start talking about it as a community: how do we deal with it? That's what's so encouraging about that.

Senator O'Neill, you asked whether they're in-house. At Garl Garl Walbu, we're in the process of trying to get funding for recovery, but it is slightly different because we recognise that a lot of Aboriginal people would like to take the abstinence approach. Normally it's about minimisation. So we would like a facility where people can have the option of living in if they want to. Quite a few people have gone away to rehab and they come back and they're put into the same environment. In this room, we all know what that can mean on certain nights during the week. It's very hard for people who come back, so we want a facility where people can have a bit of space—just quiet time to stay away from alcohol and drugs and be supported a bit more. That's just one thing.

Senator O'NEILL: Can I ask about the hours there? What are the hours available for people to get that space? Because the need happens after 4 o'clock on Friday evening.

Ms Roberts : That's right, exactly. Recovery centres are virtually like an ordinary college: you go to it, you attend courses and then you go home. Ours are slightly different. There are two reasons for that. One is to provide that extra support for those people who need it. The other thing about it is that one of the things we would ensure for our Aboriginal clients is that it has to be within cultural safety. So we talk very much about a cultural framework. One of the main things we would ensure is that although these programs aren't compulsory, we would probably insist that Aboriginal people are doing or would need to do some programs in Aboriginal history, looking at exploring their own identity. That is one of the issues. We are saying that for quite a few of the Aboriginal people it's about reconnecting with their family and community, because that's been broken. So we are trying to work out how we can do that. We'd like them to do that and we support them to do that.

The thing about that, too, is that some people have good cultural practice and understanding as young people, but then, for different reasons, they go away from family things, so it's lost. So for some people it's about reaffirming and remembering that. People are out and are supported with doing cultural activities. We would see that as being one of the major things as well. Of course we're talking very much about Aboriginal people here, because although the Garl Garl sober up night patrol is open to anyone, it's mainly Aboriginal people who attend those services, although you will occasionally get a few non-Indigenous people coming along as well.

Senator O'NEILL: Do you link people in to specialist mental health services?

Ms Roberts : One of the issues is that they're trying to do that. Like I said, at a sober up shelter someone says in the morning to a staff member, 'I haven't been feeling well,' or there is some issue, then the staff try and talk with them. We can refer them or walk them over. We are lucky that we're just next door. We have a gate there, but it's right next door. So we try and encourage them to go and see someone. We can see who is available and give them names of someone to talk to. Who it is is probably more important than the actual organisation. Like I said, Sharon, who used to work in the sobering up shelter, will say, at 4 o'clock we open, they come in, but they leave mighty early, don't they?

Ms Henderson : They've just come in to sleep it off over the night. Breakfast and go.

Senator O'NEILL: Are there people who are not eligible to come in? There are some criteria that you specify that people have to abide by to come in—what happens to those who fall outside what your service can offer?

Ms Roberts : One of the issues, of course, is that the main thing is that you have to be a drunk. It's sad. One of the people has said, 'You're supporting people to remain intoxicated.' I think you have to look at the wider picture in this, and say, 'Some people just can't cope, and are in that cycle, and we need them to have a safe place.'

Ms Henderson : A lot of them come from the communities as well. They've come to town, but there's nowhere else to go to sleep it off.

Senator PRATT: But some of them come from communities and aren't drunk, and also have nowhere else to stay. That would seem unfair, I'm sure.

Ms Henderson : If they're not that drunk, they've probably got family members in town to stay with. But some of them misbehave when they've been drinking.

CHAIR: So the families don't want them there, because they've been misbehaving.

Senator O'NEILL: I can see why you're doing this job—the fact that you're laughing while you're telling us!

Ms Henderson : That's what we say.

Senator O'NEILL: You've got to be resilient.

Ms Henderson : One other criteria is that they have to be over 18.

Ms Roberts : The other good thing they have in Derby is the short-stay accommodation, where people can stay but they can't stay if they're drunk. So what happens is we'll get a phone call from them saying, 'Someone's drunk. We can't keep them.' We say, 'Well, just send them up here.' The sad thing is some people come in for different reasons. One is funerals, which is sad time and grieving time. A lot of people turn to alcohol at those times so that's when it does become particularly difficult. So, yes, you will have that occurring.

Really it is the stigma. Often it's not only people with mental health issues but people with alcohol and drug issues who get labelled from a fairly early age, unfortunately. But the idea of these recovery colleges is to allow the consumer to have a voice and that's really important. The workshops and programs are open for anyone. We hear all the time parents say, 'I don't know what to do. I don't know what's happening. I need support.' If they also participate in these sort of workshops then that allows parents and carers and friends of the people who use or have mental health issues to hear the other story. So it's not just the experts saying, 'This is why these people are like this,' and that's it; they also hear the person say, 'Oh look, I get anxious.' I went to one in Broome about anxiety, and a woman stood up and told me about why she gets anxious. I looked around the room and just about everybody in that room was nodding their heads because they knew what this person was talking about; it made sense to them. They recognise that it's an issue for a lot of people out there.

Our main thing as an Aboriginal organisation is cultural safety. DAHS raised as well how Indigenous people feel comfortable going to an organisation that runs programs. All our staff except for one person is Aboriginal. We're lucky; we've got a good core group of people for the sober-up shelter and night patrols. They know just about everybody in town and that helps a lot with our customers.

I want to go to the next thing, which touches the alcohol and drug peer education workers. We talked about training them up. All the directors and people I've talked to say, 'We have to train our young people.' One of the things we tend to do is say, 'The kids around here are pretty useless.' But you look at DAHS. You go over there and go to different Aboriginal organisations and there a lot of young people who are working, who engage in the community, and I think that's what we need to look at more often. Often we just look at what's bad and what's not working. In every town, you have your great young workers out there. With the program we're running, you become more aware that young people want to help their peers but they need to be provided with support and training to do that.

Senator O'NEILL: They need mentoring.

Ms Roberts : Yes, they need mentoring that's intensive.

Senator O'NEILL: And supervision as well. We have been hearing about supervision for teachers and for everyone, not just psychologists.

Ms Roberts : Yes, very much. The thing about it too is that you're working with young people who, in their family, may not have had many role models in terms of working nine to five. They might have been seasonal workers on stations or whatever, or they might not have worked at all. But the point is you need that time to work with these young people. If nothing else, I know—and I'm talking about the directors here—they see that as being so important, training up some of our young people to take on those roles and to be better supported.

But I'll tell you one thing. As Lynette said, we have the lovely young Ashley, who we're all so dependent on, but with him we're fighting against—you didn't use the word, Lynette, but I'll use it—poaching! People see these young people, and they just think, 'This is it.' We can't compete with that. We've had a couple of our workers come to us and say, 'I've been asked to apply for this job.' We can't say no. We appreciate it. We see it as, 'Well, that's good; that organisation's going to have a really good worker.'

CHAIR: There should be recognition that this happens a lot in the community sector—the staff get poached after you train them up. There should be recognition that that's part of what happens, and so there should be some additional support for that sort of thing.

Ms Roberts : Yes, I think so. That hasn't been recognised at all. We cannot compete with the public sector or with the large NGOs in town, because they can provide these young people, and other people, with a lot more. We're just a small not-for-profit organisation. And we like the idea that people are being trained up. But it's true, and I'd appreciate some recognition, so people can see that could happen. But it is a big issue for small towns.

Dr Henderson-Yates : Just on Jean's point about young people going out and working with peers, providing support for those peers, and working more with younger people, it should happen at that level, because otherwise we're running groups for older men, like we did—the 28 men we talked about—after the fact, like 30 years later.

CHAIR: Yes.

Ms Roberts : Yes.

Dr Henderson-Yates : They should be starting younger, so we don't have to have these workshops later.

Ms Roberts : Yes.

Senator O'NEILL: Can I ask about early childhood and under-16s in terms of mental health and accessing support. I know you're not the experts, but you'd be interacting with families.

Ms Roberts : Yes, definitely. You'd probably have to look to Lynette and the others. But certainly, for us, when you look at the people who end up at the sobering up shelter, most of the time there's a lot of historical stuff there—community issues and family issues that you would have all heard about previously. And you know when you walk down the street. When I walk down the street, I just know by the houses. I see the young people. I see what's happening. People are there drinking. I just fear for those young toddlers in those particular households: what are you going to be like in five years time? And I'm not the only one. We just know.

But, having said that, I think we should look at the positives. There are a lot of great families in town and there are communities that want to help their people. I must say, from working with the young people, I have a much better appreciation of young people in the community. Drunk or not, or whatever, they will talk to each other and support each other. Whether they're skilled up or not, they will listen to each other. I think that's where we need to go from to better support them.

Senator O'NEILL: Use that asset.

Ms Roberts : Yes.

Senator PRATT: What do you do if you identify pregnant women who are drinking, and how do community services work together?

Ms Roberts : I would say, for us—

Ms Henderson : We don't get that many pregnant ladies coming to us.

Ms Roberts : Yes. But Lynette and I work on FAS, working with the school. There's the Lililwan project on FAS, as you would know, and we wanted to know what was happening in Derby. Of course, we couldn't repeat what they had done, because that was massive, but we got someone to research the paediatricians' letters and doctors who spoke to women when they were pregnant and followed them through, so we had an idea. They'd write anything about FASD, alcohol syndrome or whatever that they had mentioned and that was picked out. When that research was done it was pretty clear that we were getting figures that would have been similar, if not worse, to what was happening in Fitzroy Crossing. We know there's not a big war between Fitzroy Crossing and Derby, so it's not surprising.

An unfortunate thing is that as FAS children grow up they'll get pregnant and tend to, as you know, have kids with FAS, so it's a sad thing.

Senator PRATT: You're providing an accommodation solution for people who need to be taken away from the house—

Ms Roberts : That's right.

Senator PRATT: but actually there might still be drinking in that house and there might be a need for somewhere for pregnant women to go to separate themselves from that culture—

Ms Roberts : It'd be lovely. That's one of the things is worth exploring. We're trying to do some clear vision-type things with different agencies and—

Ms Henderson : We've actually have a good precinct here because we've got health and social and emotional wellbeing. We've got employment across the road. We've got alcohol and drugs next door. They're trying to look outside the square—not just providing a bed and a meal but also looking at how do we prevent it? We collaborate quite a bit and it makes a good precinct in terms of supportive and innovative programs.

CHAIR: I want to go back to this issue you talked about towards the beginning of your comments, which is around the people that you're picking up, who are staying at the shelter, and mental health. If I understood you correctly, you were saying there was a strong link there for a number of people. Could you outline how many people you think there's that strong link between—they've also got a mental illness and that's interlinked with their drug and alcohol addiction?

Ms Roberts : That's difficult. I'd say a lot of the ones we see are probably older ones with a dementia-type thing that comes with using too much alcohol and drugs, so that's there. But also I'd imagine—Sharon, I might have to have some help from you—a lot of the younger ones would be showing mental health issues generally. Certainly when you talk about mental health, anger and all of that comes out.

Ms Henderson : When they admit themselves in it's hard to know if it's only through their behaviour and aggression, and you probably pick something up. If they're there for the night and if you can respectfully talk to them on their level they'll probably settle down. But it's hard to know if it's mental health or just alcohol or some drugs that's causing it. You see how they feel in the morning and go from there. It's not until the alcohol wears off that you can really notice if it's going to be a mental health issue or not.

CHAIR: And that's when you'll try and refer people on but, as you said, also people leave pretty early, so I'm presuming that means sometimes it's hard?

Ms Henderson : There are very few who request being referred on. The ones from the isolated communities have come into town for business, a funeral or something. They've had a drink, they sleep it off and off they go again. Police also drop people off at the sobering up shelter. Plus the hospital used to patrol quite a lot to pick up people who presented at emergency after some domestic violence or something, but it's mainly to transport them back home again or somewhere else, like the sobering up shelter.

CHAIR: We've got no further questions. Thank you very much for your time and your evidence. It's very much appreciated. Thank you for the thought you've put into the information you've given us. We really appreciate it, thank you. That's the end of our hearing. Thank you, everybody.

Senator PRATT: We're not having the Kimberley Mental Health and Drug Service?

CHAIR: No, we're catching up with them elsewhere, from my understanding. We'll officially adjourn and we'll recommence in Broome.

Committee adjourned at 11 : 35