Debates in the mental health of Indigenous young people

 Author: Narelle Smith, 2008

This article was an essay written as one of my final pieces of work for completion of my Masters degree. It was later reworked and published as an article titled “Indigenous and invisible”. 

 

“What is significant is that no matter which factors are examined – be it poverty, nutrition, access to services, smoking…the list goes on – you will find that Indigenous people are over represented at the wrong end of the spectrum.”

Dr Lowitja O’Donoghue, 2000, cited by Higgins, 2005

 

 “Family, and support for Aboriginal identity, are the major influences for young people. The issues are localised and there is no “one size fits all” approach to the problems being experienced by cultural groups. Forty per cent of the Aboriginal population are aged fifteen years and under. There are still issues with education, health, drug and alcohol, family violence, but young people are saying that they want to be involved and heard, they want to contribute. The best social movements are flexible and understand context. Young people want to look to their “healthy elders” who have integrity, to create an intergenerational dialogue. There is currently too much focus on the barriers, and we need to remain positive about what young people can achieve. Young people are constantly seen as problems or bad statistics. Young people need validation for their enthusiasm and healthy cynicism, as they represent hope and potential. We need to connect the dots of activity and success.”

Tim Goodwin (2008) Deputy Chair, National Indigenous Youth Australia Movement

 

 

Introduction

Colonisation and the subsequent dislocation of people from their lands and removal of children from their families, has had a traumatic impact on Indigenous people. Indigenous people’s lives are frequently defined by hardship, sufferance and invisibility (Gruen & Yee, 2005) and whole communities appear resigned to their condition. Hardship is imposed by poor and inadequate housing, poor nutrition, illiteracy, ill-health, substance abuse, unemployment, and family violence (Attachments A, B, and C provide some figures on the disadvantage for Indigenous people in Australia). Daily existence can be difficult and disadvantage on multiple levels reduces access to opportunities to improve their situations when compared to non-Indigenous people.

Indigenous young people are being exposed to the risk factors for poor developmental outcomes, and feature heavily on every measure of disadvantage (social, physical, educational, psychological, incarceration, and mental health) in Australia. However, there is concern that Indigenous youth are synonymous with bad statistics and their Indigeneity is seen as the cause of their problems (Palmer & Collard, 1994; Palmer, 2003). The post-colonial discourse still largely consists of the tensions between intervening in Indigenous people’s lives and the desire to provide care and education (Haebich, 1988, 2000, cited by Palmer, 2003).

This paper will discuss some of the current debates in working with Indigenous young people. There will also be a short précis of the implications for clinical practice and developing cultural competence to support engagement of Indigenous young people with non-Indigenous practitioners and services. In this paper, the term ‘Indigenous’ refers to Aboriginal and Torres Strait Islander people, reflecting the mobility and heterogeneity of the population.

Current Debates

Indigenous people have a diversity of cultures. Indigenous culture is multidimensional, dynamic, and complex, and depends on geographic location (remote, rural, urban), lifestyle, language, and engagement (Dudgeon, 2000). Indigenous communities experience life on a continuum between traditional and contemporary ways (Gruen & Yee, 2005). Stereotypes are erroneous and can create confusion for young Indigenous people about their identity, particularly if they don’t fit into the romanticised notions and images of Indigenous traditional life imposed by mainstream society (Beresford & Omaji, 1996, cited by Dudgeon, 2000).

Indigenous youth make the transition through adolescence within the context of the strengths and difficulties of their families and communities, fulfilling the mutual roles and obligations required by their culture, whilst also forming their personal and Indigenous identities (Larkins, Page, Panaretto, Scott, Mitchell, Alberts, Veitch, McGinty, 2007). Indigenous communities believe that spiritual, cultural, and identity formation is the most important factor in the development and empowerment of young Indigenous people (Knox, 2006). However these values are diffused in the context of substance abuse, family violence, and child sexual abuse. The effects of poor health and reduced lifespan, and high birth rate in the Indigenous population, has resulted in forty per cent of the Indigenous population being aged fifteen years and under. With fewer “healthy Elders” (Goodwin, 2008) to turn to, the young people are growing themselves up. In some communities there is such a lack of respect for adults and Elders that young people intimidate family members and Elders to give them money for drugs and alcohol (Blagg, 1999; Ferguson, 2006).

When asked where they saw themselves in ten years (in a study of 60 Indigenous and non-Indigenous young men in juvenile detention: Dunn, 1989), 75% of the Indigenous youth replied that they would be dead, drunk or locked up. Eighty per cent of the non-Indigenous youth saw themselves in middle class settings. Dunn (1989) suggests that Indigenous young people perceive the causes of their problems as stable and them not having any ability to control or change anything, resulting in reduced expectations for their futures. This sense of hopelessness and resignation to one’s fate was also seen in a study by Olgilvie and Zyl (2001) investigating the reasons for the high rates of juvenile detention in the Indigenous community.

However, what was evident in many of the journal articles and reports reviewed (Dunn, 1989;Olgivie & Zyl, 2001; Holmes, Stewart, Garrow, Anderson, & Thorpe, 2002; Butt, 2004; Dawes & Dawes, 2005; Higgins, 2005; Palmer, Watson, Watson, Ljubic, Wallace-Smith, Johnson, 2006 ) was that if given the opportunity to participate in and be guided by older mentors and Elders in meaningful, empowering, and culturally appropriate activities, Indigenous young people (from a variety of settings) who are engaging in activities that expose them to risk are able to be redirected, supported, and encouraged to more positive outcomes. Indigenous young people embrace opportunities to be safe and become stronger and smarter (Olgivie & Zyl, 2001).

Risk and protective factors are culturally bound (Zubrick & Robson, 2003) and a failure to recognise this may result in interventions that are irrelevant, inappropriate, and risk placing blame for their failure on the people they were meant to assist. Whilst there is recognition that Indigenous young people have different trauma narratives to their parents and grandparents (Clarke, Harnett, Atkinson, & Shochet, 1999), very few of the articles reviewed for this paper discussed how Indigenous young people: define themselves; what they see as their risk and protective factors; and how they negotiate the conflicting roles, responsibilities, and expectations of Indigenous and non-Indigenous culture.

Many of the behaviours exhibited by Indigenous young people which are viewed as ‘anti-social’ by mainstream society, within a strengths-based framework can be regarded as adaptive (Clarke et al, 1999; Bottrell, 2007). For many Indigenous young people, the peer group replaces the role of family and provides a sense of identity. However, these survival responses set Indigenous young people along a pathway to further risk and negative outcomes such as leaving school early, violence, teenage pregnancy, unemployment, long-term substance use, self-harm, and suicide (Blagg, 1999; Clarke et al, 1999;Olgivie & Zyl, 2001).

The identification of the mental health needs of Indigenous youth needs to be culturally valid and reliable and take into account the amount of acculturation of the young person presenting for assessment (Westerman, 2002). DSMIV is a Western construct for the diagnosis of mental illness and there are several features of Indigenous ways of being which do not conform to the mainstream diagnostic criteria (Connard, 2000; Petchkovsky, Cord-Udy, Grant, 2007). Cultural concepts such as ‘sorry time’, ‘being sung’ by an aggrieved person, spiritual visits by ancestors, and ‘longing for country’, may be diagnosed in the Western system respectively as self-harm, paranoia, psychosis, and depression (Vicary & Westerman, 2004). Indigenous concepts of mental health are more holistic and incorporate physical, mental, social, cultural and spiritual elements of wellness (Vicary & Bishop, 2005). Aboriginal culture is linked to mythology and ancestors and nature is experienced as intrinsic to one’s being, thus the self is broader than the relatively narrow Western concept of self (Jung, 1983, cited by Petchkovsky et al, 2007). Indigenous people may discuss mental health problems in terms of an individual ‘having worries’ because ‘being mental’ is stigmatised in many communities (Vicary & Westerman, 2004).

There is general distrust of non-Indigenous services. Medication targets the mind as being separate from the rest of the system, and hospitalisation removes the individual from family, culture and country (Vicary & Bishop, 2005). The Indigenous system of treatment for mental illness is to draw upon the immediate family first. If there are still problems the extended family is called upon to help and this may mean that the young person relocates to another area, for example, from an urban setting to a rural one. Community, Elders, traditional healers, and Indigenous services will generally be consulted before a non-Indigenous service is considered. By the time, a non-Indigenous service is consulted, the individual’s illness may be so severe that more invasive treatment (in effect, medication and hospitalisation) is recommended. Within the Indigenous cultural framework, interventions targeted at an individual are possibly going to be more effective if peers, family, and community are involved and supportive. There appears to be a need for culturally specific awareness campaigns, strategies and assessment tools in Indigenous communities to facilitate the recognition of early warning signs of mental health problems in an effort to have young people receive the most effective treatments before they develop into serious problems.

Implications for clinical practice

Cultural competence and the implications for clinical practice can be encompassed in a ten-point model of engagement with Indigenous young people (Vicary & Bishop, 2005) involving: self-reflection; formative preparation; networking and supervision; referral; research; potential limiting factors; contact; therapeutic options; follow-up; and evaluation. This model will be used as a template to organise the advice and guidance of several writers on the implications for clinical practice with Indigenous clients.

Self-Reflection

The practitioner should reflect on his or her motives for wanting to work with Indigenous people (Vicary & Bishop, 2005). The practitioner’s motives must be altruistic and aimed at empowering Indigenous people. The small amount of Indigenous knowledge obtained by the practitioner must not be used to make decisions on Indigenous people’s behalf or to push one’s own agendas (Vicary & Westerman, 2004).

Prejudice and stereotypes of Indigenous people by non-Indigenous people may serve four functions (Pedersen, Griffiths, Contos, Bishop, Walker, 2000) relating to: how we structure the world according to our beliefs and attitudes based on our experience (experiential schematic); our membership in society and beliefs and attitudes about how people should behave (social-adjustive); our values (value-expressive); and our importance in society (self-esteem maintenance). Non-Indigenous practitioners must be conscious of an attraction to work with Indigenous clients based on their ‘other-ness’ (yearning), and the ways they distance themselves and their clients (spurning) (Palmer, 2003).

Non-Indigenous practitioners and services should adopt a therapeutic nurturance towards the Indigenous population both in the way they conduct themselves and the services they assist the communities to develop (Petchkovsky et al, 2007). The problems in Indigenous communities reflect the failure of white Australia to provide adequate care and nurture to Indigenous people. Non-Indigenous practitioners and services should question how they can develop greater capacity for nurture towards Indigenous people – extending the practitioner’s development of reflective empathy and effective nurturance (cultural immersion); and developing the organisation’s capacity to be effective nurturers (support for Indigenous empowerment, strengths-based practice, local solutions to local problems, attention to Indigenous ways of being) (Petchkovsky et al, 2007).

Formative preparation

The practitioner should undertake cultural awareness training and research the community in which he or she is going to work in (Vicary & Bishop, 2005; Fan, 2007). The research should include all aspects of local politics, history, culture, language, protocols, practices, and discussions with an Indigenous cultural consultant. The study of language and cultural protocols for Indigenous communities can be quite extensive and those interested should refer to the work of Dudgeon, Garvey, & Pickett (2000) for a comprehensive guide.

Networking

The practitioner needs to develop professional and personal networks and relationships within the community via an Indigenous Liaison officer, but should avoid making friendships too quickly (Vicary & Bishop, 2005; Fan, 2007). The practitioner also needs to form networks with other culturally competent practitioners and services that can provide practical support and advice to clients (Fan, 2007) when unable to provide a service to the client him/herself.

Collaboration is effective in working with young people (Collard & Palmer, 2006) when the Indigenous and non-Indigenous workers exchange ideas and knowledge. The Indigenous worker contributes his or her expertise in relation to the Indigenous cultural domain (protocols, law, culture, country, language, local politics, community, family) and the non-Indigenous worker provides his or her area of specialised professional skill (whether it be health, psychology, youth work, psychiatry, teaching, social work, etc).

Supervision

The practitioner should engage in self-reflective and nonjudgemental practice (Vicary & Bishop, 2005). Indigenous people can quickly detect those practitioners who have not been able to disengage from a Western framework. The practitioner should also develop an Indigenous supervision group for cultural validation of the work (Vicary & Westerman, 2004).

Referral

Requests for practical forms of assistance are usually the first approaches that Indigenous people make to agencies (Fan, 2007). Providing this assistance will help to establish the rapport needed for the person to engage in services that will alleviate the struggle of daily living (Fan, 2007). The problems of survival need to be attended to before people can deal with more challenging and in-built problems. Once the immediate problem is alleviated the client may not return until the next crisis hits (Fan, 2007). If rapport and relationship has been established then the practitioner may invite the client to talk at a deeper level the longer-term problems they are experiencing. Providing outreach services to Indigenous people in their communities encourages a level of engagement that cannot be achieved by less visible services (Fan, 2007). Referrals come in a variety of ways, and agencies should accept referrals from a third-party (Cleworth, Smith, & Sealey, 2006).

Research

The practitioner should gather information about the client’s relationship to family and country and a personal history from the client, the person referring if possible, and the cultural consultant (Vicary & Bishop, 2005; Cleworth et al, 2006). The Indigenous cultural consultant can provide guidance on whether the client’s ideas and beliefs are within the cultural norms (Cleworth et al, 2006). A genogram depicting inter-transgenerational trauma for the client’s family within the context of the impact of colonisation and government policy on Indigenous people may provide the client with an understanding of the social, cultural, political, psychological, family, environmental, and community influences on him or herself, family, and kinship (Atkinson & Edwards-Haines, 2003; Atkinson, 2006).

Potential limiting factors

The clinical team needs to discuss barriers to providing an effective service to the client, such as gender, age, culture, family dynamics, language, appointment time and location, community events, and concerns about confidentiality (Vicary & Bishop, 2005).

Contact

Practitioners should be willing to conduct assessments in a place where the client feels most at ease (Vicary & Bishop, 2005; Cleworth et al, 2006) and in the presence of a person or persons nominated by the client. Practitioners who build trust and rapport with their clients will be ‘vouched’ by them to the community and the practitioner may be requested to provide services to other family members outside of service specifications (Cleworth et al, 2006). Appointments may need to be made in terms of the client’s daily activities and be more flexible than mainstream services (Cleworth et al, 2006).

Therapeutic options

The therapeutic process needs to be explained and transparent to Indigenous clients (Vicary & Westerman, 2004). The clinician may need to modify his/her counselling and engagement skills (Wettinger, 1997; Vicary & Bishop, 2005). Use simple and jargon-free language, consider the need for an interpreter, and consider the culturally derived learning strategies of Indigenous people.

The question and answer format of many styles of therapeutic practices may not suit an Indigenous client who may prefer to ‘yarn’ about his or her problems in a narrative way (Vicary & Westerman, 2004). Indigenous people may find Western therapies frustrating when they are not provided with practical solutions to problems and are asked to find answers for themselves (Vicary & Westerman, 2004). The practitioner will need to become comfortable with silence, giving the young person the time and space to formulate responses.

For Indigenous people to return to wholeness, Atkinson (Atkinson & Edwards-Haines, 2003) identifies six processes: create culturally safe places; find and tell their stories; make sense of their stories; feel the feelings; move through the layers of grief and loss; and reclaim their sacred selves.

The practitioner may be requested by the client to disclose personal information about his/her family and country (Cleworth et al, 2006).

Follow-up

There is a need for practitioners and services to focus on the modest and practical clinical interventions (Hunter, 2002). Goal setting needs to be realistic given the environments that clients return to (Vicary & Bishop, 2005). The big picture issues may take years and generations to take effect and require a whole-of-government approach to health promotion, prevention, and intervention. Moral outrage has its place but does not solve problems at the grass roots level.

Evaluation

Feedback may be difficult to obtain from Indigenous clients due to them not wishing to appear ungrateful (Vicary & Bishop, 2005). Feedback may be obtained via the cultural consultant. The practitioner will also be able to evaluate the effectiveness of the service by the number of incoming referrals resulting from the ‘vouching’ system (Vicary & Westerman, 2004).

Conclusion

Several areas of need have been highlighted in this discussion of the current debates in working with Indigenous young people. The voices of Indigenous young people relating the struggles they experience, their strengths, and their needs, do not appear to be strongly represented in the current literature. Indigenous young people have challenges that are unique to them and a strengths based framework is required to identify the skills they are using to adapt their circumstances. Indigenous culture has its own system of responding to their young people who are troubled, but there appears to be a need for further investigation into culturally appropriate ways of early recognition, response, and treatment of potentially serious mental health problems to avoid unnecessary and prolonged suffering. There is a need for the non-Indigenous practitioner to consider the Indigenous world-view of health and wellbeing, and to develop cultural competence and strong collaboration with Indigenous workers, communities, families, and individuals to be effective and relevant. A model of engagement was discussed as a starting point to developing a trust relationship with Indigenous young people.

References

Atkinson, J. & Edward-Haines, C. (2003). Social and emotional wellbeing: An Indigenous perspective. Canberra: AIATSIS

Atkinson, J. (2006). Principles of practice in defining evidence in research. Internet address: http://www.aracy.org.au/AM/Common/pdf/seminars/ArcNetworkEvents_080506.pdf  Accessed 10/5/08.

Blagg, H. (1999). Working with adolescents to prevent domestic violence: Indigenous rural model. Canberra: National Crime Prevention.

Bottrell, D. (2007). Resistance, resilience and social identities: Reframing ‘problem youth’ and the problem of schooling. Journal of Youth Studies, 10:5, pp597-616.

Butt, J. (2004). Summary of findings from the Get Real Challenge evaluation: Issues facing Indigenous youth who misuse volatile substances, and outcomes of a program targeting these issues. Brisbane: UniQuest.

Clarke, C.;Harnett, P.; Atkinson, J.; Shochet, I. (1999). Enhancing resilience in Indigenous people: The integration of individual, family and community interventions. Aboriginal and Islander Health Worker Journal, 23:4, pp6-10.

Cleworth, S.; Smith, W.; & Sealey, R. (2006). Grief and courage in a river town: A pilot project in the Aboriginal community of Kempsey, New South Wales. Australasian Psychiatry, 14:4, pp390-394.

Collard, K. (2000). Aboriginal culture. In: Working with Indigenous Australians: A handbook for psychologists. History, Section 1 (pp21-25) Perth: Gunada Press.

Collard, L. & Palmer, D. (2006). Kura, yeye, boorda, Nyungar wangkiny gnulla koorlangka: A conversation about working with Indigenous young people in the past, present and future. Youth Studies Australia, 25:4, pp25-32.

Dawes, G. & Dawes, C. (2005). Mentoring 2: A program for ‘at risk’ Indigenous youth. Youth Studies Australia, 24:4, pp45-49.

Dudgeon, P. (2000). Indigenous identity. In: Working with Indigenous Australians: A handbook for psychologists. Issues, Section 1 (pp43-50). Perth: Gunada Press

Dudgeon, P.; Garvey, D.; & Pickett, H. (eds). (2000). Working with Indigenous Australians: A handbook for psychologists. Perth: Gunada Press

Dunn, R. (1989). Preventing juvenile crime: Aboriginal youth and offending. Australian Institute of Criminology conference proceedings, number 9, 17-19 July 1989.

Fan, B. W. S. (2007). Intervention model with Indigenous Australians for non-Indigenous counsellors. Counselling, Psychotherapy, and Health. 3:2, Indigenous Special Issue, pp13-20.

Ferguson, S. (2006). Inside the gangs of Wadeye. Channel 9 Sunday programme aired 30 July 2006. Transcript obtained from Internet address: http://sunday.ninemsn.com.au/sunday Accessed 19/5/08

Goodwin, T. (2008). Talking Stick, aired on ABCTV1 on 25 April 2008. Australian Broadcasting Corporation.

Gruen, R.L. & Yee, T. F. M. (2005). Dreamtime and awakenings: Facing realities of remote area Aboriginal health. Medical Journal Australia, 182:10, 16 May 2005, pp538-540.

Higgins, D. (ed.). (2005). Early learnings. Telstra Foundation research report, volume 02. Melbourne: Australian Institute of Family Studies.

Holmes, W.; Stewart, P.; Garrow, A.; Anderson, I.; & Thorpe, L. (2002). Researching Aboriginal health: Experience from a study of urban young people’s health and well-being. Social Science & Medicine, 54, pp1267-1279.

Hunter, E. (2002). ‘Best intentions’ lives on: Untoward health outcomes of some contemporary initiatives in Indigenous affairs. Australian and New Zealand Journal of Psychiatry, 36, pp575-584.

Knox, K. J. (2006) Designing and Developing Aboriginal Service Organisations: A Journey of Consciousness. Doctoral thesis. University of Western Sydney, Australia

Larkins, S. L.; Page, R. P.; Panaretto, K. S.; Scott, R.; Mitchell, M. R.; Alberts, V.; Veitch, P. C.; McGinty, S. 2007. Attitudes and behaviours of young Indigenous people in Townsville concerning relationships, sex and contraception: the “U Mob Yarn Up” project. Medical Journal of Australia, 186:10, 21 May 2007, pp513-518.

Palmer, D. & Collard, D. (1994). Aboriginal young people. Family Matters, 38, August 1994, pp26-31.

Palmer, D. (2003). Youth work: Aboriginal young people and ambivalence. Youth Studies Australia, 22:4, pp11-18.

Palmer, D.; Watson, J.; Watson, A.; Ljubic, P.; Wallace-Smith, H.;& Johnson, M. (2006). “Going back to Country with Bosses”: The Yiriman Project, youth participation and walking along with Elders. Children, Youth and Environments, 16:2, pp317-337.

Pedersen, A.; Griffiths, B.; Contos, N.; Bishop, B.; Walker, I. (2000). Attitudes toward Aboriginal Australians in city and country settings. Australian Psychologist, 35:2, pp109-117.

Petchkovsky, L.; Cord-Udy, N.; & Grant, L. (2007). A post-Jungian perspctive on 55 Indigenous suicides in Central Australia; deadly cycles of diminished resilience, impaired nurturance, compromised interiority; and possibilities for repair. Australian e-Journal for the Advancement of Mental Health, 6:3, http://www.auseinet.com/journal/vol6iss3/petchkovsky.pdf  Accessed 10/5/08.

Robson, A.; Silburn, S.; & members of the Aboriginal Suicide Prevention Steering Committee, Western Australia. (2002). Building healthy lives: Partnerships to promote Aboriginal child health & wellbeing and family & community resilience. Auseinetter, 15:2, July 2002, Internet address: http://auseinet.flinders.edu.au/resources/auseinet/netter15/1-12.pdf  Accessed 15/5/08.

Vicary, D. A. & Bishop, B. J. (2005). Western psychotherapeutic practice: Engaging Aboriginal people in culturally appropriate and respectful ways. Australian Psychologist, 40:1, pp8-19.

Vicary, D. A. & Westerman, T. G. (2004). ‘That’s just the way he is’: Some implications of Aboriginal mental health beliefs. Australian e-Journal for the Advancement of Mental Health, 3:3. Internet address: http://www.auseinet.com/journal/vol3iss3/vicarywesterman.pdf

Westerman, T. G. (2002). Children and domestic violence: An analysis of the nature of violence in Aboriginal communities and the psychological effects on Aboriginal children and communities.  Internet address http://www.gtp.com.au/ips/inewsfiles/P17.ppt  Accessed 6/4/08

Westerman, T. G. (2002). Psychological interventions with Aboriginal people. Connect, Health Department of Western Australia.

Wettinger, M. (1997). Psychological assessment of Aboriginal people. Psychologically Speaking.

Zubrick, S. R. & Robson, A. (2003). Resilience to offending in high risk groups: Focus on Aboriginal youth. Criminology Research Council.

ATTACHMENT A

Indigenous population facts and figures, compared to non-Indigenous population – Australia-wide

Demographic Total population 517,200 – 2.5% of population (30/6/2006).32% live in major cities, 43% in regional areas, 25% in remote areas.Median age of population is 21 years
Labour Force Unemployment rate of 16%, three times higher than non-Indigenous people.Median household income $362 per week, 56% of weekly income for non-Indigenous people.
Housing Home ownership 34%, half the rate of non-Indigenous people.27% living in overcrowded conditions.17% living in Supported Accommodation (SAAP), 75% being women.
Health 29% Indigenous adults describe their health as fair/poor.Indigenous adults twice as likely to report high/very high levels of psychological distress.Hospitalisation for potentially preventable illness five times higher.50% of Indigenous adults smoke.57% of Indigenous people over 15 years overweight or obese.

Median age of carers is 37 years, 12 years less than non-Indigenous people.

Mortality Life expectancy 17 years less than non-Indigenous people.Mortality rates almost three times higher, for adults and children aged over 1 year.Perinatal mortality rate is 1.5 times higher.
Community Services Indigenous children six times more likely to be on care and protection orders.Indigenous youth in juvenile justice 44 per 1000, non-Indigenous youth 3 per 1000.

Source: Health and welfare of Australia’s Aboriginal and Torres Strait Islander Peoples, 2008, Australian Institute of Health and Welfare.

ATTACHMENT B

Indigenous population facts and figures, compared to the non-Indigenous population – New South Wales

Demographic 77% live in major cities57% aged under 24 years83% aged under 44 years
Health Infant mortality 79% higher2 to 3 times more likely to be treated in hospital for alcohol related trauma or disease.5 times more likely to be in drug and alcohol treatment programmes.2.7 times more likely to be treated for self-harm.
Justice Females 4.3 times more likely to be victims of sexual assault, domestic violence, and personal crimes.Personal violence towards Aboriginal males is 80% higher.Adults and young people 7 times more likely to appear in criminal court.20% of adult males in prison are Indigenous.33% of adult females in prison are Indigenous.

Children and young people 3 times more likely to be victims of domestic violence and sexual assault.

Community Services 33% of children in out-of-home care are Indigenous.

Source: Two ways together report on indicators 2007, New South Wales Government, Department of Aboriginal Affairs.

 

ATTACHMENT C

Findings from the Western Australian Aboriginal Child Health Survey of 5289 Indigenous children aged under 17 years

Demographic(WA) 10% of all Indigenous children lived in areas of extreme isolation44% lived in areas with some level of isolation34% lived in Perth (no isolation)
Social(WA) Just over two in every five children lived in households affected by forced separation or forced relocation of at least one primary or secondary carer or grandparent.6% of children aged 0–3 years, and 20% of those aged 12–17 years, were cared for by someone other than their birth parent(s).44% of Indigenous families reported that they only had enough money to get through to the next payday, and only 5% being able to save consistently.
Health(WA) 23.6% had recurring infections involving the ear, skin and/or gastrointestinal tract.24.4% had asthma, of whom 12.9% used medication11.3% had abnormal vision and 7.8% wore contact lenses or glasses.45.6% had decayed, missing or filled teeth.Indigenous young people had less contact with all types of health professionals except Indigenous health workers, Indigenous medical services and nurses, and were half as likely as non-Indigenous young people to use Medicare or the Pharmaceutical Benefits Scheme.

58% of 17 year-olds smoked regularly.

40.8% of 15–16 year olds had tried marijuana.

Alcohol consumption peaked in Indigenous 15–16 year olds, and almost half of those consuming alcohol had drunk to the point of vomiting in the past 6 months, similar to the pattern seen in non-Aboriginal 15–16 year olds.

Of Indigenous 12–16 year olds, 21.6% of males and 33.0% of females had not exercised strenuously in the previous week.

74.5% of Indigenous 17 year olds had had sexual intercourse.

33.4% of 15 year olds and 43.9% of 16 year olds had had sexual intercourse.

Of those who were sexually active, 70.1% relied on condoms to prevent pregnancy.

One in 10 girls had been pregnant at least once: 33.7% of 17 year olds and 21.9% of 16 year olds.

20.5% were at high risk of clinically significant emotional or behavioural difficulties.

31.4% were at high risk of clinically significant conduct problems.

9.0% of females and 4.1% of males had attempted suicide in the past 12 months.

Source: Blair, E. M.; Zubrick, S. R.; & Cox, A. H. (2005). The Western Australian Aboriginal Child Health Survey: Findings to date on adolescents. Medical Journal Australia, 183:8, pp433-435.

About Narelle Smith

Child & Family Worker

5 Responses to “Debates in the mental health of Indigenous young people”

  1. I really enjoyed reading this, as it raised so many important questions about how we approach our work. I am going to have to respond casually, as I’m balancing baby wrangling with this response…

    Much research argues that people who are categorised within marginalised or disadvantage groups are often portrayed with sameness and silence difference (Trin T Min Ha, Kresteva etc…).

    This leads to my argument, that there is a fine balance between what ‘culturally appropriate’ services/programs are. I struggle with this concept within my workplace. Clients who identify as Aboriginal young people, do not identify with the Aboriginal services they could tap into. When asked why, they say things like ‘they are black’ or ‘I don’t know any of that mob’ or ‘im not interested in that,’ ‘its not me.’

    I find, contrary to Vikary and Bishop, within my experiences working with homeless young people, of whom are Aboriginal, show the same distrust, if not more for Aboriginal Services. Perhaps this is a bi-product of being within an Urban Australian context? A bi-product of the modern globalised young person?

    Forging an Aboriginal identity as a homeless young person is an interesting paradox. The clients that I see face many of the struggles research so often discusses as the effects of colonisation- dislocation from culture (where do I belong, I am neither here nor there, black nor white, I have no home…), health, poverty, drug and alcohol addiction, low school retention etc. etc. But this does not define who they are…? Aboriginality is complex varied and unique for each of the young people I have spoken with…some people have numerous cultures, Aboriginal Dad, Turkish mum, Aboriginal young person raised in a second generation Australian home… etc.

    So then how can we provide Aboriginal services which meet these complex identity needs? What is Aboriginality for these young people?

    Is it too much to expect, that Aboriginal young people, who come from a lineage of generations who have been subject to removal from their families would want to connect with Aboriginality? Do Aboriginal young people see Aboriginality the same way, older Aboriginal people do?

    Another thought… I would hate to think that the age old Foucaultian argument prevails; the categorisation of disparity faced by Aboriginal people informs the identity of Aboriginality. People begin to embody this and identify it as being Aboriginal… Much academic text discusses the prevailing negatives associated with Aboriginality, media portrays Aboriginality as violent, in need etc.
    So then, if risk and protective factors are culturally bound, what cultures are they bound to for these people? Does this culture go across categorisations of race and ethnicity to include, generational, place based culture?

  2. Being from the UK, I cant comment on aboriginal culture or reference my comments, but I did enjoy reading this post because it could just as well apply to work with Asian or Black or Chinese or Refugee youth here. Or any disadvantaged group really. So there is much to think about.

    When the youth themselves diss their own cultural organisations I tend to think it represents internalised racism to a certain extent (nothing is ever “always” something!) and needs addressing as much as anything else. And yes, I agree DSMIV would have us label things as unhealthy that are perfectly capable of having a reframed meaning when thought about in context.

  3. Mahalo nunui for you well thought out work. I am a kanaka maoli (native Hawaiian) working as a Family Support Worker in Hawaiʻi and we consider ourselves aboriginal peoples to this ʻāina – land. We kanaka maoli have been illegally occupied by the United States gov. for 123 years and have been living in oppression for over two hundred years. The cultural trauma is real and our kanaka families top the stats in incarceration, domestic violence, illness/disease, children in foster care, alcohol/substance abuse ….. on and on. The western system does NOT work for my people and I greatly appreciate you shining the light on this matter.

    • Warami (good to see you)

      Thank you for your comment, and for telling me your story.

      What can I say? The struggle is real. The wheels turn very slowly. Economics takes precedence over looking after the Country and its people. It’s the same story, over and over, for First Nation people.

      Keep your Language and your Culture strong. Much of it has been lost here, and it is a source of great sorrow and loss.

      You may enjoy this video…

      Yanu (by and by)

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