Submission to the National Anti-Racism Strategy 2012

Australian Human Rights Commission

This submission was prepared for the Australian Indigenous Psychologists Association by Dr Pat Dudgeon, Mr Glenn Williams and Liz Orr.

May 2012

Brief Summary

`a strong and confident national identity is one that begins with its First

Nations peoples, their knowledge, heritage, and spiritual connection to the

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land and seas’ Racism Roundtable 2009.

The Australian Indigenous Psychologists Association (AIPA) applauds the Human

Rights Commission intention to develop a National Anti-Racism Strategy. This

submission focuses on the impact of racism evident through the lack of culturally

appropriate and culturally safe mental health services. AIPA calls on the Human

Rights Commission to include social and emotional wellbeing/mental health and

institutional racism in the scope of the National Anti-Racism strategy. The

delivery of Indigenous-specific safe, high quality social and emotional wellbeing

services are needed to work at the many levels required to prevent the impact of

racism and to support community and institutional change. A national Anti-

Racism Strategy must address systemic racism and advocate for change at the

institutional and cultural level as well as the individual and personal level. Social

and emotional wellbeing services for Indigenous Australians are urgently

required. Prevention programs and campaigns to raise awareness and encourage

social activism against racism are also required

Table of Contents

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1. Australian Indigenous Psychological Association (AIPA)....................................52. Recommendations.............................................................................................................73. Focus..................................................................................................................................... 94. Addressing Social and Emotional Wellbeing issues..............................................9

4.1 Distinguishing Social and Emotional Well Being from Mental Health...............114.2 Social and Emotional Well Being assessment tools..................................................144.3 Action about health inequalities........................................................................................18

5. Psychology and Racism................................................................................................. 195.1 The roundtable on racism and Durban Declaration..................................................20

6. Indigenous mental health movement and culturally appropriate paradigms........................................................................................................................................................ 23

6.1. Self-determination and meaningful ongoing consultation.........................................246.2. Psychology: current & proposed AIPA actions to combat racism...........................256.3. Anti Racism, responsible media and using media as strategy..................................266.4 Anti- racism education and resources.............................................................................276.5 Research & evaluation...........................................................................................................29

References.................................................................................................................................. 32

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1. Australian Indigenous Psychological Association (AIPA)

AIPA is the national body that represents Aboriginal and Torres Strait Islander

psychologists in Australia. AIPA is an unincorporated Association and the

Australian Psychological Society (APS) provides organisational and financial

support to AIPA, including the auspicing of contracts from the Australian

Government

AIPA is committed to improving the social and emotional well-being and mental

health of Aboriginal and Torres Strait Islander people by increasing the number

of Indigenous psychologists and by leading the change required to deliver

equitable, accessible, sustainable, timely and culturally safe primary mental

health care to Aboriginal and Torres Strait Islander peoples in urban, regional

and remote Australia. Furthermore, AIPA is committed to supporting

indigenous psychologists through undergraduate and post graduate courses;

and providing professional development to Indigenous and non-Indigenous

psychologists to increase the cultural safety of indigenous clients and expanding

the skills of psychologists to work with indigenous clients. By maintaining a

high standard of practice and engaging in Indigenous psychological research,

AIPA is committed to being on the forefront of Indigenous psychology in

Australia. AIPA is supported in its functioning by the Australian Psychological

Society.

For more information about AIPA and its members, please refer to AIPA’s

website: http:/ /www.indigenouspsychology.com.au/

The Australian Indigenous Psychologists Association (AIPA) applauds the

Human Rights Commission steps to develop a National Anti-Racism Strategy.

AIPA, together with the host, the Australian Psychological Society (APS),

contributed to a roundtable about research concerning racism at the University

of Western Australia in June 2009. Key organizations including the Human

Rights Commission, the Australian Indigenous Doctors Association, the Telethon

Institute for Child Health Research, WA, the School of Indigenous Studies UWA,

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and the University of Notre Dame Australia attended. The Roundtable was

initiated by AIPA Chair and APS Fellow Dr Pat Dudgeon, who saw it as one way

to renew the momentum for combating racism that was generated a decade ago

by the APS Position Paper Racism and prejudice: Psychological perspectives

(1997).

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2. Recommendations

Recommendation 1: That the National Anti-Racism Strategy encompasses a

broad definition of racism, including individual, institutional and cultural racism.

The strategy should also seek to broaden the communities understanding of

racism, from individual incidents or attacks, to policies and procedures that

unfairly disadvantage Indigenous people

Recommendation 2: That AIPA endorses close collaboration with Indigenous

people that involves meaningful and ongoing input and appropriate resourcing

for actions that emerge from the strategy.

Recommendation 3: That the National Anti-Racism Strategy find ways to

address the needs of individuals and work to change systemic, institutional and

cultural racism. This may include:

Indigenous access to the Better access Program

Resourcing Aboriginal Community Controlled Health Organisations to

provide Social and Emotional Well Being programs

Changes to current Mental Health Systems and services and appropriate

resourcing for actions that emerge from the SEWB strategy. This is a key

action and may be a quantifiable measure against systemic racism.

Recommendation 4: That the Principles of the UN Declaration on the Rights of

Indigenous peoples, in particular the right to free, prior and informed consent

are incorporated into the strategy.

Recommendation 5: That the National Anti-Racism Strategy supports the call

to acknowledge Indigenous Australians as the first custodians of the land and

recognise the role Indigenous Australians continue to play in contemporary

multicultural society within the Australian Constitution. Working with the

National Congress of Australia’s first peoples, along with other Indigenous

specific organisations, the strategy should promote this recognition among all

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government departments, educational institutions and community

organisations, as well as the general public.

Recommendation 6: That the strategy promotes positive stories of survival

and strength about Indigenous Australians and highlights our ongoing

contribution to the broader community and country.

Recommendation 7: That the National Anti-Racism Strategy investigate

accountability mechanisms for media representation of Aboriginal and Torres

Strait Islander peoples that the strategy:

prioritise media campaigns to reduce racism.

get the media to develop strategies to take responsibility for

representations of Aboriginal and Torres Strait people in ways which

highlight the diversity within groups and similarities across groups,

thereby discouraging negative stereotyping.

Investigate how to ensure media compliance with accountability

mechanisms for media representation of Aboriginal and Torres Strait

Islander peoples. For example perhaps there could be a media watch

officer with statutory powers.

support cultural awareness training to be made available for all people

involved in the media

Recommendation 8: AIPA recommends that anti-racism training be developed

based on multiple mechanisms, be adjusted to the local context, and be age

appropriate.

Recommendation 9: AIPA recommends that the Australian Government

support accurate qualitative and quantitative data on racism against Aboriginal

and Torres Strait Islander peoples and that this data collection be done within an

Indigenous framework with Indigenous people involved in all stages of the

design, collection and knowledge transfer stages. This suggestion is in

accordance with Recommendation 103 of the Durban Review Conference

outcomes document.

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Recommendation 10: AIPA urge the HRC to ensure that the national Anti-

Racism Strategy works to change the health system. A key element in the

prevention of serious psychological distress from yielding a high burden of

mental illness among Indigenous peoples, particularly high-prevalence disorders

such as anxiety disorders, depression and substance abuse disorders, is

universal access to culturally appropriate SEWB and primary mental health care.

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3. Focus

In light of the urgent need to address the impact of racism on the social and

emotional wellbeing of Aboriginal and Torres Strait Islander people, AIPA calls

on the Human Rights Commission to put forward the recommendations outlined

in this paper to the government of the day, and to all future governments. These

recommendations will assist governments address the individual, institutional,

and cultural racism evident in the mental health systems in Australia. This

submission focuses on ensuring that ‘Close the Gap’ initiatives develop Social

and Emotional Wellbeing frameworks to assist Indigenous Australians deal with

the forms of racism they experience and to assist those charged with making

systemic and cultural change to eradicate racism.

4. Addressing Social and Emotional Wellbeing issues

The direct and indirect racism and inequality experienced by Aboriginal and

Torres Strait Islander people and communities is one of the most pressing issues

facing Australia today (APS 2012). The human rights of Aboriginal and Torres

Strait Islander peoples are not sufficiently protected or promoted and the

insidious effects of racism continue to impact their lives and scar our nation.

Indigenous people are confronted with racism on a daily basis -to the point

where they sometimes think this is normal and they may accommodate the

situation in what is described as internalized racism (Dudgeon 2012, Paradies et

al 2008). The effects of racism on Aboriginal and Torres Strait Islander people

are being named and documented in an increasingly thorough and meaningful

manner (Paradies 2012).

Paradies, Harris and Anderson (2008) note the challenges in measuring the

impact of racism on health. However, they identify that this is due to the

complexity and subtlety of racism:

…racism can be subtle, unintentional, unwitting and even unconscious, it

is rarely possible to definitively attribute a particular event to racism. A

subjective experience of racism may, in fact, be caused by other forms of

oppression (e.g. sexism), while an individual may erroneously attribute

an objectively racist experience to another form of oppression or to

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his/her own limitations. Moreover, internalised racism and systemic

racism can be invisible …

Racism creates physical ill health, a greater propensity to disease and a range of

social and emotion and psychological distress such as low self-esteem, mistrust

of the dominant culture, anxiety, substance misuse, depression, internalised

racism, confusion, and disengagement. Atkinson 2002; and Atkinson, Nelson

and Atkinson, (2010) point to the trauma of racism, its intergenerational impact

and the ongoing difficult task of healing from colonisation. With regard to the

impact of colonisation:

`There is little doubt that in real and symbolic terms, Australian

Aboriginal culture has been traumatized by the European invasion’

Halloran (2004):

The impact of colonisation and ongoing racism inflicted upon Aboriginal and

Torres Strait Islander people is starkly demonstrated by poor outcomes in

relation to health, education, incarceration, child protection, morbidity and

mortality with the average life expectancy gap between Indigenous and non-

Indigenous Australians of around 11 years (ABS, 2009). Furthermore,

Aboriginal and Torres Strait Islander peoples do not have access to justice.

Extensive data indicates that Aboriginal and Torres Strait Islander peoples

experience race discrimination at every stage of the justice system. For example,

in Western Australia 43% of prisoners are Indigenous from 3.5% of the

population (Kelly, Gee, Dudgeon, & Glaskin, 2009). Aboriginal and Torres Strait

Islander children lack access to safe, culturally appropriate, resourced, and

accessible quality education. Along with significant improvements to the quality

of education, the right to language needs to be realized through the education

system. Teaching in language is an important protective factor and this is widely

evidenced (Kelly et al., 2009).

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4.1 Distinguishing Social and Emotional Well Being from Mental Health

Social and emotional wellbeing includes a plethora of issues such as; issues

relating to suicide, family violence, removal of children and young people,

incarceration of family members, drug and alcohol issues, witnessing or being

subject to violence, grief and loss, anger management, low self-esteem and high

prevalence disorders such as anxiety and depression. The Social Health

Reference Group describes social and emotional wellbeing as recognising:

the important connection to land, culture, spirituality, ancestry, family

and community and how these affect the individual. Social and

emotional wellbeing problems cover a broad range of problems that

can result from unresolved grief and loss, trauma and abuse, domestic

violence, removal form family, substance misuse, family breakdown,

cultural dislocation, racism and discrimination an social disadvantage

(Social Health Reference Group 2004).

AIPA purports that the racism strategy identifies ‘social and emotional

wellbeing’ in terms of an Indigenous cultural concept that differs in important

ways to mainstream concepts of mental health and illness. Rather than simply

adapting and delivering models designed for mainstream Australians, social and

emotional wellbeing and mental health services need to strongly engage with

the diversity of cultures and Indigenous language groups/nations and each

group’s understanding of social and emotional wellbeing and support their ways

of achieving it. As well as addressing factors that influence the ‘mental health’ of

all Australians, services need to specifically address the aftermath of

colonisation: unresolved grief, loss and trauma, removal from family, family

breakdown, cultural dislocation, racism and discrimination and ongoing

disadvantage (SHRG, 2004).

Aboriginal and Torres Strait Islander people are exposed to a disproportionate

number of stressful life events compared to other Australians, contributing to

high levels of serious psychological distress and suicide (Kelly, Dudgeon et al,

2010). Any program that works on one issue in isolation from the others may

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alleviate some problems in the short term but will not achieve the ultimate goal

of restoring social and emotional wellbeing across each language group/nation.

The definitions and determinants for mainstream mental heath and Indigenous

SEWB suggest clear overlaps and important differences between the two

concepts, and as many Indigenous scholars have noted, the relationship between

the two continues to be discussed, debated and negotiated (Garvey 2008).

Consistent with the Social Health Reference Group, AIPA acknowledges and

recognises the importance of mental health, but positions it within the larger

framework of SEWB—a framework that includes the domains of wellbeing that

are unique and essential components of Aboriginal and Torres Strait Islander

health (Kelly et al. 2009).

There are big challenges to service delivery posed by small, dispersed Aboriginal

and Torres Strait Islander communities in remote Australia, where 92,960

Aboriginal people live on traditional lands. The lack of infrastructure to support

service delivery and the extreme poverty and disadvantage found in these

communities often make survival the main task. Rather than simply adapting

and delivering models designed for mainstream Australians, social and

emotional wellbeing and mental health services need to be able to engage with

each group’s understanding of social and emotional wellbeing and how best to

achieve it.

There is little capacity to offer choice for the majority (76%) of the Aboriginal

and Torres Strait Islander population who live as dispersed minorities within

mainstream populations in urban and regional Australia. A two way strategy to

increase both the Indigenous mental health workforce and improve the cultural

competence of mainstream service providers to meet the needs of Aboriginal

and Torres Strait Islander people in their client base, is urgently required.

Aboriginal and Torres Strait Islander peoples continue to experience high levels

of racism in Australia, across multiple settings. For example, the Challenging

Racism data released in March 2011 found that Aboriginal and Torres Strait

Islander respondents experienced four times the racism of non-Aboriginal

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Australians in relation to contact with police and in seeking housing (AIHW

2011) .

Similarly, 2008 research found that 27% of Aboriginal and Torres Strait Islander

peoples over the age of 15 reported experiencing discrimination in the

preceding 12 months (AIHWP 2008). Other research has found that three out of

four Aboriginal and Torres Strait Islander peoples regularly experienced race

discrimination when accessing primary health care, contributing to some people

not being diagnosed and treated for disease in its early stages(Paradies 2008).

The destructive impact of racism on Aboriginal and Torres Strait Islander

peoples' social and emotional health and wellbeing reaches beyond its

immediate impact. See for example Reconciliation Australia, Australian

Reconciliation Barometer 2010, Question and Answer Fact Sheet, At:

http://www.reconciliation.org.au/home/resources/factsheets/q-a-factsheets/

baromter-2010 (viewed 1 February 2012) which notes respondents’ belief that

previous race-based policies continue to affect some Aboriginal and Torres Strait

Islander people today.

Evidence suggests the need for ongoing research to fully understand the

different impact of racism across the lifespan and in different geographical and

social settings (Purdie et al2010). However, there is compelling evidence of a

link between race-based discrimination and poor mental health and wellbeing

(Paradies, 2006).

It is also noted by Parker (2010) that `prior to European colonization of

Australia (mental illness) was, most likely a fairly rare occurrence. The much

greater prevalence of mental illness in the Aboriginal And Torre Strait islander

population currently is a reflection of the significant disruption to Aboriginal

and Torres Strait Islander society and has a strong context of social and

emotional deprivation’. He goes on to note that management of the issues

therefore …`requires a strong emphasis on cultural safety along with the

recognition of family, culture and community in any healing processes’.

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As a measure of `walking the talk’, AIPA strongly endorses close and ongoing

collaboration with Indigenous people in the development and monitoring of a

National Anti-Racism Strategy. This will require meaningful and ongoing input

and appropriate resourcing for actions that emerge from the strategy along with

supporting research that will assist to continue build the evidence base about

culturally effective services and approaches.

We call on the HRC to consider racism against Indigenous peoples as a public

health and Human Rights issue that requires a whole of government and cross

sector response. In recognition of the unique place of Indigenous culture and

the specific nature of racism against Aboriginal and Torres Strait Islanders that

manifests in unparalleled bad health and mental health outcomes we urge the

HRC to ensure that the national Anti-Racism Strategy works to change the health

system. A key element in the prevention of serious psychological distress from

yielding a high burden of mental illness among Indigenous peoples, particularly

high-prevalence disorders such as anxiety disorders, depression and substance

abuse disorders, is universal access to culturally appropriate SEWB and primary

mental health care.

4.2 Social and Emotional Well Being assessment tools

Inappropriate social and emotional wellbeing assessment tools and the poor

outcomes in relation to individual, community, and social and emotional well-

being amongst Indigenous populations are of particular concern to AIPA.

Literature about Indigenous psychology and Indigenous social and emotional

well being is replete about the need for culturally appropriate assessment tools

for working with Aboriginal and Torres Strait Islander people (Drew, Adams &

Walker, 2010; Sheldon, 2010; Gilies, 2012) and a recognition of historical and

cultural contexts for social and emotional well-being must be central to

psychological and psychiatric assessments.

In developing culturally appropriate tools greater attention must also be paid to

the context and characteristics of mental health morbidity indicators and

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strategies. For example, the rate of suicide in the Indigenous population is

almost three times greater than that of the non-Indigenous population (3.7%

compared to 1.3%) and Indigenous Australians are three times more likely to be

hospitalised for intentional self-harm than other Australians (ABS & AIHW,

2008). Whilst these higher rates of suicide have long been acknowledged there

has not been a corresponding development of safe, culturally appropriate,

resourced and accessible services to support social and emotional well-being.

Furthermore, the work of researchers such as Hunter (1999, 2001) and Hunter

and Milroy (2006) alert us to the phenomena of suicide clustering, the fact that

suicidal behavior is fairly recent as a socio-cultural phenomenon and that there

are significant regional variations that need to be considered in strategies to

prevent suicide.

These issues have been documented by the Co-operative Research Centre on

Aboriginal and Torres Strait Islander Health (Kelly et al 2009; Paradies, Harris &

Anderson 2008) and in many major government reports including: the Social

Justice Reports, the Bringing Them Home Report, the Little Children are Sacred

Report and the Royal Commission Report into Aboriginal Deaths in Custody.

The following major national conferences, inquiries and reports have found a

high level of unmet need among Aboriginal and Torres Strait Islander people

and a perception that mainstream mental health services have failed them:

1992 The Royal Commission into Aboriginal Deaths in Custody Report

1993 National Aboriginal Mental Health Conference

1994 The Burdekin Report on Human Rights and Mental Illness

1996 The Ways Forward Report: National Aboriginal and Torres Strait

Islander Mental Health Policy: National Consultancy Report.

1997 Bringing Them Home: Report of the National Inquiry into the

Separation of Aboriginal and Torres Strait Islander Children from

their Families

There is a high level of consensus in the findings of these reports and enquiries

that non-Indigenous mental health practitioners have little understanding of

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Indigenous concepts of social and emotional wellbeing, history, culture and

society, and that this has resulted in barriers to service provision, frequent

misdiagnosis and inappropriate treatment (Barrett 2011).

A local example is the Indigenous Community Response to Suicides in Mackay’

report which outlines the community’s need for prevention, intervention and

post-intervention strategies that are broad, flexible in scope and Indigenous-

specific (Barnett et al., 2010). It was within this context that the ‘Call-a-Cuz’

help-line was suggested - a tool for Indigenous people to access Indigenous

mental and social health professionals for assistance to address their emotional

and psychological distress within a social and emotional wellbeing context,

underpinned by a strengths-based model of service provision which draws upon

protective factors that are unique to Indigenous Australians, such as connections

to land, culture, spirituality, ancestry, family and community (Kelly, Dudgeon,

Gee & Glaskin, 2009). The understanding that Indigenous Australians

experience emotional and psychological distress associated with feelings of

hopelessness, disconnectedness and grief - rather than mental illness - is

associated with the unique Indigenous experience of such losses as

dispossession, marginalisation, loss of culture and tradition as a result of past

governmental policies (Barnett et. al., 2010). From these fundamental

experiences stem the cumulative effects of an almost inexhaustible list of serious

psychological distress factors experienced at a higher rate than that of other

Australians, which requires sensitive management (Kelly et al., 2009).

Institutional racism is also evidenced as an unintentional consequence of the

design and delivery of existing services. The location and style of services to

address emotional and psychological distress make them accessible to other

Australians whereas the many remote Indigenous communities that require

such services have little if any access to them. In addition, while the need for

after hours counselling and support has been met through 24 hour telephone

services such as Lifeline, Relationships Australia and the Kids Helpline, uptake of

these services by Indigenous Australians has not been proportional (2.5%) and

the evidence of unmet need is reflected in Indigenous rates of psychological

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distress twice that of the general population (30% compared to 16%). Many

government departments and agencies throughout the country (e.g., Australian

Taxation Office, Medicare) recognise Indigenous people have specific needs and

have addressed this by providing Indigenous-specific access lines to facilitate

culturally competent service delivery (Barrett 2011).

AIPA supported a proposal by the APS to develop a national Indigenous social

and emotional wellbeing help-line with culturally competent and highly skilled

Indigenous mental health practitioners. Such a service would have the capacity

to identify and manage Indigenous-specific risk factors using strength-based

approaches which draw upon Indigenous-specific protective factors found at

individual, family and community levels in order to address the range of social

determinants which impact negatively on Indigenous social and emotional

wellbeing and stimulate high levels of psychological distress. When considering

the high level of unmet need for social and emotional wellbeing and mental

health support, the challenges posed by the demographics of the Aboriginal and

Torres Strait Islander population, and the lack of parity of Indigenous people

within the five professions which constitute the mental health workforce

(psychiatrists, psychologists, mental health nurses, social workers and

counsellors) it is reasonable to propose that a national help-line would enable

accessibility on a larger scale and help overcome many of the existing barriers to

accessible, culturally appropriate crisis intervention and referral services.

This proposal identified the need to deliver mental health care within

Indigenous frameworks of social and emotional wellbeing, as advocated in the

Ways Forward Report and the Social and Emotional Wellbeing Framework 2004

– 2009 (Swan & Raphael, 1995; Social Health Reference Group, 2004)

Additional strategies for providing culturally appropriate services for those

disabled by serious and recurring mental illnesses such as schizophrenia, major

depressive and bipolar disorders, are also required. Support and training to

state mental health service crisis intervention teams and recruitment and

training of more Indigenous mental health around the nation is part of the

APS/AIPA reconciliation action plan but this is a longer term objective and more

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immediate goals include the provision of cultural competence training and

ongoing skill and career development for the health and community services

workforce.

Further issues that need to be investigated to change institutional and cultural

racism within the health system include:

Recognition of the diversity of understandings of social and emotional

wellbeing which exist among the many language groups throughout

the country;

Communication issues for English speaking health providers working

with Indigenous patients for whom English is not their first language;

Unequal technological needs and resource availability in urban, regional,

rural and remote communities throughout the country;

Access to communication technology that is appropriate for use by

members of the Indigenous community nation wide;

Telephone help-line services currently provided by organisations need to

eradicate barriers to uptake and service provision- this may include

their support for an Indigenous-specific help-line;

Developing service delivery models, practice and operational frameworks

for an Indigenous help-line;

Working in collaboration with Indigenous health organisations to

investigate requirements for the recruitment, orientation, preparation,

on-going support needs, and retention of health service providers and

operational procedures for service providers.

The proposal to develop help line is one of many approaches to support victims

of racism and a national Anti-Racism Strategy should call for an updated and

specific Indigenous Social and Emotional Well Being (Mental Health) Strategy to

counter the racism of the current Mental Health Systems in Australia.

4.3 Action about health inequalities

Health inequalities between Aboriginal and Torres Strait Islander people and the

general Australian population are well documented and links between poor

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health outcomes and racism are internationally recognized (WHO Determinants

of Health 2011 Marmot & Wilkinson 2006;). The social gradient of health and

psychosocial characteristics in the gradient such as depression, psychological

stress and associated health outcomes is also well documented (Wilkinson &

Marmot, 2003, Marmot 2004;) For example, higher mortality rates amongst

Indigenous Australians compared to other Australians relate to: accidents,

homicide and suicide (16% compared to 6% of non-Indigenous deaths);

maternal (five times higher) and infant mortality (three times higher) factors;

chronic diseases; poor living conditions; reduced access to healthcare, education

and employment opportunities in remote, regional and urban areas; and the

continued fragmentation of family networks due to Indigenous people being

removed from families through the child welfare, youth justice and incarceration

systems (Barnett et. al., 2010).

The lack of Indigenous mental health service professionals and providers and

the under-resourcing of the Aboriginal Community Controlled Health

Organisations (ACCHOs) are additional area that, if addressed as part of a

strategy , could reduce the impact and strengthen the response to racism. The

Co-operative Research Centre for Aboriginal and Torres Strait Islander Health,

now called the Lowitja Institute, has identified the further development of the

Indigenous health workforce as another key strategy to address health

inequalities (Lowitja Roundtable 2011).

5. Psychology and Racism

The discipline of psychology has been part of the colonising process and has

contributed to cultural and institutionalized racism as it presents in Australia.

The links between the newly emerging sciences of psychology at the turn of the

century with the salience of biological theories of race were documented in the

APS Racism Position Paper 1997. This notes ` …the tendency to loosely equate

biogenetic designations of race with social categorizations and popular

understandings’ thus contributing to negative stereotypes and confusion about

cultural practices and beliefs’. There are also a number of papers that provide

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critiques of psychology and provide overviews of useful ideas about the

construction of prejudice and strategies to reduce racism (Sanson et al 1997;

Rickwood, Dudgeon & Gridley 2010; Gilies 2012, Penderson 2008).

As a discipline, psychology has taken some steps forward and in recent years

there have been some important paradigm shifts that move towards

understanding the social determinants of mental health and an acceptance of

Indigenous ways of describing and experiencing mental health. As noted earlier,

in Australia, this includes concepts such as social and emotional well-being and

the importance of self determination, which are being embraced by mainstream

mental health providers and practitioners led by psychologists.

(Purdie,Dudgeon & Walker 2010).

AIPA acknowledge the underlying racism evident in the use of biogenetic

theories of psychosocial development and note that the APS- through its

Reconciliation Action Plan (RAP) Working Group and AIPA- will be updating its

critique of psychological literature and work to ensure appropriate Indigenous

content in psychology courses. This action and the RAP, will contribute to

creating appropriate curricula and resources and the mentoring and support of

more Indigenous psychologists.

5.1 The roundtable on racism and Durban Declaration

Psychologists regard people as intrinsically valuable and respect their rights,

including the right to autonomy and justice. Psychologists engage in conduct,

which promotes equity and the protection of people’s human rights, legal rights,

and moral rights. The APS Code of Ethics (APS 2007) reflects psychologists’

responsibilities, which include principles of respect for the rights and dignity of

people and peoples, propriety, and integrity. The Code is complemented by sets

of ethical guidelines, including guidelines on the provision of psychological

services to Aboriginal and Torres Strait Islander people. The Universal

declaration of ethical principles for psychologists (2008)

www.am.org/iupsys/resources/ethics/univdecl2008.pdf explicitly recognizes

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that Psychology as a science and a profession functions within the context of

human society, and as such has responsibilities to society that include using

psychological knowledge to improve the condition of individuals, families,

groups, communities, and society.

Psychologists work to understand important issues facing society and to

enhance community wellbeing by improving the social and environmental

conditions that impact on wellbeing. Through the APS, AIPA specifically raises

concerns and contributes to actions to address racism. This includes advocacy

for the rights of clients to receive culturally appropriate psychological services,

the need for psychologists to access cultural competence training, to facilitate

the profession and discipline of psychology to contribute to the prevention of

racism and to work towards alleviating the impact of institutional and cultural

racism on the social and emotional well being of Indigenous people.

Indigenous psychologists and others within in the APS have been tireless

advocates for the rights of Aboriginal and Torres Strait Islander peoples. This

has included supporting an Aboriginal and Torres Strait Islander Peoples and

Psychology interest group, co-facilitating a Racism Roundtable attended by over

40 researchers and public figures from across Australia in 2009, and developing

Reconciliation Action Plan for theAPS (www.psychology.org.au/reconciliation).

AIPA endorses the contribution of the APS 1997 ‘Position Paper on Racism’ and

the Racism Roundtable Boatshed Declaration (2009). The Boatshed Declaration

called upon the Prime Minister and the First Ministers of Australia to initiate a

plan of action that embeds constitutional protection against racial

discrimination and formally recognizes the capacity and rights of Aboriginal and

Torres Strait Islander peoples to self-determine their future. The Boatshed

declaration also noted that the happiness and wellbeing of all Australians and

their future generations will be enhanced by valuing and taking pride in

Australian Aboriginal and Torres Strait Islander peoples – the oldest living

cultures of humanity. Furthermore, the Declaration noted four key areas for

action to counter racism against Indigenous Australians:

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·Constitutional - that there be a preamble to the Constitution that

recognizes the rights of First Nations peoples, followed immediately by

the establishment of a treaty that details a formal agreement between the

Australian Government and Aboriginal and Torres Strait Islander

peoples, and a framework for national action.

·Policy - that policies that affect and impact on Australian Aboriginal and

Torres Strait Islander peoples must be based on their full involvement

and engagement to ensure appropriate agendas and appropriate levels of

resourcing are applied.

·Practice - that effective and genuine partnerships with governments and

capacity building agendas be recognized as essential pathways to

improving the outcomes for Aboriginal and Torres Strait Islander

peoples' education, health and wellbeing

·Standards - that all actions must be based on, and be an expression of,

the articles in the UN Declaration of the Rights of Indigenous Peoples,

particularly Article 3 (the Right to Self Determination) and Article 42

(calling on the states and agencies of the United Nations to implement the

Declaration).

AIPA supports the call made at the International Action Against Racism: Durban

Declaration and Program of Action. Furthermore, we emphasise that without

culturally appropriate screening and assessment tools and the development of

culturally competent health and mental health systems, there is a high risk that

serious psychological distress will be misdiagnosed, and inappropriate

treatments will be provided in response to help-seeking on the part of

Indigenous people. Cultural competence is directly linked to producing positive

outcomes, as it can only be said to have been achieved when there is a

demonstrated improvement in Indigenous SEWB and mental health outcomes at

an organisational, regional, system and population level (Kelly, Dudgeon Glaskin

2009) .

As already noted AIPA’s unique contribution and expertise is about the impact of

racism evident through the lack of culturally appropriate and culturally safe

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mental health services. We propose that the National Anti-Racism Strategy seek

to address the need for change in this area and propose that appropriate

resourcing for actions that emerge from the SEWB strategy we acknowledged at

a key action in the Anti-Racism strategy as a measure against systemic racism.

AIPA also recommends that the HRC promote the celebration of diversity as part

of its strategy.

6. Indigenous mental health movement and culturally appropriate paradigms

Considerable changes have come as a result of the actions of many over the last

four decades. For example, the formation of the National Aboriginal Mental

Health Association (NAMHA) in 1979 was a founding voice about Indigenous

mental health. They successfully advocated for the inclusion of mental health in

the training of Aboriginal health workers (reference?). There have been many

years of collaboration between Indigenous and non-Indigenous mental health

workers and a philosophical approach of empowerment and self-determination

in the provision of mental health services for Indigenous people (Purdie et al:

2010:21; Tsey and Whiteside 2009, Whiteside 2011). Aboriginal and Torres

Strait Islander people have used their own medicines and healing practices for

centuries. This is sometimes acknowledged and more recently has become a

respected and sometimes collaborative practice. See for example, stories of

Aboriginal healers in Central Australia and their work in collaboration with

mainstream health services (NPY Women’s Council2003; see also Peters 2010).

Culturally appropriate assessment tools require paradigms that acknowledge

the diversity of Aboriginal and Torres Strait cultures and diverse colonization

experiences in Australia. A recognition of historical and cultural contexts for

social and emotional well-being must be understood and included in

psychological and psychiatric assessments. These issues have been documented

in many major Government reports including: the Social Justice Reports, the

Bringing Them Home Report, the Little Children are Sacred Report and the Royal

Commission Report into Aboriginal Deaths in Custody. Psychological issues may

be a result of physiology or trauma, or it may be linked to transgressions of the

law- even unknowingly. What matters most importantly is for workers to find

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effective communication processes to determine the ‘patients view of their

situation’.

Gilies: (2012 ) notes that the promotion of self-determination is also critical in

the discipline of psychology and identifies that it this is underway within the APS

through the reconciliation process and the Bendi Lango Scholarship. However,

she goes on to state

`… we have a long way to go. Based on population estimates there should

be 624 trained Indigenous psychologists in the country to contribute to this

process, but currently there are only 45. ‘

6.1. Self-determination and meaningful ongoing consultation

Central to individual and community wellbeing is the concept of self-

determination. A person’s right to determine their own destiny impacts directly

on happiness and health, and is particularly significant for Indigenous

communities because of the denial of this right in the past. Self-determination

must go beyond consultation to active engagement and partnership with ATSI

communities to be fully realized. AIPA endorses the plan’s actions to work with

the National Congress of Australia’s First people, as well as support by the

Government to recognize Indigenous people in the National constitution. But

these should be starting points within a broader commitment to recognition,

reconciliation and respect.

Land and connection to land and water are at the core of Aboriginal spirituality

and well-being. Aboriginal people have a right to their lands and the resources,

which they have traditionally owned. AIPA supports the strengthening of native

title arrangements and notes that further action is needed to address the

watering down of the Native Title Act as a result of the 1998 amendments

having weakened the position of Aboriginal and Torres Strait Islander peoples

within native title law. The native title system is unnecessarily lengthy and

complex and this process has been divisive for many Aboriginal and Torres

Strait Islander peoples, impacting significantly on their wellbeing. (APS 1997)

25

The suspension of the Racial Discrimination Act (1975) with little or no

consultation was a disrespectful and colonizing action against Aboriginal and

Torres Strait Islander people in the Northern Territory. Although the Act has

now been reinstated, there remain concerns that this has not been done fully or

unconditionally. Serious issues remain with the current legislation, Stronger

Futures, due to be put before the Senate which is built upon a paternalistic and

discriminatory rationale. (i.e., compulsory welfare quarantining based on race).

It is imperative that the Principles of the Declaration on the Rights of Indigenous

Peoples, in particular the right to free, prior and informed consent are realized.

AIPA calls for implementation of the constitutional protection against racial

discrimination; for example, this would mean ensuring that initiatives like the

Stronger Futures (NT) better reflect the aspirations of Aboriginal and Torres

Strait Islander peoples for themselves and acknowledgement of the capacity and

the right of Aboriginal and Torres Strait Islander peoples to self-determine their

futures.

6.2. Psychology: current & proposed AIPA actions to combat racism

This submission calls for sound research in endeavors to combat racism as a

threat to Indigenous social and emotional wellbeing in Australia. Paradies et al

(2008) argue that establishing the forms of systemic racism that are the easiest

and most beneficial to address, and developing interventions to foster

sustainable anti-racist cultures and environments are important principles in

anti-racism work. They go on to note that improving health system performance

is a key objective to address the systemic racism in the health sector. Enhancing

and tightening health system practices, policies and processes leaves less leeway

for systemic or interpersonal bias to influence clinical decision-making. Better

treatment and health outcomes for Indigenous patients have been demonstrated

via improvements in service provider practices. Research from the United States

describes a range of effective approaches to reducing racial bias among health

care providers that should be explored in Australia (Burgess et al. 2007).

The racism identified in the general health system is also present in the Mental

health system. A national Anti-racism strategy must address systemic racism

26

and advocate for change at the institutional and cultural level as well as the

individual and personal level. Social and emotional wellbeing services for

Indigenous Australians are urgently required. Prevention programs and

campaigns to raise awareness and encourage social activism against racism are

also required.

6.3. Anti Racism, responsible media and using media as strategy

There is anecdotal evidence from many Aboriginal and Torres Strait Islander

people that the perpetuation of inaccurate and negative portrayals of Indigenous

Australians is itself a form of racism and feeds racist attitudes. The recent (May

6th 2012) description in the media- ABC news and National print media- of a man

being `scalped’ at a remote Indigenous community is one such offensive

example. Similar injuries against non-Indigenous people are generally reported

as `serious head injuries’. This example is a clear negative stereotype that is

weighted with negative cultural baggage and from another first nation country

at that!

Media campaigns have been shown to be effective in encouraging attitude and

behaviour change. Compared to health issues that have been associated with

numerous media advertising campaigns over the last two decades, media

advertising has been under-utilised in marketing social issues such as racism.

Media campaigns linked to raised awareness about the impact of Family

Violence, Smoking and AIDS are examples of the successful use of media.

Research on the effectiveness of media advertising campaigns that are

specifically designed to combat racism in the community are few and far

between. One such study, however, is reported by Donovan and Leivers (1993)

who, together with government agencies and local Aboriginal groups, designed a

two-week media campaign challenging negative stereotypical beliefs about

Aboriginal people in employment found that the campaign had significantly

shifted community perceptions about the proportion of employed Aboriginal

people and their length of time in employment.

Engaging the media to ensure training is provided to journalists, media policies

and procedures, guidelines, ethical codes designed to promote fair reporting on

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issues relating to indigenous communities and the inclusion of anti-

discrimination messages in entertainment media are important elements to

consider..

AIPA recommend that the national Anti-Racism strategy prioritizes media

campaigns to reduce racism, as well as working collaboratively with the media

to develop strategies to take responsibility for representing Indigenous

Australians in ways that discourage negative stereotyping. We also recommend

that cultural awareness training be made available for all people involved in the

media.

6.4 Anti- racism education and resources

The series First Australians which premiered on SBS in 2009 is an excellent

resource that could rotationally screened on all free to air television stations

several times a year and at advertised times for schools.

Given that early childhood is the time when stereotypes and attitudes are first

being formed, there is an emphasis in the anti-racism literature on early

childhood interventions. However, the importance of cross-cultural awareness

and education for adolescents and young adults should not be underestimated.

Some young adults, especially those who attended predominantly monocultural

schools in their formative years, may have had little contact with people of

different backgrounds. AIPA support the APS recommendation that education

for intercultural understanding, antiracism training and effective conflict

resolution, in age appropriate forms, be integral parts of school and preschool

curricula. Schools and other organisations should make use of the research

literature and resources to ensure such programs are as effective as possible.

One aspect of this education should be an examination of history which

illustrates the changing boundaries between groups. Members of local

Indigenous groups should be involved in the development and teaching of these

programs.

In light of the potential of legislation to change community attitudes in the long

term, historic legislation such as The Native Title Act (1993) may in future be

viewed as a milestone in shaping Australian race relations. The symbolic

28

significance of abandoning the doctrine of ‘terra nullius’, which had for 200

years been embodied in Australian law, cannot be over-estimated. The national

Apology 2007 is also an important milestone to include in anti-racism programs.

Whilst it is important to change individual attitudes, this is only one strategy

that should be used.  We need to look at the wider picture; governments (as

noted above) can influence public attitudes.  While changing individuals’ racist

attitudes is important, so is changing racist structures. 

Effective anti-racism education involves processes whereby members or groups

of the dominant culture take responsibility for working in partnership with

indigenous groups to: tell the true history of colonisation; address structural

change in institutions; embed policies of cultural safety in programs and

intervention strategies; and share power and resources in ways which require

the dominant culture to transform itself.

The APS summary of the anti-Racism literature suggests that the best possible

strategy for combating racism is multi-faceted, and developed in accordance

with the specific and local circumstances of the community for which it is

intended. Specifically, a dynamic, iterative and consultative approach, using both

‘top-down’ strategies (e.g., community or institutionally instigated action, such

as advertising campaigns targeting specific actions or behaviours — as in the

successful HIV/AIDS prevention Grim Reaper campaign) and ‘bottom-up’

strategies (e.g., addressing specific racist behaviours), is more likely to succeed

than are replications of ‘one-size fits all’ programs, without due regard for local

community concerns and political sensitivities around the issues of entitlement,

dispossession, racism and prejudice(APS 1997). More recent programs such as

the LEAD program in Whittlesea agree that in the design and implementation of

any strategy, it is advisable to work collaboratively with other community

agencies, in order to avoid the duplication of initiatives, and — in future — to

evaluate the success of each strategy with reference to empirically rigorous

process, interim and longer-term outcome criteria (Paradies 2012).

APS also identifies that the lessons learned regarding what works to address or

reduce racism include;

29

Involving groups who have and continue to experience racism in the

development, delivery and evaluation of anti-racism initiatives

No strategy for change will be successful without significant political will,

as not everyone wants to reduce racism, as arguably sections of the

general community currently benefit from prevailing intergroup tensions

Moral exhortation to be nice to one another does not work

Attempts to portray groups as ‘different but nice’ do not work

Attempts to reduce prejudice and racism are unlikely to have generic

effects (need to be locally targeted)

Any strategy must not expect instant results, change takes time

Strategies must target different aspects of prejudice and racism at

different times in a sequenced program

Attitudes are important to target as precursors for introducing more

structural or legislative change.

This research points to a need for continuous interventions at all levels. If the

benefits are eroded by day-to-day experiences, organisational culture, media

portrayals and by government action and lack of action, we cannot expect even

the best designed but time-limited and localised programs to have a strong,

lasting impact.

6.5 Research & evaluation

High quality research and evaluation should inform public policy and everyday

practice and as such it must be at the heart of our endeavours to understand and

combat racism in all its forms (Racism Roundtable, 2009).

Research about racism in Australia is not given the central role it warrants and

deserves despite recognised scholarship in this field (Paradies, Dudgeon,

Purdies, Walker). The Racism Roundtable gathering proposed combating racism

as an interdisciplinary undertaking and AIPA is a strong advocate for such

collaborative work.

It is also important that mechanisms to collect, compile, analyze, disseminate

and publish, reliable statistical data are supported at state and national level.

30

This would contribute to informed assessments of the situation of all victims of

racism, racial discrimination, xenophobia and related intolerance, in accordance

with the Durban Declaration and Program of Action.

Strong cultural identity on the part of those subjected to racism has been

associated with positive self-conceptions and greater resilience (Paradies 2008

Dudgeon 2010;Zubrick et al 2005; Paradies 2011) Programs that support

cultural identity need to be put in place for many reasons but high amongst them

are that they build resilience and assist to combat the effects of racism.

AIPA, and Psychology as a discipline, are committed to contributing to the

evidence base about what works to improve Social and Emotional Wellbeing/

Indigenous mental health. Research to develop and evaluate Indigenous specific

assessment tools, empowerment programs and crisis support are urgently

required. AIPA has developed a cultural competence training program that is

oversubscribed. Support to continue and perhaps expand this mainstream

program could be linked to requirement for all health professionals to regularly

undertake cultural competence training. We also support the proposal by APS

for an Indigenous specific 24hr crisis telephone support service and the

development and trail of Indigenous specific psychological assessment tools-

particularly for use in the forensic, health and school systems.

In conjunction with the APS, AIPA has developed a Reconciliation Action Plan

that advocates for Indigenous curriculum in all psychology courses; an increase

in the number of Indigenous psychologists; the continuation of mentoring and

scholarship programs for Indigenous psychology students, partnership and

collaboration in health research, review of APS governance and policies and

cultural competence training for the APS board and members. These are some

of the concrete steps being taken to challenge racism in our discipline and

profession.

31

32

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