Issue 1 • 2021

RACP Congress 2020: First Peoples’ Health

RACP Congress 2020 focused on pressing health issues that Australia’s Indigenous communities face, including Indigenous youth suicide, the incarceration of Indigenous children, the syphilis epidemic, and Indigenous trauma and wellbeing.
Chair of the Aboriginal and Torres Strait Islander Health Committee, Associate Professor Luke Burchill, Yorta Yorta / Dja Dja Wurrung man, chaired the session, stating that the goal of the discussion was one of activation, “to inform and move participants and to take participants from being active listeners to active champions”.
“We need your help to improve the lives, opportunities and health outcomes of our communities. This is not our work alone,” said Associate Professor Burchill.
Indigenous youth suicide
Professor Patricia Dudgeon, from the Bardi people in Western Australia and Australia’s first identified Indigenous psychologist, Director of the Centre for Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention at the University of Western Australia, spoke on youth suicide and what needs to be done to prevent it.
“The overall Aboriginal suicide rate was twice that of other Australians. The rate of intentional self-harm among young Indigenous people aged 15 to 24 is about four times the rate of other young Australians,” shared Professor Dudgeon.
Professor Dudgeon relayed that the high Indigenous suicide rate is attributed to a range of complex and interrelated factors that heighten the risk of suicidal behaviours and self-harm. These can include the cumulative impact of:
  • ongoing exposure to socio-economic disadvantage and multiple psychological stressors
  • grief from the premature deaths of family, community members and friends, including suicide
  • violence and interpersonal conflict
  • transgenerational trauma, grief and loss associated with the ongoing impact of dislocation and the effects of forced removal of children and mistreatment
  • pervasive racism and discrimination at individual, institutional and system levels
  • a loss of a sense of purpose and meaning in life
  • poor health, including a number of co-morbidities and severely compromised health and social and emotional wellbeing
  • an ‘access’ gap to mental health services, with 34.5 per cent of Indigenous peoples who reported high or very high rates of psychological distress also experiencing access problems to health services.
“The biggest take away is there needs to be self-determination. Aboriginal and Torres Strait Islander people need to be in the co-design of any suicide prevention program and service or policy. They need to be in charge, and part of, doing regional plans and programs. We need to engage in a process of Indigenous governance and self-determination,” said Professor Dudgeon.
Incarceration of Indigenous children Next on the panel, presenting on ‘Too young for Facebook, old enough for prison’, was Dr Mick Creati, paediatrician, adolescent physician and College spokesperson on raising the minimum age of criminal responsibility.
Dr Creati spoke about Change the Record, Australia’s only national Aboriginal-led justice coalition of legal, health and family violence prevention experts, whose mission is to end the incarceration of, and family violence against, Aboriginal and Torres Strait Islander people.
“The coalition specifically brings attention to Raise the Age, where we are campaigning to raise the criminal age of responsibility from 10 to 14 years. Aboriginal and Torres Strait Islander people are one of the most incarcerated people in the world. On any given day, of children aged 10 to 13 years in custody in Australia, 60 to 70 per cent are Aboriginal and/or Torres Strait Islander,” said Dr Creati.
Until efforts are made to ‘close the gap’ and Indigenous Australians have the same socio-economic outcomes as non-Indigenous people, we will continue to see over-presentation of Indigenous children in custody. Incarceration is now one of the indicators in ‘Closing the Gap’. Dr Creati and the coalition view raising the criminal age of responsibility from 10 to 14 as one of the pillars for achieving the Closing the Gap targets.
“We now have lots of evidence that the human brain is not fully developed until the age of 25 years. The last part of the brain fully developed is the prefrontal cortex, which controls your executive functions, your capacity to foresee the consequences of your actions and to control your impulses. A lot of the ‘crimes’ the children are incarcerated for are impulsive actions explained by the relative immaturity of their brain.
“We are also incarcerating children whose behaviours are driven by really significant trauma histories. Ironically, we are then exposing these children to additional trauma that children in detention are inevitably exposed to i.e. separation from parents, and lockdown, often in isolation, which is completely out of line with what society expects children to be protected from.
"Government has a choice – do we treat these children as vulnerable or do we treat them as criminal? I think we are winning the argument that it is absolutely ridiculous to lock these kids up.”
The syphilis epidemic Professor James Ward, a Pitjantjatjara Narungga man and a national leader in Aboriginal and Torres Strait Islander research, presented on the ongoing challenges of sexually transmitted infections (STIs) in remote communities, including a syphilis outbreak plaguing these communities for some time now. “This syphilis outbreak has been ongoing since 2011. It wasn’t until the end of 2017, that the Commonwealth really put a lot of effort into rolling out a large-scale test and treat program into remote communities. This is an epidemic that we are still trying to get under control in many communities across Australia,” said Professor Ward. Professor Ward reflected on what needs to change, mentioning:
  • social determinants of health (education, income, employment and housing)
  • ongoing impact of colonisation (unresolved trauma, unfinished business, no truth and reconciliation commission), ignoring the Uluru Statement from the Heart
  • relentless racism within society and within our systems
  • social and fiscal environments (gap between the haves and the have nots)
  • health system reform.
Indigenous trauma and wellbeing Associate Professor Tamara Mackean is a Waljen woman and Fellow of the Australasian Faculty of Public Health Medicine.
As the last speaker, she shared “It’s incredibly important for us as physicians to understand the nature of bonding that Aboriginal and Torres Strait Islander peoples and other First Peoples have with their place, their Country that they have lived on for tens of thousands of years. Many Aboriginal and Torres Strait Islander peoples don’t always get the opportunity to be in Country and are at a distance from their sovereign place, their homelands. That connection to Country is a very strong, very real and very important for the way we move forward as a society today.
“The Uluru Statement from the Heart shows us the importance of sovereignty and what that means for Aboriginal and Torres Strait Islander wellbeing. As healers, as physicians, we need to understand all the bonds that are important for our patients and their families. We also need to understand some of the disruptions to those bonds. First Peoples often carry complex trauma burdens that include cultural, spiritual, historic and intergenerational aspects.”
Associate Professor Mackean shared three care frameworks for physicians as they engage in clinical interactions. “Patient centred care is part of our quality healthcare system and it means that we must take into account individual people’s context of their lives, and the priorities as they see them. Culturally safe care means that we need to understand how privilege and how culture can interact and be unhelpful in a clinical interaction. It also speaks to the notion of decolonisation, which is to really engage with what colonisation has wrought upon Aboriginal and Torres Strait Islander peoples and move in a way and conduct one’s self in a way that sees that and does not deny it. Trauma informed care is a critical area as we move into the future. This is about people’s sense of safety. We automatically think that people who come to see us as healthcare providers should feel safe. That is certainly not the case for First Peoples all of the time. It takes a lot of work to make sure someone is safe, and someone isn’t retraumatised by the process of engaging with yourself as a physician.”
  • Self-determination is essential – Aboriginal and Torres Strait Islander people need to co-design suicide prevention programs that meet them where they are.
  • End incarceration of Aboriginal and Torres Strait Islander children in custody – join the Raise the Age campaign to raise the criminal age of responsibility from 10 to 14.
  • Patient centred, culturally safe and trauma informed care frameworks are essential knowledge for clinicians providing care to Aboriginal and Torres Strait Islander people.
Learn more and watch the full recording of the
RACP Congress 2020 session on First Peoples Health.
© 2021 The Royal Australasian College of Physicians