Keynote Address: Stephanie Bell - One Life Is Too Many
TRANSCRIPT
KEYNOTE ADDRESS: Stephanie Bell - One Life Is Too Many
Stephanie Bell, chief executive of the Central Australian Aboriginal Congress, talks about suicide as a preventable cause of death in aboriginal communities in the Northern Territory, with evidence of successful interventions and initiatives.
Well good afternoon everyone. Look, firstly, as it is our custom, I would like to begin to paying my respects to the Maori elders, both past and present. I also want to give special recognition and acknowledgement to the youth that are here today as well.
I’d like to thank the conference organisers for giving me the honour and privilege to come to your country and to come and talk about the issues across the ocean in terms of suicide, but also not to talk about it, but what we can practically do about it. So part of my talk is speaking from the point of view of a Health Service provider.
The first thing I wanted to do was give an outline to everyone about the Central Australian Aboriginal Congress. We grew out of a people movement in 1974, where the local aboriginal people at that time were in a paradigm of segregation. And so the local leaders took action to make sure that aboriginal people got the appropriate access to healthcare and a whole range of social welfare services at that time.
I want to then talk a little bit about the epidemiology of suicide, both within a national context, but also from within a context of the impact in our community, and the level of suicide. And then I’ll talk about Alice Springs where we live.
I then want to focus on some of the key determinants of suicide, with particular emphasis on interventions that have a strong evidence base, and can make a big difference in reducing the terrible suicide rate in aboriginal communities in Australia, especially among our young people.
So much more could be done than is being done, and we need to implement the types of programmes that I’m going to talk about, in key areas, as a matter of urgency.
Suicide is preventable, and even one death from suicide is one death too many.
Much of what I’m going to say is in a policy platform paper that our organisation has developed which is called ‘Rebuilding Family Life in Alice Springs in Central Australia - the social and community dimensions of change for our people’.
The next part is just an organisational chart, we started in 1974. At the moment we have three hundred staff, full-time, that work for us. And we do that in across what we call Aboriginal Community Controlled Comprehensive Primary Healthcare, which is providing a holistic approach to aboriginal health.
We have a range of services and programmes, and a lot of it’s outreach community-based. We provide support to five remote communities; some of those communities are within three hundred kilometres of where we live, others are within seventy-five to a hundred, so we provide a... like a big brother support role to those broader communities around their own development, their aspirations and the needs for their people.
The next slide is just letting you know that part of what we do tries to follow the principle of equity and access, and reducing barriers for people across the whole health spectrum.
I just want to talk briefly about what’s happening in Australia in the Northern Territory around suicide. In this graph here, it just shows you that nationally, suicide rates are declining, including for youth. As you can see, suicide is much more common... is a much more common cause of death in men, and this is true for aboriginal communities as well.
The next graph shows you, in the Northern Territory where we live, that we have got the highest suicides rate of any other state and territory. And that’s where we live and work. In the Northern Territory there’s a total of fifty-five thousand aboriginal people who live there, and fifty percent of that fifty-five thousand are under the age of twenty-five. The challenge is quite enormous.
The next graph here shows that the suicide rate is increasing in the Northern Territory, especially young youth, and this is in contrast to what is going on nationally where the suicide rates are declining.
As you can see from this graph, it is more likely to affect a younger person in an aboriginal community than in the broader Australian community, so that just shows you the Northern Territory aboriginal population, and the Australian population, and the age group.
The increasing trend amongst indigenous males is very clear, and when you compare the number of deaths per year for two decades with the first two years of this decade, the end... the Northern Territory has continued with the very high rate over that decade.
This data here is a more of an indication within the region that we live, where between the year 2001 and 2011 we had a total suicide deaths of 108, and it shows you the age group within them, and which were youth and which was over 25 years of age.
The next graph shows you the comparative difference between non-indigenous and indigenous, and the gender is on the next column, and down in the lower corner it shows you the three main town areas within which we live, where those resident communities sit.
In the community of those three regions up there we have a population of about forty-five thousand people, and there’s twenty-one thousand of those which are aboriginal. Even though we make up less than half the population, seventy-five percent of the suicides are aboriginal people. Alice Springs has a... where we live is a population of twenty-thousand people. Tennant Creek has three thousand people, which is five hundred kilometres from where we are, and the rest of the population, about fifteen thousand, live in dispersed geographical bush locations, and a lot of those communities live in very poor infrastructure, no housing, most of them would probably only have a doctor visit them once a month, and they fly in, so people are living in really extreme circumstances.
And as I’ve said that in the last twelve months, nearly all of the suicides have been by youth under twenty-five.
This next slide is to demonstrate that our government, as here, has taken note of the number of people under the age of twenty-five taking their own lives, and has set up an enquiry in terms of what the government response, but also, importantly, a community response to what needs to happen.
The next part of what I want to talk about is what we’re focusing on in our own community, is that I think on the basis of the evidence and what we know across the globe – this is a global issue – that we think the issues of early childhood need to be seen as essential in how to address suicide.
Where I think the calling even from the Royal Colleges of Psychiatrists are all saying that there’s got to be a better focus on early childhood in order to reduce a whole range of health issues including self-harm and suicide, and that tackling mental health early in life will improve educational attainment, employment opportunities and physical health, and reduce the level of substance misuse, self-harm and suicide as well as family conflict and social deprivation.
There’s a number of strategies, programmes and services that we need to do, and we’ve got to take a bottom up and a top down approach, and we’ve got to do that in collaboration. I think the science without the community is nothing. It’s the same with medical care and medical models, that one without the other is not going to assist us to close the gap, and in fact it’s making the gap wider. And so I think that’s an important message about where we’re coming from, and we’ve got to get integration, and we’ve got to focus on primary prevention.
I want to just reference, because I’m in your country, I thought that there’s a study that you might have... that came out recently which revealed the extent of the correlation between impulsivity and self-control identified in early childhood, and the longterm health and well-being. Impulsivity itself is an important character trait that probably places young people at an increased risk of suicide.
The scientific evidence, and what we all hear about in terms of a medical clinical approach I think is necessary, but it’s only a framework that allows us to have a dialogue, and the key challenge I think for all of us is the implementation of that knowledge, and defining best practice in an indigenous context. They’re the challenges, because I think evidence is something that we don’t lack, intellect, we all have a knowledge, but one without the other is not going to assist.
There’s an Australian Early Development Index that we use in Australia that comes out regularly, reporting on the extent of children in terms of language and cognitive domains and development, and that, really, it’s sending a message that we’ve got to get in much earlier, and get in the front end rather than trying to plug all these holes with massive interventions at the wrong end of the system, which is where the medical model and that paradigm sort of disempowers us. And I think even though we can all recognise it’s got a role, it singularly cannot address the social issues for us as aboriginal people, and we need both tools. And the indigenous paradigm seems to get left off the train, and I think that’s a struggle that we’re all in, to try and assert our authority and our knowledge in a system that ignores it.
The next thing I wanted to talk about was to let people know about what we’re trying to do in our community about primary prevention, getting in the front end. And this programme has come out of a University in Colorado, by a guy named Professor David Aules where he’s trialled this programme over a thirty year period. And it’s a licensed programme which has got a whole lot of integrity and requirements that you have to fulfil when you’re implementing it, and what it’s demonstrated over its thirty year pilot is that if you provide a home visitation programme to young mothers in early pregnancy, up until they’re two years old, it has a lifetime effect on both the mother and the child. And it has, and it reduces a whole range, has better improved pregnancy outcomes, it improves child health and development, and it improves the parent’s economic self-sufficiency.
And for us, we see this as making an investment. It’s a non-clinical programme and it works on the parameters of the social cultural context of that mother and that family’s life. And it doesn’t mean their health doesn’t get addressed, but it just doesn’t dominate, and it puts the social cultural context of that family at the front of everything.
He’s done this study in a number of communities, and the reason our community got selected in Australia is because in Alice Springs we have one of the highest births of aboriginal families in Australia, besides Victoria and in another town called Cairns, so those three communities are where the most aboriginal births take effect. So we have three hundred births a year in our region, and at the moment we’ve got a hundred and one mothers that have enrolled on the programme, and it’s really having good impacts.
Next week we’re having the first anniversary of a mother who’s graduated in the two year programme, and it’s completely home visitation. And a lot of the environments and the areas that our young mums that are on this programme, they live in an environment which we call back home ‘town camps’, so they’re pretty equivalent to the shanty towns you see in South Africa. So that’s where a lot of our young mums live in those type of environments – very tough, and there’s a few criteria like you’ve got to be twenty-eight weeks pregnant as a part of being eligible, but you get a whole range of support before the baby’s born.
And I think our staff are quite hesitant, and felt that because we’re going to have all these non-aboriginal nurses that work with our aboriginal family support workers, that the acceptance of them going into those environments would have a negative impact. But it’s actually worked quite well for both the mothers and the dads, so we’ve had lots of men who have engaged, and over time the men... and we’re talking about men who are... who live quite traditional lifestyles, and, you know, the social status issue that is a part of all of that, and it’s really allowing them to engage in a programme that’s... we’ve had lots of the young men saying look, I need to do something about my behaviour, I shouldn’t be like this, and it’s... and then because we have a whole range of services and programmes that’s all under the one roof, the men can then come and be introduced to our male health programme, or they go to where they can get some treatment for alcohol or whatever they want, and it’s working in a way that it’s almost like a family, and so they shop around and get the assistance that they need.
So when he did this study he did a predominantly white community in one of the low income socio-disadvantaged population outside of New York, so most of the women in there were single, they were into prostitution, they were heavy into drugs, in and out of prison, and what he’s done with each of these family groups he’s gone back and followed them up fifteen years later. And so when he went to Memphis he did a predominantly Afro-American community, and then he did a study in Denver which was predominantly on the Hispanic community, and so it’s out of all of those programmes where he’s refined the way this programme functions, and, as I said for us, I think we’re taking a risk, but I think given the environment and the situations that we’re confronting, we’re actually compelled to act, and we’re to do something and to see if it will have the kind of outcomes that he’s had in other communities.
And I think at the moment our community, and the young women of today that are having children, are responding quite positively. We can’t be completely certain whether the evidence of those three communities is actually transferrable for aboriginal population, but that’s part of the journey of reflecting on our own services and programmes, and whether it’s working. We can’t keep delivering services if they’re not having the outcome.
And it’s shown as part of that outcome that most of the young children that he... that got two years of a complete home visitation, it took a two year programme, that a lot of the young children ended up with better education attainment, their risky behaviours were reduced, and their mothers got reintroduced into the workforce.
So at the moment with our one hundred and one mums that we’ve got on the programme at the moment, we’ve identified thirty of them which can’t... they... those thirty young women who have got their first-time babies, none of them can read and write, and part of the programme is introducing them back into, and they’re attending sort of TAFE College, literacy and numeracy programme, and they’re turning up every day. And they’re just... they’re enjoying it, so it’s giving them a sense of achievement, and a journey of change for themselves.
So this is where the programme, from our perspective’s really having the outcome, and it, as I said, it’s a non-clinical medical approach, it’s actually the social cultural context of supporting young mums with the challenges of today.
The programme’s prescribed, so I mean it’s sort of... it’s got a ratio where the home-nurse visitor has to case manage twenty families. We found that that was going to be quite extreme because some of the mums that are on the programme have already got three or four children. Trying to implement these type of programmes in a family environment where someone’s got three other children has been quite challenging, because the importance of working with the mum is giving her the... empowering her to make better decisions about what she needs to do in terms of her family and the future.
These are just slides which talk about the economic benefits and gains that this programme makes just on the premise of two years of home visitation. This little snippet that I’ve put up here is really a snippet that’s come out of a monthly journal that talked about the level of suicide, and how young people in the top end of where we live are suiciding. We all need to recognise, I guess, that alcohol is one of the many causes of suicide - certainly in our community – and that needs to be addressed as an underlying cause.
The causation of suicide is complex, it’s multi-faceted, and it does include alcohol. Impulsivity is being seen as a contributing factor, that it might be things that it’s already instilled in our children before they get to a point. And we need to think about that, and what that means, and I guess what we’re trying to do is look at addressing that from within a preventative lens, and get in early and see primary prevention in early childhood as a way of eradicating some of the symptoms and signs later on.
I wanted to talk just a little bit about cultural continuity, because I think that’s something that’s come up here quite a lot today. I’ve referenced a study that’s been done in Canada which I think we all understand what it means, and I think we’ve got to renew that. And it came up in the indigenous session earlier, that we’ve got to find that pathway and journey back about strengthening our community and who we are, if we want to have, you know, the issue of suicide and our young people to be our leaders in the future.
In spite of the need to focus on early childhood, it’s also necessary to provide programmes that work for young people who already have a range of issues and problems that they’re experiencing. And the key that we think, to all of these approaches, is the need to work with family, parents and community, as well as teachers and schools, peer groups, as a way of then achieving those goals that we can which give the young people the support they require at that particular time where they are.
The other thing I’ll just roughly talk about is an approach that we’ve been looking at in terms of multi-systemic therapy. It’s an intensive family and community-based treatment programme which focuses on the entire world of chronic and violent juvenile offenders, their homes and families, schools, teachers, neighbourhoods and friends. And it works with the toughest offenders.
There are adolescent males and females between the ages twelve and seventeen who have longterm arrest histories, and this multi-systemic therapy approach allows the integration and the kind of support that young people need to work through the issues that creates those kind of behaviours and outcomes that we see currently. It’s a very expensive model, it’s worked in a couple of communities in Australia, it’s got a lot of evidence base, and it seems to have the outcome and effect that you want in terms of young people.
I know that was very quick, and I hope that I was able to provide a snapshot to you about where we’re coming from in the Northern Territory, the challenges that we have in Australia which I think are global, and I think that coming here and sharing what we’re doing, and what we see as the future for our children and families, to deal with these issues as they arise, is really what we’re on about.
So I hope some of the key interventions, and the trials and tribulations that we’re attempting to address, gives a window of opportunity for people to think about. And as I said, the paper that we’ve developed, and if people want to obtain a copy, just come and see me. So, thank you.
