Ways forward: national Aboriginal and Torres Strait Islander mental health policy
Mental health problems of Aboriginal children, young people and families
The demographic profile of Aboriginal people highlights some essential differences from the general population. For instance over 40% of the Aboriginal population is below the age of 15 and almost 15% below 5 years. The comparable figures for the total population are 22% aged less than 15 and 7% less than 5 years. There are comparatively fewer old people with only 6% of Aboriginal people over the age of 55 compared to 20% for non-Indigenous people. The population mobility is similar with above 45% with a different address on census night. Multifamily households are more common with almost 12% of Aboriginal families living in such settings compared with only 1.5% of the non-Aboriginal population. Average household size is almost double (4.6 persons compared with 2.6). There are more than double the number of single parent families (27% compared to 12.6%) and more families with dependents (73% compared to 53%). These issues are highlighted in a valuable report from SNAICC (1994).
This report also documents some of the social and economic disadvantage experienced by Aboriginal families, but highlights as well the disempowerment that comes from identifying Aboriginal problems just in the context of "Disadvantaged" families, rather than recognising the effects of Indigenous status, historical effects of colonisation and institutional racism (SNAICC, 1994). Income levels are low with almost two thirds of the population aged 15 and over reporting income levels below $12,000 compared to 45% of the non-indigenous population. Only 2.2% of the Indigenous, compared to 11% of the non-Indigenous earn greater than $35,000. Unemployment levels range from 30% perhaps as high as 70% if CDEP programs were not in place (CDEP - Community Development Employment Program).
There is also a very high proportion of long term unemployed and it is stated that 60% of all those registered as unemployed and waiting placement are Aboriginal. Thus Aboriginal families, because of high proportion of young people and low levels of employment, have high dependency ratios which make them very vulnerable in terms of policy changes and disempowered in terms of their relationship with Government. This is further added to by the fact that single parent families are in high proportion. All these factors contribute to the vulnerability of children, young people and families to the effects of these factors on mental health, an influence well established in other settings. (Raphael, NH&MRC, 1992)
Children, young people and familiesThere is little systematic information about the mental health problems and mental disorders affecting Aboriginal children and young people. However it is recognised that there are significant problems facing children and young people in the general Australian population with at least 10 to 18% of young people having a diagnosable psychiatric disorder (Connell et al., 1982, Sawyer et al., 1990). There is also much to suggest that such problems are increasing in young people (Brandenburg et al., 1990). What is known in the general population is likely to also be relevant for Aboriginal populations, although clearly differing family structures and culture are likely to influence the nature and form of problems presenting.
Delinquent and antisocial problems and conduct disorders are disruptive and prevalent, and while there are no national studies, available evidence from New Zealand data (Anderson et al., 1987) indicates that rates of 3.4% for conduct disorder are likely. Conduct disorder not only leads to problems in childhood, such as disruptions of learning and social development, but is also associated with an increased vulnerability to disorders in adult life, with considerable continuity with antisocial personality disorder in adolescence and adulthood. The high rates of incarceration of young Aboriginal people (25 times the rate of non-Aboriginal young people (Dodson, 1994)) may be only in part a response to such behaviours, but may also represent the legal system and enforcement agency responses to stereotyped views of the meaning of such behaviours. The degree to which young men seek an identity on such "antisocial" acts (in terms of rebellion against white stereotypes and rules) is also important (Hunter, 1993). The critical issue is the need for understanding of the sources of such behaviours, their level and significance in Aboriginal contexts and identification of social and psychiatric contributions that require attention. A further matter that is of relevance is the relation of such antecedents (for example behavioural problems in childhood) to substance abuse in adolescent and adult life.
This needs to be put in context when examining problems such as petrol sniffing, alcohol and elicit drug use among Aboriginal young people.
Kosky (1992) describes the way in which Aboriginal young people do badly in the juvenile justice system. For instance in Adelaide, they make up about 2% of the adolescent population, yet in the 5 years 1979-84, they formed 7.8% of those apprehended, 13.9% of Children's Court appearances, and 28.1% of detention orders, and in 1989, 15% of inmates (Kosky, 1992). In New South Wales where Aboriginal young
people aged 5-19 make up 1.8%, they constitute just under a quarter of those detained. In Queensland, they are 3.8% of the 5-19 age group and a third of those detained; and in Western Australian, 4.1% of 5-1+9 years old and 75% of juveniles in detention (Hunter, 1992). Hunter goes on to point out that these outcomes may be the result of class but there is also race bias, as evidenced by the reports of physical maltreatment in custody (85% of Aboriginal juveniles reported physical mistreatment in custody or detention in one study (Cunneen, 1990). This whole area is one of enormous importance from a preventive and service point of view in terms of mental health. Firstly there is the impact of these separations. Then the suggestion that such detention replaces other ritual as a rite of passage to manhood. And finally there is the beginning of a "criminal" identity which may seem the only available option and develop a status of its own. Then these young people, usually young men, become absent fathers, with implications for their own children, especially sons.
Depression is a significant problem in adolescence for young women in the broader society with rates increasing during the adolescent years to 20%-25% compared with about 10% in young men (Pattern et al, 1994). How this affects young Aboriginal women is unknown although the high rates of self-harming behaviour (Radford et al, 1990) and low feelings of self-worth suggest it is also a problem for them, mixed complexity as it is in the non-Aboriginal population with social constructions such as those related to the roles and value of young women. It seems likely that young women may deal with bad feelings by self-harm, or may become pregnant at a young age, gaining status and esteem, but perhaps also difficulties because of early child bearing and problems for the infant. There must also be concern about the impact of depression on learning, development, and the capacity for achievement as well as potential relationships to substance abuse at least for males (Hunter, 1993) and eating disorders and substance abuse for girls (Pattern et al, 1994.)
The prevalence of other disorders in childhood is unknown in the Aboriginal population and the levels of problems such as Attention Deficit Disorder, those associated with Developmental delays etc. not in any way established. This also applies to anxiety, obsessive compulsive disorders and problems such as autism.
Risk factors for disorders in childhood and adolescence are prevalent in the general community and also in Aboriginal communities. There include parental discord and violence, parental alcoholism, child abuse including childhood sexual abuse, as well as failed parenting, family breakdown, parental separation and losses (Raphael, NH&MRC, 1992). Vulnerabilities associated with poor obstetric outcomes and their effects on infants, severe acute and/or chronic illness in childhood, are all more frequent in Aboriginal communities (AIHW Report on Aboriginal Health Differentials, 1994). Thus it is extremely likely that at least the levels of problems found in the general population of Australian children and young people are likely to be present in Aboriginal children.
Significant disruptions of learning and learning problems, if not disorders, are likely to be prevalent, particularly in association with reported levels of learning impairment through high rates of middle ear infection, and eye disease may also contribute.
Childhood abuse presents a major problem in the general Australian community. Although levels of abuse are not established in National surveys a number of studies suggest that sexual abuse is reported to occur for up to 10% of boys by age 16 and 28% of girls, figures substantiated by findings in other communities such as New Zealand and the United States of America (Raphael, 1994). The Australian Institute of Health and Welfare’s report Child Abuse in Australia 1990-1991 (Angus and Wilkinson, 1993) reported 4,032 cases of abuse and neglect of Aboriginal children of which 2,089 were substantiated (these levels are not likely to include all cases because of differing reporting and other requirements in States). Of the Aboriginal children notified this included 42% for neglect, 14% for sexual abuse, 20% for emotional abuse and 24% for physical abuse. This highlighted the higher levels of neglect as a cause compared to the non-Aboriginal population (approximately 25%) and may reflect the effects of impoverished conditions. For the year 1991-92 the AIHW found there were 3,418 substantiated cased of Child Abuse and Neglect in Aboriginal and Torres Strait Islander communities for that year. The proportion of Child Abuse and Neglect was higher at 8% than the representation of Aboriginal people in the general community (less than 2%). There was also a higher "At Risk" population, 60% compared to 49% in the general population, and neglect here too was high, 40% compared to 24% of all children. These facts indicate the high burden of problems and care for Aboriginal and Islander Child Care Agencies (AICCA’s). It is considered that the effects of poverty, drug and alcohol abuse, family violence, high stress levels and low self esteem, particularly as a consequence of lack of access, opportunities and control as well as historical experience, contribute to these problems.
The Secretariat of National Aboriginal and Islander Child Care (SNAICC) has recently provided a discussion paper for: A proposed Plan of Action for the Prevention of Child Abuse and Neglect in Aboriginal Communities. This discussion paper makes a very strong case for prevention as the priority, pointing out that it is currently impossible to meet needs for care with demands increasing. Thus there must be action to stop abuse occurring. It is believed that successful prevention strategies must be grounded in principles associated with: the impact of colonisation and historical context; the right to self-determination; recognition of Aboriginal child rearing practices; taking a holistic approach to Child Abuse and Neglect; holistic measures for Prevention of Child Abuse and Neglect. There is a need for healing processes and prevention addressing the effects of removals, separation and abuse as they have affected Aboriginal families as a result of colonisation. There is a need to value and have recognised the positive contributions of Aboriginal Child Rearing practices, the kinship and elder roles, as these may contribute to prevention of Child Abuse and Neglect. The discussion paper highlighting these issues is proposed to be used as a basis for State-wide and Territory workshops, which would in turn lead to a final report with recommendations and strategies for the prevention of Child Abuse and Neglect in Aboriginal Communities. It is also suggested that such Strategies should include ways of improving mainstream services and their consultation with Aboriginal communities and use of Aboriginal non-Government services (e.g. Aboriginal Child Care Agencies and Aboriginal Medical Services). The Report of the Royal Commission into Aboriginal Deaths in Custody, and the National Aboriginal Health Strategies should also be linked to the Plan of Action. This proposal was linked to the National Child Protection Council Initiatives and, like these, emphasised a number of components: community awareness, including establishing state-wide Child Abuse and Neglect prevention networks; development of information packages and a media campaign; skills and knowledge development and provision of information and advice through education of children and parents; policy development; community based initiatives and services such as early intervention, support and locally based prevention.
A Working Party Report on Child Protection and Aboriginal Communities in New South Wales highlights further issues and the need for: intervention to provide immediate protection of children; immediate action against known paedophilia, prostitution and pornographic activities; action against perpetrators within Aboriginal communities; support for Aboriginal women to assist them to protect their children; counselling services and protective behaviour programs for children; foster placements with Aboriginal families which are safe, well-resourced and where the foster parents are well-supported by the placement agency/department; Aboriginal group homes staffed with appropriately trained Aboriginal people; comprehensive awareness strategies around STD’s including HI V/AIDS; prompt notification of all cases and coordination.
Useful initiatives addressing these issues are also being developed in other States (e.g. Western Australian pamphlet on "Take Care of our Kids. Listen to Them. Sexual Abuse Happens. Stop it Now.")
The National Prevention Strategy on Child Abuse reviewed initiatives at a State level (July, 1994) and noted initiatives such as Local networks and state-wide prevention networks (Tasmania, Western Australia, Queensland, Victoria, New South Wales, Australian Capital Territory, Northern Territory). Parent education protective behaviour program, early intervention programs, public awareness and education, home visitor programs, support program telephone services, policy and legislation initiatives, have all been identified, but a coordinated national strategy does not yet appear to be in place and implemented. Initiatives in relation to Aboriginal communities (and workers to address these) are described only in some instances (e.g. Northern Territory) though seen as part of most state responses. The effects of media intervention have been positive in increasing awareness of these issues, but need much further development and specificity, as well as linking to other comprehensive multifaceted approaches (Donovan, 1994).
Issues of relevance in Aboriginal childhood have been described by Hunter (1994). He suggests that there was a consensus that early childhood has few controls so that children were little prepared to be subjected to the authority of others as they grew up. Girls were gradually introduced to adult roles by maternal figures, participation in women's activities and seen as mature with the onset of menstruation. Boys moved to the world of men from the world of women and thus to a new set of relationships, previously by specific initiation rites. These traditional matters have been significantly impacted on by social change. The focus of these changes and the intergenerational tensions is usually adolescence.
Amongst the studies that provided some information on the problems of Adolescent children and adults, the early work of Kidson, who reported psychiatric disorder in 2.6% of population aged 15 years and younger in a remote community in central Australia, and identified sociocultural change and marginal situations as contributing. Gault, in the late 60's, surveyed Aboriginal adolescents in Victoria and the Kimberley town of Derby and found high levels of disturbance of delinquency and antisocial behaviour as well as social maladjustment (both reviewed by Hunter, 1994). Nurcombe's research in the late 1960's and early 1970's with John Cawte emphasised the adverse social experiences of Aboriginals in the processes of change and effects of poor housing, unemployment, loss of roles, cultural loss and trauma as contributing to the problems of Aboriginal young people, including petrol sniffing. They questioned the appropriateness of European models of assessment (e.g. of language and cognitive skill development) and diagnostic categorisation and for instance social processes that supported internalisation rather than freedom, from early childhood. They found of 280 children surveyed on Mornington Island at that time, 10% were believed to have some form of psychogenic disorder and that these disorders arose following the social and economic and ecological impact of external acculturative pressures.
Kamien (1978), in his study in Bourke, found substantial behavioural problems in just over one quarter of Aboriginal males and one third of Aboriginal females between 5 and 14 years (n = 250). Anxiety symptoms and enuresis were more common among girls. These girls were also sexually active at an early age. This may well have been associated with abuse, although this was not identified at that time. Childhood separations were frequent having occurred for a third of the adults studied within community survey.
Webber (1980) examined mental health problems amongst Aboriginal children in north Australia by establishing a register of child mental health cases from tribal communities in the north of the Northern Territory. It was found that there were a preponderance of serious learning difficulties in the children presenting, with a preponderance of male cases. Behaviour problems were also frequent at 19.4%, with learning difficulties 26.3% and mental retardation 17.1%. Brain syndrome constitutes 16%.
In his review, Hunter goes on to emphasis the ongoing separations experienced by Aboriginal children, with them seven times more likely to be placed in foster care, as well as the excess detention in juvenile justice institutions.
Maternal and paternal roles have been compromised in Aboriginal families. These factors, disadvantage, and separations, impact adversely, as do educational and developmental disadvantage, creating high risk burdens in terms of mental health, and little opportunity for those factors likely to promote resilience and resistance. Hunter concludes that Aboriginal young people "experience at least the same rates of most mental health disorders as children elsewhere, but have less access to professional services. They are far more likely to manifest a range of behaviours that reflect social realities of Aboriginal disadvantage." (p24) Many articulate their anger and construct their identity through behaviour, including violence, that signifies resistance to perceived oppression." (p22) Others, with opportunity have found more positive outcomes, but he concluded "resistance without opportunity will both further disadvantage Aboriginals and lead to escalating conflict" within the modern society (p22).
Young people and problemsHunter (1992) has reviewed the problems of Aboriginal adolescents, particularly those in remote communities. He emphasises the impact of social factors, including the pressures of social change, social dislocation and intercultural pressures. He notes that they may experience more economic disadvantage than urban Aboriginal populations, and may live in "settlements" established by processes of forced centralisation "which meet neither their cultural nor economic needs." (p79).
Such remote communities may be further disadvantaged by high costs of basic items, and by lack of services and facilities for health, work and leisure activities.
Young people may be impacted by the forced removal of children from their parents, leaving an ongoing legacy. As well Hunter suggests, as do others, that in some ways the removal continues with the high numbers of Aboriginal youth in detention centres. It is thought that earlier separations resulted in more girls being taken away (impacting on parenting) and more recently on boys (delinquency). The imprisonment of many adult Aboriginal men even if transiently, has meant that male role models have been compromised (through father absence or incapacity e.g. through alcohol). Hunter believes that this, coincident with welfare (money) support for mother and children, has lead to an increasingly matriarchal family structure. All these factors may have damaging consequences for the identity development of Aboriginal young people.
In these remote communities, there are even more likely to be developmental impacts of physical illness. For instance, children in the Kimberley are more likely to be born underweight and remain underweight throughout childhood, to be undernourished, and to have a range of other health problems such as hearing problems (Hunter, 1992, p87). All these not only affect development, but also education through absenteeism and other factors.
Alcohol problems affecting young Aboriginal people have been described in urban, rural and remote communities, with peer pressure a factor in early and hazardous use. While many Aboriginal people do not drink, studies quoted by Hunter (1992, 1993) indicated that rates are high, especially for young people in terms of current drinking (60% of females and 87% of males aged 15 to 20 years in the Kimberley). These young people also consumed, as an average well above the hazardous levels, averaging 88 gms per drinking day for females and 169gms for males (Hunter et al, 1991, p28). Kava has been used in some Northern Territory communities and has also been associated with problems (Mathews et al, 1988, p67).
Petrol sniffing has also been a problem in a number of regions (Brady, 1991, p71). In a national survey of 837 communities, 56 (6.7%) were reported to have petrol sniffing which may be associated with lead intoxication and death. It is of interest that communities with a history of Aboriginal involvement in the pastoral industry were protected, perhaps because of the capacity for work in a productive economic enterprise. (Brady, 1991)
Other issues reviewed by Hunter as affecting Aboriginal young people include violence, childhood physical and sexual abuse, self-harm behaviours and stresses of parenthood. Young age of parenthood for both males and females is a specific factor with the fertility rate for Aboriginal females aged 15-19 years in Western Australia in 1987 being 8.5 times greater than for the same age group generally. On the other hand high STD rates bring significant problems including infertility for some. These issues will be discussed further with the consideration of women's mental health, although it should be noted that pregnancy may have positive and protective outcomes for young women at least initially.
However as Hunter states, there is totally inadequate information about urban Aboriginal youth and a need to urgently address their problems. These are likely to be similar to those in rural remote centres, although access to mental health and health services may be greater, if these are used, which they frequently are not.
There is, according to Hunter's review, an urgent need to address the issues of above, including psychological and social problems, drug and alcohol use, physical health, and the dangerous morbidity and mortality from behaviour that is related to substance abuse, related to depression, anger and frustration. There is an urgent need for programs for Aboriginal children and youth. In particular there is also a need for programs to avoid the criminalisation of Aboriginal youth. Finally there needs to be an addressing of the social, transgenerational and economic factors that impact on the health and well-being and mental health of Aboriginal Young People.
The health of young AboriginesA thorough review of the health of young Aboriginal people aged 12-25 was edited by Brady (1992). This report provides information on the distribution of Aboriginal young people and relevant sociodemographic variables.
There were 30,277 Aboriginal young people aged 10-14; 29,106 aged 15-19; and 24,044 aged 20-24, across Australia according to the 1986 Census. Of these 22,564 were in Queensland; 22,035 in New South Wales; 13,676 in Western Australia; 12,409 in the Northern Territory; 5,191 in South Australia; 4,608 in Victoria; 2,499 in Tasmania; and 455 in the Australian Capital Territory. In the Northern Territory the Aboriginal population is chiefly rural (69%) and in Western Australia and Queensland about 35%. The major urban components are Victoria (48%) and New South Wales (36%).
Only 21% of young Aboriginal people aged 15-19 are employed and only 37% of those 20 to 34 according to the 1986 census. According to this review less than 2000 Aboriginal and Torres Strait Islanders are engaged in some form of post-secondary education. Aboriginal people generally are in low status jobs, regardless of how long they stayed at school and as noted elsewhere, severely disadvantaged on average earnings.
Significant physical health problems affect Aboriginal young people as well as Aboriginal people as a whole and the prodroma of disorders such as diabetes may be present at this time. However they are generally the healthiest age group of the Aboriginal population.
However it is reported that mortality in this age group is usually related to external causes of injury and poisoning with some deaths also due to "mental disorders" associated with alcohol and drug use. Suicide accounts for increased deaths in the 15-19 age group of both Aboriginal and non Aboriginal males, with hanging the commonest method.
Social factors contribute significantly to the ill-health of Aboriginal young people. Brady examines in this context sexually transmitted diseases which are prevalent among Aboriginal young people. Although some have declined, especially with the condom campaigns related to AIDS risk, rates are still high - for instance of chlamydia, herpes. HIV infection has been found in some communities and there have been some deaths. With the high rates of ulcerative STD's this is an area of major risk. Pelvic inflammatory disease is a cause of infertility and appears to be rising in the general population.
There is a high incidence of youthful pregnancy among Aboriginal women, and as with all pregnancies under 16 years, these are likely to be higher risk. These young mothers are also less likely to have adequate antenatal care, one of the risk factors for perinatal morbidity. Lack of antenatal care may be aggravated by many cultural and social aspects of Aboriginal life, and particularly the need for this process to be women's business. As Brady notes the higher level of youthful pregnancies may relate to the fact that having a baby provides young women with interest, someone to care for, social network, and a new social position within their community. However they may need the support of mothers, aunts, grandmothers and others to care for their babies. And there is much evidence to suggest that education (of these young women) will be one of the strongest influences on the health status of these mothers and their infants.
Hearing problems resulting from childhood ear disease may result in cultural and educational defects. Blindness, for instance from trachoma, may have similar effects.
Psychosocial health issues were substantial among young people, according to Brady's review. There is a comprehensive account of the nature of alcohol and drug use in terms of available data; but most is descriptive and there is little quantitative data for this age group across different communities. Alcohol use in a Northern Territory Survey was reported in 36.6% of 15-20 year olds and 48% of 21-30 Aboriginal people in one survey, with males predominant. The only urban survey suggested levels of 56% (by asking levels of other drinkers) These young drinkers are vulnerable in terms of accidents, deaths (e.g. deaths in custody) and so forth. Tobacco use is also frequent, as was marijuana. Petrol sniffing was a group experience strongly influenced by peer culture.
The desire to be part of the peer group was probably the main factor in this drug use; in addition there are heavy drinking role models of parents and other adults. In addition extra social problems arise for parents and community because of their inability to control this disturbed behaviour of those drinking heavily in the younger petrol sniffers. Drinking and petrol sniffing are also used to facilitate social interaction and action.
Stress is a significant factor of the lives of Aboriginal young people. Bereavement, including the deaths of parents prematurely, is a feature of the high Aboriginal mortality rates. Furthermore there are high levels of self-harming intent and behaviour. These feelings are often connected to loss of hope. Hunter's work suggests that the high levels of anxiety and depression in the young men he studied resulted because they had born the brunt of rapid social change in Aboriginal communities. In urban communities young Aboriginal people may experience stressful and frequent contact with the police.
Interpersonal violence, accidents and poisoning, which are among the leading causes of death of young Aboriginal people, arise from many sources including stress, alcohol and norms of violence as in male to male fighting. Domestic violence and child abuse, as well as sexual assault, are further stressors and sources of mental ill health. These behavioural outcomes reflect the impact of historical factors, colonisation and disadvantage, but require further research to clarify the complex sources of violence and effective interventions.
Social factors may also affect the health and well-being of young Aboriginal people in other ways - for instance lesser access to and opportunity with respect to housing, education, diet and health services. The access to resources for sport and recreation should also be considered in this context, as well as places of living and their consequences, urban, rural and remote.
Brady concludes this valuable and wide-ranging review by comparisons with the Kaui long term study of high risk children (related to the ill-health and social stresses being experienced) and the resilience of some young people that emerged. She makes a series of recommendations linked to improving health services and programs for these young people including holistic health care, community controlled health services for young people, programs to prevent substance abuse, intersectoral collaboration, programs for young mothers and the children of young mothers, special support for those lacking social bonds, enhanced access to meaningful activity and work for young people. Of special significance are recommendations for the involvement of young people in determining priorities and programs, conferences, drop-in centres, health promotion and prevention and community awareness and in representation on all relevant formal and informal bodies.
Aboriginal familiesChildren and young people frequently present difficulties which reflect the impact of parental or family problems. For instance the physical development of infants and children may be severely affected by poor nutrition, a result of low family income, or diversion of family resources into gambling or substance abuse (SNAICC Report, 1994; Hunter, 1993). Physical illnesses such as repeated infections associated with adverse physical environments and understanding of and access to services for families may interfere further with development and education.
Family violence has profound and adverse effects on the mental health and well-being of children, as indicated above, both through the environments of violence that becomes a norm for behaviour, and the personal effects of abuse and assault.
The strong association of family violence and mental health has been identified in the New South Wales Aboriginal Mental Health Report, and in repeated reports to the National Aboriginal Mental Health Conference (1993).
The New South Wales Family Health Strategy (1994) also reinforces the importance of addressing family violence and sexual assault in Aboriginal communities and the coalescence of mental health and family health. The overall objective of this Strategy is to "reduce family violence and sexual assault in Aboriginal communities" (p5). There is emphasis on the importance of breaking patterns of denial and acknowledging the incidence and unacceptability of family violence. It is seen that solutions to family violence and sexual assault within Aboriginal communities are Family Health solutions, with education and follow-up a priority. Furthermore it is seen as critical that men participate by acknowledgement and taking responsibility for their violence and taking an active part in solutions. For instance Aboriginal communities are demanding that "men accept traditional responsibilities and participate in men's business, taking responsibility for the reworking of spiritually strong masculine roles". (p6)
The strategic aims of this Family Health Strategy encompass both lessening denial and increased criminal reporting on action, as well as to
- "increase personal and community self-esteem through a community controlled infrastructure of education and service provision related to Family Health." (p10)
"increase knowledge, skills and experience in dealing with Aboriginal Family Health issues by Aboriginal communities and health and other service professionals." (p10)
- "extend the provision of existing Health services to Aboriginal people to include Family Health services which are:
- directed at well-being
- place as much emphasis on preventative and follow-up programs as on crisis care and criminal prosecution
- maintain family structures within a strong culture
- link with other health issues such as substance abuse and mental health." (p10)
Critically here, as in other areas there is a need for baseline data relating to family violence and sexual assault in Aboriginal communities (p18) highlighting the need for resources to address these issues. There is also a need for data on family problems, their prevalence and potential solutions.
The responses to this consultative document highlight the multiplicity of approaches, but also the critical need to consider intersectoral issues in all problems to do with family, children and young people, in Aboriginal as in non-Aboriginal communities. Responses come from Education, Youth Affairs, Legal services, Women's Policy areas, regional health services, sexual assault services. Thus it is central to any development of services for Aboriginal children, young people and families that intersectoral resources and involvement are mobilised.
The decline and rise of Aboriginal families has been described by Gray, Trompf and Houston (1991). After describing the impact of "dislocation, desecration, and destruction" through colonisation, the taking away of the children, disease, policy and environmental factors such as housing, these authors provide a hopeful conclusion on the renewal of the family with communities "strong and getting stronger" (p118).
O'Shane (1993) also highlighted the problems facing Aboriginal families in the plenary address to the Australian Family Therapy Conference which was titled "Assimilation or Acculturation: Problems of Aboriginal Families". She details the enormous problems facing families and concludes "There needs to be a proper recognition of the fact that many Aboriginal families are in crisis as a direct consequence of colonisation; that those circumstances give rise to very particular needs; and that those needs can only be addressed by carefully, and deliberately, designed programs of empowerment and therapy" (p198, 1993).
Further emphasis on families is highlighted by Dodson (1994) in his discussion of the rights of Indigenous people in the International Year of the Family. He states that in indigenous societies, "the extended family traditionally managed virtually all areas of social, economic and cultural life" (p34), but that the authority of the family has gradually given way to that of the State. The family in contemporary Australia has roles for procreation, cohabitation, private and intimate relationships, but "the transmission of culture has historically been, and largely remains the responsibility of the family." (p35) This results from the role of parents in passing on to their children, beliefs, knowledge, language, customs, attitudes and so forth. He emphasises that in terms of Human Rights everyone has such rights and that Aboriginal and Torres Strait Islander families should not be prevented from transmitting their culture, and should be supported to do so. The adverse effects of colonisation on indigenous families occurred at every level: uprooting from traditional lands; eliminating traditional means of survival; separating people within kinship groups; removal of children; starvation; massacre; rape; disease. These factors prevented families surviving and reproducing, and intervention of institutional systems of law, welfare, education, interference with kinship obligations and the education of children by parents and law, and the transmission of culture, language, law and so forth. Conflict and other consequences including the disproportionate level of intervention in Aboriginal families strongly supports the need for special protection of Aboriginal children and their families. There has been a call for "culturally relevant" National legislation relating to Aboriginal and Islander child development for more than a decade, without this resulting. Self-determination is seen here too as a critical issue, with a sound "social, economic, cultural, and political base which will ultimately support our families and our ability to care for ourselves and each other from the inside" (p39, Dodson, 1994). Thus our aim should be for Indigenous families to enjoy the "security, health and cultural integrity" which is their right.