NSW Aboriginal Mental Health And Wellbeing Strategy 2020
NSW Aboriginal Mental Healthand Wellbeing Strategy2020-2025
AcknowledgementsThe NSW Ministry of Healthacknowledges and respectsAboriginal people as thetraditional custodians of thelands and waters of NSW andpays respect to Elders past,present and emerging.Our Journey: the artworkOur Journey is about comingtogether and learning off oneanother. The journey in the paintingdetails the healthy lifestyle choiceswe make with evident bush tuckerand seafood. Also, the blue circlesrepresent the water holes in whichwe gather, drink and source supplyfrom as well as continue theteaching with our young ones. Thebig circle in the middle symbolisesa meeting place in which allpeople come together and meet,learn, teach and grow to achievebetter results for our families andcommunities. The symbol on the topright-hand corner represents ourancestor spirits who watches overour journey and helps guide us.*The Connections AboriginalWomen’s Art Therapy Groupsupported Aboriginal women wholived with mental illness throughart therapy and group work. TheConnections artists met once aweek in a studio in Redfern topaint, yarn and support each other.The group was supported2by St Vincent’s Hospital with theCity of Sydney providing the studiospace. Kaylene Simon from StVincent’s Health Australia was thegroup’s coordinator, establishingthe group in 2002. Many of thewomen who attended the groupwere from all over Australia and thearts and crafts were based on theirstories.The Mental Health Branch isauthorised to use Our Journeyartwork image under licencein Aboriginal mental healthpublications 2017 – 2026.*The symbol on the top right-handcorner of the artwork representsour ancestor spirits and is indicativeof the Kimberley region which mayhold cultural sensitivities to thetraditional owners of this land.Cover artwork: Our Journey byConnections Aboriginal Women’sArt Therapy group 2017We acknowledge andthank members of theAboriginal Mental HealthSteering Committee and theAboriginal Expert AdvisoryGroup who have contributedvaluable experience, advice,time and guidance. Weacknowledge Aboriginalcommunities, communityorganisations, mainstreamservices and governmentdepartments from acrossNSW for their engagement.A full list of the AboriginalMental Health SteeringCommittee members andthose who contributed to theconsultations can be found atAppendix 1.We would also like to thankthe Aboriginal consultancyagency Cox Inall Ridgewayfor its expertise in facilitatingconsultations that helpedinform the development ofthis Strategy.Note that within NSW Health,the term ‘Aboriginal’ isgenerally used in preferenceto ‘Aboriginal and TorresStrait Islander’, in recognitionthat Aboriginal people arethe original inhabitants ofNSW.1
NSW Aboriginal Mental Health and Wellbeing Strategy 2020-2025ContentsA message from the Minister5Aboriginal mental health and wellbeing in NSW6The social and emotional wellbeing approach6The need for change8The policy and service delivery environment9A new approach for Aboriginal mental health and wellbeing in NSW10The Strategy at a glance11Who is this Strategy for?12Shaping the future of Aboriginal mental health and wellbeing in NSW13Strengths-based, Aboriginal led co-design13Cultural capability and safety13Trauma informed holistic healing14Supporting and growing the Aboriginal mental health workforce14Access to quality, coordinated and connected care15Co-designed, local implementation16Monitoring and reporting16Strategic Directions & Actions17Goal 1: Holistic, person and family centred care and healing17Goal 2: Culturally safe, trauma-informed, quality care20Goal 3: Connected care26Glossary31Acronyms32Appendix 1 – How was the Strategy developed?33Appendix 2 – Aboriginal Nations Map34References353
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NSW Aboriginal Mental Health and Wellbeing Strategy 2020-2025A messagefrom theMinisterI am pleased to introduce the NSW Aboriginal MentalHealth and Wellbeing Strategy 2020-2025. Thisdocument provides important overarching strategies foraction for NSW Health services over the next five years.This Strategy sets the scene for a dramatic shift in theway NSW Health engages with Aboriginal staff, services,consumers, carers, families and communities.Improving the mental health and wellbeing of Aboriginal communitiesacross the state is a priority of the NSW Government. We are committed toensuring Aboriginal people and families receive the support and attentionthey need. We respectfully recognise the diverse cultures of Aboriginalpeople and communities and are determined to work in partnership tomake a positive difference in service delivery.The Strategy will help NSW Health services embed the strategic directionsand actions and achieve the goals of holistic, person and family-centredcare and healing; culturally safe, trauma-informed, quality care; andconnected care.I encourage you to explore the many resources and spotlights availablethrough the document that have been developed in partnership withAboriginal people and communities throughout NSW. The resources andspotlights are examples of good practice, highlighting strong cultural waysof working and providing holistic care.This document is more than a Strategy; it is a valuable resource in leadinga culturally safe and valuable service in improving the mental health andwellbeing of Aboriginal people, families and communities.The NSW Government is committed to an ongoing monitoring of theimplementation process, to ensure NSW Health services are accountablefor the ongoing care of Aboriginal people and communities who encounterthese services.The Hon. Bronnie Taylor, MLCMinister for Mental Health, Regional Youth and Women5
Aboriginal mental healthand wellbeing in NSWAboriginal people belong to a strong living culture that has continued to thrive forthousands of years.2 Along with a history of survival, healing and resilience, Aboriginalpeople have a proud heritage of commitment to family and community, spirituality, andhave strong connections to culture and country. Aboriginal people have great strengths,creativity and endurance and a deep understanding of the relationships between humanbeings and the environment.The Aboriginal social and emotional wellbeing model(Figure 1) is a strengths-based approach to workingwith mental health and wellbeing. It recognises theinfluence of social, political, historical and culturalfactors and can be applied across the continuum ofmental health care.If connections are disrupted, and for many Aboriginalpeople and families some of these connections havebeen significantly disrupted from colonisation, itcan lead to ill-health. The healing and strengtheningof these connections will help increase social andemotional wellbeing for Aboriginal people, families andcommunities.Promoting strong connections is about maximisingthe benefits of the protective factors, while minimisingexposure to risk factors and particularly those that arealso risk factors for mental health conditions.56sntanPolitConnectionto spirit,spirituality &ancestorsConnectionto countryConnectionto bodySelfinantstermdealicSocial and emotional wellbeing is widely understoodto be the foundation for Aboriginal people’s physical,mental and spiritual wellness.3 Social and emotionalwellbeing is a holistic concept that recognisesthe importance of connection to country, culture,spirituality, ancestry, family and community, andhow these affect the individual.4 This holistic viewincorporates the mental health and physical, social,emotional, and cultural wellbeing of individuals andcommunities and how they each intertwine.Figure 1. A Model of Social andEmotional WellbeingHistorical determiThe social and emotional wellbeingapproachConnectionto mind &emotionsConnectionto family& kinshipConnectionto cultureConnectionto communitySotsci aldetermi nan Gee, Dudgeon, Schultz, Hart and Kelly, 2013As detailed in Table 1, the National Strategic Frameworkfor Aboriginal and Torres Strait Islander Peoples’ MentalHealth and Social and Emotional Wellbeing 20172023 recognises these and other risk factors, but alsoprovides examples of protective factors that strengthenmental health and social and emotional wellbeing andbuild resilience.6
NSW Aboriginal Mental Health and Wellbeing Strategy 2020-2025Table 1: The Domains of Social and Emotional Wellbeing with Risk and Protective FactorsDomainDescriptionExamples of risk factorsExamples of protective factorsConnectionto BodyPhysical health – feeling strongand healthy and able to physicallyparticipate as fully as possible in life. C hronic and communicablediseases P oor diet S moking A ccess to good healthy food E xercise Access to culturally safe,culturally competent and effective healthservices and professionalsConnection toMind and EmotionsMental health - ability to managethoughts and feelings. D evelopmental/ cognitiveimpairments and disability R acism M ental illness U nemployment T rauma including childhood trauma E ducation Agency: assertiveness, confidence andcontrol over life Strong identityConnection toFamily and KinshipConnections to family andkinship systems are central to thefunctioning of Aboriginal and TorresStrait Islander societies. bsence of family membersA Family violence Child neglect and abuse Children in out-of-home care L oving, stable, accepting and supportivefamily Adequate income Culturally appropriate family focusedprograms and servicesConnection toCommunityCommunity can take many forms. Aconnection to community providesopportunities for individuals andfamilies to connect with eachother, support each other and worktogether. amily feudingF Lateral violence Lack of local services Isolation Disengagement from community Lack of opportunities foremployment in community settings S upport networks Community controlled services Self-governanceConnection toCultureA connection to a culture providesa sense of continuity with thepast and helps underpin a strongidentity. Elders passing on without fullopportunities to transmit culture S ervices that are not culturally safe L anguages under threat C ontemporary expressions of culture A ttending national and local culturalevents C ultural institutions C ultural education C ultural involvement and participationConnection toCountryConnection to country helpsunderpin identity and a sense ofbelonging. R estrictions on access to country Time spent on countryConnection toSpirituality andAncestorsSpirituality provides a sense ofpurpose and meaning. N o connection to the spiritualdimension of life O pportunities to attend cultural eventsand ceremonies Contemporary expressions of spiritualitySocial and emotional wellbeing may change over thelifespan of an individual. What is important to a child’ssocial and emotional wellbeing may be different to anElder. Aboriginal people’s understanding of social andemotional wellbeing can also vary between differentcultural groups and individuals.7Embracing Aboriginal concepts of social and emotionalwellbeing can assist policy makers, organisations,clinicians and support staff to enable a strengths-based,‘whole-of-person’ healing approach within the broadersocial, cultural and historical context.7
The need for changeIn NSW, Aboriginal people fare significantly worse thannon-Aboriginal people on every indicator of economicand social disadvantage8, and experience multiplestressors that are pre-determinants of mental healthproblems and substance use.9This has stemmed from the significant impact ofcolonisation on Aboriginal people, families andcommunities resulting in intergenerational andvicarious trauma and abuse, grief and loss, violence,removal from family and displacement throughthe Stolen Generations, substance misuse, familybreakdown, cultural and country dislocation, racismand discrimination, exclusion and segregation, loss ofcontrol of life, and social disadvantage. These negativeimpacts also shape the social determinants of healthincluding housing, education, employment status,income, physical environment and social supports.10The Commonwealth’s Closing the Gap Report 201911found that the target to close the gap in life expectancyrates for Aboriginal and non-Aboriginal people by 2031is not on track. Large gaps remain between Aboriginaland non-Aboriginal people’s life expectancy estimates.8Suicide and self-harm rates for Aboriginal peopleare unacceptable, and tragically high and growing.Aboriginal suicide rates in NSW have increased from11.3 per 100,000 people between 2009-2013 to 17.7 per100,000 people between 2014-2018.12In 2018-19, the rates of hospitalisations resulting fromintentional self-harm are also higher in Aboriginalpeople (264.6 per 100,000) than non-Aboriginal people(85.6 per 100,000).13Aboriginal people also report higher levels ofpsychological distress than non-Aboriginal people.14Aboriginal people who experience racism are at agreater risk of developing depression and anxiety andthis continues to have a significant impact on Aboriginalpeoples’ decisions about when and why to seekhealth services and acceptance of, and adherence totreatment.15
NSW Aboriginal Mental Health and Wellbeing Strategy 2020-2025The policy and service deliveryenvironmentThe Strategy is the foundation for change that willsupport a future way of working under the nationalAgreement for Closing the Gap in Aboriginal Healthoutcomes.16The Strategy also supports the Fifth National MentalHealth and Suicide Prevention Plan17, and the NSW AuditOffice’s Mental health service planning for Aboriginalpeople in New South Wales18 report.This Strategy is aligned to existing policies that providespecific directions and support for the public mentalhealth sector in NSW: NSW State Health Plan: Towards 2021 NSW Aboriginal Health Plan 2013-2023 NSW Health Good Health-Great Jobs: AboriginalWorkforce Strategic Framework 2016-2020 Health Professionals Workforce Plan 2012-2022 Towards Zero Suicides Premier’s Priority NSW Strategic Framework and Workforce Plan forMental Health 2018-2022 Strategic Framework for Suicide Prevention in NSW2018-2023 OCHRE: NSW Government Plan for AboriginalEducation, Employment and Accountability 2011 Living Well in Focus 2020-2024: A strategic plan forcommunity recovery, wellbeing and mental health inNSW19 NSW Mental Health Commission Lived ExperienceFrameworkThis Strategy is also aligned to key national policies andapproaches, including: The Gayaa Dhuwi (Proud Spirit) Declaration National Strategic Framework for Aboriginal andTorres Strait Islander Peoples’ Mental Health andSocial and Emotional Wellbeing 2017-2023 National Aboriginal and Torres Strait IslanderSuicide Prevention Strategy 2013 Cultural Respect Framework 2016-2026 forAboriginal and Torres Strait Islander Health National Safety and Quality Health ServiceStandards for Aboriginal Health National Disability Insurance SchemeThe Gayaa Dhuwi (Proud Spirit) Declaration promotesthe importance for mental health services to recogniseAboriginal concepts of social and emotional wellbeing,mental health and healing in practice, and to strengthenAboriginal leadership and influence. The NationalAboriginal and Torres Strait Islander Leadership inMental Health (NATSILMH) group developed thedeclaration in collaboration with partners including theMental Health Commission of NSW.The Strategy recognises the complex service deliveryenvironment in NSW. Mental health and wellbeingservices are provided by local health districts (Districts),speciality health networks (Networks), Aboriginalcommunity-controlled health services (ACCHOs),community managed organisations (CMOs), PrimaryHealth Networks (PHNs) and the private sector.The Strategy also acknowledges the leadership role ofthe NATSILMH group, the Aboriginal Health & MedicalResearch Council of NSW, the Centre for AboriginalHealth and the Aboriginal Mental Health LeadershipGroup.9
A new approach for Aboriginalmental health and wellbeing in NSWThe overarching vision of the Strategy is for all Aboriginal people of NSW to have accessto holistic and culturally safe services that provide the best opportunity for improvedmental health and social and emotional wellbeing.This Strategy is designed to support and assist NSWHealth services in delivering respectful and appropriatemental health services in partnership with Aboriginalservices, people and communities. It reflects the NSWGovernment’s commitment to closing the health gapbetween Aboriginal and non-Aboriginal people in NSW.The Strategy is supported by three goals:Goal 1: Holistic, person and family-centred careand healingGoal 2: Culturally safe, trauma-informed, quality careGoal 3: Connected careThese goals are based on the NSW Strategic Frameworkand Workforce Plan for Mental Health 2018-2022 andalign with the NSW Health vision of a sustainable healthsystem that delivers outcomes that matter to patients, ispersonalised, invests in wellness and is digitally enabled.The Strategy provides clear direction to NSW healthservices on:1. Co-designing mental health service planning,delivery and monitoring with Aboriginal services,people and communities2. Delivery of holistic care that responds to Aboriginalpeople’s mental health and wellbeing.3. Delivering culturally safe, trauma-informed, andquality public mental health services4. Building and sustaining the Aboriginal mentalhealth and wellbeing workforce.5.10Creating culturally safe work environments6. Delivering coordinated mental health services forAboriginal people and strengthening partnershipswith Aboriginal health and community services7. Implementing what works and building theevidence8. Strengthening performance monitoring,management and accountability.We are committed to improving service planning,coordination and delivery of health services to supportthe social and emotional wellbeing and mental healthof Aboriginal people in partnerships with Aboriginalservices, people and communities. Each strategicdirection and action reflects our commitment to dobetter, to listen and engage more, and to strive towardsthe quality care that we know we can provide.This Strategy recognises that Aboriginal people areexperts in Aboriginal communities and needs, and thatimprovements in the coordination of services and inthe quality of service delivery and planning will need tostart in genuine co-design processes, led by Aboriginalpeople. Person centred and culturally safe servicesacknowledge the strength and resilience of Aboriginalpeople, families, and communities.A driving strength of this Strategy is the commitmentby Districts and Networks to develop localised, codesigned implementation plans with Aboriginalservices, staff, people and communities. The Strategywill help build on current programs and partnerships,and build new relationships to ensure that the careprovided to Aboriginal people is designed and led byAboriginal people. This meaningful and compassionateco-design approach will reflect the needs of individualsand communities on the journey to healing.
NSW Aboriginal Mental Health and Wellbeing Strategy 2020-2025The Strategy at a glanceVISIONAll Aboriginal people of NSW have access to holistic and culturally safe services that provide the best opportunityfor improved mental health and social and emotional wellbeing.GOAL 1GOAL 2GOAL 3Holistic, person and familycentred care and healingCulturally safe, traumainformed quality careConnectedcareSTRATEGIC DIRECTIONS1. Co-design mental healthservice planning, delivery andmonitoring with Aboriginalservices, people andcommunities2. Deliver holistic care thatresponds to Aboriginalpeople’s mental health andwellbeingSTRATEGIC DIRECTIONS3. Deliver culturally safe,trauma-informed, andcompetent quality publicmental health services4. Build and sustain theAboriginal mental health andwellbeing workforce5. Create culturally safe workenvironmentsSTRATEGIC DIRECTIONS6. Deliver coordinated mentalhealth services for Aboriginalpeople and strengthen
Shaping the future of Aboriginal mental health and wellbeing in NSW 13 Strengths-based, Aboriginal led co-design 13 Cultural capability and safety 13 Trauma informed holistic healing 14 Supporting and growing the Aboriginal mental health workforce 14 Access to quality, coordinated a
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PAGE 4 NSW Health Decision Making Framework for Aboriginal Health Practitioners This framework will enable NSW Health organisations to make local decisions regarding Aboriginal Health Practitioners undertaking clinical activities. It will help to address the fact that Aboriginal Health Practitioners currently have a variety of
This Aboriginal Health Plan 2018–2022 builds on the successes of the former Sydney South West Area Health Service Aboriginal Health Plan 2010–2014, and aligns with the National Aboriginal and Torres Strait Islander Health Plan 2013–2023, NSW Aboriginal Health Plan 2013–2023, and the Sydney Local Health District Strategic Plan.
Health Plan 2013-2023 – at a glance Vision Health equity for Aboriginal people, with strong, respected Aboriginal communities in NSW, whose families and individuals enjoy good health and wellbeing. Goal To work in partnership with Aboriginal people to achieve the highest level of health
Aboriginal / Aboriginal Peoples – ‘Aboriginal’ is a general term used in the Canada Constitution (1982) to describe the Inuit, Métis Nation and First Nations and as such is still used in some official government documents but is falling out of use. Aboriginal Peoples is more acceptable than Aboriginal.
Cara Pinchbeck, Senior Curator Aboriginal and Torres Strait Islander Art: cara.pinchbeck@ag.nsw.gov.au Georgia Connolly, Manager Exhibition Loans & Touring: . This NSW Aboriginal Curator Placement (Emerging) opportunity comes with 30,000 financial support for each fellow. A maximum of two fellowships will be awarded.
E. Kreyszig, “Advanced Engineering Mathematics”, 8th edition, John Wiley and Sons (1999). 3. M. R. Spiegel, “Advanced Mathematics for Engineers and Scientists”, Schaum Outline Series, McGraw Hill, (1971). 4. Chandrika Prasad, Reena Garg, "Advanced Engineering Mathematics", Khanna Publishing house. RCH-054: Statistical Design of Experiments (3:1:0) UNIT 1 Introduction: Strategy of .
