Now,  can I say it gives me great pleasure and pride to introduce our keynote speaker for today Professor Tom Calma.
Professor Calma is an Aboriginal elder from the Kungarakan tribal group and a member of the Iwaidja tribal group in the Northen Territory
and has been involved in Indigenous affairs at a local community, state, national and indeed international level for more than 40 years.
Tom is the Co-Chair of Reconciliation  Australia and the former Aboriginal and Torres Strait Islander Social Justice Commissioner at the Australian Human Rights Commission.
he was the founding Chair of the
Close the Gap campaign for Indigenous Health Equity.
he's also currently Co-Chair of the Aboriginal and Torres Strait Islander Mental Health and Suicide Prevention Advisory Group
the National Coordinator for Closing the Gap tackling indigenous smoking measures.
and Chancellor of the University
of Canberra.
We are really honored to have you here to speak to us this morning, Tom, welcome.
Wow,  great to look out and  see everybody here today.
So firstly can I thank Chicken Madden for his warm welcome to country.
and I also acknowledge the Gadigal people of the Eora nation and their elders
past and present.
and  I would also like to recognize their youth as I do with all youth who are going to be our future leaders
and the custodian of our stories, our cultures, our histories and our languages.
And ah I've got a dirty glass, hey, hopefully that works  .. yeah.
Thank you Eddie Bartnik for your, ahm, words of wisdom and information that you've ah set the scene on what I want to talk about today.
And ah,  and also, ah, Commissioner John Feneley for your kind introduction.
But I also like to thank the Commissioner and his team for the tremendous feat of organizing this international event and asking me to be your speaker today.
and I'd also like to recognize a guy called Chris Holland  for his enduring support to Indigenous health.
he's one of those behind the scenes
people who who for us he's non-Indigenous
has provided a lot of support in, in and around Indigenous health and mental health and suicide prevention.
Now well I do not want to repeat what the Commissioner's naming of the many noteworthy people here today
and Natasha also, also,  I would also like to acknowledge you.
and can I also make special mention of the Indigenous mental health, addiction and disability leaders, experts, consumers and those who've had lived experience here today.
including those from New Zealand, Canada and the US and all the other countries who have travel here, so far to be with us.
I  welcome all of you to this combined meeting of the International Initiative for Mental Health Leaders Leadership and
International Leadership for Disability Leadership International Initiative for Disability Leadership 2017.
In the past decade the world has received wake up calls about mental health and disability crises  in its midst.
Worldwide depression is estimated by
the World Health Organization to affect more  than 300 million people.
About eight hundred thousand die due to suicide every year
and it's the second leading cause of death in 15 to 29 year olds across the globe.
In 2011 the W.H.O reported one billion
persons living with disability.
and about 15 percent, that represents about 15 percent of the world's population.   With 110 to 190 million people having very significant difficulties in functioning.
Forums like these are important, ahm, because they put global mental health and disability  movements ahm, ah at the forefront ah to be able to address the global challenges
and such global responses are appropriate  given the common impacts of mental health problems and disabilities  that our populations experience.
Tragically today those living with mental health problems or  disabilities are increasingly becoming members of an underclass.
This challenges our society's fundamental values of democratic participation, fairness, social justice and equality of opportunity.
So how can our community truly thrive with such growing social  exclusion along health, mental health and disability defined lines?
How many amazing and enriching contributions from people with mental health problems and disabilities will be missed in such circumstances?
Conversely our society, communities and
families capacity to thrive is challenge when untreated mental health problems manifest as anti-social behavior particularly in the young.
Our family's capacity to thrive is undermined by overwhelming care responsibilities in the absence of adequate support services.
We must not forget that our societies and communities thrive when the families and individuals within them thrive
and fail to thrive when families and individuals fail to thrive.
Please do not imagine that because Australia is one of the wealthiest nations in the world somehow it stands apart from the global situation.
No,  this country is but a microcosm of  the world when it comes to the scale of the
disability and mental health challenges.
About 18.5 percent of the population
have a disability and 6 percent have severe or profound disability.
Over 45 percent of all Australians are expected to experience a common mental health related condition such as depression, anxiety or a substance abuse disorder in their lifetime.
And around six hundred thousand of us are estimated to have severe mental illness
and about 2.7 million are in carer roles of various kinds and that represents around
twelve percent of our population.
And here to the mental health and disability burdens in Australia falls heaviest on some of the most vulnerable citizens
our young, our old, our LGBTQ population and our Indigenous peoples amongst them.
Suicide provides a stark example of how Indigenous Australians also share challenges with Indigenous peoples across the world.
Indigenous Australians have doubled the rate of suicide of the non-Indigenous population.
with our kids dying from suicide
at up to five or six times the rate of their non-Indigenous peers.
Canadian first nation suicide rates are twice as high as that of the non-Indigenous Canadians.
In the United States suicide rates amongst  Native Americans has been estimated to be at least 1.5 times higher than the national average
and in New Zealand the suicide rate of Maori  is 1.8 times higher than the Pakeha or the non-Maori population
and the young person's suicide rate is 2.4 times the rate of Pakeha.
Now these populations all report worst mental health and  disability outcomes than their non-Indigenous peers .
and for us when compared to non-Indigenous Australians
we, as Aboriginal and Torres Strait Islander
Australians, have three times the rate of
high to very high psychological distress affecting around 30 percent of the population.
We are about 20 percent more likely to have symptoms associated with clinical depression and we are
hospitalized for mental health conditions
at double the rate of non-Indigenous peers.
And while few of us drink alcohol, when compared to other Australians, those who do are more likely to be problem drinkers or addicted to alcohol.
Disability for us is inherently connected
to our significant poorer, significantly poorer, health when compared to other Australians.
and there is a well known 10 year life expectancy  gap between Indigenous and non-Indigenous Australians.
that itself comprises a bundle of health gaps including the mental health
issues that we are discussing today.
Chronic disease and particularly diabetes which we die from at six times the rate of other Australians is a major cause of disabilities.
Communicable, Communicable Trachoma cause blindness and Otitus Media cause deafness in children is relatively common amongst us
and while we must support those with existing disabilities an equally important goal must be the prevention of future disabilities.
This fundamentally means closing the health gaps and ensuring Indigenous Australians have access to health care.
In 2012 about one in four of us reported a disability compared to one in five other Australians
Our zero to fourteen year olds who are more than twice as likely as non-Indigenous children to have a disability
and we typically have greater assistance needs and are almost twice as likely to require assistance with communications.
Whatever, our difficulties, however, what unites us as global disability and mental health leaders is far greater than what divides us.
What I'll do in my keynote today is discuss how Indigenous  Australian leaders have responded to our mental health and disability challenges
and distill some of the key messages that will, I hope, be of use to all of us here Indigenous and non-Indigenous
and from whichever part of the world you come from.
Indigenous Australia has a health, disability
and mental health story that must start with the geography, history and politics of the country.
Australia is a seven million square kilometer  island continent
for 50,000 years Indigenous Australians successfully inhabited
all parts of this vast landscape with climates ranging from lush tropical jungles to arid deserts and then to snow capped mountains
By 1788 an estimated up to one million of us shared two hundred and fifty different language, languages, across the nation.
Key to  the phenomenal long lived success of our  traditional ways of living was and remains today our cultures.
The continuing importance
of cultures to our health and well-being is only just starting to be recognized by non-Indigenous Australia
It is sometimes said that culture is life or that culture is health and that's
how connected they are and how much we understand them to be.
The slide above is a diagrammatic expression of this cultural, social and wellbeing concept as we refer to it.
Perhaps the key thing to understand is that the country we walk on, the spirit world and you,  your families and your communities very being  are deeply connected
and to learn more about the concepts, I recommend that you look at the 'Working Together' book, ahm, that should be in your conference take home bags and, ah, just be careful of excess luggage,  ah, ahm, as you go home,
but we, we are very, very glad, that you are taking a copy.
Ahm, but in a nutshell the implications are that health practices to us are more than just treating the individual's body or mind in
isolation.
Health is ultimately about restoring wholeness and connection.
Now you'll notice in this slide the historical and social determinants circling the self  and against which culture, social and emotional wellbeing are providing a protective force.
So what are these  historical and social determinants and how have they changed our health and our  mental health?
In 1788 for us the profoundly
traumatic events that colonization have begun
I use the term traumatic deliberately because colonization occurred within only three to eight  generations of Indigenous peoples living today.
By inter-generational
and trans-generational transmission the trauma is still with many of us.
The first wave of colonization is not a distant event, a historical event,
the last officially sanctioned massacre is recorded at Coniston in the Northern Territory in 1928.
In a second wave of colonization from the late 1800's to 1950 we were subjected to racist legislation that controlled all aspects of our lives
and many of us were further traumatised by being forced off our country and mixed
with different cultural groups on reserves and missions that were controlled by missionaries.
At best we've been confined to camps outside of towns under various state legislation and segregationist policies
and this is what happened to some of our elder folk living to day and to our parents and our grandparents and our great grandparents.
So, it's still within our frame of reference, our living experience.
The other defining experience of this period was the forcible removal of tens of thousands of children who were often referred to as the 'Stolen Generations' to be
assimilated into non-Indigenous society.
Many people are living today are directly affected and the trauma transmitted down family lines.
From the 1950s on segregation and reserves, segregation and reserves, were dismantled and anti-racist and decolonisation norms took root in the west.
The last of the residential facilities closed
in the early 80's
and a couple of weeks ago it was announced that 71 of  former residents of the home for Indigenous Stolen Generations
Children in Darwin who suffered horrific sexual and physical abuse will be compensated in
what their lawyer says is the largest class
action in Northern Territory history.
Legal equality and the restoration of our human rights was of course welcome but a perverse
outcome was that it enabled us  to access both welfare and alcohol without restriction and in practice
legal equality on its own did nothing
to bring us closer to the economy, services, or any other benefits that are enjoyed by
other Australian citizens
and this scenario led to what my esteemed
colleagues Professors Helen Milroy and Ernest  Hunter
have referred to as 'normative instability'
in many of our communities where welfare and alcohol dependency were layered upon trauma and distress, dysfunction, in other words.
Across the country then, we remain a part in deep collective poverty and without  access to political power
We were by  that point a small minority in our own land. Even today we comprise only three percent of the total Australian population.
But by 1967 there was enough disquiet
and international embarrassment about our squalid
living conditions that a referendum to change the Constitution and provide the Federal Parliament
with the constitutional power to make laws
specifically for Aboriginal people were passed
with the unprecedented and overwhelming public support of 90.77 percent.
Which is the most successful referendum that we've ever held in Australia and only eight of 44 referenda ever passed in Australia and  that one to recognise us to be counted on the census, was, ah, was, the most popular.
The promise was that the Commonwealth would set up, would step in to ensure we received
the services and support that the states and territories had failed to provide and rectified decades of segregation
But this did not start to happen until the mid 1990s and while there
has been much change since the 1967 referendum racism and social exclusion remain a defining feature of our lives.
In an authoritative 2006 survey  fifty, ah, fifty seven percent of Indigenous Australians agreed that Australia was a racist country.
In 2010 almost ten percent of Indigenous Australians were estimated to suffer deep and persistent
social exclusion compared to approximately only five percent of the general population.
So, in this situation social determinants continue to have a much greater impact on our health, mental health and rates of  disability.
Injuries and violence also contribute to both disability, trauma and mental health problems.
In 2014/15 more than one in five of us reported experiencing physical or threatening violence and that's
2.5 times the rate of non-Indigenous people
and the most frequent recorded contributors to high rates of psychological distress are the death of a family member
or friend, a close family member, or friend,
serious illness, unemployment and mental illness itself.
Alcohol and drug use and suicide are
also problems in many communities and racism to cannot be ignored.
In a 2016 survey thirty seven percent of us reported experiencing verbal racial abuse in the previous six months
and racism has been connected to psychological distress and trauma in the United States African-American population
and there's little reason to doubt that similar impacts are taking place on us here in Australia.
All of this hits our friends and families hard. Sexual abuse is also reported at higher rates in our communities.
Our  precious children are eight  times more likely to be in child protection services than non-Indigenous.
and disabling developmental trauma in our children is an emerging problem.
For some of us our continuing social exclusion is connected to where we live in Australia.
In 2016 the population of Australia was just over twenty four million people and about 10 percent smaller than the
combined 2013 population of the Netherlands who are here and Belgium.
But spread out in an area over a hundred  times the size of both those countries.
Eighty two percent live in just fifty urban centres and almost half live in just Sydney
and Melbourne alone.
This leaves remote and very remote areas
so called because of their distance from urban centres that have well established service hubs
The remote and very remote areas are  shown in blue and purple respectively on the map on the left hand side of the slide above.
Now like the general population about eighty percent of the estimated seven hundred and fifty thousand Indigenous Australians today also live in major or regional cities or close to them.
However,  fifteen percent or so live in very remote areas.and that's, that, purple shaded area where they comprise about 45 percent of the population
So fifteen percent of our Indigenous population comprise forty-five percent in the very remote areas and that's tens of thousands of Indigenous Australians.
In these areas the negative impact of the lack of reach of government health, mental health and disability services, let alone market driven service providers falls disproportionately on us as Aboriginal and Torres Strait Islander people.
Yet there are some compensatory factors of remote living.
Research suggests that the protective forces of practicing culture and ceremony
of being with family and community, of walking on country
and nurturing and fiercely proud
Indigenous identity develops resilience against
the impacts of stress and trauma and the ability to do these things is enhanced in remote areas.
But nonetheless to be living with a disability or mental health issue in these areas is a significant challenge.
I'm Chair of Ninti One an organization that worked with Indigenous Australians with disabilities and their carers living in remote towns and communities
and particularly in the Ngaanyatjarra Pitjantjatjara Yankunytjara  lands in South Australia in 2015.
Now Ninti One is engaged to identify the needs of Indigenous Australians
in these areas as part of the
roll out of the National Disability Insurance Scheme that Eddie  referred to earlier.
Now, there although we noticed that people with disabilities also benefited in ways from their remote living
we found poverty and poor housing, let alone,  housing modified to be able to accommodate people with disabilities was common place.
Demanding family and spouse carer roles was also the norm.
There was also almost no exception expectation of transformative life changing disability support on the part of Indigenous clients
There were also gaps in the cultural appropriateness of the services being delivered and poor
disability literacy meant that people with
roughly identical disabilities receive very different supports.
So how has Australia and the Indigenous
and Indigenous Australia responded to the situation?
Well from day one of colonialization
Indigenous peoples and their leaders have resisted gathered and planned to regain control of their lives.
Every decade since has had its heroes who struggle for change and Indigenous health leaders have responded to the health, disability and mental health challenges we face at three levels
from within our communities, through our community based and controlled organizations
and at the macro or state or national levels.
In practice our leaders might begin leadership roles in their community leaders lead through
community organizations and eventually emerge at a state or national level with their leadership.
For them there may be no neat delineation
between the levels of leadership in which
they operate and indeed they may significantly contribute as leaders and advocates precisely
because they know their communities and can ensure that their voices are heard at the
national level, which is so important when
we look at such a big country as Australia.
Even when operating at the state or national levels it is critical for us in leadership roles to not lose touch of our communities.
An Indigenous leader is always accountable to those they  represent
and this is one reason why it's important for governments to not cherry pick Indigenous leaders aligned with their political agendas.
Instead they should look at those with genuine support in communities or who may otherwise spearhead movements with clear Indigenous support
and a reminder here again of some of the work that Ninti One  has done with the exceptional women
of the Ngaanyatjarra Pitjantjatjara Yankunytjara  Women's Council
and this organization was formed in 1980 to deliver community, family, research and advocacy services in the vast
central desert region of Australia and Ninti One has worked with the NPY Women's Council
to understand the needs of children and young people with disabilities in these areas to
inform the National Disability Insurance Scheme roll out there.
and I note that Andrea Mason the Chair of the NPY Women's Group Council also works at the national level
and was just this month appointed to the Prime Minister's, or actually last month, the
Prime Minister's Indigenous Advisory Council that formally advises the Australian government on Indigenous issues.
So, we are very confident that Andrea will raise issues about remote Australia.
So, here is a classic example of how the three levels of Indigenous leadership inter-relate.
Now focusing on the health and mental health leadership that has also been built from the ground up.
From the late 1960s on in the absence of effective government action and as an expression
of self-determination Indigenous community leaders in Sydney and Melbourne organized
to provide their own health services.  A community control model was developed in which local
Indigenous boards of management control these services. Chicka mentioned one of them he's involved with this morning.
So, over time Australian governments have begun providing financial support. Such that a  hundred and fifty or so of these services now exist.
Some are big urban medical centers that provide holistic and comprehensive primary health care
and others in remote areas might just
be a clinic with only a nurse and maybe a visiting GP or physician.
In regional and remote areas Aboriginal community controlled health services are used by both Indigenous and non-Indigenous peoples.
Each state and territory also has a community controlled health service peak body
and at the national level the peak body for community control health services is the National Aboriginal Community Controlled Health Organisation or NACCHO
and it has and continues to play a key leadership role in the Indigenous health movement.
On these foundations in 2006 I was honored as the Aboriginal and Torres Strait Islander Social Justice
Commissioner of the Australian Human Rights Commission to help establish and act as the
Inaugural Chair of the 'Close the Gap' campaign for Indigenous health equality.
The campaign aims to close the 10 year life expectancy gap, happened to be 17 years at that stage, between Indigenous and other Australians.
But we used human rights based approach with non-negotiables including Indigenous leadership
partnership between us and the Australian Governments equality based health planning and the use of equality targets.
Now the campaign membership comprised of Australia's peak Indigenous and
non-Indigenous health bodies, health professionals and human rights organizations
including NACCHO'S as the peak body and membership was contingent on agreement that
Indigenous  lead organizations would always have the final say in how the campaign operated
which I think is critical.
The campaign was founded on a clear articulation of need with goals and principles based on human rights law.
It was framed as both a drive  for Indigenous health outcome equality and equality of opportunity for healthy life.
Eventually over thirty Indigenous and non-Indigenous organizations and bodies joined the campaign
and they funded, were self-funded to be independent and operate a dedicated secretariat
and with the support of Oxfam the campaign implemented a remarkably effective grassroots strategy
to garner the support of the media, the public and Indigenous people and communities
and we've got about over 300,000 people signed up as members of the Close the Gap campaign.
So, today,  Close the Gap Day, which is celebrated on the 16th of March this year, is an important fixture in the Indigenous calendar.
Politically the campaign secured multi-partisan  political support through the signing of the Close
the Gap Statement of Intent by the then Prime Minister and leaders of all major political parties at both the national and state and territory levels
and critical to our advocacy was agreeing and endlessly repeating the key messages until they began to be repeated back
to us from the mouths of politicians and bureaucrats as if their own ideas.
We shaped to discourse in other words.
In this way we succeeded in
securing over five billion dollars in additional funding to address our health, housing and other social determinants.
Further,  two health targets were set to close the gap in life expectancy by 2031 and to halve the under five child mortality gap  by 2018
and further targets for key social determinants have also been set.
So, each year in the first week of Parliament the Australian Prime Minister makes a statement to the nation on these targets and the campaign.
We publish our own independent shadow  report.
So the government will say what has been achieved and what hasn't been achieved
and we will say whether we agree or don't agree and, ah, so forth
so its an accountability measure
that, ah, is unsurpassed anywhere but hopefully
will, ah, it's going to take take hold of a few
other campaigns that we've got.
Because progress is slow the campaign consistently must remind politicians and the media that we cannot turn around the
disadvantage of Indigenous Australians overnight.
Life expectancy will only lift following
improvements through outcomes in numerous areas
and there are real and positive signs of
change.
One of my other hats that I wore that is mentioned is that of the National Coordinator for Tackling Indigenous Smoking
and I don't encourage anybody to smoke there is  no such thing as a safe smoke, is there Pat?
In this role and through a significantly funded Indigenous specific anti-smoking campaign we are seeing
smoking rates consistently drop over time and potentially huge benefits and health
implications and particularly we were looking at it from the mainstream of of smoking
and mental health issues and the effect of
smoking on medications and so forth
because they do have some very detrimental impacts.
In 2006 when we started the Close the Gap campaign mental health was a poor cousin  to physical health.
In part this is because we are not
yet nationally organized as mental health leadership bodies at that time.
The Australian Indigenous Psychologists Association the peak body for Indigenous psychologists was not established until to 2008
and the Healing Foundation was established in 2009
and I commend the Healing Foundation to you as a great example of an Indigenous
led healing initiative that has supported
many community level healing programs and activities
So happily mental health is now at the heart of the efforts to achieve healthy equality more broadly
as well as being understood as a significant challenge in its own right.
The National Health Leadership Forum that emerged from the Indigenous leadership group of the Close the Gap campaign
of 2011 is now the overriding national Indigenous health peaks forum.
It has successfully partnered with the Australian government to develop the National Aboriginal Torres Strait Islander Health Plan 2013 to 2023 and has ensured that mental health is included in it.
The Health Plan Implementation Plan  which followed and a task force is now working to operationalize the implementation plan and
a multi, multi portfolio social and cultural
determinants working group to develop a blueprint
to apply its determinants approach to health policy and programs.
The start of the Indigenous mental health
movement can be dated to 1995 and the
'Ways Forward National Indigenous Mental Health Report' developed under joint Indigenous and non-Indigenous leadership.
The growing movement has boosted, was boosted, when the 1997 'Bringing Them Home Report'
brought home the impact of the forcible child removals on our mental health and Bringing Them Home
recommended a national apology that was eventually made by the Australian government.
In February 2008 and I had the privilege
to be nominated by the Stolen Generations
people to provide the formal response to the Prime Minister's apology on their behalf.
Over the past decade the government of the States and Territories have also apologized.
So we've now got nationally that recognition and more recently I commended  the Australian Psychological Society for its
2016 apology to us for some psychologists
role in child removals
and it's my hope that other bodies of professionals that were involved and my fellow social workers, psychiatrists,
and so on will also  follow that lead and
make apologies.
Another result of Bringing Them Home was the funding of counselling and social emotional wellbeing services primarily
aimed at the stolen generations and in some community controlled health services
and today largest services are likely to employ mental health professionals onsite or as visitors
Aboriginal mental health workers are also an established element of the work force in the services.
However, amongst Aboriginal community controlled health services
overall about six in 10 still report
gaps in mental health and social and emotional
wellbeing services and about half report gaps in alcohol and other drug services.
Now roughly half of the indigenous population use or  relies on community controlled health services and
as such the absence of mental health and other services in them is a significant barrier to treatment.
The indigenous mental health
movement has two main objectives
first building on the community controlled
health service model to establish mental health
services controlled by and specifically for
Indigenous peoples and that operate within
a cultural framework and second to ensure that general population mental health services
are responsive to our often greater and more complex needs and cultural experience and
cultural, experiential and language difficulties and remember I said only half of the indigenous
population use a community controlled health services and the other use mainstream and other services.
So we need to ensure that
everybody is able to culturally cope with delivering services to our people.
Critically to both these efforts is a renewal of the national strategic framework for Aboriginal and Torres Strait Islander people  mental health and
social emotional wellbeing that was initially
developed in 2004 by Indigenous, cultural, social
and emotional wellbeing mental health and
suicide prevention leaders and I'm pleased to report that the
Aboriginal and Torres Strait Islander 
Mental Health and Suicide Prevention Advisory Group
were at some SPAG mostly Indigenous body that I  Co-Chair with my good friend
Professor Pat Dudgeon and we advise the government on mental health suicide prevention and social and emotional wellbeing and
other things we've been charged with
this renewal and we believe that that's a very imminent  response on that.
Other important related policies emphasise the need for Indigenous
control in Indigenous specific responses include the 2013 National Aboriginal Torres Strait Islander Suicide Prevention Strategy
and the National Aboriginal and Torres Strait Islander Peoples Drug Strategy 2014 to 2019 and both were developed under Indigenous leadership.
Now, looking forward trauma is increasingly being recognised
as perhaps the foundational challenge not only to improving Indigenous Australians mental health
but also for addressing a range of so called
wicked problems that continue to undermine our  communities lives.
A wicked problem denotes a challenge that
is difficult or seems impossible to solve
because of contradictory or challenging causal factors that are often difficult to recognise in the first place
and it's my belief that such, many such, wicked problems have much of
their origins in the multiple and compounding layers of trauma in the Indigenous population.
In addition to historical traumas this includes traumas from repeated exposure to life stressors
in the present day and things like racism
that I mention and trauma from exposure to violence and childhood stressors and later with potential
developmental impacts that can lead to disability and I note with some hope that at some SPAG has
begun to map the beginning of what may be a national comprehensive response to trauma in Aboriginal and Torres Strait Islander  communities.
that includes healing and holding the transmission of past traumas as well as preventing new traumas.
Indigenous mental health leadership took a significant step forward with the
In 2013 with the  establishment of the National Aboriginal and Torres Strait Islander Leadership in Mental Health
Or at some SPAG or at ATIMHL which I'm a member and and Professor Dudgeon is the Chair
and ATIMHL is independent
and operates its own secretariat and it
comprises a core group of senior Indigenous people based in or associated with national and state level mental health commissions.
But the Healing Foundation, AIPA the Australian Indigenous Psychologist Association and
NACCHO who I previously mentioned are also members and that all was established to
help implement the International 2010 Wharerata Declaration that as many you will
know recognized the importance of Indigenous leadership in mental health systems to better
respond to the mental health needs of their
Indigenous populations in a culturally appropriate way.
To that end ATIMHL developed in
2015 the Gayaa Dhuwi or Proud Spirit Declaration as a domestic companion document to the for
Wharerat Declaration it comprises five, five,
themes including that focus including two
that focus on the culturally different nature
of Indigenous leadership itself.
And I'm happy to report that the references to the declaration are in draft copies of the Fifth National Mental Health Plan.
Australia's overarching mental health plan
that is currently being renewed and this achievement
bodes well for the future of Indigenous mental health leadership in the country.
In parallel to the above a national Indigenous disability movement can be traced to a 1999 national
gathering of Indigenous disability leaders
in Alice Springs.
From there the New South Wales Aboriginal and Torres Strait Islander Disability Network was established in 2002
and in 2010 the First Peoples Disability Network with CEO Damien Griffiths who will be speaking tomorrow I  believe at this event was established
Proudly and for all Indigenous Australians this is the only organization in the world constituted and governed by Indigenous
peoples with disabilities. It is also an important part of the broader Indigenous health movement in Australia
In 2014 the First Peoples Disability  Network chaired an interagency meeting of government departments
to develop an Indigenous Disability Action
Plan under the National Disability Strategy
and an Indigenous reference group has also been established.
I will finish this part of my keynote by including on the slide above what I believe to be some of the key themes challenging leadership, if it works?
I want to close by looking at a potential challenge to Indigenous
community leadership in relation to mental
health and disability services.
In 2015 31 primary health networks were established as part of an ongoing reform effort to decentralize
the Australian primary health care system.
PHNs they're called are intended to promote responsive regional level needs based planning and service delivery.
The governors agreed to six key priorities
for targeted work by PHNs and these
include mental health and Indigenous health. Further to this PHNs have recently been given
the task of overseeing the establishment of
a stepped care model of primary mental health
care clinical services in the regions including specific Indigenous mental health and suicide
prevention activities and PHNs are required to work closely with the National Disability
Insurance Scheme providers because of the need for psychiatric disability support services
integrated into the stepped mental health
care model.
Now a key PHN role is mapping service gaps and commissioning new services where gaps are
identified. And this requires them to work
closely with the community control services in Indigenous communities.
But it is not clear how Indigenous community leadership will be preserved in this situation
there are concerns that this will amount to
a consultation rather than a negotiation process.
A further concern is with the proper roles
of market driven processes such as some PHNs
tender based commissioning processes, processes that have historically not delivered the right
services to Indigenous communities and too often these tender processes are boiled down
to a competition of who can draft the best
application and not who is able to offer the best services.
So, we have real concerns and and our group, the advisory group is doing a little report on this to the Ministers.
Now I've been lucky to play a small part
in a decades long Indigenous health and mental
health movement involving hundreds of thousands of Indigenous leaders, advocates, experts and
stakeholders and their non-Indigenous allies working at all levels. The cumulative effects
of this I believe is that we have established
the foundation for future Indigenous Australians
with mental health conditions and disability
to lead contributing lives and partake in thriving communities.
Now despite the disheartening statistics. My message to you
is one of hope of survival against the odds
of great resilience
and of the value of struggle in the face of
adversity. Our global movement is far from over
and work remains to be done. And like democracy
ensuring our brothers and sisters with mental
health problems or issues and disabilities
lead the best possible lives is likely to require eternal vigilance.
It remains to future generations and future leaders to keep these
flames alive and to write the next chapters
and I hope this keynote will inspire and support this future.
And with a view to stimulating a lively discussion I close with three challenges, my three challenges to you,
as a slide shows which we'll discuss
in a minute but also leave with one of my
mantras that I use very often and that is
From self respect comes dignity, from dignity comes hope and from hope comes resilience
Thank you.
Tom Calma, stay with us for a moment,
Eddie Bartnik
Thank you very much Professor Calma, what a powerful summary of mental health and disability in Australia
and for your messages of resilience and hope.
Tom's observations I'm sure will resonate with many people both in Australia and other countries.
We will have an  opportunity to discuss those parallels shortly and the alternative meantime your message about
people getting control of their lives sits
very strong with the values of the National Disability Insurance Scheme.
On behalf of our combined organizations we'd like to thank you very much Tom for your presentation
But but also for your many contributions
to the to the community.
I don't know how Tom still finds time to be the Chancellor of the  university
and to give back to the Australian sort of wider community. So I Tom we have a gift for you
So yes. Yes. Thank you very much (laughter).
I'm now going to hand back to
Natasha Mitchell who, so, we can discuss Tom's
insights and the issues they raise in your lives as leaders
and from now on it's going to be Natasha, so I'll leave you in her capable
hands for  the remainder of the program.
Thanks very much Eddie. Thank you. Great.
If we could have the last page of the last slide up please? Is that possible? Fantastic.
Thank you Tom.
And I love how we made you take your own gift (laughter)
and some of the thoughts that I have from Tom's presentation in addition to the
questions we're going to pose to your tables
is often health and mental health and disability leaders like yourself are activists.
You know there's an inherent activism to being
a leader in this arena and in representing
the communities that you want to support or that you are a part of as leaders. So and
the other thing that that emerges for me
is in this era of fake news and such
things the power of data you know that Closing the Gap Report that comes out each year it's sobering.
It's a tough read, it's sometimes very depressing but it fundamentally creates a path
of accountability for leaders. They must, they must be, accountable for that data.
So that's that's another point that I would
think of and also just the power of leaders
to say sorry either for past actions of policies or practices or services but also contemporary leaders to
acknowledge you know their own deficits as they try and as you try and build and lead
services in your own countries and your own communities that really it's very hard to
find to acknowledge mistakes isn't it as well along the way and how do you build a conversation
that allows that to happen? And the saying
of sorry you know that image of the two women
hugging each other. You know it still brings
tears to me every time I see that photo.
So, you know the power of of sorry. So, these questions. The first one we'd like you to
we'd like you to discuss all three at your
table if you're at a table with colleagues
that you know you might want to sort of shuffle around and do a bit of a swap.
It's up to you I'll leave that to you. You
can manage where you sit throughout the day.
You might want to change spots throughout the day but those three questions Tom.
We have a question here and I'll come over to Alan shortly. Thank you.
Yeah. Jenny,  or a comment, yeah, from the Mental Health Foundation in the UK. First of all I would like to
thank Tom for an absolutely amazing speech. It's very inspirational and while the UK isn't one of
the nations with Indigenous peoples in that
sense there are many things that he said that are very, very transferable.
I think the thing that we have for a number of different countries around this table
I think what we found particularly strong was your reference to a human rights
structure underneath as being the basis of
which you could argue all the other points
and argue for inclusion, argue for leadership
making sure that a focus on localism and you know competitive
services didn't trump what is fundamentally
that people's right to good health services and good health support.
So, thank you for that and I don't know if you've got reflections on how we could spread your learning more widely.
But, can I just pick up on that to
I mean human rights sometimes feels nebulous doesn't it when systems take over that core
vision gets lost in the moment to moment and day to day delivery. So how do you retain that core substrate in your work?
Putting it back to you.
Well it's something that we're working on
and struggling with really I think it's bringing
the the language that can seem remote into the language that feels right for the people
who are know what they're getting isn't good enough and want that to change.
I know the number of workshops I have been at where people said no not a service, I'm a citizen.
I'm sort of very sick in my mind because that means people are recognizing that their own
advocacy is actually probably the greatest
ingredient in creating good health for them and their community
And language matters doesn't it?
I'm not a patient, I'm not a service user
I'm a human being with human rights.
Tom, so, exactly and I think it's very important and I guess the, if anybody is interested to go
into the Auistralian Human Rights Commission web site you just go into Close the Gap and there's
a ton of work there and especially some of
the early work. The report I did in 2005 which
established that that you know there was really only human rights based approach and that's
really about engaging with the community the people most affected is paramount. What we
do. Making sure that we apply things like
the principle of progress of realization.
Meaning you've got to set some really good
timeframes that are achievable and
the whole the whole essence of what we're
trying to achieve is equality and so it's
the right to equality and so things
like accountability is there, set the timeframe
set the targets make sure that
all the parties are accountable to doing it.
Make sure that funding is based on need and
and once those principles are there and you
have the accountability both back to the community
and as we've got the various Prime Ministers
to do since 2008 is to give the report back
to Parliament which is the public accountability
for what what government services are required
to be provided to all citizens and that's
the key thing you've  got citizenship rights and you've got human rights  and human rights, ah, apply to every citizen of the world.
Did anyone talk about some of the marketplace challenges of service delivery?
There was a lot of buzz in this title and I'm not saying enough hands up, yes. Thank you. Let's get
a mike to the middle. Hands up if there's
a comment or a point that you'd like to make
that emerged at your table just to get the
conversation started across the room. Thank you.
Thank you, my name is Ermay  from New Zealand and we didn't actually talk about this at our
table but about 15 years ago we hit the emergence of ?????  for Maori service providers and
we recognized that that were going to fail
if we didn't support them and so what the
government did was that they set up a new
department and funded it 10 million dollars
a year simply to train and provide support
to providors to stay viable and to
continue growing and that was an extremely successful initiative to ??????
still exists. It's run by Maori to support
the development and growth of Maori oganisations
and to train their leaders so, if you
want Indigenous  leaders then one of the things
that you can do is set up organisations to grow them.
So what sort of training, yes, but what sort
of practical support does that 10 million a year provide?
Whatever they need, they decide they developed a template for self-audit for organizations they identified
what they required in order to stay viable or 
to grow, they set up scholarship funds.
Mason Drury was on there board and there advisor who is one of the icons
in terms of Maori service development and research they grew research fellows. So they've set up
a whole program of activities so you can go online and just Google them just have a look at what they're doing.
But it was a very successful model in New Zealand and many of you know
that they've gone from strength to strength
in terms of Maori surviving.
Great. Thank you. Introduce yourself.
I'm Donna ?? I manage a alcohol and  drug service in Rotorua ????we've got some AAD contacts
and adult use as well as residential
for our  midlands region.  ????? out there Tom
??????   Leonards Creek in terms
of some of the workforce aims particularly
Maori focusing for Maori the only thing
that I would say that slightly different learning
is while there are a lot of Maor providers
doing some fantastic work we are still being
undermined by non Maori services in a lot
of our contracts are being uplifted from Maori
providers and going to the national non-Maori providers. I've got a huge issue with it and
constantly challenging  our government and Ministers around it.
So, don't sit down yet
Tell us more, about what is happening and why that that that loss of provision or power is happening?
Well actually I don't have the answer and
neither do they. So, I can only talk about my experience in my community
as I have 3 this year that have been uplifted to go  to non Maori services and I cannot get an answer to that.
So the services are being  taken away from Maori providers and is that come through the competitive tendering sort of process?
Yes it does. But on the upside we also won quite a significant contract from a non Maori provider.
Given, that those, alot of those who did use those  drug treatment units in prisons are full of Maori. So we
you know we have got one ??? member. But I do challenge non-Maori providers when
you are going for contracting ???? to be
careful when you're taking that funding from they're often from Maori providers.
So as leader do you feel that you
have got the voice of the ears of the people who are driving the tendering process?
I get invited back. Surprises me, I don't know that I've got the ear. But I think I've got
a lot of support from other Maori colleagues and service providers. We're quite united
in our conversations and but you still get
on and do the work at the end of the day.
We still have money to do and like Tom said and has caught it all. I'm not just responsible
to the funder in our government. I'm responsible to a whole community of people, our families
our community, particularly Indigenous communities and if you don't get it right you're heads on a platter.
Yeah, in many ways, more ways than one family as well. So what about in Canada. Yes thank you.
We've got a comment there.
Some of our colleagues in Canada here as well might be wrestling with these issues.
So, Arthur Evans I'm from the United States
and I'm actually on the public payer side
and this is an issue that we deal with quite
often and there are two things that I've done as a public
payer to try to adjust this one is to build
into every competitive process criteria that
makes it almost impossible for someone who doesn't have ongoing experience with the community
to be successful in obtaining a grant and
the others to make sure that people with lived
experience are part of the decision making
process and in fact in my agency
we do not make any funding decision without people from the community being a part of
the ongoing decision making process. So those are two ways that we've tried to manage this
whole issue of people who don't have experience with the community sort of coming there and being more competitive
Yes. OK. Any other points or to pick up on?
Yes, thank you. This is Rennie.
Hi, I'm Rennie Linklater from Canada and I work at the Center for Addiction and Mental Health
which is a hospital with provincial responsibility in Ontario. And so what comes to my mind around
Indigenous leadership is that whether we're
talking about services within our communities
within Indigenous led services or whether
we're talking about mainstream services and
we know you know Professor Calma made a comment about about 20 per cent of Indigenous
people are accessing both right Indigenous
services as well as mainstream services.
So, there's a real need across the entire system to build capacity. But what I feel really strongly about is that we have
indigenous people leading those processes. And so where we have mainstream organizations
it becomes really important to have a core
indigenous team doing that work and really
developing partnerships with communities are really engaging and assuring that we're being culturally responsive.
Thank you.
Yes, thank you.
Over here, we will wrap shortly for morning tea but I just want to grab the grab a little bit more in the room while we can.
??????
Oh hey Kori, Oh hey Kori. Oh I think if we stick to the smoke free we want to smoke freely.
Umm, ah, I just wanted to just  pick up those three questions again and two things if you want, umh
Lord knows there are enough of us sick people out there, we don't have to fight over the clients.
What the tendering service does is pit service against service and loose innovation and create cost
and you just churn your wheels so we don't like and I've run Maori organisations and I've run
mainstream services, population whole services,  that have obligations for Maori in the Pacific
and you don't get better outcomes by pitching services against each other.
Data is how do you make sure people are accountable count the right things apples for apples.
But if you want to do it with a leadership question you've got to have it.
If I can just demonstrate it's across, you've
got to have it top and across and sometimes
it's the level three positions if we have
enough Maori Pacific, Elgie ,PTI women. consumers
at that level they will drive the cultural
change that makes organizations responsive
to the needs of Indigenous people. You don't just buy it and you only have one available at the top.
You've got to do it across that way
and when you get there you get it it works.
So just to point point back to you just briefly how do you start building the cross?
What's the first step people should do?
Start with the Human Resources people,  the people who hire. What are they hiring for?
What are the KPIs? Who makes the cut? Start with the human resources people.
They've got a strategy, you'll have got respect, start with HR.
Fantastic, lots of nodding heads in the room on some of this stuff.  So, you'll continue the conversation at morning tea.
Tom,  Alan Rosen, local superstar, psychiatrist, leader of services, activist
Thank you, Natasha.  All round good fellow, it's mutual It is a communal admiration society
it's a wonderful mental health community we have.
It goes out to all of us. Tom,  I congratulate you particularly on the mention and thank
you for the mention of the apology and what we can do, what we can do, as non-Indigenous
people in this sphere, as well as the practical things that have been mentioned which I agree with.
But I think the issue of apology is
important in terms of the transforming Australia's
mental health service system has put out the which is an off shoot of the Themes Conference
the Mental Health Service Conference of Australia and New Zealand has put out the challenge to the
mental health professions to make an apology for, for our contribution as mental health
and different mental health professions to
the predicament that Aboriginal people and
other Indigenous people have in the world. This has gone to all the professions but
the APS the Australian Psychological Society is the first, I think worldwide, to make that
apology, they've made it in their own words. They haven't followed the template that we provided
but the other professions are looking
at it and it is now going to a presidential
debate in Berlin at the World Psychiatric
Association in October.
So, there is some progress happening with it. But thank you for the mention
particular tribute to Pat Dudgeon and to Helen Milroy who helped him encourage this process along.
Thanks, Alan, thank you. And I should just
say for those who haven't met Pat Dudgeon
she's come up, that name has come up at least four times. That's Pat, if you'd like to grab her and talk to her.
One brief comment, thank you.
Thank you. This stuff is very important I am ????   from the US with Dignity Recovery Action International.
The integration, I always think that there's really two problems though that
we don't really get to,  meaningful
involvement,  meaningful integration of the lived experience
whether it is cultural or of disability or mental health conditions. Is a ,is a, really
thorough project you have to go from inclusion which sometimes just feels like tokenism to
real active integration and there's a whole
there's a whole process there.
So you know we've developed and I think that one of the things that we like to see a lot
more is a process for organisations to really think strategically and technically about
how are you going to go from where you are to the next step in terms of empowering their
communities, bringing the wisdom of the lived  experience into your, into your, organisation or project
or your program and really plan to do that
over time. Now the other side of this though
is that a lot of people whether they've not
had opportunities because of interrupted education
or because of not having the same educational opportunities as professionals they're not really truly
able to be empowered because they don't have the support and the learning ability to get
to the place where they can be really effective as change agents within organisations.
So, I, I, really feel like this is so important
to do it right. You really have to bring focus
both on strategy also on training and support and helping guide people who are trying to bring
those lived experiences into places where they can be effective without being isolated and manage
the stigma and discrimination and things that are going to come along with it. So, so, putting
Putting these two together to me those are the wheels that you need to have on your car
If you are going to move forward and make it really true empowerment.
Thank you very much. So we have, we have, someone has emphasized start with human resources.
What? Who are you hiring? According to what criteria?  Support those people that you do
hire to  be the leaders that they have the
capability to be and we're going to talk much
more about lived experience with an incredible speaker after morning tea. So we'll pick that
up any final comments from you Tom?
Look,  just thank you, thank you for everybody being here. You know in this sector both our
sectors we have to really work together
and I think we can work together.
Can I just pick up on a couple of the points
that were said I think none of us want to
have and see token appointments on our boards and committees so they've got to be real and meaningful.
But the first step is opening
the door to allow participation and then once
that door is opened and people put their hand up they need to be supported to get into those
positions as has been mentioned.
And we've got a lot of good people out there who may not be but you know all that well
formally educated but can can offer a fair
bit. You know and I think the lived experience
as as somebody affected but also as a carer is really important that we do listen and
and be directed by those people
because we can do as much as we like and try
and see things from a principle position
but really informed position is when you got
people from with the lived experience or first hand experience
as a carer to help guide us. I think you know, you all know that but I think it's always
important and particularly important if we
got bureaucrats around to hear this because
too often they don't participate in forums like this.  So, we have a lot of liked minds here. We've just
got to look at ways to be able to influence
the politicians and bureaucrats who hold the
purse strings often and and determine the
policy about. Thank you, enjoy morning tea.
Thank you, thanks, Tom, fantastic.
And for all the bureaucrats in the room
there are psychologists available for support if you need it today.
