Transcript for
Positive partnerships with Aboriginal and Torres Strait Islander organisations
Emma Carlin (00:00): You have to realise that Aboriginal clients, patients, consumers that you’re working with will have had adverse experiences in the hands of non-Aboriginal people. So it’s your job to really put your best foot forward to really seek to invest in understanding who your client is and what their strengths are.
Narrator (00:25): Welcome to the Emerging Minds podcast.
Narrator (00:30): This podcast is one of a five-part series developed in partnership and led by the team from the Transforming Indigenous Mental Health and Wellbeing research program and the Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention. You’ll have the opportunity to hear and learn from inspirational Aboriginal and Torres Strait Islander experts and their allies in the field of social and emotional wellbeing and mental health. You’ll also explore key concepts and frameworks and learn how you might apply this knowledge in your own practise to better support the social emotional wellbeing needs of Aboriginal and Torres Strait Islander children and their families. Welcome from beautiful Broome, where today we come to you from the land of the Yawuru people. In this episode, we will hear from Zaccariah Cox and Emma Carlin from KAMS, the Kimberley Aboriginal Medical Services.
(01:19): This is part of a partnership series that we will be releasing over the coming months with the team from the Transforming Indigenous Mental Health and Wellbeing at the University of Western Australia. Transforming Indigenous Mental Health and Wellbeing is a groundbreaking research program transforming Aboriginal and Torres Strait Islander mental health care through Aboriginal leadership and authentic partnerships with Aboriginal organisations. Emma and Zac are contributors to this work based within the Kimberley Aboriginal Medical Services in Broome. Hi Emma and Zac, thank you for your time today and your willingness to share some of your insights about Aboriginal and Torres Strait Islander social and emotional wellbeing. Firstly though, we would love to hear a little bit about yourself.
Zaccariah Cox (02:03): I’m Zac Cox. I’m currently the Senior Social and Emotional Wellbeing and Mental Health Manager at KAMS. I’ve been at KAMS for about seven years now in a few different roles. And my mob come from up the peninsula, up the top, about 140 K north of Broome on the eastern side of the Dampier Peninsula, the Nimanburr people and also grandmother is from Nimanburr Country, which is the Horse Creek and surrounding communities and areas there as well in the central community. And I’ve sort of been involved in the mental health and wellbeing space for quite some time, I suppose. Been here for six or seven years in this space. I came from mining. Mining wasn’t sort of the most rewarding job in the world in terms of life meaning and purpose and satisfaction.
(02:46): So I was lucky enough to come back and work for KAMS where my grandfather was one of the main players, I suppose, in being a part of the establishment of the organisation. So he’s on the mural inside there in the main office and was really sort of, I’m empowered and felt a sense of, again, purpose, I suppose, and meaning to come back and work in a field that I’m passionate about and that sort of runs in the family and where we know the needs are, I suppose, in terms of opening and supporting them up to understand more about what they’re experiencing, how they’re feeling, and what they can do to counteract or improve their lives in general.
Emma Carlin (03:20): Hi, I’m Emma. I am a non-Aboriginal woman who has also worked at KAMS, Kimberley Aboriginal Medical Services for a little over 8, 7, 8 years. And I’ve mostly been in the Social and Emotional Wellbeing or research space. So I’m currently the senior researcher officer for KAMS, and I also work for the University of Western Australia. I’m affiliated with the rural clinical school and also with the School of Indigenous Studies’ Professor Pat Dudgeon.
Narrator (03:53): Excellent. What drew you to the field?
Emma Carlin (03:55): So I guess I’ve been privileged enough to work alongside Aboriginal people and grow up alongside Aboriginal people all of my life. And I started working in youth work and was very involved in the central desert region in youth development. And I have spent, I guess the last 10 years in Broome and it’s offered me the opportunity to move kind of exclusively into research. My daughter was born in Broome and it’s a really amazing place to, I guess, have that work-life balance. It’s a really beautiful place to bring up kids and there’s a lot of freedom. And my daughter owns one pair of shoes, which she regularly forgets to take anywhere.
(04:42):
And in terms of the work we do in research, I guess it’s the dream research job. We are not sitting in an ivory tower of an academic institution, 2000 K away, thinking about or talking about Aboriginal Social and Emotional Wellbeing. I’m embedded within an Aboriginal medical service. My colleagues are often Aboriginal people, either from the Kimberley or with really strong links to the Kimberley. And the work that we do in research is really focused on translation, on how do we take good practice or emerging practice and implement it to have better health outcomes, health and wellbeing outcomes for Aboriginal people. So I think for me, that drive to be practical in research and to see incremental change is important.
Narrator (05:33): A lot of people understand that as a concept on a piece of paper. Do you want to tell me what social emotional wellbeing means to you?
Zaccariah Cox (05:41): So for me, I suppose social and emotional wellbeing, yes, while the term is, it’s in English, it’s obviously the term that Aboriginal academics have done research to be able to identify and put together. But I think for us, not just myself, but all our mob, we’ve always known social and emotional wellbeing, what it was and what it is or what it means for us. It’s holistic, I suppose. It’s all that we are as Aboriginal people. It includes us as individuals, our families, our communities, the country, the ocean, the trees, the animals, everything in our living environment and also our connection to our ancestors and our dream time stories, our songlines and our culture. So it’s everything really. And we’ve known it in Broome or in the Yawuru language, we often refer to, when we talk about our wellbeing, we often refer to Liyan. And so that describes or that talks to how we’re feeling, and that Liyan is your connection to what I mentioned already, everything that we are, our environment, our surroundings, our communities, our families, and our physical being.
Narrator (06:51): Zac, that was a beautiful description. Emma, how would you be able to put what Zac just said so beautifully into a way that non-Aboriginal people might understand it because there’s a real deep connection, there’s a heart connection, a soul connection to it. A lot of times non-Aboriginal people think it’s just a term of mental health. How would you describe it or how do you write about it in a way that connects to non-Aboriginal people?
Emma Carlin (07:18): Yeah, that’s a good question. I think with the idea that our SEWB is often conflated with mental health might be a nice starting point. We hear that quite a bit often from mainstream service providers or from non-Aboriginal practitioners. This idea that yes, we are looking after clients’ SEWB, we are screening them with an Aboriginal modified K10, and so we know where their mental health is. And I think one of the things that we do, and probably Zac’s team more broadly, is continue to advocate around that holistic nature. There’s enough, kind of, mainstream health research now that talks about not just mental health, but the social determinants of health, the cultural determinants of health, political determinants of health, has all been components of the wellbeing of the person.
(08:19): So we can either kind of take that recourse back to those broader determinants of health or just ask people to think and reflect on their own life and what the key components of any of us are. And I think it’s a shame that Western society has lost so much of its integration of health and wellbeing. Certainly, my family are Irish, and three generations ago, health was very holistic for Irish people, as it was for the whole natural remedies of lots of different parts of Europe. So I think there’s both inviting people to reflect personally on their own wellbeing and what they consist of as individuals, and also looking at that emerging evidence base of all of the components that aid health and wellbeing.
Narrator (09:17): Zac, Emma just spoke about the social determinants, the cultural determinants and the political determinants. Do you want to explain to me what she’s talking about?
Zaccariah Cox (09:28): So when we speak about the historical, political, social, and cultural determinants of health, they’re the factors I suppose that have influenced over the years. And then obviously since colonisation, when we talk about historical determinants of health, have influenced where we’re at today in terms of a society and especially for Aboriginal people may have influenced the state or the situation of where we are at as Aboriginal people in a lot of our communities, it’s different for everyone but from what I’ve seen, those factors obviously have played a big part in the struggles and the challenges that we are currently experiencing within our own mob and our communities and our towns, but also as a nation and society as a whole. So those are historical determinants, colonisation, past injustices and the act of genocide, the policies that were racist and were quite very draconian, very…
Narrator (10:24): Very about punishing people.
Zaccariah Cox (10:25): Yeah, very, very mean. And really, yeah, were intended to pretty much wipe out our race. I suppose as a society and as a community or as a nation, as we’ve progressed into currently where we are now, a lot of those impacts are being seen today as we can see when it comes to the social determinants of health, we struggle with housing, we struggle with education, we struggle with employment. And the reason for that has a lot to do with systems and policies that haven’t been in the favour or have been sort of against what we know and what worked through our mob.
Emma Carlin (11:01): And particularly stolen generation, I think is a really powerful example of that. I mean, the Kimberley Stolen Generation Centre, on their website, have got some statistics about the number of children that were in care in the 1960s, and it was basically like two thirds of all Kimberley children were living on residential missions. And some of those missions, Bridge Danger for example, didn’t wind up until the eighties. This isn’t ancient history. This is a very contemporary impact on families.
Zaccariah Cox (11:40): Cultural language, they’re at the centre or a big part of Aboriginal society and Aboriginal culture. And with the historical impacts and with the current systems and policies they’ve been designed as well to go against culture and to try and eliminate culture and to tell Aboriginal people that culture, you shouldn’t learn your language. You need to move into this new way of living, the Western way, learn English, give up your culture, give up your cultural rights and practises, and fit in with this new society, which has caused devastating impacts on Aboriginal people’s sense of identity and also knowing where we are, where we’re at, where we currently sort of fit in this crazy society that we all live in today.
Narrator (12:24): How does it impact children and families today?
Zaccariah Cox (12:27): Well, politics develop policies that obviously have an ongoing effect or ripple effect on people. And so, for example, we know that the current Western education system is not designed and does not encourage a lot of remote communities and a lot of our remote Aboriginal people, kids, to attend in that style of system of education. And so that would be a political example of decisions that have been made, systems that have been created and developed and implemented where Aboriginals have been expected to just follow through or fit in with and it hasn’t worked. And we can see that it’s still not working and we need to be realistic and be truthful about our mob and especially in our remote communities, our mob knowing what’s going to work for them and what’s not going to work for them in terms of education for their kids, I suppose is one example.
Emma Carlin (13:18): Yeah, I think you’re right. When you talk about policies, and there’s so many examples of enduring experimental government policies such as the cashless welfare card or the myriad of different ways that we try and penalise Aboriginal communities with various job seeker changes to CDEP, to CDP, this revolving door of ways to punish Aboriginal people for living remotely, not having the same access to our education or the health or the housing, those endure and Aboriginal people wear the brunt of that, day in day out. There are so many, I guess, contemporary ways in which we have stopped Aboriginal people since the disbanding of ATSIC to have a meaningful approach to self-governance.
(14:18): And we can see already how discussion around voice is just getting twisted into nasty pockets of populist racist clap trap. So there is a number of ways to consider those political determinants of health. I guess the point that both of us are probably trying to make is that they’re not abstract. They’re not things that happened 10, 20, a hundred years ago. There are things that continue to happen today and can be evidenced in probably any glance at any media outlet on any day of the week.
Narrator (15:00): Zac, I’m really interested to hear around these policy interventions. This ongoing narrative of deficit, the ongoing way that communities are seen as a problem to be fixed. What does that do to identity?
Zaccariah Cox (15:12): Tough question, I suppose. I think for a lot of our mob, obviously, I see it within my own mob and travelling around in certain areas in Kimberley. I think people are living in a way that they only know how to live, and that’s the result of them not having the opportunity to understand that they can live better or in a way that sort of helps to support their wellbeing or support their health in a more constrictive and positive way. It’s just governments that keep making decisions that, without Aboriginal influence or Aboriginal input, you’re not making these decisions that we know don’t work on the ground for our mob in reality.
(15:54): So yeah, we need to be more honest and more accountable, and governments need to be accountable to themselves and to our communities. And if they want to know what’s happening in the community, and then when I start making decisions, they should be on the ground and talking to the people where they’re making decisions from and not making them from Canberra or making them from offices in the cities from information that they’re sort of thinking is the truth or is what’s happening on the ground because part of the staff can be misconstrued and lot of the information can be portrayed in a way that doesn’t truly reflect what’s actually happening on the ground and where the needs are and what the people are saying.
Emma Carlin (16:34): I think we see a lot of that in a paper that we’ve just published as well around Aboriginal SEWB workers and that sense of responsibility really being heightened that there is not a lot of services on the ground for Aboriginal people and not all services that are on the ground are necessarily culturally safe. So there’s this kind of attrition of where people can access the help that they need. And I think it’s fairly well established that Aboriginal people would like to access help from Aboriginal organisations and from other Aboriginal people.
(17:15): And so the sense of pressure that puts on Aboriginal Social and Emotional Wellbeing staff to navigate every crisis that comes through the door, often in very complex communities or townships, it’s real. It’s a real sense of the desire to be the best SEWB worker you can be for your community and to demonstrate to, also, the broader community that Aboriginal people can be there, can stand up for each other, can show that professionalism and that solidarity. And I think that can be quite exhausting. There’s real strength in providing that service as we hear from our research participants, but there is also a level of exhaustion that comes with that, and that’s all of the impacts of working in a system where you are fairly marginalised and that policies around self-empowerment are emerging.
Narrator (18:17): Can you give me an example of where, within research, working within a Social Emotional Wellbeing framework, where it’s actually working really well, have you got any examples that you can talk to me about?
Emma Carlin (18:27): So SEWB, in terms of taking the framework of SEWB and translating that into service delivery, I think is a real emerging space across Australia and particularly across Aboriginal community controlled organisations in Australia. There’s lots of work that’s happening at the moment around evaluating SEWB service translation, but I think there’s projects and programmes independent of SEWB services that use SEWB service models and have demonstrated really positive outcomes. So any kind of cultural strengthening projects, any language revival projects, examples of SEWB in action. In the Kimberley, we’ve spent the last five or so years implementing a different way to screen Aboriginal women for perinatal depression and anxiety, which is focused much more on broader understanding of SEWB rather than just that pointy end of depression and anxiety.
(19:44): We’ve introduced yarning components to any SEWB or mental health screening, and that’s what we’ve seen is rates of screening increase in the Kimberley for perinatal Aboriginal women because that tool becomes more acceptable. People are more willing, Aboriginal people are more willing to participate in the process of screening when it makes sense, when it’s acceptable, when it’s got those kind of markers of cultural safety along the way. And healthcare providers are more likely to administer screening to Aboriginal women when they can see that it’s being accepted and that it’s generating a different level of information, clinical information that can be then used to support well pregnancies and keeping families safe and strong during those early years.
Narrator (20:41): Yeah, that’s really exciting. For a non-Aboriginal practitioner that has a different experience and doesn’t connect with it, what could be some practical advice or tips you could give them? Because there’s a lot of non-Aboriginal practitioners that really want to do the right thing, but they don’t know how. The concepts are quite foreign. So what would be your practical advice that you’d be able to say?
Zaccariah Cox (21:03): So for any practitioner, could be a nurse, doctor, practical advice would be in the first instance, whoever they’re working for, hopefully they’ve got a really rigorous and valuable cultural awareness programme. As much as services strive to, we hope they do strive to have programmes that reflect the communities that they’re working with and the cultural security and safety that they need to be aware of. And I think the best way practitioners can understand how they can be working and what they should be thinking about and aware of, in a health setting or in an education setting wherever it may be, is to involve yourself within the community.
(21:40): Meet local Aboriginal people if they’re a bit reluctant, they’re a bit, shame as we say, or a bit nervous about meeting Aboriginal people, then definitely engage with local Aboriginal staff in their organisation to start building relationships there. But it basically comes down to relationship building, and that’s a big part of Aboriginal culture is trust and the relationships. So if practitioners can really understand the importance of relationships and not sort of diving in, being led by Aboriginal people to get a better understanding of what it’s like for Aboriginal people who live and work in those towns or communities would be my advice, the starting point.
Emma Carlin (22:23): So following on from what Zac’s saying about that relational aspect of service delivery, I think one of the other things that’s really important, and you touched on this before Rosie, is that there’s a really pervasive deficit discourse that surrounds Aboriginal people. And Aboriginal people are seen as an inherent risk factor. They’re seen as, there’s something wrong and there’s a real pathology around not understanding Aboriginal people in the entirety of their humanity and their experiences. So certainly ensuring that you take a strengths-based approach to work with Aboriginal people and their families is really important because as a non-Aboriginal person, you have to realise that Aboriginal clients, patients, consumers that you’re working with will have had adverse experiences in the hands of non-Aboriginal people. So it’s your job to really put your best foot forward. To really seek to invest in understanding who your client is and what their strengths are.
(23:36): Research that we’ve done, again in the perinatal mental health space, we’ve analysed data and it’s shown that family, close family relationships are a real protective factor for Aboriginal people and really appear to mitigate against a diagnosis of depression or anxiety. So often we hear Aboriginal people and their families spoken about as a burden or a risk or something that’s going to bring them down, but that’s from people outside of culture. When we centre and we put our aboriginal culture as the centre and we seek to look for protective factors and we understand protective factors like family, like connection to country, we start to have a very different way that we can approach and have dialogue with Aboriginal people. Some of the research we’ve done where we’ve talked to Aboriginal women about their protective factors, they’ve shared with us that it’s the first time they’ve ever had healthcare professionals inquire.
(24:44): It’s the first time they’ve felt seen, not just this collection of deficits or risks or crap things about themselves that they need to change, but someone has sat there and heard who they are, how they’ve managed some hard times, how they seek to find safety and security and wellbeing for themselves and their family. So yeah, I think having that strengths-based approach is super important and there’s lots of resources out there. Our Aboriginal welcome guide whilst geared towards the Aboriginal workforce is a really great way to look at SEWB in action, what SEWB can mean for a client cohort.
(25:29): The Kimberley Mum’s Mood Scale free online training, again, narrated by Erica Spry, is such a beautiful way to take in some of that strengths-based psychosocial yarning training and resources. I think as a non-Aboriginal person, I’m always pretty humbled by the flexibility and the forgiveness of Aboriginal people, that we will always get things wrong and we will always transgress cultural norms because it’s not our culture, but sharing a bit about who you are, about what your intentions are and co-designing outcomes with Aboriginal people, talking to your Aboriginal colleagues, being led by your Aboriginal colleagues, being able to understand and recognise that you’re not always going to know.
(26:27): We have such a dominant cultural discourse of, we need to know or we need to have the answers. And I’m not always going to understand aspects of cultural wellbeing, and that’s okay. I don’t need to, I’ve got Zac, I’ve got Erica, I’ve got a team, just like I might be a nurse and I mightn’t understand neuropsych, that’s okay, I’d go and see a neuropsychiatrist or a neurosurgeon if I needed that advice. So I think recognising that we don’t have to be knowledge holders for Aboriginal people, we can work in our teams is also really important.
Zaccariah Cox (27:08): Yeah. I think moving, understanding that what you’ve learned at university, what you’ve learned in the Western professional setting or system is probably not going to work in the same way when you’re working with Aboriginal people. So being aware of that and taking that into account and really sort of thinking about things rather than following through or doing things in a way that you normally would as a practitioner, asking questions, taking a step back, and especially when you’re unsure, talking to your Aboriginal colleagues, talking to Aboriginal health workers, if you do have them in your service, they’re the go-to people for any matters that people are unsure of. That goes for clinical managers to GPs, to prime ministers to the Queen, you know what I mean?
Emma Carlin (27:57): And if you don’t have them, if you’re in a mainstream service that doesn’t have Aboriginal health workers or Aboriginal SEWB workers, then reach out and make those links with your Aboriginal community controlled health services. They will most likely have Aboriginal health workers and Aboriginal SEWB teams. So starting to break down some of those organisational silos is really important to optimise the care of Aboriginal people as a non-Aboriginal practitioner.
Zaccariah Cox (28:29): Yeah, we’re supporting a new SEWB service in the Kimberley that’s recently been funded, but they’re clearly sort of leading the way in terms of having non-Indigenous managers or leaders be led by their Aboriginal staff within that service. So whilst they’ve got that technical knowledge and sort of the managerial experience and qualifications, they understand the importance of being led by the local people that they have working for them because the local people know the local context and they have the local knowledge of what’s happening on the ground and beyond that, obviously, happen every day in Aboriginal town, community amongst Aboriginal families, those yarns, obviously, that information can be sent back to or provided back to the service managers and leaders to make sure that people are being safe, staff are safe, clients, participants, community members are safe if something sort of happened where it could jeopardise anyone’s safety in a health setting.
Narrator (29:35): That’s a little step, isn’t it?
Zaccariah Cox (29:37): Yeah.
Emma Carlin (29:38): Yeah.
Narrator (29:39): Thank you both so much for sharing your insights today. It has been an honour to walk on your beautiful country.
Narrator (29:46): Visit our website at www.emergingmines.com.au to access a range of resources to assist your practise. Brought to you by the National Workforce Centre for Child Mental Health, led by Emerging Minds. The National Workforce Centre for Child Mental Health is funded by the Australian Government Department of Health under the National Support for Child or Youth Mental Health Program.