Black Dog Institute is Australia’s leading medical research institute investigating mental health across the lifespan, to create a mentally healthier world for everyone.
They recently invited Nyaree Mewett, Brisbane South PHN’s Aboriginal and Torres Strait Islander Programs Manager to speak on a Black Dog Institute Suicide Prevention Network panel about self-determination for First Nations peoples in preventing suicide.
Self-determination is ‘the fundamental right of people to shape their own lives’ (Australian Human Rights Commission, 2022). In First Nations communities, it’s also a powerful tool to prevent suicide.
For Nyaree Mewett, delivering suicide prevention services in First Nations communities means bringing the whole community on board.
‘One of the things I’ve been pushing in our suicide prevention planning is around educating the whole family, the whole community, and around what supports are in place for when someone is feeling that way,’ says Nyaree, a Quandamooka woman and the Aboriginal and Torres Strait Islander Programs Manager for the Brisbane South PHN.
‘Most of the time, you don’t want services involved; you just want your family around. The last thing you need is people you don’t know coming and saying, ‘We’re here to help; tell me how you’re feeling.’’
Empowering families and communities to recognise and respond to suicide is about more than just keeping people safe at a moment of crisis. It also prepares Indigenous communities to take control of how they look after their people and how, when and where they seek help.
This concept is known as self-determination – and the evidence shows it’s crucial to successful suicide prevention for Indigenous Australians.
Self-determination: The right to choose
According to the Australian Human Rights Commission, self-determination is ‘the fundamental right of people to shape their own lives’ (ibid, 2022). In an Indigenous context, the right to self-determination acknowledges First Nations peoples as Australia’s First people and plays an important role in helping them to overcome the lasting trauma associated with colonisation.
As an ‘on-going process of choice’ (ibid, 2022), self-determination ensures that Indigenous communities decide how to meet their own social, cultural and economic needs. ‘The loss of this right to live according to a set of common values and beliefs, and to have that right respected by others, is at the heart of the current disadvantage experienced by Indigenous Australians’ (ibid, 2022).
‘Part of the whole colonising experience has been to not only take land, culture and everything else but to take away people’s agency,’ says Professor Pat Dudgeon, Director of the Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention (CBPATSISP) at the University of Western Australia.
‘We have a history of being excluded, other people taking over, determining your realities, what your issues are and what the solutions should look like. So, self-determination at a number of different levels is very important.’
It’s no surprise, then, that leading research from the Aboriginal and Torres Strait Islander Suicide Prevention Evaluation Project (ATSISPEP), which was led by Professor Dudgeon, identifies self-determination as being strongly linked to better suicide prevention outcomes for Indigenous people and communities.
Research conducted among First Nations people in Canada and detailed in the ATSISPEP final report showed that communities who achieved key indicators of self-determination and cultural maintenance had few or no suicides among young people in their communities (Aboriginal and Torres Strait Islander Suicide Prevention Evaluation Project Report, 2016).
‘First Nations peoples need to be at the table; they need to be empowered to consider the issue and to come up with solutions,’ Professor Dudgeon says.
Building trust, overcoming fear
Many First Nations suicide prevention practitioners already understand the importance of self-determination – and, like Nyaree Mewett, they’re embedding it at the core of suicide prevention service design and delivery.
One such example is Healing Works, a social enterprise that delivers suicide intervention training, community engagement and consultation services in Indigenous communities around Australia.
Led by co-founder and CEO Dean Bayliss, a Kamilaroi man, Healing Works teaches the LivingWorks I-ASIST model to community members, as well as to Indigenous and non-Indigenous service providers. The goal is to bring suicide prevention expertise into community, thereby reducing their reliance on external intervention.
‘The model of the I-ASIST is really connected to our cultural nuances and protocols. If you’re looking at a holistic way of doing an intervention or suicide prevention, it’s actually giving self-determination and advocacy, as well as the skill, so it’s building capacity around culture,’ says Dean.
But Dean and his team don’t just show up and start training people. Instead, engagements start with intensive consultation sessions that can sometimes take months to complete.
‘We’ll actually go to a community and say, ‘What’s happening here? Where have the deaths been? Who are the traditional owners? Who are the mobs involved, the old family networks and members?’’ Dean says.
‘We speak to the Elders and we’ll speak to the leaders of Indigenous organisations, to community, NGOs and NSW Health groups all at once.’
Undertaking this groundwork has two crucial purposes: firstly, it helps the Healing Works team to understand the local context of suicide activity in the area, which in turn supports the development of additional activities around the core I-ASIST training that can be adapted to respond to local needs. For example, Dean says, sometime Healing Works will invite ngankari (traditional healers) to participate after the sessions as a way of bridging the gap between Indigenous and western models of care.
Secondly, the process also establishes trust between Healing Works and the community before the training sessions begin. This trust is crucial to getting participants to engage with the training, which touches on issues that many Indigenous people find difficult to talk about.
‘There’s a lot of fear about even saying the word ‘suicide’,’ Dean says.
From there, the work of upskilling local community members and service providers in the I-ASIST model can begin. The end result is a community that’s home to individuals with suicide prevention skills and knowledge, as well as services equipped with an understanding of the unique facets of Indigenous suicide prevention.
‘The skills are actually in the community already,’ Dean says.
‘They’ve been doing it for thousands of years – looking after mob, looking after family or community.
‘The training is really about sharing the knowledge, hearing what’s in the community, what’s happening, providing a framework and building on that strength that they already have.’
Working within an First Nations cultural framework
Healing Works is a strong example of the power of self-determination in action, but not all services designed to support Aboriginal and Torres Strait Islander suicide prevention are Aboriginal led. What, then, of mainstream services operating in this space?
A 2018 publication from CBPATSISP and Black Dog Institute suggests giving First Nations communities ‘control of the design and implementation of suicide prevention activity taking place within them; or direction and leadership guiding external organisations to the same end’ (A Guide for Primary Health Networks, 2018). As such, embedding First Nations expertise into service design and delivery in mainstream organisations ensures that the community can access a range of culturally safe options when First Nations-led care is unavailable.
‘I think the biggest thing is giving First Nations peoples choices,’ Mewett says.
In that spirit, Mewett and her team are embedding cultural training into their commissioning processes, and they’re also working to modify their procurement and tendering processes to ensure that First Nations peoples are represented on tender panels for any services that will be available to their communities.
‘We’re rolling out a three-step training process, so we’re starting with online training, then offering a face-to-face small group, and then ending with a course called Courageous Conversations, which delivers a foundation for the pursuit of systemic change through a lens of racial equity,’ she says.
The aim is to ensure that all PHN service providers are working within an First Nations cultural framework and that First Nations people have input into how those services are developed and delivered. In an ideal world, the result will be greater numbers of culturally safe services available to First Nations service users and increased choice in terms of where people can go to seek care.
Like all suicides, those that occur in First Nations communities are the result of myriad complex issues. Changing the narrative can be a long, slow process. But, thanks to research from organisations like CBPATSISP and Black Dog Institute and on-the-ground service delivery from passionate advocates like Nyaree and Dean, solutions are increasingly being placed in the hands of people who know what their communities need.
‘Suicide is a community issue, not a mental health issue,’ Dean says.
‘You can’t stop people having thoughts of suicide, but you can stop behaviours, getting to the behaviour stage, and that’s what we’re trying to achieve.’
Australian Human Rights Commission, Right to self determination, accessed February 16 2022.
5 Solutions That Work: What the Evidence and Our People Tell Us. Aboriginal and Torres Strait Islander Suicide Prevention Evaluation Project Report, 2016, p1.
6 First Nations Governance for Suicide Prevention in Aboriginal and Torres Strait Islander Communities: A Guide for Primary Health Networks, 2018, p5.
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