Indigenous Expert responds to WA Govt Indigenous Suicide Prevention Plan

I am an Aboriginal woman from the Pilbara. I am a proud Nyamal woman. The young lives we are losing to suicide are crushing my heart. It has driven me to relentlessly pursue and self-fund solutions in the complete absence of government funding for two decades. Second, I am a highly trained psychologist with a PhD in Clinical Psychology and 21 years of clinical expertise with at risk Indigenous people. I have developed and validated the only evidence-based screening tools and programs in Indigenous suicide prevention in this country and I have had a gutful.

I don’t think my heart can break anymore. I’m tired, and I’m angry.

I was asked to address seven state cabinet ministers in May 2019 to provide them with an extensive, evidenced based, measurable road map of solutions in respect of the Fogliani Inquiry (the Inquiry). Since then, I have received no follow up. Further, my expertise was not sought out in the Government response to the Inquiry, nor was I called as an expert witness.

Instead, three days ago – on a Friday afternoon – the WA Government released its long-overdue response to the Inquiry which examined the deaths by suicide of 13 Aboriginal children in the Kimberley. It took 13 months of ‘consultation and consideration’ (during which time we lost SIX more young lives to suicide). It is a report of 36 pages in length, with very large font and half of it taken up with Aboriginal artwork, pictures and ‘cultural’ infographics. This is a Government response to 13 suicide deaths!

Once you extract yourself from the blinding headline of $266 million ‘allocated’ by the Government and past buzz words like “culture driven” and “community co-design of programs”, it is a response predictable in its failure to go beyond the Inquiry’s recommendations and address the significant gaps in Indigenous suicide prevention.

The Government approach should be evidence based. It should enable us to predict suicide risk, to provide clarity about what is preventing suicides and ensure programs are clearly informed and accountable in their ability to do so. Our children’s lives deserve that Governments are not only listening to the best available evidence but implementing that evidence in a way that is measurable and trackable over time. This response is not that. Not even close.

Distressingly, the ONLY evidence we are capturing to determine program success (or in this case, failure) is the suicide death rate. A rate that is escalating each year.  Western Australia has the highest Indigenous suicide rates in Australia by a significant margin. The Government’s failure to be guided by clinical expertise on this issue has resulted in approaches that are reactive, inconsistent, adhoc and ambiguous about what is reducing suicides.

I have never had the expectation that politicians are across an issue this complex. However, it is not unreasonable to expect them to seek out the relevant experts to guide them accordingly. This doesn’t mean have a one off presentation or meeting with them. It means ongoing guidance.

Where did Fogliani get it wrong?

In my professional opinion, the Coroners recommendations simply don’t match the evidence of bereaved parents and are not suicide prevention informed.

The recommendations are filled with misplaced preventative intent that read like an archaic retrospective on human behaviour. This continues the well-worn path of attributing suicide causes where they should never be; at the hands of factors external to the individual (abuse, alcohol etc).

This reads as, Indigenous families effectively being blamed for the suicide deaths of their own children.

I have long argued factors such as alcohol abuse and FASD, have never been shown to be suicide causes. Getting suicide causes wrong results in the direct escalation of suicides. The Northern Territory for example, which is currently under the Intervention that undermined the human rights of Indigenous people, has had a shocking 160% increase in suicides since the Intervention commenced.

The problem with inquiries is they do little to inform us about suicide prevention. Coroners aren’t psychologists, nor do they understand Indigenous culture well.  The Governments’ blind acceptance of the Coroner’s recommendations and love affair with having Indigenous suicide inquiries, in my experience, compounds ongoing negative outcomes.

This Government has now had a 2016 Parliamentary Inquiry, a 2018 Senate Inquiry and the 2019 Fogliani Inquiry. All the while, suicides continue to escalate. There is significant political currency in having inquiry after inquiry. The intent is that we, as Indigenous people, feel as if we have been ‘heard’ but everything essentially stays the same.

How the Government has continued to misstep

After drawn out inquiries, Governments then conclude we need more consultations. Indeed, while the Government’s own Response to the Inquiry concluded that community are tired of talk , they nonetheless continued to consult for 13 months while 6 more young Indigenous lives were lost to suicide.

Endless ‘working parties’ ‘round table meetings’, decades of community consultations and action plans in the absence of suicide prevention activities would be comical if the outcome wasn’t so devastating.

Let’s now drill down into the “$266M” Government allocation. Sadly, it seems evident this money is mostly re-labelled money.

PLEDGE 1: $2.7 million for Foetal Alcohol Spectrum Disorder (FASD) Prevention

I am starting to feel like a broken record, so I will quote the Coroners own report, “I have not found any of the children had FASD and none had been diagnosed with FASD”.

Yet 9/42 recommendations focused on FASD and alcohol restrictions.

The report states that FASD was ‘diagnosed’ based on historical reports by “others”. This is clearly not sufficient. The original study that created this FASD “freight train” involved cognitively and culturally biased assessments on 108 Aboriginal children with just 13 ‘diagnosed’ with FASD (this blew out the ‘prevalence’ rate and made FASD ‘the ‘go to’ explanation for all of the ‘ills’ in Aboriginal communities).

We now have practitioners charging up to $42,000 for FASD ‘treatments’.

There are significant issues with diagnosis of FASD in Aboriginal people. General developmental delays (e.g. failure to thrive) are often mistaken for FASD. There is a myriad of psychological issues (ie. trauma) that can look like FASD. Importantly, mainstream assessments significantly distort FASD diagnosis as they do not consider cultural factors. This includes the cultural identity of the person undertaking the ‘diagnosis’ – known as ‘practitioner error’. The greater the cultural difference between (Aboriginal) client and practitioner the greater the error in assessment.

There is also a lack of recognition that many women (regardless of race) often drink in ignorance for the first 6-8 weeks of pregnancy. FASD is as prevalent amongst white populations; there is just more restraint in labelling entire cultures in addition to the considerable ethical challenges that prevent this type of research from being undertaken.

Importantly, research has yet to determine FASD as a suicide causal pathway. The basis for this FASD hysteria (outside of the obvious racism of it) is that individuals with FASD have been shown in some studies to have a higher likelihood of psychiatric disorders. This has then been used to argue  that those with psychiatric disorders have higher rates of suicide. This link is tenuous at best. Yes, it is that loose.

Yet millions is thrown at FASD, for one primary outcome: ensuring higher numbers of Aboriginal people diagnosed with FASD and that the Government are therefore undertaking suicide prevention.

This is not suicide prevention. It stereotypes bereaved Indigenous parents. Infuriatingly, it distracts us from addressing actual Indigenous suicide causes, from funding suicide prevention activities and training our workforce around treatments of best practice.

It’s dangerous to reduce Indigenous suicides to a single cause and effect relationship but this has been the historical approach by Governments who do not understand suicide well.

Suicide is, at the end of the day, an internal ‘life and death’ weigh up. The psychological pain that drives suicidal individuals is at its core, a human experience.

These internal drivers (depression; lack of coping mechanisms) moderate external factors and are critical to address as clinicians, yet we place zero emphasis on funding treatments which target these treatable factors.

PLEDGE 2: $208.9 million to support the future of remote Aboriginal communities

This money is for infrastructure (e.g. housing, swimming pools).  These are things that all Australians have a basic right to.  Unbelievably, this infrastructure pledge is being sold to Indigenous people as suicide prevention.

This pledge makes up 78% of the government’s response.

I suggest that the Government has identified how much they spend across the state on infrastructure into remote communities, re-labelled it ‘Indigenous Suicide Prevention’ and are now claiming it as a response to the Inquiry.

PLEDGE 3: $6.2 million for the Kimberley Juvenile Justice Strategy

This is a diversion program. It is not suicide prevention nor is it Indigenous specific.

Given WA wears the badge of honour for incarcerating Aboriginal youth at arguably the world’s highest rate, and has a virtual absence of investment in prevention, I don’t hold a lot of hope here.

PLEDGE 4: $32.3 million for implementation of a State Suicide Prevention Action Plan

This is an action plan for ALL West Australians. I am confused as to how it became counted in the Governments ‘allocation’ in their response to the Coronial Inquiry.

Outside of this, the draft plan is deeply flawed. It references literature and programs that have no evidence of reducing Indigenous suicides.

I have written to the WA Mental Health Commission and provided an extensive analysis of the significant deficits in this plan; The Plan does not provide an evidence-based approach to indigenous suicide prevention.

PLEDGE 5: $1.3 million for Empowered Youth Network for young Aboriginal leaders

Any funding for youth empowerment is important, however, again, it is not suicide prevention. We are also placing a significant burden on our young people to lead and navigate a path through the highly complex matter of suicide.

PLEDGE 6: $1.4 million to Connecting to Country grants

Once again, this is not suicide prevention and it must not be labelled as such.  We need to stop holding our communities responsible for suicide prevention. Popular buzz words like ‘community led’ and ‘co-design’ are effectively being heard by Governments as ‘community are responsible’. We need to STOP letting Governments off the hook as a community.

As a psychologist, clients come to me because they are grappling with complex psychological issues. They don’t have answers. Why do we have the expectation that Indigenous communities don’t need specialist expert assistance when they are in crisis?

PLEDGE 7: $11.6 million for educational programs to encourage Aboriginal girls to participate in school

Anything that has a focus on improving educational outcomes for Aboriginal people is always welcome. However, given only 10% of Indigenous children complete year 12 and that 25% of suspended children are Indigenous, it is important this funding addresses the structural issues within the educational system that is feeding these poor outcomes. Again, educational programs are a worthy investment, but this is NOT suicide prevention.

PLEDGE 6: $3M for mental health services

This money is not Indigenous specific. It is for the whole of the Kimberley. We have the highest rates of Indigenous child suicide in the world. Research confirms that a major failure in the system is that communities do not have adequate access to culturally competent services and programs.  This is not rocket science.  The bulk of funding must be allocated here, not a mere 2% of it.

Indeed, the Inquiry concluded all children experienced ‘system failure’. The failure of Governments to ensure ready access to culturally and clinically competent systems and workforces is blindingly obvious. It is why I self-funded and launched the Dr Tracy Westerman Aboriginal Psychology Scholarship Program. A program that directly addresses these needs. This is yet to gain one cent of state political support.

We need to SHOUT this from the rooftops:

“Not ONE of the 13 children who died by suicide had a mental health assessment”

Yet, just 1/42 of the Coroners recommendations on assessment.

If you cannot assess risk, you cannot prevent it. Pretty simple. So, why is this not front and centre of the Inquiry or the Governments response to it?

What needs to happen?

Step 1: Determine Suicide Causes and make programs accountable:

We must concentrate efforts and funding on determining suicide causes for Indigenous people (known as causal pathways). At the moment we only analyse demographic data – age, gender, region.  This is completely useless for prevention but very useful for click bait headlines.

Undertaking this simple task would ensure many crucial outcomes. First, it would inform programs on where to focus interventions. Second, it would ensure programs are actually addressing suicide causes. Third, it would enable Governments to ensure funding allocation occurs relative to evidence of program success.

Something so simple. I have requested assistance from Government to undertake this approach for many years now. These requests continue to fall on deaf ears.

The Governments response speaks of loose, generic frameworks that will ‘drive accountability’. These frameworks have no clinical foundation or evidence to show they measure client or program outcomes.

Staggeringly, funding also does not require that programs demonstrate a measurable reduction in suicide and mental health risk factors.

Step 2: Fund an audit of Indigenous suicide prevention activities: This audit should categorise programs based on the types of suicide intervention and prevention initiatives they are providing. This will ensure existing programs have access to Government resources in a way that addresses deficits in our overall suicide prevention capability. It makes allocation of funding clearer because Government will be required to fund in accordance with suicide prevention type and capability.

Importantly, this needs to be done by those1) not already receiving government funding; 2) not already advising government on where to spend the money, and 3) by those with clinical expertise in suicide prevention.

Step 3: Increase workforce clinical and cultural competency: When you have spent your life’s working in Indigenous suicide prevention, as I have, I can tell you that despite extensive training, suicide prevention challenges you at every level. The nature of suicide risk is that it changes. Being able to predict and monitor it takes years and years of clinical insight and judgement. Throw culture into the mix and it becomes the skill set of very few in this country.

Heartbreakingly, I addressed the 2016 Parliamentary Inquiry and provided evidence of the importance of upskilling our workforce around Indigenous suicide risk assessment. I provided the Inquiry with the Westerman Aboriginal Symptom Checklist – Youth and Adults – the only culturally and clinically validated tools that screen for suicide and mental health risk. No recommendations were made in relation to this. Just 18 months later, 13 Indigenous children died without a mental health assessment.

30,000+ practitioners across Australia have chosen to be accredited in these tools: they are the ‘practitioners’ choice’ for good reason. They are evidence based and enable practitioners to work at a best practice level with Aboriginal people. They enable treatment outcome to be measured and evidence to be gathered about what reduces suicide risk.

Despite all of this, there has been no political support for the roll out of the WASCY/A into remote communities.

Step 4: Fund Suicide Prevention

As a country facing this growing tragedy, we have had no nationally accepted evidence-based programs across the spectrum of early intervention and prevention activities. I have recently had a publication accepted on the first evidence based Indigenous specific whole of community suicide intervention program that has demonstrated suicide risk reduction. These programs have not been able to be delivered in WA for over 10 years due to a complete absence of funding. A fact the state government is fully aware of. These programs cost a total of $192 per person to deliver.

Notwithstanding the rhetoric, I know that:

• Funding housing, swimming pools and infrastructure is not suicide prevention.
• Diagnosing FASD is not suicide prevention.
• Cultural camps are not suicide prevention.
• Coroners’ Inquiries are not suicide prevention.

So Please stop. Our people, particularly our children, deserve better.