7881ENV Startegies report

25 October2016
ANDREA TRUBODY,
S5048151 ELINA PANAHI,
S5029120 NATALIE
JONES, S5040136
STRATEGIES TO
IMPROVE THE
HEALTH AND
WELLBEING OF
INDIGENOUS
AUSTRALIANS BY
ADDRESSING SUICIDE
DETERMINANTS USING
THE OTTAWA
CHARTER
Andre a Tru bo d y , s5 0 4 8 1 5 1
Elina P a na hi, s5 0 2 9 1 2 0
Na ta lie J o ne s, s5 0 4 0 1 3 6
HEALTH PROGRAM PLANNING AND EVALUATION
ASSIGNMENT 3: CASE STUDY WRITTEN REPORT

REDUCING THE RATE OF INDIGENOUS SUICIDE
2
TABLE OF CONTENTS
Introduction................................................................................................................................... 3
Methodology, Search Terms and Definitions.............................................................................. 3
Background and Rationale........................................................................................................... 4
Community Needs Assessment .................................................................................................... 5
Population, community profile and setting................................................................................. 6
Stakeholders................................................................................................................................ 7
Needs Identification .................................................................................................................... 9
Identified Issues......................................................................................................................... 11
Issue Prioritisation.................................................................................................................... 11
Issue 1: Mental health........................................................................................................... 13
Issue 2: Trust issues between Indigenous and non-Indigenous ............................................ 14
Issue 3: Loss of connection to Indigenous cultural identity ................................................. 15
The Ottawa Charter.................................................................................................................. 16
Health Promotion Programme Plan.......................................................................................... 18
Aim ............................................................................................................................................ 18
Objectives.................................................................................................................................. 18
Strategies................................................................................................................................... 19
Strategy A ............................................................................................................................. 19
Strategy B.............................................................................................................................. 20
Strategy C.............................................................................................................................. 20
Actions and Evaluation............................................................................................................. 21
Discussion, Barriers and Recommendations ............................................................................ 22
Conclusion ................................................................................................................................... 24
References.................................................................................................................................... 25

3
INTRODUCTION
Suicide is a global concern, claiming over 800,000 lives worldwide on a yearly basis.
However, many more lives are also affected by unsuccessful attempts as well as by the incidence
of self-harm (WHO, 2016). In 2010, suicide represented 1.6% of total Australian deaths (ABS,
2010). In that same year, it accounted for an alarming 4.2% of registered Indigenous deaths.
After adjusting for age, the Indigenous suicide rate was 2.6 times the non-Indigenous rate
(Aboriginal, 2013).
In our research, we discovered that the Kimberley region of Western Australia
experiences Indigenous suicide rates that are among the highest in the world and were intrigued
to know more. In 2014 alone, 553 Kimberley residents presented with suicidal behaviour
(deliberate self-harm or suicidal ideation); 86% of these individuals identified as Indigenous
(McHugh, 2016). To further narrow our focus, we chose to study the Shire of Halls Creek, as it is
both the fourth fastest expanding shire in Western Australia as well as the fact that 82% of its
residents identify as Indigenous (ATSISPEP, 2015).
While we can report statistics, it is important to remember that suicide cannot be solely
based upon numbers. Numerical data is no substitute for the experience and long-term impact
that suicide has on the Indigenous community.
This project is subdivided into two parts: conducting a community needs assessment
(CNA) to identify and subsequently prioritise the underlying issues and determinants responsible
for the discrepancy between Indigenous and non-Indigenous suicide rates in the Kimberley
region of Western Australia; and the development of a health program plan that maps out
strategies to address the above-identified issues and meet specific objectives in order to reduce
the incidence of Indigenous suicide in the Shire of Halls Creek.
METHODOLOGY, SEARCH TERMS AND DEFINITIONS
The purpose of this assignment was to conduct a community needs assessment and utilise
the data to develop a program plan. Again, this was a workshop exercise and the report is not
based on real empirical data.
An official definition of Indigenous has not been adopted by any system or body
including the UN, however;

4
Section 51 (25) of the Australian constitution defines Indigenous as those persons of
Aboriginal or Torres Strait Island descent who both identify as such and are accepted as such by
the community in which they live (Commonwealth of Australia Constitution Act, 1900).
Therefore, for the purpose of this report, we have referred to Aboriginal and Torres Strait
Islanders as Indigenous to clarify any potentially misleading terminology.
The main search terms used in this report included words such as: “mental health” OR
“mental disorder”; Australia*; Indigenous, Aboriginal*; “Torres Strait Islander*”; determinant*;
“Ottawa Charter”, “health program planning”; community*; trust; identity; and issue*.
BACKGROUND AND RATIONALE
Nationally, as many as one in ten deaths from suicide are Indigenous persons. More
specifically, Western Australia has one of the highest rates of Indigenous suicide in the country
(Australian Bureau of Statistics, 2012). Within the Kimberley region alone, the rate has doubled
in the last decade and is occurring at levels now being deemed catastrophic (Thorne, 2016).
As a result, a petition has been established calling for the establishment of a Royal
Commission into Indigenous Suicide (Australian Nursing and Midwifery Journal, 2016).
Additionally, The Aboriginal and Torres Strait Islander Suicide Prevention Evaluation Project
(ATSISPEP, 2015) is currently evaluating the rate of Indigenous suicides Australia-wide. It has
identified a cluster of suicides in the Kimberley region as well as classified the population as one
at risk with a current rate of about 70 suicides per 100,000 Indigenous persons (ATSISPEP,
2016).
We chose to focus our work on the Shire of Halls Creek, a region of the Kimberley that
represents the 4th fastest expanding shire in Western Australia (Shire of Halls Creek, n.d.) and
one in which 82% of residents identify as Indigenous (ATSISPEP, 2015).
Suicide impacts small communities severely as much of the population is closely-
linked and often face similar challenges. Mental illness (including depression and anxiety) are
common and significant risk factors for suicide (Government of western Australia mental Health
Commission, n.d.) Many Indigenous people experience grief, trauma, discrimination and loss to
a much greater extent than non-Indigenous persons. Other causes of suicide include the loss of

5
family networks and substance abuse (which can cause cognitive disturbances) (ATSISPEP,
2015). Indigenous health is currently the focus of many programmes including the ‘Close the
Gap’ campaign launched in 2008 by former Australian Prime Minister, Kevin Rudd. All sections
of society from individuals, communities, governments, voluntary organizations, NGOs, local
authorities and businesses need to mediate to promote equality in healthcare access and practices.
The Ottawa Charter calls for the adaptation of health promotion to accommodate social, cultural
and systemic differences and lists reorienting health services as an area for priority action (Better
Health, 2016). Although several suicide prevention policies/campaigns have been introduced, a
variety of underlying issues and determinants still remain. Until these are properly addressed, the
opportunity for progress in this regard is quite diminished.
COMMUNITY NEEDS ASSESSMENT
For the community needs assessment, we included a mixed-methods approach to
investigate risk factors and determinants that contribute to the high prevalence of suicide within
the Indigenous community. A variety of methods were chosen to fully understand the needs for
the community profile, community internal analysis, and community need analysis (see table 1).
These methods included both primary (surveys, in-depth individual and group interviews) and
secondary research (literature review, data from various databases).

6
Component Input
Types of Needs
Normative Comparative Expressed Felt Needs
1.
Community
Profile
Community
Profile
Databases,
Surveys
Australian
Bureau of
Statistics,
Local Shire’s
databases,
Databases
Databases,
Surveys
Health Facilities,
Health care
workers and
Australian
Indigenous
HealthInfoNet,
Databases
2.
Community
Analysis
Community
Internal
Analysis
ABS statistics,
State database,
Police Database,
Local services
database
Secondary data
from other
communities
in WA or other
states
Interviews,
Secondary data
from Indigenous
support groups,
Interviews:
Structure &
Group
3.
Community
Need Analysis
Community
Consultation
(What/Why/
How)
Secondary Data:
Research Papers
on findings
Interviews:
Structure &
Group
Interviews:
Structure &
Group
TABLE 1: COMMUNITY NEEDS ASSESSMENT PLAN: TYPE OF NEEDS.
POPULATION, COMMUNITY PROFILE AND SETTING
The Community Needs Assessment (CNA) was both issue- and population-based. As
stated above, the chosen issue was the prevalence of Indigenous suicide in the Kimberley region
of Western Australia.
The main goal of the CNA was to understand the discrepancy between Indigenous and
non-Indigenous suicide rates in this region with two overall objectives: to fully explore the
disparity between suicide rates and also examine the underlying region-specific determinants
associated with suicide and suicide-related behaviour. Our proposed project plan was aimed to
target the Indigenous population in the Shire of Halls Creek in an appropriate and integrated
manner with the inclusion of all relevant stakeholders.

7
Figure 1: Map of the Shire of Halls Creek, Kimberley Region, Western Australia.
STAKEHOLDERS
Five main groups of stakeholders were identified as having a role in this issue, including:
governing bodies, non-governmental organizations (NGOs), research institutions/universities,
community-based organizations, and the people/communities themselves. These ranged in size
and scope from the Government of Western Australia to the Kimberley Aboriginal Medical
Services Council (KAMSC) to an Indigenous community representative. For a culturally
appropriate and applicable project plan design, we felt it was important to include a
representative of the Indigenous community. However, we did not want to overlook the
importance of including state, regional and local government/policymakers.

8
Group Institution Code
Government of WA Local Government of Shire of Halls Creek Ins-01
Department of Health Ins-02
Mental Health Commission Ins-03
Office of Chief Psychiatrist Ins-04
Kimberley Mental Health and Drug Service (KMHDS) Ins-05
Department of Aboriginal Affairs Ins-06
Office of Aboriginal Health Ins-07
Education Department Ins-08
Community and People Elders of Indigenous Australian Community (WA) Ins-09
Emergency Services (Police, Ambulance Services, Medical
Emergency Department)
Ins-10
Community cultural centres Ins-11
Community-based
Organization
Kimberley Aboriginal Medical Services Council
(KAMSC)
Ins-12
Aboriginal Health Services (one per Shire) Ins-13
Mental Health and aged care services Ins-14
Research institution/
University
University of Western Australia, School of Indigenous
Studies
Ins-15
Edith Cowan University (ECU) Research centre;
Australian Indigenous HealthInfoNet
Ins-16
Non-Governmental
Organisation
Indigenous Communities Volunteers Ins-17
- Community
Controlled Health
Organisations
Western Australian Association for Mental Health Ins-18
The Aboriginal Health Council of WA (AHCWA) Ins-19

9
The National Aboriginal Community Controlled Health
Organisation (NACCHO)
Ins-20
Australian Indigenous Doctors’ Association (AIDA) Ins-21
TABLE 2: A COMPLETE CHART OF THE STAKEHOLDERS
NEEDS IDENTIFICATION
A plan was formulated to assess the four types of community needs: normative,
comparative, expressed, and felt. We utilised both qualitative and quantitative methods to collect
the relevant data to compile the community profile, community internal analysis, and the
community consultation. We also chose a mixed-methods approach in order to be able to ask
both open- and closed-answered questions.
Data Type Needs ResearchMethod Data Source
People Indigenous Australian in
Kimberley
Normative
Needs
Interviews, Survey,
and Questionnaire,
Focus-group)
Health Facilities,
Health care workers
and Australian
Indigenous
HealthInfoNet
Place Shire of Halls Creek,
The Kimberley region
Normative
Needs and
Comparative
Needs
Comparative Data
Collection,
Observation
Australian Bureau of
Statistics, Local
Shire’s databases
Organisation Indigenous Community
Groups, NGO
Comparative and
Expressed Needs
Interviews, Focus-
group, Surveys
Databases

10
Existing
Resources
and Services
Health Care Facilities;
Local Hospitals and
Aboriginal Medical
centre; Department of
Mental Health
Committee; Emergency
Service’s database,
Department of Education
Expressed
Needs,
Normative
Needs
Secondary Data
and Interview
Databases, Surveys
TABLE 3: A COMPLETE CHART OF THE COMMUNITY NEEDS ASSESSMENT
RESULTS.

11
IDENTIFIED ISSUES
A number of sub-issues were identified as a result of our CNA and reiterated within the
literature. These included:
DIAGRAM 1: IDENTIFIED SUB-ISSUES IN THE INDIGENOUS POPULATION IN
SHIRE OF HALLS CREEK.
ISSUE PRIORITISATION
Our identified sub-issues are based on the combined results of our CNA and subsequent
secondary research. As this was a workshop exercise, the issue prioritisation was not ranked
according to empirical research. Priority was determined based on the following criteria:
severity, urgency, feasibility, affordability, and sustainability. Each issue was given a score from
Social
Exclusion Racism
Sexual
Abuse
Trauma
Identity
Crises
Suicide
cluster
effect
Access to
Health
Program
Mental
Health
Culturally
inappropriate
programs
Access to
education
Trauma
Public
Policies
Substance
Abuse
Lack of
Program
Funding
Poverty
Trust
Social
Economic
Status
Domestic
Violence
Feeling of
Inequality
Suicide

12
0 to 10 (see table 4) to find our top three sub-issues relevant to suicide in the Shire of Halls
Creek, Kimberley.
Issues
Identified
Criterion Total
Score
Ranking
Severity Urgency Feasibility Affordability Sustainability
Social
exclusion
8 8 8 8 8 40 8
Racism 8 10 9 8 9 44 5
Sexual
abuse trauma
9 10 9 8 9 45 4
Identity
crisis
10 10 8 9 10 47 2
Contagion
effect
8 9 9 8 9 43 6
Access to
health
program
8 9 9 9 9 44 5
Mental
health
10 10 9 9 10 48 1
Culturally
inappropriate
programs
10 10 8 8 9 45 4
Access to
education
8 10 8 8 8 42 7
Trauma 8 10 8 8 9 43 6
Public
policies
10 10 8 8 9 45 4
Substance
abuse
8 10 8 8 8 42 7
Lack of
program
funding
10 9 8 8 9 44 5
Poverty 8 9 8 8 9 42 7
Trust 10 10 9 8 9 46 3

13
Socio-
economic
status
8 9 8 9 8 42 7
Domestic
violence
8 9 8 9 8 42 7
Feeling of
inequality
8 10 8 8 8 42 7
TABLE 4: PRIORITISED SUB-ISSUES ACCORDING TO THE OTTAWA
CHARTER.
ISSUE 1: MENTAL HEALTH
It has been shown that people with a mental disorder are at a higher risk of suicide. In
Western Australia, around half of the women and men who completed suicide had suffered from
a diagnosed psychiatric disorder in the preceding 12 months (Hear Our Voices, 2012).
MENTAL HEALTH AND THE OTTAWA CHARTER
Determinants Structural Environmental Cultural Individual Health Service
Limited support
for those with
mental illness
and limited
access to mental
health services in
the rural settings
Support centres
not located in
remote/very
remote areas,
where the high-
risk population
is located
Culturally
inappropriate
health services
that have
focussed on
clinical
approach
Social stigma
represent a
barrier in rural
communities
Health services
don’t meet the
diverse needs of
the communities
with mental illness
Strategy Policy Supportive
Environment
Community
Action
Education Re-orient Health
Service

14
Create and
implement more
community-
controlled health
care services that
are provided in a
culturally
appropriate
manner
Relationship
within the
community and
spiritual
connections to
the land and
ancestors need
to be considered
in the
interpretation of
health issues
Create and
promote
community
representatives
An innovative
approach to
tackle the
inadequate
provision of
mental health
service to
youth at risk
through a
suicide
prevention
peer education
project
Health services
must address the
inequities in
mental health
promotion and
services in rural
and remote areas
TABLE 5: MENTAL HEALTH ACCORDING TO THE OTTAWA CHARTER
ISSUE 2: TRUST ISSUES BETWEEN INDIGENOUS AND NON-INDIGENOUS
The lack of trust between the Indigenous patients and non-Indigenous health providers
represents a significant barrier to health equality for Indigenous Australians, with regards to both
access and outcomes.
TRUST AND THE OTTAWA CHARTER
Existing
services &
facilities don’t
allow equal
access for
Indigenous and
non-Indigenous
persons
As many
communities/
individuals are
nomadic it is
difficult to
regularly
contact them
Indigenous
communities
do not trust
governments
& NGOs due
to past events
such as the
Stolen
Generation
Indigenous
persons feel that
persons in
leadership
positions don’t
listen to them
Services don’t
offer facilities
which cater for
traditional/
Indigenous
healers or
medicines

15
Environment
Community
Action
Education Re-orient Health
Service
Provide
facilities and
staff that are
‘Indigenous-
friendly’ and
cater to cultural
needs
Improve
infrastructure to
allow for
improved
communication
and access to
health care
Establish
‘yarning
groups’ to
allow for
discussions
and evaluation
of services
Empower the
communities
through
appointment of
‘go-to health
persons’
Enable a
reference system
that allows
persons
considered ‘at risk
of suicide’ to see
an Indigenous
healthcare
worker/healer
TABLE 6: TRUST ISSUES ACCORDING TO THE OTTAWA CHARTER
ISSUE 3: LOSS OF CONNECTION TO INDIGENOUS CULTURAL IDENTITY
The loss or weakened connection of the Indigenous to their own culture can rock the
foundation upon which their very identity is based, often ending in tragedy. “The predictable
consequence of such personal and cultural losses is often disillusionment, lassitude, substance
abuse, self-injury and self-appointed death at an early age” (Hear Our Voices, 2012, p. 84).
IDENTITY CRISES AND THE OTTAWA CHARTER
Limited and
inconsistent
funding for
Indigenous-
led support
programs
Difficulty in
regularly
accessing
meetings/events
held by these
programs
Perceived
loss of
connection to
Indigenous
community
and cultural
identity
Lack of available
leadership
training programs
for Indigenous
leaders/mentors
Disconnect
between
healthcare
providers and
Indigenous-led
programs
Environment
Community
Action
Education Re-orient
Health Service

16
Allocate
more funding
toward
Indigenous-
led
community
groups/
initiatives
Facilitate
access for
participation in
Indigenous-led
initiatives
Promote
participation
in existing
Indigenous-
led
community
groups
Empower
individuals
through ongoing
leadership and
community
development
training
Educate health
service
providers on
community
programs
offered and
encourage their
engagement/
participation as
well as their
patients’
TABLE 7: IDENTITY CRISES ACCORDING TO THE OTTAWA CHARTER
THE OTTAWA CHARTER
BUILDING HEALTHY POLICY
Existing healthcare facilities do not have services that cater to the needs of Indigenous
persons. The non-Indigenous staff neither speaks the language of the community nor
accommodates the cultural needs of the people and their traditions. The development of a skilled
professional Indigenous health workforce is essential to change the Indigenous perception of
healthcare facilities (Creative Spirits, 2016). Currently, many Indigenous define ‘hospital’ as ‘the
place you go to die’ (Creative Spirit, 2016, n.d.). However, the presence of an Indigenous doctor
is considered a strong attraction for Indigenous accessing health services (Creative Spirits, 2016).
A policy which allows for the provision of ‘Indigenous-friendly’ facilities is required.

17
CREATING SUPPORTIVE ENVIRONMENTS
There is a lack of access to healthcare services – especially mental health. This is due to
the nomadic nature of many communities. An adaptive infrastructure needs to be established to
allow access.
STRENGTHEN COMMUNITY ACTION
The active engagement of community leaders and Indigenous youth needs to continue to
be encouraged and promoted within Indigenous communities.
DEVELOPING PERSONAL SKILLS
There is a low-level of understanding around personal health and education. Social
stigma represents a barrier in rural communities and an overall mistrust in the health services.
RE-ORIENT HEALTH SERVICES
Ineffective health care facilities do not meet the needs of the Indigenous people, creating
a disconnect between health care providers and Indigenous-led programs.

18
HEALTH PROMOTION PROGRAMME PLAN
Source: Febi Dwirahmadi
AIM:
The overall goal is to reduce the incidence of Indigenous suicide in the Shire of Halls
Creek of the Kimberley region.
OBJECTIVES:
This exercise developed three objectives, each to address our three identified sub-issues.
A. To ensure that 30% of all existing regional mental health policies include the Indigenous
population within the next five years.
B. Promote development of trust as demonstrated by increased use of health care facilities
by 25% over the next five years.

19
C. Increase community-wide participation in Indigenous-led community programs by 25%
over the next five years.
STRATEGIES
Once the objectives were determined, strategies (Tables 8-10) were formulated which
met the five areas for consideration contained within the Ottawa Charter to achieve each
objective: Healthy Policy; Supportive Environments; Community Participation; Personal
Skills/Education; and Re-orientation of Health Services.
STRATEGY A
Include the social determinants of health of the Indigenous population in existing regional
mental health policies.
A)
Include the
social
determinants
of health of the
Indigenous
population in
the existing
regional mental
health policies
Policy Supportive
environment
Community
Participation
PersonalSkill Re-orient health
service
A1. Create a
comprehensive
local mental
health policy;
implement
strategies to
restore social
and emotional
well-being at
community
level
A2. Local policy
makers need to
ensure that the
programs and
strategies are
well-resourced
so they are
sustainable and
supported
A3. Promote
participation in
existing
Indigenous-led
community
groups
A4. Empower
individuals,
through
education on
well-being and
mental disorders
to reduce stigma
on professional
help-seeking
behaviour
A5.
Collaboration
between mental
health providers
and Indigenous
leaders
TABLE 8: MENTAL HEALTH

20
STRATEGY B
Promote development of trust as demonstrated by increased use of health care facilities.
B)
Promote
development of
trust as
demonstrated
by increased
use of health
care facilities
Policy Supportive
environment
Community
Participation
PersonalSkill Re-orient health
service
B1 Provide
facilities and
staff that are
‘indigenous
friendly’ and
cater to cultural
needs
B2 Facilitate
access for
participation in
Indigenous-led
initiatives
B3 Establish
‘yarning groups’
to allow for
discussions and
evaluation of
services
B4 Empower the
communities
through
appointment of
‘go-to health
persons’
B5 Enable a
reference system
that allows
persons to see
an Indigenous
healthcare
worker/healer
TABLE 9: TRUST
STRATEGY C
Strengthen Indigenous individual/community ties to cultural identity.
C)
Strengthen
Indigenous
individual/com-
munity ties to
cultural
identity
Policy Supportive
environment
Community
Participation
Personal Skill Re-orient health
service
C1. Allocate
more funding
toward
Indigenous-
led
community
groups/
initiatives
C2. Facilitate
access for
participation in
Indigenous-led
initiatives
C3. Promote
participation in
existing
Indigenous-led
community
groups
C4. Empower
individuals
through
ongoing
leadership and
community
development
training
C5. Educate
health service
providers on
community
programs
offered and
importance for
mental
health/wellbeing
TABLE 10: IDENTITY CRISES

21
ACTIONS AND EVALUATION
For each strategy, we created a corresponding action plan to outline all items required to
promote a health program plan. What we found in our literature review of previous interventions
was an overall lack of evaluation to assess the efficacy and effectiveness of chosen interventions
(see Table 11).
Strategy Action By Whom Time
frame
Where Evaluation
A) Include the
social
determinants of
health of the
Indigenous
population in
the existing
regional mental
health policies
Create supportive
policies specific to
mental disorders
addressing
Indigenous social
determinants of
health; Educate
more local health
providers on
community-based
mental distress
- Australian
Government,
- Department
of Health,
- Western
Australia
State
Government,
Government
of Shire of
Halls Creek,
- Hall’s Creek
Shire Council
- The
Aboriginal
Health
Council of
WA
- Kimberley
Mental
Health and
Drug Service
- Indigenous
Approx.
5 years
Shire of
Halls
Creek,
Kimberley
Region,
Western
Australia
- Six-monthly
reviews of program
development
- Efficient support
from local policy
makers
- Monitoring of
Indigenous and non-
Indigenous
healthcare workers
B) Promote
development of
trust as
demonstrated
by increased
use of health
care facilities
Establish & run
groups where
community
members feel
comfortable to
discuss needs and
health options;
Choose individuals
from the
community to be
points of contact for
medical issues;
- Six-monthly
reviews
of program
development
- Ensure allocation
of funding to correct
areas
- Monitoring of
Indigenous
healthcare workers’
levels

22
Offer incentives to
facilities in increase
Indigenous staffing
to +/- 50%; Create a
referral system for
Indigenous health
workers/healers
community
members and
elders
C) Strengthen
Indigenous
individual/
community ties
to cultural
identity
Create supportive
policy; Promote and
facilitate access to
attend initiatives;
Empower through
leadership training;
Educate health
providers on
programs and
encourage cross-
promotion
- Quarterly review of
program
development/funding
to ensure long-term
feasibility
- Consistent
solicitation/
monitoring of
program feedback/
evaluation
TABLE 11: ACTION PLAN
DISCUSSION, BARRIERS AND RECOMMENDATIONS
Indigenous Australians identify closely with the land (especially in remote areas). These
persons can also experience deep distress when having to relocate to medical facilities, often
leading to a tendency not to seek medical attention in the first place (Sinclair et al, 2014). Family
support is also regarded as highly important, which therefore can lead to reluctance in the
utilization of a healthcare system based on individual care/treatment. In terms of communication,
western medical staff often do not consider decisions made after family discussion as valid and
may alienate individuals by demanding ‘on the spot’ decisions. In that same vein, some

23
Indigenous individuals feel that family disputes may arise in their absence. Another barrier is the
taboo that exists within Indigenous communities around the discussion of death, depression, and
mental health issues, etc. (Hear Our Voices, 2012).
For health promotion to succeed, a whole-of-community approach works well as tribal
and community networks can be used to spread information whilst minimizing the possibility of
misunderstanding. Previous Indigenous-related interventions have used broad generalisations in
their analysis. However, in targeting a specific group or issue, it is critical to understand the
context of the community that the program is trying to address. Indigenous Australians have a
diverse cultural tradition and each community is not the same (Hear Our Voices, 2012).
Indigenous Australia often views health promotion as an act of the ‘paternalistic
government’, akin to control of land, lives and culture as well as a judgment of powerlessness
and lacking self-determination (McPhail-Bell, Bond, Brough & Frederich, 2015). It is somewhat
ironic that although efforts are being made to ‘Close the Gap’, this perception has not been
examined. Indigenous Australians often feel disconnected from health promotion, particularly
concerning mental health. They feel excluded from community involvement due to issues such
as racism. This social dislocation is linked with suicide and emotional distress (Nagel, Hinton &
Griffen, 2012). Also, members of the ‘Lost Generation’ experience a greater degree of
disconnection as they do not identify as being Indigenous (Vicary & Westerman, 2004).
Interestingly, Indigenous Australians believe illness derives from three causal areas –
physical illness, sorcery or spiritual malfeasance (Oliver, 2013). Indigenous persons view
depression differently from non-Indigenous persons. They tend to believe that depression cannot
be treated, that it is simply a characteristic of the individual. It can then be extrapolated that
many persons do not seek assistance as they do not feel that they are ill. Indigenous persons also
view mental illness as something that has arisen due to a cultural indiscretion/external forces or a
longing ‘for the land’ and thus needs the attention of a tribal/community healer (Vicary &
Westerman 2004). Initially, Indigenous experiencing mental health issues could consult with this
type of healer. If symptoms continue or worsen, western health services might then be
considered in order to avoid a potential suicide risk.
It has also been noted that Indigenous persons avoid the western mental health system
through fear stemming from several sources. For example, some have had relatives who have
sought treatment and have returned to their families a changed person. Many communities attach

24
a stigma or heap shame upon a person exhibiting a mental illness. In these cases, suicide is
viewed as a socially-acceptable alternative to medication/hospitalization (Vicary & Westerman,
2004).
A possible solution from the Indigenous point-of-view is to have non-Indigenous
counselling provided in a style which allows ‘yarning’ (a narrative/storytelling style). This would
overcome the criticism often levelled at western medicine – the counsellor is considered rude by
interrupting to ask a question.
For future recommendations, it is important to fund programs that are more issue-
targeted, locally and culturally responsive. The government has spent millions of dollars in the
Kimberley region with the purpose of improving health in Indigenous communities through
various programs. However, many are either not sustainable, culturally appropriate or have not
provided a safe or accessible environment for participation. These factors are important when
dealing with a sensitive population. We recommend the support of programs that are more issue-
specific, collaborative (better stakeholder integration with existing programs/services) and
Indigenous-led as well as the increased use of skill-development training to promote mentoring
and leadership in the communities.
CONCLUSION
This workshop exercise utilised a CNA and health program plan in order to highlight and
address suicide in the Indigenous population in the Shire of Halls Creek. The exercise
highlighted how critical the implementation of a community needs assessment is prior to
employing any interventions.
Three prioritized issues were identified for intervention and a broad issue- and
population-based approach was employed to target mental health, trust and loss of cultural
identity. A combined top-down and grass-roots approach was then outlined, utilising both
supportive public health policies and Indigenous-led community initiatives to target the above
issues. We believe that such a comprehensive plan is required to provide Indigenous
communities with a solid foundation on which to build the health of their future generations.

25
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