There is a demonstrated need to increase Indigenous community capacity and mainstream workforce capacity to understand, cope with, and respond to, people experiencing trauma, loss and grief. This involves developing skills such as conflict mediation, suicide prevention, mental health first aid and lateral violence prevention to build a trauma-informed workforce (Healing Foundation, 2014).
Suicide Prevention workforce development and training involves delivering suicide prevention awareness training to people in key occupations as a key part of suicide prevention and contributes to the goal of reducing suicide Australia. The National Mental Health Commission and the Australian Government have identified workforce development in mental health and suicide prevention as a priority for the next five years. This section includes effective, culturally responsive training support to workforce groups to provide compassionate, culturally-informed care and support to Aboriginal and Torres Islander people experiencing suicidal thoughts and behaviours to achieve a reduction in suicidal behaviours and their impacts on families and communities.
The workforce groups include those:
providing social and emotional wellbeing support
likely to interact with people experiencing a suicidal crisis
health (and other) workers likely to interact with those at risk of suicide and/or needing ongoing management and care
non-health workforces who may interact with people at risk of suicide or those impacted by suicide
families and carers, community groups and workforces interacting with the community and all other workforces.
A review of the literature include of training programs in Australia confirms
Gatekeeper programs such as ASIST and Mental Health First Aid are the most commonly used at a community level.
Very few have been a culturally adapted.
Gatekeeper programs provide general knowledge and skills to support someone who may be suicidal and are generally provided for community gatekeepers rather than health professionals.
Community gatekeepers in suicide prevention are defined as an individual in a community who is highly regards and has contact with large numbers of community members. Gatekeeper are trained to identify persons at risk of suicide and to conduct a brief intervention refer them to treatment or support services as appropriate
Suicide prevention is a whole of community responsibility, highlighting the need for families and communities to receive education and training.
Assessing the effectiveness of workforce development and training involves:
Increased opportunities for participation in evidence-based suicide prevention training in the short term
A culturally and clinically competent workforce that can provide high quality trauma-informed care to Aboriginal and Torres Strait people at risk or affected by suicide
Aboriginal Mental Health First Aid (AMHFA-National)
Aboriginal Mental Health First Aid (AMHFA) is a national program designed to train participants to assist Aboriginal or Torres Strait Islander adults with mental health issues or crises until professional help is available or until the crisis is resolved. The course is offered routinely across Australia.
Aboriginal Mental Health First Aid was informed by strategic guidance from a similar Canadian program, First Nations Mental Health First Aid (CMHFA). Evaluations of CMHFA reported that participants experienced gains in knowledge, self-efficacy, skills and decreased self-stigma. To make the program appropriate for Aboriginal and Torres Strait Islander (hereafter just Aboriginal) communities in Australia, after consultation with expert reference groups, stakeholders and local community members, the CMHFA was adjusted for cultural factors, to produce the AMHFA.
From 2007-2008, 199 Aboriginal Instructors were trained through one of the 17 five-day Instructor Training Courses held around Australia. Since then, over 600 Aboriginal people have become AMHFA Instructors, with 200 Aboriginal people currently active as accredited AMHFA Instructors. Since the launch in 2007, a revised 14-hour AMHFA course has been run approximately 2,700 times across all states and territories to over 50,000 members of the community.
Courses have been informed by a range of Delphi consensus studies drawing on the expertise of Aboriginal people with lived or professional experiences across Australia. Through these consultations, the 14-hour AMHFA Course is now in its third edition. Additional programs have also been developed to supplement the 14-hour course. These are:
A four-hour course for accredited AMHFA Instructors who have completed the 14-hour AMHFA Course to refresh their knowledge and skills three years after completing their training
A five-hour ‘Talking About Suicide’ course which focuses on teaching skills on how to provide mental health first aid to an Aboriginal person experiencing suicidal thoughts and behaviours
A five-hour ‘Talking About Gambling’ course which focuses on teaching skills on how to provide mental health first aid to an Aboriginal person experiencing gambling problems
A five-hour ‘Talking About Non-suicidal Self-injury’ course which focuses on teaching the skills of providing mental health first aid to an Aboriginal person engaging in non-suicidal self-injury
A Youth AMHFA course which focuses on teaching adults how to provide mental health first aid to an Aboriginal adolescent
The overall vision of those who have developed and implemented the AMHFA is of a community where many people have the skills to support those with mental health problems. To achieve this vision, the objectives are to:
Provide high quality, evidence-based mental health first aid courses to train community members to become accredited AMFA instructors
Provide refresher courses to accredited AMHFA Instructors
Consult regularly with Aboriginal communities regarding course updates
Update the courses according to these consultations
Aboriginal Mental Health First Aid focuses on developing knowledge about symptoms and behaviours linked with help-seeking by Aboriginal people experiencing mental illness, as well as increasing individual and community understanding of suicide prevention. Accredited AMHFA Instructors were more likely to run AMHFA courses if they had previous teaching experience and were provided with follow-up support from one of the program trainers. Overall, AMHFA has been shown to be effective in improving trainees’ knowledge of mental illnesses, their treatments and appropriate first aid strategies and increasing their confidence in providing first aid to a person experiencing a mental health problem. Other participant outcomes are decreases in stigmatising attitudes and increases in the amount and type of support which they are able to provide to others1.
An evaluation framework to inform and guide the implementation of the program was established at the commencement of AMHFA in 2007. The evaluation report by Kanowski et al. (2009)1 presented information on its uptake and acceptability for Aboriginal people based on quantitative and qualitative data. Analysis showed that both the Instructor Training Course and the AMHFA course were culturally appropriate, empowering and provided relevant and important information for training to assist Aboriginal people with a mental illness2.
A later evaluation3 confirmed that program attendance led to an improvement in the recognition of mental disorders, confidence in the value of treatment, decreased social distance from people with mental disorders, increased confidence in providing help and an increase in the amount of help provided to others, which was shown to be sustained for up to six months after program completion.
Aboriginal Mental Health First Aid was rated as strong evidence of effectiveness and best practice. It is evident from survey feedback and literature pertaining to AMHFA that the program is a valuable initiative to build community capacity. The program aligns with community consultations and enables people to talk, share with and build social connectedness. Concurrent action to address stigma by creating safe community environments was consistently identified.
A review of psycho-social programs3 to improve social and emotional well-being in Aboriginal people scored 16 interventions for strength of evidence. Aboriginal Mental Health First Aid was ranked first as having the strongest evidence with a 100% score. There was strong support from the Aboriginal respondents with 64% of the respondents finding the program increased knowledge and skills3.
The program is constantly evaluated and improved using the Delphi consensus method with 28 Aboriginal health experts participating across two independent Delphi studies.
This method was identified as a useful consultation tool for Aboriginal people gauging culturally appropriate best practice in mental health services. The AMHFA guidelines and culturally appropriate guidelines for providing mental health first aid to an Aboriginal person who is experiencing problems with alcohol or drug misuse have been updated. Furthermore, a trial of the latest edition of the 14-hour AMHFA Course and the ‘Talking About Suicide’ course is being planned to evaluate its efficacy.
A review of the program evaluations confirm that the AMHFA program is well-organised, comprehensive and provides a sound cultural adaptation of a more general program to assist Aboriginal people experiencing psychological distress. Importantly, this program is in accord with best practice guidelines and has been developed and managed by Aboriginal people.
Aboriginal Mental Health First Aid builds strengths and capacity in Aboriginal communities, especially by providing materials and resources that are appropriate for the needs of Aboriginal people in diverse community settings. It also offers access to community-based programs to improve suicide awareness among “gatekeepers” and “natural helpers” in communities affected by self-harm and suicide through contextualised delivery of programs to people in the community. It also builds strength and resilience in individuals and families through culturally appropriate, life-promoting, resilience-building and sustainable strategies that are tailored specifically for Aboriginal people. The program focuses on developing knowledge about symptoms and behaviours linked with help-seeking by Aboriginal people experiencing mental illness, as well as increasing individual and community understanding of suicide prevention. Aboriginal Mental Health First Aid was rated very highly as strong evidence of effectiveness and best practice.
It is evident from the feedback from the informational survey and the literature that the AMHFA training program is a particularly valuable type of initiative to build community capacity. The program aligns with community consultations regarding the need to enable people to talk and share with one another and build social connectedness.
Kanowski LG, Jorm AF, Hart LM. A mental health first aid training program for Australian Aboriginal and Torres Strait Islander peoples: description and initial evaluation. International Journal of Mental Health Systems 2009;3(1):10.
Day A, Francisco A. Social and emotional wellbeing in Indigenous Australians: identifying promising interventions. Australian and New Zealand Journal of Public Health 2013;37(4)
Gamarada Suicide Prevention, Therapy and Training Programs (NSW)
These programs are offered through Gamarada Universal Indigenous Resources Pty Ltd, an Aboriginal owned, not-for-profit organisation which is uniquely placed in the market and deeply embedded into the community of Redfern in inner Sydney. The programs are designed for both Aboriginal (hereon Aboriginal and Torres Strait Islander)and non-Aboriginal people and people recently out of incarceration. The program is governed by a board of Aboriginal and non- Aboriginal members1. Similarly, they are led by both Aboriginal and non- Aboriginal people.
In 2007, Ken, an Aboriginal Kabi Kabi man, led the establishment of Gamarada Indigenous Healing and Life Training Pty Ltd (Gamarada) that responds to the therapeutic and educational needs for culturally safe community healing, life skills and cultural leadership programs targeting family violence, addiction, suicide prevention and access to Justice. Gamarada Programs are based in inner Sydney at Redfern and incorporate traditional Aboriginal healing alongside Western and Eastern methods. Funding is provided by Aboriginal and non-Aboriginal sponsors2.
A diverse range of programs are provided, including two-day healing and ten-week healing programs; and a Healing and Cultural Leadership Program2. Some programs are structured whilst others are not. Programs use life skills and practical techniques. An example of a practical technique taught is Dadirri3 or Deep Still Listening. The program is generally delivered in yarning groups of 15 to 25 participants sitting in a circle. This enables some groups to be run by the participants themselves under the direction of Gamarada leaders. The program requires a full commitment by participants to work from strengths not weaknesses and to be patient to develop a bond of trust and inspiring interactions to generate positive feelings to move forward. Older participants share time with younger males, to enable them to observe and model positive men’s behaviours.
To assist Aboriginal people (participants) and families through the direct relief of sickness, poverty, suffering, distress and helplessness
To increase social inclusion, family cohesion and economic engagement of participants by bringing the community together and directly addressing barriers that exist between the program participants and the rest of the community
To undertake steps to further these objectives
Progress towards Objective 1 is achieved by front-line program delivery using Gamarada coaching techniques. To hasten the achievement of Objective 2, participants are encouraged to access Healing Hubs at locations within the community. Here kinships and professional networks are utilized for robust community engagement under culturally safe and trauma informed frameworks and protocols. For example, Healing and Life training initiatives are weekly gatherings where participants and other members of the community can access therapeutic change and cultural renewal. Service providers are regularly invited. Gamarada leaders move towards achieving Objective 3 through systemic advocacy such as conference presentations, public awareness campaigns, community forums, the promotion of community cohesion, kinship and strong cultural leadership. These are all in-line with Aboriginal led mental health and SEWB initiatives as well as the Gayaa Dhuwi (Proud Spirit) Declaration4.
Outcomes of the Gamarada Healing Program include providing participants with opportunities for:
Learning and healing
Increasing self-esteem and confidence
Young males to observe positive men’s behaviours
Exploring Aboriginal culture1
Participants commented positively on the techniques learnt through their participation in Gamarada programs. For example, regular practice of Dadirri was mentioned as a positive skill that was useful for self-reflection and keeping positive. One commented that learning these techniques helped him to reflect on his mistakes and to stay positive during the oncoming week. Participants described the program as honest and open and as helping them to share by way of the safety provided by the non-judgemental approach of leaders. Through the program, participants described how their self-control and ability to make positive choices had promoted their personal development1.
Increases in self-esteem and confidence of participants in the Gamarada Men’s Group have been independently identified5. For example, the author was impressed with these qualities in the men who participated in the Gamarada Men’s Group in 2013. Gamarada’s role in this respect was evidenced by the testimonies of the men. Likewise, participants of this program identified the importance of making time to share positive men’s behaviours with younger males5.
A Program Quality Assessment was carried out during the second half of 20151 using the Critical Success Factor Framework. The project involved the assessment of five consecutive sessions of the Gamarada Healing Program on Monday evenings. Feedback from participants was generated by the assessors with the showing of a short PowerPoint presentation to a focus group which explained the purpose of a particular activity. Attendance levels have been an important strength for Gamarada since its inception1. During 2014, Gamarada’s Monday evening sessions provided an average of more than ten participants a session. The evaluation1 also reported that participants had adopted a total commitment to working from strengths and what can be developed, rather than what’s wrong.
Gamarada was recognised by the NSW Department of the Premier and Cabinet with an Excellence Award for Building Leadership in Indigenous Communities in 2010. In 2019, Ken was awarded an Honorary Doctorate by the University of Sydney in recognition of his many achievements, particularly those with Gamarada. The work of Gamarada is cited in over 100 publications and interviews including: TheElders Report into the Prevention of Youth Suicide, the Aboriginal and Torres Strait Islander Social Justice Commissioner’s Social Justice Report and the NSW Mental Health Commission’s Living Well Report. Clients and collaborators include the NSW Ministry of Health, Central Eastern and Western Sydney Primary Health Networks, Sydney Local Health District, the University of NSW, Sydney’s University of Technology, the Aboriginal and Torres Strait Islander Community Health Service Mackay, QLD.
Gamarada has transformed healing practices for Indigenous people and pioneered ground-breaking principles which are examples of best practice. Ken and his team are committed to systemic advocacy through holding regular community forums and national and international conference presentations across the Health and Justice spectrum.
Suicide Story is a three-and-a-half-day suicide prevention program created for use in Aboriginal and Torres Strait Islander (hereon Aboriginal) communities by Aboriginal people who live and work in remote communities. The workshop is structured around nine topics which are covered in an accompanying DVD and target community-based helpers.
Suicide Story was developed by the Mental Health Association of Central Australia (MHACA) in partnership with a Suicide Story Aboriginal Advisory Group . The latter consisted of Aboriginal people from remote communities in the central Northern Territory (NT) who ensured the cultural appropriateness of the program. Under the Suicide Story umbrella, workshops are delivered by trained local Aboriginal facilitators. A local and culturally specific approach is used to guide participants through the process of understanding suicide and reducing the associated stigma so that they can effectively identify and respond to the signs of an impending suicide attempt in a family member or friend. This approach respects the unique needs and issues within each community.
Suicide Story was launched in March 2010 and funded by the NT Department of Health and Families and the NT Primary Health Networks to support healthcare workers and Aboriginal people living in remote communities. Suicide Story is a prevention-oriented program and responds to requests from communities using a capacity building approach. Suicide Story was adapted from the MHACA, Life Promotion Program (LPP) which delivered ‘gatekeeper training’ to healthcare workers and Aboriginal people who might encounter people at high risk of suicide. A two-day Applied Suicide Intervention Skills Training (ASIST) workshop was used in the NT in 2001 and was consistently in demand among those working in the community healthcare sector in Alice Springs. However, it was found that this model did not address some of the core issues central to the needs of Aboriginal people, especially those living in remote regions and town camps. Through extensive consultations with Aboriginal people and discussions with related service providers, the LPP team began to further develop this resource and the style of training to tailor to the needs of Aboriginal people. Suicide Story was created.
Utilising a community development and action research approach, Suicide Story is a community suicide awareness and prevention training program which is developed, led and delivered by and for central Australian Aboriginal people. Over the years, the content and delivery of the program have been reworked and adjusted through a continuous cycle of participatory action research and quality improvement processes according to extensive feedback from facilitators and participants. A Suicide Story Aboriginal Advisory Group has been maintained to ensure ongoing cultural safety and the integrity of storytelling throughout the Program. This has optimised its effectiveness and ability to be applied in multiple communities and to multiple language groups. A key message to participants is that there are no right or wrong answers.
The program incorporates a DVD composed of short films that feature the voices of Aboriginal people, combined with animation, artwork, music, pictures and posters to generate scenarios, conversations and discussions. The DVD focuses on nine topics relevant to suicide, and accompanies nine modules that are completed over the three-and-a-half-day program to address the following questions:
Should we talk about suicide?
Why is suicide a problem in Aboriginal communities and how big is the problem?
What leads people to think about suicide?
How do I recognize a person at high risk of suicide?
What can families and community members do to help protect their community from suicide?
What gets in the way of helping?
What are good ways to support people at high risk of suicide?
How might people heal after the death of a loved one by suicide?
How can we keep the helper safe?
Core elements of the program are:
Listening … sharing … learning
By listening, sharing and learning from the stories of Aboriginal people, a relevant contextual picture of suicide is developed. Suicide Story contains meaningful training material that is respectful of the people, culture, language and context of people’s lives in Central Australia including Alice Springs, Santa Teresa, Yuendumu, Tennant Creek and Gove Peninsula. It includes drawings, animation and film that have been added to enhance this unique, culturally developed training resource.
In 2006, women from the remote community of Santa Teresa painted two banners for World Suicide Prevention Day which portrayed a local understanding of some of the causes of suicidal behaviour and some of the ways to care for people who display suicidal behaviour. This artwork and the associated story remind participants that Suicide Story is about ‘raw and real’ experiences. It is based on the premise that the best way of reducing the rates and pain of suicide for Aboriginal people is to guide them to understand their own experience and to bring to them new learnings in the best possible way.
A culturally sensitive approach Suicide Story provides a culturally sensitive approach to understanding the issues surrounding suicide. It recognises the importance of learning through sharing stories and sharing knowledge through recognisable symbols, images and language in Aboriginal communities. The program uses a collaborative approach that allows community members to work with service providers in a culturally safe space.
The program’s mission is to target suicide by empowering local facilitators. This can be achieved by increasing the skills, knowledge and confidence of participants to work with at-risk people. In turn, local facilitators can work to improve the health and wellbeing of Aboriginal people in remote communities of Central Australia and restore their hope for the future.
The objectives of Suicide Story are to:
Deliver Suicide Story only within communities where Elders have formally requested the program and then, only if the community is considered ready for change
Deliver suicide prevention workshops in remote regions of the NT free of charge and to interstate workshops for a service fee
Accommodate varying levels of English literacy and different ways of learning among program participants
Empower adults in remote Aboriginal communities with the tools to identify the warning signs of suicide
Increase participant awareness of the problem of grief and trauma in their communities and to understand how this has been impacted by historical and social factors
Debunk the myth (especially among some Elders and smaller communities) that suicide threats, especially by young people, are ‘just kids mucking up’
Refer members of the community who seek extra and/or ongoing resources to the relevant provider(s)
Overcome the lack of understanding of some communities about the pain some people experience, especially in the smaller communities and homelands where fewer people have experienced suicide first-hand
Identify and support networks of appropriate people within traditional communities who would like to undergo training and work in their own regions/communities
Work with the community to identify the issues, the requirements and how this can be achieved within the context of service providers and existing programs
Encourage service providers to attend workshops to increase their capacity to identify the warning signs of suicide
Explore impulsive suicide, suicide as a threat, along with blame and payback in Aboriginal people within a cultural and local context
Explore the history of social injustice and legislated change and the consequent losses which pertain to current suicide issues in Aboriginal communities
Examine issues around traditional language and skin groups and whether transgressing traditional systems exacerbates suicide rates and impacts the availability of resources for the transgressors.
The DVD helps participants to realise that there are many Aboriginal people who are willing to ‘talk up strong on suicide’ because of family members lost to suicide. From March 2017 to June 2018, Suicide Story delivered workshops to 141 participants. Each year, six workshops are delivered in the NT: two in the Top End and four for Central and Barkly regions. On average, around 20 people attend each workshop.
Suicide Story has been evaluated in 20121, 20142 and 20193. The program received recognition in 2017 by Lifeline with the LiFE Award for Excellence in Suicide Prevention in the Aboriginal and Torres Strait Islander category4. The program was recognised for the strong collaboration of developers with the Suicide Story Aboriginal Advisory Group to develop a curriculum. In the LiFE award evaluation, it was stated that 97% of participants gained skills to identify the warning signs of suicide and 98% stated that the workshop ‘strengthened their fire’ to support suicide prevention in their community4.
In a review of mental health and suicide prevention services, the Northern Territory Mental Health Coalition described Suicide Story as an example of an invaluable prevention resource which required long-term and secure funding5. Reviewers expanded with an explanation of how Suicide Story aimed to reduce the need to remove people at risk of suicide from their community by providing local people with the skills, confidence and ability to deal with attempted suicides or suicide ideation5.
The most recent evaluation3 sought to answer three questions which related to:
1) assessing the impact at the individual and community level,
2) how this impact can be strengthened, and
3) the continued benefits after the delivery of the workshop.
The findings confirmed that the program is having a positive impact on the resilience of individuals and the community through increased awareness of grief, trauma and suicidal ideation; normalisation of discussions around suicide; and, increased confidence of individuals to proactively intervene. The factors that moderate these actions include local governance, local language, local facilitators and being culturally appropriate.
The 2019 evaluation3 recommended that:
the program proceed without fundamental changes except for the review and up-dating of the general materials and resources and the development of a youth-focused program with corresponding learning materials.
a greater governance role for the program’s advisory group and increased governance by local Aboriginal community-led organisations with a reduced role of the Mental Health Association of Central Australia in the management of the program.
greater attention be paid to the preliminary groundwork prior to the program and an increased number of follow-up visits post-program.
considering the proven effectiveness of the program, Suicide Story be run more frequently and expanded through increased training and development of local facilitators and support staff.
This last recommendation would require increased liaison and awareness-building by funding and government bodies as to the value and effectiveness of the program which would lead to increased resourcing.
Suicide Story builds strength and capacity in Aboriginal communities and resilience in individuals and families. Specifically, it promotes participant capacity to initiate, plan, lead and sustain strategies to promote the awareness of suicide risk and subsequent prevention plans within a community.
Suicide Story also provides materials and resources which address the needs of Aboriginal peoples in diverse community settings. This program also provides culturally appropriate community activities that engage youth, build cultural strengths, leadership, life skills and social competencies, resulting in life promotion and resilience-building. Suicide Story also builds long-term, sustainable prevention strategies that build resilience and promote social and emotional wellbeing. It is specifically adapted from programs for the general public and made appropriate for Aboriginal families and children. Suicide Story also offers a coordinated approach through multi-sectoral co-ordination across levels and sectors of government and supports regional and local co-ordination of suicide prevention. There are agreements to support collaborative approaches to joint case management to ensure continuity of services and support for higher risk clients. There are also strong partnerships between services, agencies and communities.
Suicide Story demonstrates high standards in suicide prevention. There is a comprehensive plan to develop and support the participation of Aboriginal people in the suicide prevention and wellbeing workforce with a focus on community engagement, cultural awareness in wellbeing services, early intervention and a focus on quality improvement for social and emotional wellbeing and mental health care.
Suicide Story was rated very highly as strong evidence of effectiveness and best practice. Drawing on a strong theory base of what works in suicide prevention training, the program has been adapted to be culturally responsive. This is a very organised, well-structured and well-designed program with a clear set of deliverables and reflective practices. The program is able to be flexible, dynamic and accommodates different learning styles, languages, traditions, issues and levels of readiness. It is designed using logic and an approach that adheres to culture, a local approach by local people, a respect for Elders and Aboriginal spiritual and cultural values.
Finally, the program strongly aligns with the guiding principles of the CBPATSISP Evaluation Framework. It emphasises the need to ensure the representation of local communities. The program examines the needs of each community and responds accordingly with an underlying emphasis on the significance of culture, history, and human rights. The program also incorporates an individualised plan for participants to identify the services and stakeholders and the ways in which the Suicide Story team can co-ordinate their work with the existing infrastructure within their community. This allows the program to address more pressing concerns that are specific to a community and advocate for any identified gaps in service.
Lopes J, Lindeman M, Taylor K, et al. Cross cultural education in suicide prevention: Development of a training resource for use in Central Australian Indigenous communities. Advances in Mental Health 2012;10(3):224-34. doi: 10.5172/jamh.2012.10.3.224
Evaluation of suicide prevention activities: Suicide Story Train the Trainer 2014 [Available from: https://www.health.gov.au/internet/publications/publishing.nsf/Content/suicide-prevention-activities-evaluation~Appendices~appendixa~project43 accessed 2019 June 6.
Guenther, J., & Mack, S. (2019). Evaluation of Suicide Story, Final Report. Batchelor: Batchelor Institute of Indigenous Tertiary Education. [Available from: https://mhaca.org.au/wp-content/uploads/sites/13/Evaluation-of-Suicide-Story-FINAL-REPORT-web.pdf accessed 2019 September 24.
Suicide Prevention Australia. 2017 LiFE Award Winners for Excellence in Suicide Prevention Brisbane, Australia2017 [Available from: https://www.medianet.com.au/releases/139369/ accessed 2019 June 6.
Northern Territory Mental Health Coalition. Mental Health & Suicide Prevention Service Review, 2017.
Healthcare Management Advisors. Suicide Prevention in Aboriginal and Torres Strait Islander Communities: Learnings from a meta-evaluation of community-led Aboriginal and Torres Strait Islander suicide prevention programs. 2016. https://www.atsispep.sis.uwa.edu.au/resources.
The Djirruwang Aboriginal Mental Health Worker Education and Training Program (NSW)
The Djirruwang Aboriginal Mental Health Worker Education and Training Program is an Australian, clinically based, tertiary level mental health course designed for Aboriginal and Torres Strait Islander people.
Contact: Faye McMillan, Program Director, Djirruwang
School of Nursing, Midwifery & Indigenous Health, Charles Sturt University,
Wagga Wagga NSW 2678 Ph/Fax: (02) 6933 4202 /Email:firstname.lastname@example.org
The Djirruwang Aboriginal Mental Health Worker Education and Training Program (The Djirruwang Program) pioneered the establishment of an Australian, clinically based, tertiary level mental health course designed for Aboriginal and Torres Strait Islander (hereon Aboriginal) people. It was the first course to incorporate the National Practice Standards for the Mental Health Workforce (The Practice Standards) and embed the Aboriginal and Torres Strait Islander Mental Health First Aid Certificate within its curriculum structure1. The program has restricted entry and is designed for Aboriginal people to gain high quality knowledge, skills and attitudes in the field of mental health, building on existing knowledge and combining mental health theory with clinical practice. The program provides the opportunity for Aboriginal people to gain formal mental health qualifications at diploma, associate degree and degree levels2. The Djirruwang Program is an important example of fostering an Aboriginal mental health workforce to improve Aboriginal mental health outcomes. This is one of the four priority areas of the National Mental Health Commission as described in A Contributing Life: the 2012 National Report Card on Mental Health and Suicide Prevention3 and further acknowledged in the 5th National Mental Health and Suicide Prevention Plan (the Fifth Plan). The guiding document for this priority is the National Strategic Framework for Aboriginal Mental Health and Social & Emotional Wellbeing 2017 – 2023 (NSF). The NSF has listed the development and support for emerging workforces under Action Area 1: an effective and empowered mental health and social and emotional wellbeing workforce. It also lists and notes that additional support is required for the development of specialist Aboriginal mental health education courses.
The key goal of the Djirruwang Program is to develop a skilled Aboriginal workforce within the mental healthcare system to address the over-representation of Aboriginal people with high levels of depression, psychotic disorders and suicidal behaviours in communities. The program has incorporated a mainstream understanding of clinical mental healthcare together with cultural elements. It seeks to increase the understanding of the burden of mental ill-health and distress. Further, it seeks to address the negative impacts on Aboriginal social and emotional wellbeing through the lens of the ongoing impact of colonisation, along with current health and social circumstances4 5.
The program has been developed and refined over many years by key clinicians, Aboriginal leaders, organisations, health disciplines and communities working in close partnership and with reciprocal learning to produce both a curriculum and a delivery which has won national awards6. The program emphasises the importance of recognising Aboriginal cultural experiences and knowledge within the mental health curriculum and providing a culturally safe environment to facilitate effective outcomes1. The program elevates and legitimates the importance of Aboriginal Mental Health Workers as equally significant to psychiatrists, psychologists, social workers, nurses and occupational therapists in addressing the social and emotional wellbeing and mental health needs of Aboriginal people1. Program co-ordinators state that failing to acknowledge the important role of mainstream clinical care is inappropriate and only further exacerbates the stress levels of mental health workers and is likely to result in increased complications for clients and their families. At the extreme end, this could even become the subject of a coronial investigation1.
The aims of the Djirruwang Program are to enable Aboriginal people to:
Develop the appropriate knowledge, skills and attitudes to work as an Aboriginal Mental Health Worker
Develop the skills needed to work effectively in a community mental health setting
Develop the skills to assist communities to identify mental health needs and initiate primary prevention and early intervention programs1 76.
The program has continually been evaluated by the University with input from the mental health professional sector. Ongoing evaluations of the program have recorded the direction and continual building of evidence. Each evaluation has found the program to be unique, valuable and meeting the needs of health services by developing a well-qualified Aboriginal mental health workforce1. An external evaluation of the Djirruwang Program was undertaken in 2010 and resulted in revisions to the skills, knowledge and attributes of the students to enhance the professionalism of graduates1. The review highlighted key areas for engagement with industry partners, the University and the student cohort which has led to informed curricula development and change. This new curricula, which commenced in 2013, includes a greater emphasis on dual diagnosis, pharmacology and understanding of the diversity within the Australian demographics. Further to this, the course had minor curricula amendments in 2015 and is currently undergoing a course review due for completion in 20202.
Embedding culture in the curriculum The Djirruwang Program positively validates and affirms cultural difference as making an ongoing contribution within the mental health area1. Brideson et al.1 emphasised the critical importance and value of embedding culture and affirming processes as a key strategy to address the burden of mental health issues and suicide within Aboriginal communities and the role that the Vocational Education and Training (VET) sector can play in this regard. They draw on the findings of an economic review by Dockery8 which argued that incorporating cultural elements into curricula and models of delivery of education and training which affirm and recognise Aboriginal culture are likely to improve outcomes across all sectors and promote a positive sense of cultural identity for Aboriginal students8. On page ten, Dockery makes the point:
If a strong sense of continuity of self-identity safeguards young people against taking their own lives, it may also have positive impacts in other domains in which people ‘invest’ in their futures, such as education, health, a career and relationships with family and community
In 2013, an independent evaluation of the program9 was published by ATRD Consultants. It was concluded that overall the Djirruwang Program is highly valued by Local Health District (LHD) mental health services across NSW and is increasing staff knowledge and understanding of Aboriginal mental health and cultural issues. It is also improving the capacity of LHDs to provide accessible and relevant services to local Aboriginal people. The Program is providing a unique opportunity for Aboriginal people to gain valuable skills and a tertiary qualification to work as mental health professionals, support their communities, and be role models for others. A perceived weakness is that the program does not relate to specific professional qualifications in one of nursing, social work, psychology or occupational therapy9.
The program values Aboriginal people’s experiences and affirms all aspects of culture within the curriculum, structural arrangements and implementation. At the same time, it incorporates clinical guidelines and practices to make a significant contribution to health and social services professions and one that values Aboriginal people at the core of all developments. This is an exemplar of mental health workforce training and of significant relevance to supporting mental health and social and emotional wellbeing and reducing suicide and self-harm through the provision of training, skills and professional qualifications at all levels.
Brideson T, Havelka J, McMillan F, et al. The Djirruwang Program: cultural affirmation for effective mental health. In: Dudgeon P, Milroy H, Walker R, eds. Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice2014:523-32.
Gee G, Dudgeon P, Schultz C, et al. Aboriginal and Torres Strait Islander social and emotional wellbeing. In: Dudgeon P, Milroy H, Walker R, eds. Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice2014:55-68.
Parker R, Milroy H. Aboriginal and Torres Strait Islander mental health: an overview. Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice 2nd ed Canberra: Department of The Prime Minister and Cabinet 2014:25-38.
NSW Health. Walk Together, Learn Together, Work Together: A Practical Guide for the Training of Aboriginal Mental Health Professionals in New South Wales, 2010.
Kanowski L, Westerway J. Koori Mental Health Outreach Workers Training Program, 93/94: Goulburn Health Service, 1996.
Dockery AM. Cultural dimensions of Indigenous participation in education and training. Australian Conference of Economists (ACE09) Paper, 2009.
ARTD Consultants. Evaluation of the NSW Aboriginal Mental Health Worker Training Program: Final Report Executive Summary, 2013.
Wontulp-Bi-Buya College Suicide Prevention Training Course (QLD)
Wontulp-Bi-Buya College Suicide Prevention Training is a training program delivering the Indigenous Mental Health (Suicide Prevention) Certificate IV. This course works to promote positive responses to suicide and mental health issues in Aboriginal and Torres Strait communities.
Wontulp Bi-Buya College (WBBC) delivers the Indigenous Mental Health (suicide prevention) Certificate IV (IMC IV). This course has been delivered in six intakes from 2014-2019 and is accredited by the Australian Skills Quality Authority (ASQA). Importantly, it is approved for the ABSTUDY study assistance scheme for Aboriginal and Torres Strait (hereon Aboriginal) students1. Re-accreditation of the course is occurring during 2019.
Development of the course was undertaken by WBBC’s Course Advisory Committee in partnership with WBBC Trainer and Course Coordinator, Reverend Leslie Baird. Reverend Baird developed the Strategic Plan for Suicide Prevention in Yarrabah (1995/6) and he worked in consultation with Aboriginal leaders to adapt the IMC IV to fulfil the needs of the ASQA1. The IMC IV course works to train Aboriginal people to promote local responses to suicide and mental health issues within their community. Importantly, the course is transferrable from one community to another1.
Enrolled students are from a wide selection of communities which provides them with greater networking opportunities upon graduation. Their average level of formal education is Year 10. Hence, the teaching strategy within the IMC IV encompasses the inclusion of continued high support and modified learning plans1. For example, there is an awareness of the need for Aboriginal learning styles and cultural acceptability2. Furthermore, the IMH IV, has a strong focus on the development of workforce skills with students learning to recognise and respond to substance misuse and addictions behaviour in those around them. They are also taught where to refer those with mental issues and to provide counselling and Aboriginal mental health first aid for suicide prevention3.
Goals of the WBBC Suicide Prevention Training Course are to produce empowered community leaders by:
Increasing student awareness of mental health and suicide issues by providing ongoing support to students through their network membership
Developing students’ capacities for personal empowerment and positive lifestyle choices to improve their overall mental health and help-seeking behaviours which will be needed for them to support others
Achieving the verbal and practical skills needed to work effectively with current health and community service providers
Key objectives are to:
Promote local responses to suicide and related issues in communities
Facilitate greater communication between service providers and local communities
Facilitate access by communities around Australia to appropriate service providers2
In the pilot phase of the IMH IV, Wontulp Bi-Buya College placed 60 students who were mostly female and had an average age of more than 45 years. Compared to national norms for Aboriginal students in VET courses, college outcomes for enrolment and course completion are outstanding. In 2014 and 2015, there was a 78% completion rate for the 60 students who originally enrolled in the IMH IV2. Latest reports indicated that 85% of students graduated3. Six instances of people obtaining full-time employment due to their completion of the IMH IV course have been recorded in the College post-completion records1.
Attempts at internal evaluation of the IMH IV were made at the end of each module. However, these attempts were hampered because the student response rate was low.
Using action research, a two-year evaluation of the delivery and outcomes of the IMC IV was undertaken by Dr Anne Stephens of James Cook University from 2012–20151-3. This evaluation was designed to measure the delivery of the IMC IV and its outcomes against the key objectives. The principal investigator was initially introduced to students and observed classes. Interviews with students were conducted at different stages of the course. Students were recruited using a snowballing approach with each making the final decision as to whether or not to participate. A semi-structured questionnaire, in combination with a yarning approach, were used for interviews. The backdrop was the buildings or grounds of the College with no members of staff present. Qualitative data was collected to explore the processes that led to the recorded outcomes. The research was grounded in the experiences of students and trainers with data obtained over two years of continuous observation and collection.
Staff noticed changes in students1 and students noted changes in themselves3. Typically, those interviewed described their increased self-confidence and assertiveness along with improved literacy, numeracy and writing skills. Other areas of improvement were public speaking, and cultural knowledge3. One student said that each time he went to a residential teaching block, his/her life improved. He student went on to describe how it had been necessary to disregard some dysfunctional friends, how his/her mind had expanded and he/she now felt able to help others. Another reported that as a result of the course, he/she was better able to respond to difficult emotional states by being able to talk through an issue. Formerly, this respondent recalled that reactions tended to be violent or shameful1. Another described how the IMC IV had provided counselling skills and led to fulltime work assisting Aboriginal clients with mental health issues. Students also showed high levels of satisfaction with trainers and training material3.
The evaluators summarized by describing the College’s approach to training Aboriginal people as systemic empowerment. As a result of training, graduates are able to examine critically and holistically the opportunities, constraints, and relationships which compose the networks within a community, providing them with empowerment3. They added that the course, though highly respected by North Queensland regional employers, still needed promotion among this group3 to maximize opportunities for graduates.
Stephens A. Training for Life: supporting communities to reduce the risk of suicide. the delivery of Certificate IV in Indigenous Mental Health (Suicide prevention). Cairns James Cook University, 2015.
Stephens A. Training for impact: Building an understanding of community development training and Aboriginal and Torres Strait Islander community development outcomes. Wontulp Bi-Buya College 2012–2014: James Cook University, 2015.
Stephens A, Monro D. Training for life and healing: the systemic empowerment of Aboriginal and Torres Strait Islander men and women through vocational education and training. Australian Journal of Indigenous Education 2018