The higher rates of mental illness and suicide among Australia’s Indigenous peoples demands a radical rethink of mental health services. In fact, UNE researcher Peter Smith advocates changing the power imbalance in mental health that leaves many vulnerable people feeling culturally unsafe.
The Kamilaroi man, one of just approximately 200 registered Indigenous psychologists nation-wide, is developing a new model for mental health practitioners that promises to change the approach to care. He believes that too few professionals understand the disadvantage and intergenerational trauma experienced by Aboriginal and Torres Strait Islander peoples as a result of colonisation and some have forgotten the power of listening.
Peter says cultural responsiveness is a dynamic, ongoing process of culturally respectful learning that calls upon the practitioner to use “deep listening” or winanga-li (in Kamilaroi language). Instead of positing the practitioner as the expert, it encourages them to step out of their own culture in order to understand the culture of the other. This is something within cultural responsiveness that is called cultural safety.
Respectful of diversity
Peter would like to see all mental health professionals, educators, employers and peak bodies work harder to ensure mental health services for First Nations peoples are more inclusive and respectful of diversity.
“One of the important micro-credentials of counselling is the ability to listen, and listening is fundamental to Aboriginal and Torres Strait Islander culture and part of our spirituality,” Peter says. “Winanga-li means more than listening and hearing the words. It means that I sit with you and understand you.
“We mental health practitioners are reminded to engage with all of our clients, including Aboriginal and Torres Strait Islander clients, in ways that enable ourselves to learn from them by talking less and listening more. Our clients are the experts of their own lives.”
Our clients are the experts of their own lives.
Peter says his new model of cultural responsiveness, developed as part of his PhD in the School of Psychology, is less about the acquisition of skills and knowledge and more about “learning with humility”. It advocates practitioners constantly evaluate their practice, including their own attitudes, values and biases, and “grab bag of interventions and diagnostic categories”, to be more mindful of the specific and holistic needs of Aboriginal and Torres Strait Islander people.
“Non-Indigenous people come from an inherited position of power and privilege that goes back to colonial times,” Peter says. “This causes a lot of the problems we see today in the way Aboriginal and Torres Strait Islander people interact with the dominant culture and, in particular, mainstream mental health services. Cultural responsiveness is being able to step out of one’s own cultural perspective to understand the cultural perspective of another.”
Cultural competency workshops
The approach he has developed is born of delivering cultural competency workshops to aspiring and practising mental health professionals over the past 12 years. The fact that Indigenous suicide rates increased by 22% between 2008 and 2018 underlines the urgency of his work.
“The statistics are horrendous,” Peter says. “It is a very complex issue that varies from community to community, but suicide was never a part of our traditional culture. Deaths in custody is another huge concern. We make up just over 3% of the national population, yet something like 35% of adults in custody are Indigenous and 51% of juveniles in custody are Indigenous.
“The one-size-fits-all approach to mental health care is not working for our people. Practitioners have really got to get this message. There is a lack of understanding of what it means to come from a collectivist society, the values based around family and community and kinship, and our spirituality.
The one-size-fits-all approach to mental health care is not working for our people.
“Indigenous people going along to mainstream services are frequently finding them very alienating and unhelpful. If people are not feeling culturally safe and not finding this a supportive and therapeutic environment, they just won’t come back. Breaking down some of the barriers starts with practitioners providing culturally responsive services.”
Cultural responsiveness is now the term adopted by the Australian Psychology Accreditation Council for all tertiary psychology courses Australia-wide, and the Psychology Board of Australia. Cultural responsiveness workshops are already a feature of UNE’s School of Psychology program for undergraduate and postgraduate students, and Peter has served as both a presenter and consultant to staff.
“I am really hopeful of making an impact and helping to close the gap in mental health for my people by improving access and cultural safety,” Peter says. “This model could easily be applied to working with First Nations peoples anywhere in the world.”
