Family Relationships Quarterly No.17
Healing services for Indigenous people
by Catherine Caruana
The release of the Bringing Them Home report in 1997 (National Inquiry into the Separation of Aboriginal and Torres Strait Islander Children from Their Families, 1997) added impetus to calls for programs and services to address the healing needs of Aboriginal and Torres Strait Islander Australians. Since then, numerous reports, articles, discussion papers and policy frameworks at both the State and Commonwealth level have recognised the need for a holistic approach to tackle the root causes, rather than just the symptoms, of Indigenous suffering and disadvantage. But what does "healing" in this context entail and what implications might the "healing movement" have for services working with Indigenous families and communities?
On 13 February 2009, the first anniversary of the delivery of the former Prime Minister's Apology to Australia's Indigenous Peoples (Rudd, 2008), the Australian Government announced the establishment of a foundation to promote "the provision of culturally-appropriate healing services to assist Aboriginal and Torres Strait Islander people to begin the process of recovering from trauma" (Aboriginal and Torres Strait Islander Healing Foundation Development Team, 2009, p. xi).1 The strategy of promoting and funding a diverse range of Indigenous-centric services, to help "heal" the social and emotional legacy of colonisation, is gaining ground internationally, and has proven effective in Canada.2 From the perspective of mainstream Australia, however, it remains largely an area of innovation.3
For Aboriginal and Torres Strait Islander people, the need for adequately funded services that are informed by Indigenous concepts of wellbeing, that address physical, emotional, spiritual, cultural and community needs, and that recognise the forces of history and the collective experience, has long been recognised (Ober, Peeters, Archer, & Kelly, 2000). Those on their own healing path have already done much work in Indigenous communities to develop and deliver healing and cultural renewal programs across a number of sectors (Aboriginal and Torres Strait Islander Social Justice Commissioner, 2008; Wilczynski, Reed-Gilbert, Milward, Fear, & Schwartzkoff, 2007). This paper provides an overview of the literature regarding the emergence of a movement to effect therapeutic healing in Indigenous Australia and the diverse range of practices, including traditional healing practices, this term encompasses.4
What is healing in the Indigenous context?
According to the Macquarie Dictionary (Delbridge et al., 2005), to "heal" - derived from the Old English "hale" or "whole" - means to restore to health, to effect a cure, to make whole or sound. Intrinsic to the meaning then is an approach that is holistic and multidimensional, treating the source of "disease", and not just the symptoms. In the Indigenous context,5 healing implies restoration of health in the broadest sense, defined in the 1st National Aboriginal Health Strategy (1989), to include "not just the physical wellbeing of the individual but the social, emotional, and cultural wellbeing of the whole community... a whole-of-life view [that] also includes the cyclical concept of life-death-life" (National Aboriginal Health Strategy Working Party, 1989, p. x).6 Greg Phillips, the chair of the interim board of the Aboriginal and Torres Strait Islander Healing Foundation, described healing as "a spiritual process that includes addictions recovery, therapeutic change and cultural renewal", and involving reclamation of identity (Phillips, 2008, 2007). Swan and Raphael (1995) saw Indigenous health as being grounded in cultural wellbeing, while Milroy (2008) talked about the restoration of harmony and balance rather than the Western construct of reducing symptoms or restoring function.
Although informed by a traditional world view, the idea of using "healing" as an approach to Indigenous disadvantage is not a concept that is always well understood (Aboriginal and Torres Strait Islander Social Justice Commissioner, 2008). The breadth of the term, the wide range of practices that it encompasses, and the fact that spirituality and culture play a central role, bringing with it connotations of alternative or "new age" quackery, has lead to skepticism of its appropriateness as a public policy response (Aboriginal and Torres Strait Islander Social Justice Commissioner, 2008; Phillips, 2007). Given the complexity and diversity of needs in Indigenous communities, "healing" will mean different things to different people, spanning sectors such as mental health, social and emotional wellbeing, family violence, child protection, addictions, sexual abuse, justice and corrections. However, there is a degree of consensus in the literature that healing relates to the personal journey of individuals, families and communities dealing with the trauma caused by past policies and current disadvantage.
Also emerging from the literature is the view that therapeutic interventions need to be preventative and restorative (rather than just reactive), be linked with programs promoting cultural reinvigoration and have regard to workforce development (SHRG, 2004). Although wider healing by way of national reconciliation may be a happy by-product of strategies to address Indigenous suffering, it is not one of the objectives (Aboriginal and Torres Strait Islander Social Justice Commissioner, 2008; Feeney, 2009; Phillips, 2008). Nor, warns one author, should conclusive or final healing be the end game. Feeney (2009) argued that, for some, the healing of wounds may not be achievable, and the implication of needing to "get over" their experiences is insulting.
Healing practice snapshots
By way of illustrating the diverse ways of approaching Indigenous healing, what follows is a brief outline of a number of healing initiatives currently being delivered in Australia.
Marumali comprises a range of workshops for Aboriginal survivors of removal policies and their families (Circle of Healing Program), and for Aboriginal and non-Aboriginal counsellors and health workers, aimed at developing skills to meet the specific support needs of members of the Stolen Generations. Devised by a member of the Stolen Generations, the workshops offer insight into: removal policies and their effects on individuals, families and communities; silence and the trans-generational effects of oppression; the spiritual dimensions of healing and the importance of identity and belonging.
The Family Wellbeing Program
Developed by members of the Stolen Generations in 1998, the Family Wellbeing Program "focuses on social and emotional wellbeing and the development of self-worth, communication and problem-solving skills, conflict resolution and other personal qualities that enable the individual to take greater control and responsibility for family, work and community life" (McEwan & Tsey, 2009, p. 1). Workshops with adults and children involve the sharing of life stories, discussions about relationships, and identifying goals for the future. The Apunipima Cape York Health Council in Far North Queensland has modified the program to meet the specific needs of the local communities of Hopevale and Wujal Wujal. For an evaluation of the program delivered in the community of Yarrabah in Far North Queensland (in response to a spate of suicides), see McEwan & Tsey (2009). During 2007, the program was incorporated into primary school curricula in Queensland.
Based on the Ngaripirliga'ajirri early intervention program (Robinson & Tyler, 2005), this 10-week program provides support for preschool children experiencing emotional and behavioural problems, and their families. The aim is to build positive behaviour and social skills in the children and support the role of the parent or caregivers, and is run in a number of communities in the Northern Territory.
Red Dust Healing
A group program for Aboriginal men and their families who have experienced family violence, Red Dust Healing aims to reclaim a sense of male identity via an exploration of cultural and traditional ways, Indigenous history and the impacts of colonisation, healthy relationships, lifestyle and diet. The program is supported by individual case management plans and a mentoring system, and has been run in Queensland and NSW with input from Aboriginal elders and local Indigenous service providers. The program is currently being evaluated.
Aboriginal Family and Community Healing
This Adelaide-based program, developed as part of the South Australian Government's Regional Aboriginal Health Plan, works with Aboriginal men, women and youth to promote effective responses to family violence. Hosted by the Aboriginal outreach service for a primary health care organisation, the program focuses on substance misuse and social and emotional wellbeing at the family and community level. For findings related to the evaluation of this program, see Kowanko et al. (2009).
We Al-Li (the Woppaburra term for fire and water) is a community-based training program devised by Professor Judy Atkinson at Gnibi, the College of Indigenous Australian Peoples (Southern Cross University, NSW). The program incorporates Indigenous cultural practices and therapeutic skills to assist recovery from trauma such as sexual assault, family violence, childhood trauma, substance abuse and other addictions. By using traditional ceremonies of healing at sites of cultural significance, the program combines experiential and cognitive learning practices, reflection and emotional release to allow for the expression of anger and sorrow within a safe and supportive context.
The We Al-Li program provides the foundation for Certificate Level 4 of Indigenous Therapies, the undergraduate degree in Trauma and Healing and a masters degree in Indigenous Studies (Wellbeing) offered at Gnibi. For more information, see Atkinson (2002), Atkinson & Ober (1995), or Gnibi College of Indigenous Australian People.
Trauma and resilience
The impact of past policy and trauma on the lives of Aboriginal Australians has been documented in a raft of inquiries and government reports.7. It is beyond the scope of this paper to list what Phillips (2009) has described as "the rosary of our sorrow". Suffice to say that Indigenous Australians are the most disadvantaged group in Australia, and have the lowest health standards of all Indigenous people worldwide (Commonwealth of Australia, 2007).8
However, a necessary counterpoint to any discussion of the legacy of the trauma resulting from the white settlement of Australia is the recognition of the strength and resilience of Indigenous people and culture in Australia in the face of extreme adversity. Protective attributes - some of which (such as the continuing strength of kinship systems and the maintenance of connection to spiritual traditions, ancestry, country and community) can be seen as being unique to Indigenous people - have enabled many people to transcend painful personal histories. Greater insight into risk and protective factors affecting Indigenous Australians should inform any future "healing" strategies (Kelly, Dudgeon, Gee, & Glaskin, 2009).
Towards a new model
The persistence into the 21st century of many indicators of Indigenous disadvantage is testament both to the complexity of the psycho-social issues facing Indigenous Australians and the inadequacy of mainstream services in addressing them (Aboriginal and Torres Strait Islander Social Justice Commissioner, 2008; Ober et al., 2000).
In spite of unacceptably high rates of psychological distress within the Indigenous community,9 Aboriginal people are less likely to engage with mainstream mental health services, and when they do, they are likely to present at a more chronic level and to engage with services for a shorter period of time (McKendrick & Thorpe, 1994; Vicary, 2002). Australian Aboriginal mental health is an area that is perceived to have been largely neglected. The mental health service responses to the needs of the Stolen Generations have been found by evaluators to be largely inadequate and/or culturally inappropriate (Wilczynski et al., 2007). Others have highlighted the failure of mainstream services to embrace Indigenous concepts of health and wellbeing (Dudgeon, Garvey, & Picket, 2000; Ober et al., 2000; Westerman, 2004), and to understand the historical context and pervasiveness of racial oppression and social disadvantage (Vicary, 2002). Rather, Western psychology is seen to offer a compartmentalised, individualistic and pathologising approach to maladaptive behaviour, with even greater emphasis over the past thirty years on cognitive rather than insight-based therapy (McCabe, 2008). Some have argued for minimum standards of cultural competency, while others take the position that merely adapting mainstream services to be culturally appropriate - described as "window dressing" - is not only likely to fail but to cause further trauma (Grieves, 2009; Ober et al., 2000).
Much has been written about the characteristics and values essential to ensure healing from the effects of oppressive historical (and contemporary)10 policies.11 A number of authors have stressed the need to first change the conditions that contribute to the trauma (Mehl-Madrona, 2006), and ensure basic needs are met.12 Others see monetary compensation as an essential part of the reparations package (Aboriginal and Torres Strait Islander Social Justice Commissioner, 2008; National Inquiry into the Separation of Aboriginal and Torres Strait Islander Children from Their Families, 1997). As to the nature of healing interventions themselves, while views may vary about the details, some basic features of an effective Indigenous healing model have emerged from the literature (see text box, "Core characteristics of Indigenous healing").
Another aspect seen as a core requirement is that services provided must be sustainable and include workforce development initiatives. Training and education is pivotal to ensure that workers are skilled and adequately resourced.13 Phillips (2003) emphasised the importance of self-care and healing for Aboriginal mental health workers - who are currently viewed as overworked and undervalued - so that experiences can be shared, creating a "healing community". Training that is experiential and affords participants an opportunity to deal with their own issues, or to "heal the healer" - such as that provided in the Family Wellbeing Program - is one way of addressing this need. A number of authors have stressed the importance of developing community capacity, which includes the training of what has been described as the "natural healers" in the community, that is, the mothers, grandmothers and elders (Phillips, 2007; Wilczynski et al., 2007). Yet others have pointed out the responsibility of governments in effecting systemic change and addressing ingrained disadvantage; acknowledging that personal and community healing does not occur in a vacuum (Aboriginal and Torres Strait Islander Social Justice Commissioner, 2008).
The role of research
The literature highlights gaps in knowledge that currently exist in a number of areas, most particularly those relating to the extent of the need for psychological healing in the Australian Indigenous community (Vicary & Bishop, 2005), the risk and protective factors associated with Indigenous social and emotional wellbeing (Kelly et al., 2009), and the efficacy of healing programs to date. Little has been published that demonstrates effective programs; many of the existing programs are small-scale, with limited reach, and are unlikely to have adequate funding for an evaluation component (Kowanko et al., 2009). The Canadian experience illustrates the importance of building a strong evidence base of innovative and effective strategies in this burgeoning area (Archibald, 2006a), while respecting the intellectual property of traditional healing practices (Quinn, 2007). The research arm of the Canadian Aboriginal Healing Foundation has produced a wealth of information that will help inform future strategies, and it is hoped that the Australian Foundation will play a similar role (Aboriginal and Torres Strait Islander Social Justice Commissioner, 2008).
Core characteristics of Indigenous healing
- Indigenous ownership, design and evaluation of services (Aboriginal and Torres Strait Islander Healing Foundation Development Team, 2009) - Informed by an Indigenous, not a Western, worldview, and using culturally sensitive screening and assessment tools (Archibald, 2006b).
- Holistic and multidisciplinary approach - That is, addressing mental, physical, emotional and spiritual needs, with a focus on familial and community interconnectedness, as well as connections to the environment and the spiritual realm (Aboriginal and Torres Strait Islander Healing Foundation Development Team, 2009; Archibald, 2006b; Quinn, 2007).
- Centrality of culture and spirituality - Cultural renewal is seen by some as an essential precursor to healing (Aboriginal and Torres Strait Islander Social Justice Commissioner, 2008; Quinn, 2007). According to Phillips (2003), "culture is treatment" (p.142).
- Informed by history - That is, being cognisant of the historical source of trauma, rather than focusing too strongly on the individual pathology.
- Adopting a positive, strength-based approach - This recognises and promotes the resilience of Indigenous people (Kelly et al., 2009).
- Preventative and therapeutic strategies - Rather than reactive responses that merely seek to reduce symptoms.
- Commitment to healing - As a process that takes considerable time, rather than as an event.14
- Commitment to adaptability, flexibility and innovation - Programs must be inclusive to ensure they reach people who may not have strong cultural ties (Feeney, 2009; Wilczynski et al., 2007) and to incorporate localised practices (Archibald, 2006b).
- Utilisation of particular approaches best suited to the Indigenous context - Such as narrative therapy (Archibald, 2006b; McCabe, 2008), group processes (Koolmatrie & Williams, 2000), and the combination of Western and traditional practices, such as the use of traditional healers, or ngangkari (Archibald, 2006a, 2006b; Milroy, 2008).
The overriding message emerging from the growing literature on Indigenous healing is that a fundamentally different approach is called for - one that is innovative in method and scope, and yet informed by traditional wisdom. Central to this notion of effecting personal healing, is the imperative to consider not only the needs of the whole person, but of the families and communities to which they belong. According to Tom Calma, the Aboriginal and Torres Strait Islander Social Justice Commissioner (2008), if we fail to strive for community-wide healing, then all future investment in social programs in Indigenous communities will be like building a house on quicksand. Any success in achieving the decolonisation of the psyche of Indigenous Australians has the potential to increase wellbeing of the broader Australian society.
The author would like to thank Mark Lawrence, Catriona Elek, Melisah Feeney, Shane Merritt, Sue Beecher and Luella Monson-Wilbraham for their comments and feedback.
Recent supportive healing initiatives
The Stolen Generations' Working Partnership
On National Sorry Day, 26 May 2010, Minister Macklin and Minister Snowdon jointly released the Stolen Generations' Working Partnership.
Through this Working Partnership the Australian Government reaffirms its commitment to working with the Stolen Generations, recognising both their desire to articulate and lead their own pathways and solutions, and the need for broader understanding within the Australian community.
The Australian Government will work with the Stolen Generations in areas which have been identified by them as priorities, including:
- keeping the memory of Stolen Generations' alive;
- emerging needs such as aged care;
- building capacity and connections with mainstream and other Indigenous services so they have a better understanding of the impact of the forced removal of Indigenous children; and
- taking into account the special needs of Stolen Generations' members in policy development
It will require innovative solutions using existing resources, a willingness to work together and a preparedness to be open and understand different perspectives.
The Aboriginal and Torres Strait Islander Healing Foundation
In May 2010 the Healing Foundation announced its inaugural funding round of $2 million for local community-led healing projects to help people to overcome the underlying causes of trauma and prevent the cycle continuing.
Grants will support local projects such as:
- cultural renewal through connecting with culture, language and country;
- the development of healing centres and community healing plans;
- using song, dance, drama and art as part of the healing process;
- group and individual counselling, as well as traditional healing methods;
- drug and alcohol recovery projects; and
- anger management and family violence projects.
The funding round marks an important step forward in the way support is provided to Aboriginal and Torres Strait Islanders, including members of the Stolen Generations, who are affected by the pain caused by past governments' laws, policies and practices.
More information about the healing grants can be viewed on the Healing Foundation website.
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Catherine Caruana is a Senior Research Officer with the Australian Family Relationships Clearinghouse.
1 The Aboriginal and Torres Strait Islander Healing Foundation Ltd was incorporated on 30 October 2009. The foundation is a national, Indigenous-controlled, not-for-profit organisation to support community-based healing initiatives.
2 See Archibald (2006a). The success of the Canadian Aboriginal Healing Foundation is evidenced by the fact that funding has been extended to 2012.
3 The social and emotional wellbeing of Indigenous Australians has only become a health policy priority in recent years, and has been incorporated into a number of policy frameworks such as: The Aboriginal and Torres Strait Islander Emotional and Social wellbeing (Mental Health) Action Plan (1996-2000); the National Strategic Framework for Aboriginal and Torres Strait Islander Health 2003-2013; the National Social And Emotional Wellbeing Framework 2004-2009 and the NSW Aboriginal Mental health and Well Being Policy, 2006- 2007.
4 This is not a full review of the literature, but rather it covers the books, articles, reports and so on that are deemed to be the most pertinent to this issue. Electronic searches of a range of databases; hand-searching a range of journals, bulletins and conference proceedings focused on Aboriginal and Torres Strait Islander issues; and Internet searches of "grey" literature on healing practices were conducted. This paper also draws on and acknowledges the work done in earlier literature reviews, namely by Wilczynski et al. (2007), Victorian Aboriginal Child Care Agency Co-operative (VACCA; 2006) and the Aboriginal and Torres Strait Islander Social Justice Commissioner (2008).
5 Healing was first used in this context by Indigenous Canadians in the 1980s to refer to culture-based programs dealing with addictions and substance abuse (Phillips, 2007).
6 The term "social and emotional wellbeing", has been seen as a more appropriate descriptor of Indigenous health than the more restrictive term of "mental health" (Social Health Reference Group [SHRG], 2004). There is a growing recognition internationally of the importance of the social determinants of health; that is, the link between the daily conditions in which people live and work, from birth to death, and their physical health. There is also greater understanding of the interdependence of physical and "mental health" (Kelly, Dudgeon, Gee, & Glaskin, 2009). As such, a picture of the psychological health of Indigenous Australians is an important measure of health overall.
7 Commonwealth of Australia, 1991; Swan & Raphael 1995; Human Rights and Equal Opportunity Commission, 1997; Zubrick et al., 2005; Commonwealth of Australia, 2007.
8 It has been proposed that the negative effects of colonisation have continued for a longer period in Australia than in other countries (Wesley-Esquimaux & Smolewski, 2004). Some authors suggest that one possible reason for this is the absence of a treaty with the Indigenous people of Australia, indicating the nature of the experience of colonisation and the relationship between the colonisers and the colonised, and the ability of Indigenous people to achieve closure on past trauma (Ober et al., 2000).
9 The 2004–05 National Aboriginal and Torres Strait Islander Health Survey (NATSIHS), which included a social and emotional wellbeing component, found that over one-quarter of respondents reported high rates of non-specific psychological distress—twice that of the general public across all age groups (Australian Institute of Health and Welfare [AIHW], 2009).
10 See Brown and Brown (2007) for a critique of the Federal Government’s Northern Territory intervention.
11 In Canada, the Aboriginal Healing Foundation formulated the "three pillars of healing" (Archibald, 2006a). Recommendation 3 of the Bringing Them Home report suggested a five-part approach to reparation (National Inquiry into the Separation of Aboriginal and Torres Strait Islander Children from Their Families, 1997), based on van Boven and Bassiouni’s (2005) Basic Principles and Guidelines on the Rights to a Remedy and Reparation for Victims of Gross Violations of International Human Rights Law. The evaluation of the Bringing Them Home programs outlined 10 good-practice principles (Wilczynski et al., 2007). Atkinson (2002) listed five essential components necessary for healing.
12 However a number of authors have expressed strong views that while striving for social justice can in itself be part of the healing, the provision of health services, including mental health services, should be seen as a basic entitlement available to all Australians, and should not come under a healing funding program (Mehl-Madrona, 2006; Phillips, 2003).
13 For more information on the Indigenous training modules currently available, see Aboriginal and Torres Strait Islander Social Justice Commissioner (2008).
14 In its final report, the Canadian Aboriginal Healing Foundation estimated that it took a minimum of 36 months for organisations delivering healing services to identify needs and to engage a community in therapeutic healing, and an average of 10 years for a community to move beyond denial, create an environment of safety within which to deal with the trauma and initiate healing (Archibald, 2006).