Other Drug Use last 12 months

1. Other Drug Use last 12 months

2. Boredom and substance abuse • higher levels of boredom were associated with worse levels of alcohol use [r=-.052, n=1472, p<0.05] • There was no association with other drug use

3. Stress and substance abuse • higher levels of stress were associated with worse levels of alcohol use [r=-.082, n=1469, p<0.001] • higher levels of stress were associated with worse levels of inhalant use [r=-.055, n=1466, p<0.05]

4. Connectedness to Friends • A negative correlation existed between a felt sense of connectedness to friends and tobacco [r=-.057, n=1480, p<0.05] • similarly, a negative correlation existed between connectedness to friends and marijuana use [r=-.075, n=1477, p<0.01]

5. Connectedness to Family • lower levels of connectedness to family were associated with higher levels of inhalant use use [r=-.058, n=1471, p<0.05] • lower levels of connectedness to family were also associated with higher level of ecstasy use [r=-.069, n=1476, p<0.01]

6. Evidence • Increased resilience and connectedness to the school led to reduction in suicidal thinking Resnick, Blum et al, 1997 • School connectedness alone accounts for 49% of the variance in depressive symptoms, whereas together with parental attachment they account for 53%. Shochet, Homel et al, 2008

7. Opinion • Indigenous suicides appear to have their roots in ‘collective despair’, related to persisting social disadvantage, cultural and social exclusion and destruction of cultural continuity and identity. Clearly these core themes must inform our understanding, as well as preventive practice in Australia.

8. The Alternative Direction

9. “Review of the social and emotional wellbeing of Indigenous Australian peoples…” (Garvey, 2008) • “The social, emotional, spiritual and cultural wellbeing of the whole community is paramount and essential for the health and wellbeing of the individuals that comprise it.” • “…ruptures to significant relationships and markers of identity including access to culturally significant sites and socially significant persons can serve to compromise the quality of an individual’s or a community’s SEWB.”

10. Opinion • According to Kunitz (1994), the particularly bad mortality and morbidity status of Aboriginal Australians can be traced back to two factors concerning how governments have dealt with Native peoples across history: signing of treaties and the level of responsibility for Indigenous affairs

11. Impact of white colonisation on Aboriginal health today COLONISATION Cultural genocide Stolen children Loss of hunter-gatherer Lifestyle, loss of culture Fixed settlements Fringe camps Urban ghettoes Marginalisation from white society, poor communication and discrimination Poor nutrition Poor housing, Poor hygiene, Overcrowding and Infectious disease Unemployment, Poverty, Poor education Alcohol and Substance abuse Respiratory disease, Ear disease, Rheumatic heart dis. Renal disease Low birthweight, Diabetes mellitus Hypertension Cardiovasc. disease Domestic violence, Accidents, deaths in custody From Matthews 1997

12. Self: Continuity & Suicide • Non-suicidal patients can all defend notions of continuity of the self • 80% of suicidal patients can mount no argument about continuity (self or other) • Failures in ‘self’ continuity ‘predict’ suicide risk (Ball & Chandler, 1989; Lalonde & Ferris, 2001)

13. Self: Does being Aboriginal matter? • Euro-American culture & Essentialism • Self & knowledge are individualistic • Aboriginal culture & Narrative • Self is relational • Knowledge is communal/cultural product • Identity is defined by Place (on the land), and is fashioned out of materials made available by culture Lalonde 2006

14. Community Factors & Suicide Courtesy: Michael Chandler University of British Columbia

15. Overall suicide rate by number of factors (1993-2000) Courtesy: Michael Chandler University of British Columbia

16. SEWB in Brief An authoritative review* of peer-reviewed qualitative empirical research regarding Indigenous people’s understandings of mental health suggested five essential themes: • culture and spirituality; • family and community kinships; • historical, social and economic factors; • fear and education, and • loss. Ypinazar et al., (2007) Indigenous Australians’ understandings regarding mental health and disorders. Australian and New Zealand Journal of Psychiatry;41(6):467-478

17. Meta-analytic Review of Spirituality • 29 Studies: 126,000 patients • Significantly greater Survival for people scoring higher on measures of religious involvement and spirituality McCullough et al., 2000 Health Psychology 19: 211-222 • Decreased Stress and increased well-being • Decreased depressive symptoms • Decreased substance abuse • Faster recovery from medical illness and surgery • Enhanced Immune system function

18. Opinion • Our view is that considerable affirmative action is required to enable Indigenous Australians to reach equity with all other Australians. • ‘We’ must engage Indigenous communities in identifying the cultural, historical and spiritual factors which may influence suicide and suicidal behaviour;

19. Opinion ‘We’ must • Promote approaches to enhance self‐esteem and capacity to enable individuals and communities to connect with a value system based on identity, place, people and land; • Develop partnership approaches with communities to strengthen local responses to complex issues, including drug and alcohol use, interpersonal conflict, violence, and grief and loss

20. Opinion • Despite wide recognition and acknowledgment of the importance of Indigenous holistic concepts of self, health, and social and emotional wellbeing, there is a lack of consensus regarding its operationalisation and measurement (Kowal et al., 2007). • There is a paucity of studies and program evaluations across Australia to indicate which initiatives and frameworks are effective in development of social and emotional wellbeing in Indigenous Australians.

21. Opinion • There is clearly an urgent need for increased training of Indigenous Australians at all levels of the Mental Health workforce to ensure a critical mass of workers steeped in local culture and acceptable to local communities. • We recommend the recently published National Aboriginal and Torres Strait Islander Health Council document ‘A blueprint for action: Pathways into the health workforce for Aboriginal and Torres Strait Islander people’ (Commonwealth of Australia, 2008).

22. Opinion • Based on our research and discussions with key informants, there remains a need for careful mapping of suicide prevention and Social and Emotional Wellbeing development programs in communities to clarify who funds what for whom, in which communities, who coordinates the programs, and where capacity needs to be enhanced? • This is a crucial exercise to prioritise values, clarify duplication, and identify gaps where additional funding might be appropriate and lead to solid outcomes.

23. “Let the healing begin…” * • The apology to members of the Stolen Generation on behalf of the Parliament of Australia (Kevin Rudd, Prime Minister of Australia, February 13, 2008) • …”an act of hope, dignity and respect” * (* Tom Calma, Aboriginal and Torres Strait Islander Social Justice Commissioner) • “reinstating belonging for Indigenous people otherwise disconnected from family and country by prior policy and action” (Darren Garvey, A review of the social and emotional wellbeing of Indigenous Australian peoples: considerations, challenges and opportunities.

24. Is an apology enough? • No! After all the other recommendations we have made I think the evidence suggests one more. • We recommend development of an Indigenous Australian Suicide Prevention Policy • This should be developed by Indigenous Australians for Indigenous Australians • Sufficient national funding should be made available to turn the rhetoric of a policy into the reality of reduced suicide rates.

25. Strategies work: New Zealand 1998