Health and wellbeing

Our shared commitment

Self-determining, healthy and safe Aboriginal people and communities.

Holistic approaches to Aboriginal health and wellbeing are critical to improving outcomes. This includes not only considering the physical, mental and social determinants of Aboriginal health, wellbeing and safety, but also the cultural determinants, such as connection to culture and Country. While many Aboriginal Victorians report good health, health inequities remain.

Together, government service providers, Aboriginal organisations and communities must take significant steps to ensure that all Aboriginal Victorians have access to high-quality, culturally safe and responsive health care services. Improving overall health outcomes and having a good quality of life is a basic necessity to ensure all Victorian Aboriginal communities can thrive.

Goal 11: Aboriginal Victorians enjoy health and longevity

11.1 Improve Aboriginal health status, quality of life and life expectancy

Measures

• 11.1.2 Proportion reporting ‘excellent or very good’ health status.
• 11.1.3 Rate of daily smoking.
• 11.1.6 Rate of emergency department presentations for alcohol or drug-related harm.
• 11.1.7 Specialist alcohol and other drug treatment services provided to Aboriginal Victorians.

Life expectancy is not the only way to measure health and wellbeing, but it is an important indicator of overall health and access to health services.

In 2017-19, 44.5% of Aboriginal Victorians rated their own health as 'excellent' or 'very good', which has increased from 2014-15 (36.9%). However, across the same period, Aboriginal people were more likely to consider themselves as having ‘fair’ or ‘poor’ health (25.8%) compared to non-Aboriginal Victorians (14.3%).

Smoking is the leading cause of preventable death in Australia. While the proportion of Aboriginal Victorians who smoke daily is still high (36% in 2017-19), there has been a long‑term downward trend in daily smoking (down from 47 per cent in 2004–05).

Between 2013 and 2017, there were 978 cancer diagnoses for Aboriginal Victorians (an average of 163 diagnoses per year). In the 5-year period 2013–17 inclusive, the incidence rate of cancer in Aboriginal Victorians was 580.8 and 494.6 per 10,000 for men and women respectively, which was considerably higher than the incidence rate of cancer in non-Aboriginal‑ men and women (346.5 and 287.1 per 10,000 respectively).

In 2018-19, Aboriginal Victorians presented at hospital emergency departments for alcohol and drug related harm at 5.8 times the rate of non-Aboriginal Victorians, with rates increasing year on year since 2012-13. Rates increased sharply among Aboriginal young people, from 27 per 1,000 in 2017-18, to 37.5 per 1,000 in 2018-19, which is around four times the rate of non-Aboriginal young people (9.4 per 1,000).

Despite increased rates of risky alcohol and drug use, Aboriginal Victorians represent just 7.2% of all Victorian AOD consumers in 2018-19, which is lower than the national average of 17% (see AIHW, 2018-19). A lack of engagement with AOD services means that opportunities to intervene early and prevent admission to emergency departments are missed.

DHHS held a roundtable with key Aboriginal sector representatives in November 2020 to explore AOD service delivery priorities for Aboriginal people, in particular the need for Aboriginal specific models of care and culturally sensitive practice across mainstream services. Further work is underway to identify opportunities to address these issues including implementation of recommendations from the final report of the Royal Commission into Victoria’s Mental Health System and as part of development of the new health model for public intoxication.

Service provision of specialist alcohol and other drug treatment for Aboriginal Victorians has increased over time. Between 2008–09 and 2017–18, the number of Aboriginal clients completing treatment increased from 55.2 per 1,000 persons to 101.9 per 1,000.

Aboriginal Cultural Safety Grants

Aboriginal Victorians have significantly higher cancer incidence and mortality rates than non-Aboriginal Victorians. A lack of culturally safe health services is one reason that Aboriginal people with cancer do not seek diagnosis or treatment. The Department of Health and Human Services’ cancer unit piloted the Aboriginal Cultural Safety Grants which provide funding of up to $25,000 to 12 metropolitan and regional health services to support culturally safe cancer services, including:

• the creation of a yarning garden next to the Bairnsdale Regional Health Service oncology unit which includes custom-made seating incorporating local Aboriginal totems and panels featuring the five Gunai Kurnai clans
• the development of quilts and dilly bags for Aboriginal patients with cancer at St Vincent’s hospital. The quilts and dilly bags made by an Aboriginal artist are gifted to cancer inpatients at the commencement of their hospital stay.

Goal 12: Aboriginal Victorians access the services they need

12.1 Improve access to health and community services for all Aboriginal Victorians

Measures

• 12.1.1 Proportion who received a health check or assessment by age.
• 12.1.5 Number and proportion of people aged 55 years or over who had an annual health assessment.
• 12.1.2 Participation rates for cancer screening.
• 12.1.3 Proportion and number accessing disability services and the National Disability Insurance Scheme (NDIS).
• 12.1.4 Number and proportion accessing aged care services.

Between 2007-08 and 2018-19, the proportion of Aboriginal Victorians who received a health check or assessment increased for all age groups. Across this period, the largest increase in participation was for those aged 0–14 years (1.5% in 2007-08 to 15.2% in 2018-19), followed by similar increases for those over 55 (7.5 per cent to 20.9 per cent) across the same period.

Between 2008-09 and 2017-18, the proportion of Victorian Aboriginal women aged 50-69 participating in BreastScreen Australia’s cancer screening program increased from 20.3% to 34.2%). Over the same period, the rate for all Victorian women remained relatively the same at 53.2% and 53.8%, respectively.

Access to disability services

In 2018-19, 623 Aboriginal Victorians accessed disability services, which represents 2.1 per cent of all disability service recipients. This is slightly lower than 2008-09 level when 2.9% disability service recipients were Aboriginal. This could suggest a gap in appropriate culturally safe disability services for Aboriginal people.

As of June 2020, the NDIS identified 2,705 Aboriginal Victorians as potential candidates for the NDIS. Of these, 66.8% (1,808 clients) had been assessed and successfully transitioned to an NDIS plan. The remaining 33.2% (897 clients) were undergoing eligibility process to transition to NDIS and were not receiving any disability supports from NDIS.

DFFH has engaged with the sector to understand the access and planning issues for Aboriginal and Torres Strait Islander people with disability and the below issues have been reported:

• Access and planning materials are not culturally sensitive and do not reflect the way that disability is perceived in Aboriginal culture.
• Plans fail to reflect Aboriginal culture in what is reasonable and necessary. For example, recognising and building in family and community supports into NDIS plans is a key challenge for both participant and the NDIS.
• Lack of Aboriginal planners who can effectively engage with participants and community.

DFFH is working collaboratively with NDIA to enhance their Aboriginal and Torres Strait Islander outreach and community engagement work. The department is also working with ACCOs and Aboriginal communities to support people’s transition to the NDIS. In 2018, the department allocated Transition Support Package (TSP) funding to ACCOs to develop local responses to NDIS transition challenges for Aboriginal people with disability. VACCHO was also allocated TSP funding to further their existing work supporting ACCOs to understand the NDIS and to implement business changes to operate within the NDIS context.

Access to aged care services

The Royal Commission into Aged Care Quality and Safety’s final report has laid out the extensive changes needed to ensure aged care services are high quality and safe and meet the needs of the people accessing them. The Royal Commission made 148 wide-ranging recommendations, including an Aboriginal and Torres Strait Islander aged care pathway to provide culturally safe and flexible aged care to meet the needs of people wherever they live.

The proportion of Aboriginal Victorians aged 50 and above accessing aged care services increased between 2007-08 and 2018-19, from 4.0 to 7.1 per cent. Over the same period, the proportion of non-Aboriginal Victorians aged 65 and above accessing aged care services has remained relatively stable at 7.1 and 7.0 per cent, respectively.

Loddon Mallee Aboriginal Reference Group Fluoride Varnish Program

The Loddon Mallee Aboriginal Reference Group (LMARG) Fluoride Varnish Program focuses on improving the oral health of Aboriginal children in key settings including schools, Aboriginal specific early years services and ACCOs. The pilot program started in 2019 and has provided approximately 200 Aboriginal children aged 3-18 years with two fluoride varnish applications, oral health screens and dental tooth packs. Highlights of the pilot include:

• Development and establishment of sustainable culturally appropriate systems and processes under the guidance of the four LMARG ACCOs in the region.
• Roll out in 6 regional towns (Bendigo, Echuca, Kerang, Swan Hill, Robinvale and Mildura) across early learning centres and schools.
• Establishment and strengthening of partnerships between ACCOs, public dental services and dental schools/universities.
• Increased awareness and engagement of Aboriginal families with oral health services.

The program has been funded an additional $360,000 to continue implementation in 2020-21 and is expected to reach approximately 600 Aboriginal children.

Goal 13. Health and community services are culturally-safe and responsive

13.1 Increase the cultural safety and responsiveness of services

Measures

• 13.1.3 Hospitalisations where patients left against medical advice/ were discharged at own risk.

There are a number of concerning trends emerging in this chapter. Culturally safe and responsive health services are vital to ensuring that Aboriginal Victorians feel safe and supported when seeking the healthcare they need. Cultural safety is about creating an environment that is safe for Aboriginal people. This means there is no assault, challenge or denial of their identities and experiences.

Both mainstream and Aboriginal organisations are responsible for providing culturally safe environments for their clients. While ACCOs and ACCHOs provide much of Victoria’s culturally safe and appropriate health and community services to the Aboriginal community, sustained efforts are needed to build the cultural safety of mainstream services to ensure Aboriginal Victorians have access to culturally safe services regardless of their service provider.

In 2018-19, Aboriginal Victorians were discharged from hospitals against medical advice at a rate of 13.2 per 1,000 people, which is over five times the rate of non-Aboriginal Victorians. This may reflect Aboriginal people not feeling culturally safe when in hospital and indicates that more must be done to ensure hospitals are safe and welcoming places for Aboriginal people requiring medical care.

Goal 14: Aboriginal Victorians enjoy social and emotional wellbeing

14.1 Improve Aboriginal mental health and social and emotional wellbeing

Measures

• 14.1.1 Proportion reporting ‘high or very high’ levels of psychological and psychosocial distress.
• 14.1.2 Rate of self-harm related emergency department presentations (by 15-24 years old, and all).
• 14.1.5 Number of Aboriginal Victorians receiving clinical mental health services.

In 2017–19, 36% of Aboriginal Victorians aged 15 and above reported 'high' or 'very high' levels of psychological distress, which is almost 3 times higher than the rate of non-Aboriginal Victorians. Psychological distress is a proxy measure of the overall mental health and wellbeing of the population, and very high levels of psychological distress may signify a need for professional help and provide an estimate of the need for mental health services (Department of Health and Human Services, Victoria’s Mental Health Services Annual Report 2019–20, p. 20.).

Aboriginal people with ‘high’ or ‘very high’ levels of psychological distress have poorer general health and wellbeing outcomes and are more likely to:

• self-report poor or fair health
• smoke
• drink at chronic or risky levels
• use illicit substances
• be a victim of violence.

This is compounded by experiences of racism across health and human service settings and the broader community. Racism continues to have a significant impact on Aboriginal peoples’ decisions about when and why they seek health services, their acceptance of and adherence to treatment

In 2018-19, Aboriginal Victorians of all ages presented at hospital emergency departments for self-harm related reasons at a rate five times higher than non-Aboriginal Victorians. Similarly, the rate per 1,000 of Aboriginal people aged 15-24 years old presenting to emergency departments for self-harm related reasons increased significantly in the last decade (5.6 in 2008-09 to 37.5 in 2018-19).

Recent (i.e. 2018-19) changes to hospital codes that identify intentional self-harm and suicidal ideation related presentations to Victorian emergency departments are likely to have contributed to the increased specificity in recording emergency presentations for self-harm related injuries. However, it is also noted that mental health emergency department presentations have been rising over time for all Victorians, and some of these presentations concern self-harm. This may in part relate to greater awareness of mental health concerns and greater willingness to seek assistance.

Evidence suggests that higher rates of mental health related issues and self-harm among Aboriginal Victorians can be linked to experiences of continued intergenerational trauma, grief, loss, sexual abuse, family violence, marginalisation, racism and discrimination, past removal policies, culturally unsafe services, unemployment, low levels of educational attainment, and lack of connection to Country, culture, community and spirituality.

Access to community mental health care services

The rate of Aboriginal Victorians receiving community mental health care services contact increased substantially from 679 per 1,000 in 2008-09 to 1,034.2 per 1,000 in 2018-19. In the same time period, non-Aboriginal Victorians accessing clinical mental health care services dropped from 313.3 per 1,000 in 2008-09 to 299.1 per 1,000 in 2017-18.

Outcome indicators show that Aboriginal Victorians continue to be over-represented in clinical mental health services. Aboriginal people form about 0.7% of Victoria’s population, with 3.1% receiving clinical mental health care, compared with 1.16% of the Victorian population overall. This has been trending upwards over the past 5 years (Department of Health and Human Services, Victoria’s Mental Health Services Annual Report 2019–20, p. 20.).

The Aboriginal and Torres Strait Islander Health Performance Framework report (2017) notes that ‘while Indigenous Australians use mental health services at higher rates than other Australians, it is hard to assess whether this use is as high as the underlying need.’ (p.167).

Yarning SafeNStrong Counselling Helpline

In response to the coronavirus pandemic, the Victorian Aboriginal Health Service (VAHS) established an Aboriginal owned and operated Yarning SafeNStrong counselling helpline. This helpline is providing counselling support to callers who experience anxiety, distress and mental health during the pandemic.

Yarning SafeNStrong is also providing outbound referrals and connecting local ACCOs and other support services (statewide and local services) with community members who wish to be contacted.

Investment in Aboriginal Alcohol and other Drug (AOD) Workers

In 2017-18, the Victorian Government invested $2.4 million per annum in recurrent funding to establish an additional 34 Aboriginal AOD worker positions, to be phased in over three years. Consistent with the Korin Korin Balit-Djak policy on self-determination, VACCHO led the design and delivery of the funding.

Over the past 3 years, this initiative increased the Aboriginal AOD workforce to 94 workers, representing a more than 50 per cent increase in community based AOD treatment and support to Aboriginal clients across the state.

Action the Victorian Government is taking

Korin Korin Balit-Djak: 2017-2027 and Balit Marrup 2017-2027

The Victorian Government, in partnership with Aboriginal communities, community organisations and mainstream service providers, is driving action to improve the health and safety of Aboriginal Victorians through Korin Korin Balit-Djak: Aboriginal health, wellbeing and safety strategic plan 2017-2027 and Balit Marrup: Aboriginal social and emotional wellbeing framework. These reforms are driven through the Aboriginal Strategic Governance Forum, and Divisional and Area Aboriginal governance committees.

In November 2020, the Aboriginal Strategic Governance Forum endorsed the development and implementation of Korin Korin Balit-Djak as a systems transformation strategy to focus on priorities that make the most difference for Aboriginal Victorians at a system-wide and departmental level. The strategy has five priority reform areas: Governance and self-determination; funding and commission reform; cultural competency; data and knowledge; and leadership and workforce.

Key investments in 2020-21 include

$40 million Aboriginal Workforce Fund for ACCOs and ACCHOs for 2020-2021 and 2021-2022.

$23.4 million for a Mental Health Bushfire Recovery Package over two years (2019-20) in East Gippsland and North Eastern Victoria. As part of this package, the Victorian Government provided $3.0 million and transferred decision making control to VACCHO who has commissioned seven local ACCOs to deliver Aboriginal social and emotional wellbeing programs in their local communities.

$1.5 million to VAHS in 2020-21 to establish a 24 hour Aboriginal owned and operated Yarning SafeNStrong (YSNS) counselling helpline.

$1.35 million has been committed in the 2020-21 Victorian State Budget to further support the Aboriginal Mental Health Traineeship program (established in 2017-18 with $3.5 million over three years) that will see 10 Aboriginal trainees across the state offered full-time ongoing employment in the area mental health service where they have undertaken their traineeship. Eight area mental health services are participating in the traineeship program: Eastern Health, Bendigo Health, Alfred Health, Peninsula Health, Latrobe Health, Mildura Base Hospital, Monash Health and Forensicare.

$1.57 million has been committed in the 2020-21 Victorian State Budget to further support the employment of clinical and therapeutic mental health positions in positions in selected Aboriginal community-controlled organisations across rural and metropolitan areas.

The clinical and therapeutic mental health positions are selected from a broad range of disciplines (such as mental health nurses, occupational therapists, psychiatrists, psychologists and social workers), as determined by Aboriginal community-controlled organisations. The clinical and therapeutic mental health positions are located at 10 Aboriginal community-controlled organisations:

• Ramahyuck and District Aboriginal Cooperation (Morwell)
• Victorian Aboriginal Child Care Agency
• Mallee and District Aboriginal Health Service (Swan Hill)
• Oonah Health and Community Services Aboriginal Corporation
• Gunditjmara Aboriginal Cooperative
• Ballarat and District Aboriginal Cooperative (BADAC)
• Budja Aboriginal Cooperative
• Winda-Mara Aboriginal Corporation
• Dhauwurd-Wurrung Elderly and Community Health Service
• Kirrae Health Services.

Key actions across 2020 include:

The Royal Commission into Victoria’s Mental Health System (RCVMHS)

The Royal Commission into Victoria's Mental Health System (the Commission) was established in February 2019, and delivered its final report on 3 February 2021. The final report was tabled in Parliament by the Victorian Government on 2 March 2021.

The final report is the culmination of a 24-month inquiry, with nearly 3,000 pages and includes 65 recommendations which set out the reforms required to deliver a reimagined mental health and wellbeing system for all Victorians. This builds on the priority recommendations the Commission made in its interim report in November 2019 to respond to immediate needs and to lay the foundations for the future.

The Commission received more than 12,500 contributions to its work including through consultations, roundtables, public hearings, witness statements, surveys, workshops and more than 3,200 submissions from individuals and organisations.

For the first time in history, Aboriginal leaders, organisations, people, families, carers, and communities were given the opportunity to share their individual and collective experiences of pain, trauma and resilience and help shape a redesign of Victoria’s mental health system. The Commission also acknowledged the significant contribution of VACCHO, which developed the Balit Durn Durn report to support the Commission’s deliberation.

The Commission’s interim report identified the urgent need to address mental illness in Aboriginal communities and the central role of self-determined Aboriginal social and emotional wellbeing services in promoting Aboriginal social and emotional wellbeing. The interim report recommended expanding the delivery of multi-disciplinary social and emotional wellbeing teams across Aboriginal community-controlled health organisations. It also recommended the establishment of a new Aboriginal Social and Emotional Wellbeing Centre to support the transformation of Aboriginal mental health care across the state.

The recommendations contained in the final report build on the interim report recommendations. They include funding for two healing centres to complement the social and emotional wellbeing services delivered by Aboriginal community-controlled health organisations. This reform recognises healing is an essential component of improved Aboriginal social and emotional wellbeing.

The Commission is also recommending a suite of reforms to provide children and families with early, culturally safe and flexible support through Aboriginal-led organisations in partnership with mental health services. Aboriginal children and young people will be able to access specialist mental health services, family-oriented therapeutic care and intensive multidisciplinary care delivered within community settings. These reforms focus squarely on care being delivered through Aboriginal organisations.

Many Aboriginal people access mainstream mental health services for their care and it is incumbent on mental health services to provide culturally safe responsive and inclusive treatment, care and support.

The Commission’s aspiration is for a mental health and wellbeing system where Aboriginal self-determination is respected in the design and delivery of care. In the new system, Aboriginal people should be able to choose to receive care within Aboriginal community-controlled organisations, within mainstream services, or a mix of both. Irrespective of where treatment, care and support are delivered for Aboriginal people, communities and families, it is fundamental that it is safe, inclusive, respectful and responsive.

In 2020, Mental Health Reform Victoria (MHRV) and VACCHO formed the VACCHO-MHRV Partnership. The VACCHO-MHRV Partnership is planning the implementation of the Royal Commission recommendations and co-designing activities to strengthen Aboriginal social and emotional wellbeing. This partnership with its focus on supporting Aboriginal self-determination is critical to the successful delivery of all the Commission’s Aboriginal and social and emotional wellbeing recommendations.

Aboriginal suicide prevention pilot programs

The Department of Health (formerly DHHS) is supporting the development of culturally appropriate and safe suicide prevention approaches which respond to particular issues for Aboriginal communities. This work includes Primary Health Networks (PHNs) implementing placed-based approaches to suicide prevention across 12 sites in Victoria. The establishment of the suicide prevention trial sites has led to the formation of more than 300 local partnerships including partnerships with local ACCOs.

An example of local partnership work to support Aboriginal suicide prevention and post-vention support, includes the Department of Health and Department of Justice and Community Safety partnering with local Aboriginal organisations, Aboriginal Elders and the Gippsland PHN to develop a Gippsland Aboriginal Postvention Framework.

The Gippsland Aboriginal Postvention Framework is being developed to support Aboriginal communities in the Gippsland region to have culturally appropriate and safe access to mental health and Aboriginal social and emotional wellbeing support services. The Gippsland Aboriginal Postvention Framework will support families, friends and communities affected by suicide while also providing a suicide prevention and early intervention response. The Gippsland Aboriginal Postvention Framework will support Aboriginal self-determination and will emphasise the strength of cultural, family and community connections.

The Aboriginal and Torres Strait Islander Cultural Safety Framework (Framework) for health, human and community services

In January 2020, the former DHHS publicly rolled out the Framework to assist mainstream Victorian health, human and community services. The Framework aims to create culturally safe environments, services and workplaces for Aboriginal Victorians. It provides a continuous quality improvement model to strengthen the cultural safety of individuals and organisations.