Mental health profession should say sorry to indigenous Australians

Mental health profession should say sorry to indigenous Australians

Since colonial settlement indigenous Australians have been the victims of misdiagnosis and disproportionate incarceration in mental health institutions. Alan Rosen tells Linda Belardi why an official apology to indigenous Australians is pressing.

Professor Alan Rosen from the University of Sydney has called upon the mental health professions to formally apologise to indigenous Australians for years of historic misdiagnosis, incarceration and maltreatment.

Rosen, a clinical associate professor in psychiatry at the Brain and Mind Institute, said there was a long history of the misinterpretation of cultural states as pathological ones. He also said while the practices were mainly historic, isolated examples of some insensitive treatment continued to occur.

An apology would help to “clear the air” and ensure these practices, including misdiagnosis and lengthy incarceration, would never be repeated. It would also help reassure indigenous people that they could approach mental health professionals when they needed them, without fear.

A draft of the apology is currently under consideration by the Mental Health Professionals’ Association of Australia, which represents all of the major professional colleges and associations.

This is the second attempt by Rosen to have the case for an apology heard by the association.

The first, in December 2009, was considered and rejected by the Mental Health Professionals’ Association of Australia on the basis that an apology had already been made or endorsed by some of them.

In a 1999 position statement, the Royal Australian and New Zealand College of Psychiatrists issued their own apology, but only for any complicity in historical practices associated with the stolen generations.

In February 2008, the Australian College of Mental Health Nurses publicly endorsed the Rudd apology to indigenous Australians as welcome and long overdue.

Kim Ryan, CEO of the Australian College of Mental Health Nurses told Nursing Review she was unable to comment on the current proposal as the college’s board was currently considering a draft.

However, she confirmed it was the position of the Mental Health Professionals’ Association of Australia that some of its members already had statements of apology and reconciliation.
Rosen said these statements were welcome but far too generic. For example, the college of psychiatrists had only apologised for its role in contributing to the stolen generations. It was not an apology for all the harmful practices and excessive psychiatric incarcerations causing distress and disruption to Aboriginal lives, families and communities that the mental health professions have participated in historically.

If accepted by the Australian mental health professions, the apology would be unprecedented.

The apology was drafted based on expert advice from a number of indigenous Australians, including Australia’s first indigenous psychiatrist Professor Helen Milroy.

Rosen has also been invited to address the World Congress of Psychiatry in September to argue the case for an international apology to all indigenous people.

Rosen said he believed it could take months or even years to gather momentum for this international campaign. “I don’t think of doing any of these things with a short-term view. But even running a campaign just makes people think.”

To begin the public discussion, Rosen presented an invited public lecture in Alice Springs in August outlining the rationale for an apology and sharing extracts of the draft apology.

He said one of the major challenges ahead would be to acknowledge that specific harm was done and that there was a case for an apology.

“A lot of the people thought they were doing a good job. They were trying to do their best but harm was done and we should acknowledge that and begin the healing process.”

Rosen said the apology was not about laying blame or guilt but creating a more constructive basis upon which to move forward.

“We’re not blaming the mental health professionals involved. I think they were trying to do the best they could in terms of the mentality of the time, but it happened to do harm in many cases.”

Indigenous incarceration rates in psychiatric hospitals are still disproportionate to their proportion of the population, which must be addressed if an apology is to be accepted, said Rosen.

“If people still benefit from these sorts of practices and they still have jobs in long-term mental institutions because of persistence in some quarters of these historic practices, an apology may be perceived as having a hollow ring.”

While a great deal of expert advice has been sought, all the psychiatric professions can do is offer an apology. It is up to the victims and descendants to hear this apology and choose to accept if for healing and forgiveness, he said.

An apology would signal that these practices including mistreatment and misunderstanding were no longer acceptable and would not be tolerated by the profession.

“Let’s make sure that the message is out there that these practices are mostly historic but we don’t want them to break out again.”

Historically, Rosen said indigenous people and families diagnosed with mental illnesses had been traumatised not only by the experience of colonisation, but by the hands of mental health services.
“The mental health professions under the state departments of mental health really took charge of Aboriginal lives a lot more than they did of other people’s lives,” he said.

He called upon all of the psychiatric professions, including mental health nurses, psychiatrists, psychologists and social workers, to acknowledge their role in contributing to this double colonisation of indigenous people.

“Indigenous people with a mental illness have been dispossessed twice by both the colonising society and by psychiatric professionals and institutions of their rights to culturally appropriate and clinically effective mental health care.

“It is timely that our habitual practices and presumptions of ownership of their lives are strongly challenged at last by indigenous people living with psychiatric diagnoses and illnesses. Evidence is emerging that many traditional cultural healing practices can contribute to recovery and better outcomes.”

Rosen said there was a long history of the misinterpretation of cultural states as pathological ones.

“There is a lot of hurt that is stored up from those experiences; experiences of being incarcerated for long periods in mental hospitals; having your frustration considered as pathological or a disturbed personality; or your bereavement as pathologised depression.”

Psychiatric practices in the past had been insensitive to Aboriginal suffering, mistreating grief as depression and spiritual experience as psychosis or schizophrenia.

Rosen said there had no specific apology by the mental health professionals or the state departments for their disproportionate incarceration in mental health institutions, practices which contributed to their removal from family and culture.

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Extracts from draft apology for consideration by the Mental Health Professionals’ Association of Australia.

Preamble
Over many years, psychiatric professionals have dominated the lives of people with mental illnesses. We have been responsible for their forced separation and disconnection from their families; incarceration in remote regions; their being humiliated, stigmatised and sequestered as moral lepers; the loss of their identities as people, denying them their human rights, their dignity and entitlement to full membership as citizens. Mental health professionals have become their officially anointed custodians –– “for their own good”. We have inadvertently broken their spirits, disempowered them, alienated them from their kin, and in many instances de-skilled them and depleted community knowledge of how to look after their own.

The Apology

• We apologise to the Aboriginal and Torres Strait Islands peoples, cultures so much older than ours in human history.
• While some psychiatric practices with Aboriginal people in the recent past were well-meaning and sometimes helpful and effective, others were thoughtlessly insensitive to Aboriginal losses, and Aboriginal suffering and deprivations inflicted by colonisation. Yet others were indifferent, uncaring, intentionally exploitive and/or oppressive, contributing to alienation from identity, family, country and culture.
• We apologise for our involvement in any applications of state mental health act laws, policies and practices of successive governments, which incarcerated Aboriginal people for long periods in our mental institutions, far beyond their proportion of the general population, alienating and dislocating them further from their families, communities, country and culture.
• We apologise for any of our psychiatric practices which may have misdiagnosed and mistreated grief as depression, spiritual experience as psychosis or schizophrenia, and political resistance as intransigent or psychopathic behaviours, mistaking cultural defiance for the disturbing behaviours of difficult patients.
• We apologise for those past psychiatric practices which sometimes conveyed pessimistic or hopeless clinical outlooks to Aboriginal patients and their families, contributing to demoralization, spirit-breaking and suicide. Instead, we should have instilled hope and invoked therapeutic optimism; we should have offered Aboriginal people more consistent expectation and glimpses of their potential for recovery, and encouragement and support to take control of their lives.
• We apologise for not recognising fully that separating Aboriginal children from parents, family, community and culture was often at the core of psychiatric problems. Our professions may well have contributed further to the life-long grief, distress, pain, loss of hope and direction of the stolen generations, their parents and their children. We acknowledge that our professions could have made a greater effort to help them to redress these indignities and injustices, and to help Aboriginal people reconnect the threads of identity and belonging.
• We apologise for not seeing the value earlier of traditional healing factors inherent in intact or sustained indigenous cultures. Only lately have we begun to see and acknowledge that working with these factors can be crucial for the recovery of Aboriginal people.
• For any of our attitudes which may have conveyed disrespect or caused distress or demoralisation to Aboriginal peoples, we express remorse and regret.
• For any of our practices which may have contributed further to the indignities and injustices suffered by Aboriginal peoples due to the policies of Australian governments, we are truly sorry.
• We recognise and apologise for the harm caused by many past actions of our professional forebears, and for both the intended and unintentional consequences of their legacy.
• We take responsibility for our actions now and in the future, and resolve to work towards making changes that will contribute to improving Aboriginal and Islander emotional health and well-being.

These include:
a) acknowledging and actively supporting the emergence of the important roles of Indigenous mental health workers;

b) ensuring that Aboriginal communities are consulted fully in developing services and policies;

c) encouraging empowerment and social inclusion of Aboriginal mental health consumers and carers in the wider community, ensuring that their voices are heard, privileged and heeded.

As mental health professionals we take responsibility for:
a) our own learning about the importance of cultural safety and security in service delivery, and of working with the strengths of Indigenous families and culture, including the strengths of Aboriginal spiritual healing, story-telling, kinship and social relations, and

b) learning to understand the impact on emotional health of dispossession, dislocations, forced assimilation and the stolen generations, and the sensitivities required to work therapeutically with a population with such losses and traumatic memories.

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