Response to Warren Snowdon’s media release

Response to Warren Snowdon’s media release re funding cuts

By Dr Craig San Roque, remote areas community psychologist, central Australia*

(*This blog post relates to previous posts:
‘Media release re funding cuts from Warren Snowdon MP‘; ‘More on mental health funding cuts…‘; and ‘The loss of RFDS from nntaria – funding slashed‘)
 

I work for the RFDS mental health service as an independent consultant and practice supervisor and on some specialist inter cultural work in the western Arrerente, Warlpiri, Pintubi region and within Alice Springs in town. In this I attempt to ensure that the delivery of the mental health practice is realistically congruent with local situations.  The RFDS team is concerned to work congruently with the way local indigenous people think about mental health. The RFDS team has been especially astute in following local indigenous advice in designing and delivering effective responses in remote areas.  The  clinical effort of the RFDS primary mental health team follows that advice – and their methodologies reflect realistic best practice in Aboriginal settings. The RFDS practice methodology can be detailed and the way this professional momentum is maintained can be demonstrated.

To my knowledge none of this was taken into account by NTML when the decision was made to strip the team of its effective service delivery.

This team has, over the last years and in recent months built up a head of steam – on the ground –  involving several collaborating agencies, bush clinics, and the NTG Remote Mental Health Team, among others. That collaboration has, in the main, been stimulated through the quiet facilitative determination of members of the RFDS team and their indigenous associates. The underlying idea behind the work of this team is derived from the famous line of  John Flynn’s –  that the RFDS would provide ‘a mantle of safety’  for people living and working throughout remote Australia.

To this we add the phrase ‘a mantle of care’. The RFDS agreed to take on financial management and support of the mental health team after Medicare Local (previously GP Network) in effect dropped responsibility in (as far as I can tell ) a rather ambiguous manner. The details of the financial management and clinical responsibility will bear investigation.

As hard going as it  has been  for the RFDS team to develop and protect a ‘mantle of care’ the team, in collaboration with their co workers, were getting results, were providing effective therapeutic services. Furthermore, this grouping of practitioners,  closely woven into the mantle of care with other care teams were defining a way of working that demonstrates some of the best of Aboriginal focused, and Aboriginal informed collaborative  primary mental health care. They work in circumstances  characterised by repetitive suicide, child neglect, chronic ill health, intoxications and generalised depressing conditions that would seem to be best described as complex psychosocial disorder- thereby demanding complex psycho social primary mental health care attentiveness.

This work and the clinical flexibility of the RFDS team has taken time and care to construct. To have that patiently constructed initiative deflated so abruptly by the withdrawal of the NTML support and comprehension, is quite frankly the worst kind of managerial thoughtlessness. There seems to be a careless lack of attention to the real detail on the ground, in the current move to cut health services in our region.

I can appreciate that local people are perplexed as to what is going on and Mr Snowdon is quite right in drawing alarmed attention to the matter, lest  the RFDS ‘mantle of care’ be let slip away – and in so slipping so too will slip the integrity of care that has taken so much effort to put in place in the bush.

I do not think that the responsibility for this deflation of service can be laid fully on Mr Abbott’s shoulders. NT Medicare Local  senior management have to be held accountable for their own decision. There may need to be an investigation of the ‘decision trail’.  Perhaps Mr Snowdon is better placed to interrogate NTML which itself seems to be either under a pressure panic or has been negligent in its attention to the facts of the Centralian indigenous Australian situation.  Or perhaps ther has been an oversight.  Nevertheless NTML seems to have been prepared to sacrifice the cohesion and progress of the Central Australian RFDS mental health team’s work. Offering to contract individuals to work in remote regions may appear to appease but in fact such an apparently pragmatic approach of contracting individual providers to offer mental health care in aboriginal settings shows a remarkable lack of knowledge of the actual conditions on the ground and a lack of understanding of what is required to support practitioners in those settings.

It would seem as though NTML itself may have failed in its  own representations to Govt. on the mental health situation in this region – or has failed because NTML itself – in its current form – has very little comprehension of what the local RFDS team has (historically) been doing, and why their work is consistent with the best practice recommendations in Aboriginal mental health work.

You will note the perplexity. Why would you let go a working team that is delivering an effective primary mental health care service in settings where there is clearly a need for such a service?

You realise that I am writing as a mental health practitioner, experienced in Central Australian situations since 1992 and it is this long term view and clinical practice knowledge that I am drawing upon as I contemplate the loss of this cohesive, pragmatic, well managed and culturally embedded team of mental health workers; who together with their collaborating agencies have in fact been developing and maintaining a mantle of care.

Another take on the matter written to a colleague  17 july 2014

My basic point is that mental health care for any people, indigenous or not- requires consistency of delivery by reliably informed and trained practitioners and the cultivation of trustworthy relationships on the ground with the families of troubled people.

This is precisely what the RFDS team has aimed for and is achieving- and it is this approach that RFDS supported, knowing well  (as did Flynn of the Inland with his ‘Mantle of  Safety’ concept) that the conditions in remote regions of Australia needed a widespread and competent mantle of care, communication and a health practice methodology, adapted specifically to remote Australian conditions.

Reacting to funding problems (no doubt) the NTML management concept of breaking up the team, or dispersing individuals on individual contracts does not seem to have been thought through- and does not seem to have  grasped or followed the basic principles of care advocated by the RFDS itself and by the RFDS mental health team

Note.

1. The current RFDS team meets regularly, exchanges  confidential and necessary integrated client information with the NTG Remote mental health team under Dr Marcus Tabart’s clinical guidance.

2. The team engages in regular supervision and professional development activities (some of which I facilitate as a senior and experienced practitioner well versed in local and indigenous issues).

3. The team members are well known locally and in the bush settings where they work by the long term indigenous families. RFDS collaborates across a spectrum of other agencies and is trusted – precisely because of the effort by the manager Christine Munday to ensure interagency collaboration.

4. Steady progress has been made in this  collaboration – (Weaving the mantle) extending the  primary mental health network with other Remote mental health services, groups such as the Mt Theo Program (WYDAC) based in Yuendumu, the NPY Women’s Council Ngangkari project, the Mutijulu/ Yulara complex and – through careful work with indigenous men in the Luritja region- Kintore, Mt Leibig, Haasts Bluff. Martin Jugadai and David Beveridge for instance have made significant contributions to the pragmatic aspects of mental health work, men’s behaviour change and child care issues- all developed within this ‘mantle of care’ – including where suicidal acts are concerned.

Overall the RFDS projects have been guided and the advised by veteran indigenous thinkers, supporters and consultants including throughout the areas where the team works. Japanardi Cecil Johnson, Andrew Spencer Japaljarri and other senior men and women experienced in handling indigenous mentalities have offered steady, careful, patient guidance on difficult mental and emotional relational matters.  This is all properly conducted primary mental health work.

The loss of the RFDS team and the disintegration of the steady effort made by those team members, their colleagues and the Aboriginal practitioners cannot really be forgiven.

In short the mantle of care was in place – The workers were getting somewhere. A practice method was in place and developing….and yet a coherent competent, carefully developed service handling remote area indigenous matters has been subject to disintegration – not from within…

Craig  San Roque Psychologist Alice Springs.