Aboriginal Health

‘‘They are impulsive acts while intoxicated. It can be after a small argument, a trivial argument with a relative, friend or partner, and they just go off and find some hose.”

There are no nice, comforting words to describe what confronts Associate Professor Murray Chapman.

A psychiatrist, trained in the UK, he is currently clinical director of the Kimberley Mental Health and Drug Service (KMHDS), which puts him at the centre of a community whose heart and soul is being torn apart by suicide.

“When you look at Indigenous suicide, it’s a completely different pattern to non-Indigenous suicide. There are many cries for help [from the young] where you live. If someone isn’t going to get a pair of shoes, they will tell you they are going to be angry, they’ll tell you they are not going home, or something like that. Here, in the Kimberley, the response is the threat of suicide. It has become the lingua franca of despair.”

In July, Professor Chapman and colleagues published a report in the Medical Journal of Australia. It was based on an audit of the KMHDS internal suicide and self-harm database, based on referrals to the service, police reports, and reports from local hospitals and various non-government agencies.

It found that, in the 10 years from 2005-2014, there were 125 suicides in the Kimberley. Of these, 102 were by indigenous people, who were mostly male (71%), mostly young (68% under age 30) and were mostly by people who had never come into contact with the services run by Chapman. Virtually all were by hanging.

This was in an estimated population of around 14,000, which equates to an age-adjusted suicide rate of 74 per 100,000 population, or seven times the national rate.

The media has long been stirred up by the topic. Earlier in the year, there were reports of a suspected suicide of a 10-year-old indigenous girl in WA. In response to the coverage, the WA State Coroner’s office announced it would hold an inquest, not just into what happened to the girl, but into another 20 recent suspected suicides.

But it is easy to find similar stories about child suicide in the news cuttings from the year before, and the year before that — similar stories stretching back over the past 15-20 years.

[Keane: are we succeeding in curbing suicide?]

The causes of the tragedy, which has unfolded across the Kimberley and much of remote northern Australia, are hugely complex, Chapman says. He talks about collective trauma, the effects of colonisation, the effects of decolonisation and the Stolen Generation.

He talks about the damage done by alcohol and communities now dealing with the fallout of fetal alcohol spectrum disorder, again at sky-high rates among those worse effected.

And then there is the basic poverty, the lives lived in the squats and slums.

“You are a young person and you have access to TV, you get Foxtel, and these kids can see the Kardashians and their ridiculous lifestyle and they look at what they have got. The mismatch of what is available and what to aspire to is substantial.”

As many indigenous leaders have pointed out over the years, Chapman says, suicide came late to indigenous Australia.

“From what we can gather in the Kimberley, until the ’60s or ’70s, and even the early ’80s, there was little in the way of suicide. But then it took off. It was at the time of the first royal commission into deaths in custody, and obviously it was partly about suicides happening in prison.

“When you look at the massive publicity in those days — there was a front cover of Time magazine with a picture of a noose — there was a recognised media effect [the Werther effect of copycat suicides] that helped push it into the community. It was probably already going that way, but [the publicity] really boosted it.”

Last month, the federal government picked the Kimberley as one of its 12 suicide-prevention trial sites, a product of Prime Minister Malcolm Turnbull’s $192 million election pledge.

The health department’s media release talks mainly in the abstract about developing models of suicide prevention to “tailor specifically to the unique and often culturally sensitive requirements of remote and Indigenous communities”.

This will use, it adds, the “expertise and local knowledge to tailor mental health solutions specific to their community needs”.

Yes, this would be welcome. But to many, its sentiments and its promises are depressingly familiar.

Back in 2007, for instance, WA State Coroner Alastair Hope began his inquest into the deaths of 22 indigenous people from suspected suicide. The idea was the same as now: to discover the broader reasons behind the individual tragedies.

Even with the distance of time, the findings make tough reading. Page after page recounting the final days or hours or moments of desperate people’s lives, short histories written in dry brutal bureaucratic words.

“During the preceding months the deceased had made several threats to harm himself … family and friends had, on occasions, physically removed objects from the deceased which could have been used as ligatures … at some point during the morning the deceased had a disagreement with his brother over a toy … a short time later he could not been seen … a search located him in front of a neighbouring house lying on the ground.”

[Trauma in the Kimberley: what life is like in remote indigenous communities]

The coroner’s report, which was published a year later, ran to more than 200 pages.

“In simple terms, it appears that Aboriginal welfare, particularly in the Kimberley, constitutes a disaster but no one is in charge of the disaster response,” Hope concluded.

He came up with 23 recommendations. He wrote about things as basic as changing the design in public housing so it was less about nuclear families and more about communal living.

He also wanted an end to a controversial work program for the indigenous unemployed, which he claimed, rather than offering meaningful work, seemed to result in what was called “sit down money” — money for doing nothing, which ended up fuelling alcohol misuse and the consequent havoc.
But he also emphasised, first and foremost, the need to connect with Indigenous leadership.

Wes Morris, head of the Kimberley Aboriginal Law and Culture Centre, which originally called for the inquest, says, in the end, only three recommendations were taken up by governments — and they were simply the sort of recommendations governments are good at delivering, namely, the creation of more services.

‘Malignant grief’

The softer, less tangible demands, he says, were largely ignored.

“Did any of it work? No. If it had worked, we wouldn’t be going through another inquest 10 years later or needing a suicide prevention trial,” Morris said.

“They assiduously avoided the much harder recommendations, such as the recommendations about Indigenous leadership. The coroner found that there was no one steering the ship, no one driving the train. And that remains largely true today.”

Morris talks about funeral fatigue in the Kimberley, the days spent in mourning the dead, the cultural exhaustion and what was described by Dr Helen Milroy, Australia’s first indigenous doctor, as ‘malignant grief’ — the irresolvable, collective, cumulative grief that spreads through the body of indigenous culture, through the body of indigenous people with the form of human despair, which kills.

He quotes from the paper Cultural Wounds by Emeritus Professor Michael Chandler, a former professor of psychology at the University of British Columbia in Canada.

“If suicide prevention is our serious goal, then the evidence in hand recommends investing new moneys, not in the hiring of still more counsellors, but in organized efforts to preserve Indigenous languages, to promote the resurgence of ritual and cultural practices, and to facilitate communities in recouping some measure of community control over their own lives.”

A myth

Human rights campaigner Gerry Georgatos, who has been writing on indigenous suicide for more than a decade, is one of the many voices repeating their calls for a royal commission into a social horror story.

In March, as news of the suspected suicide of the 10-year-old girl broke, he wrote:

“I have travelled to hundreds of homeland communities and the people who are losing their loved ones are crying out to be heard, they are screaming.

“It is a myth and predominately a wider community perception that there is a silence, shame, taboo — it’s the listening that is not happening.”

As for Chapman, he remains clear about the limits of what can be done by statutory services while the bigger societal forces that have ravaged indigenous communities remain.

“We work together, but up here all our partners — the primary care teams, the police teams — are under resourced. It’s the inverse care law.

“I’m working on the edge of nowhere. I have the least resources and the most need. But we work together. Yes, we have a standard response [when someone dies] to stop clustering, to support families to minimise the risk of further suicide. We advocate and endure.”

Professor Chapman, who has spent the past 14 years in the Kimberley, adds: “We know we [mental health services] can’t stop it on our own. We have a certain role. We save one or two, but we are standing at the bottom of cliff.

“Trying to identify individuals at high risk and trying to react is like trying to capture lightning in a jar. But everyone thinks that is what we should be doing…It’s never going to work.”

*For support and information about suicide prevention, please call Lifeline on 13 11 14 or the Kids Helpline on 1800 55 1800.

*This article was originally published in Australian Doctor