As an SBS documentary featuring musician Peter Garrett puts the spotlight on the harmful history of healthcare for Aboriginal and Torres Strait Islander people, there are calls for global acknowledgement of how the mental health sector has traumatised indigenous peoples around the world.
A non-Indigenous psychiatrist, Professor Alan Rosen, from the organisation Transforming Australia’s Mental Health Service Systems (TAMHSS), writes below that a recent apology from Australian psychologists has set an important, global precedent.
This article is published as part of a series, Acknowledgement, examining the role of healthcare in colonisation.
Professor Alan Rosen, AO, writes:
The recent apology by the Australian Psychological Society to Aboriginal and Torres Strait Islander people is of profound national and international significance.
The APS is believed to be the first mental health professional representative body in the world to endorse and adopt such a specific apology to indigenous peoples for what was done to them by the profession as part of, or in the name of mental health/psychological assessment, treatment and care.
The APS Board also substantially adopted the recommendation of its Indigenous Psychologists’ Advisory Group (IPAG), whose Indigenous and non-Indigenous members crafted this apology together. This sets a fine precedent.
As some other Australian mental health professional bodies are still considering whether to make such an apology, it is to be hoped that the APS has set a new trend. The APS has provided a robust example of how to do it well, and in a way that it is more likely to be considered to be sincere and acceptable by Aboriginal and Torres Strait Islander peoples.
Historically, Aboriginal and Torres Strait Islander peoples have suffered much more incarceration, inappropriate diagnoses and treatments, and more control than care in the hands of mental health professionals, facilities and institutions.
This is also true for all First Nations peoples, globally.
In 2009 and 2011, a recommendation was presented to the Mental Health Professionals’ Association of Australia (MHPA), an organisation representing the joint interests of all mental health professional bodies in Australia, to make a specific apology to Aboriginal and Torres Strait Islander peoples who had been historically cared for and/or controlled by Australian mental health professions and institutions. It was twice considered and declined there, on the basis that they had supported a general apology to Aboriginal peoples in 2008 by Prime Minister Kevin Rudd.
The recommendation then was taken to the World Psychiatric Association (WPA), after being adapted to be a proposal for such an apology to all indigenous peoples. This proposal is soon to be aired for wider deliberation through publication as a letter in World Psychiatry with a link to a detailed proposal on the WPA website on behalf of the WPA Section of Public Policy in Psychiatry, with the support of executive members of the Section of Conflict Management and Resolution.
If adopted by the WPA, representing the profession of psychiatry, it could be part of a process of all mental health professions developing their own apologies to all indigenous peoples.
These apologies could demonstrate concern for possible historical wrongs which may have been perpetrated knowingly or unwittingly on indigenous peoples by mental health professionals, institutions and administrations, and the enduring mental health effects of colonialism.
Professor Helen Herrman, our home-grown President-elect of WPA, has proposed a special symposium or debate on this issue at the WPA Congress in Berlin in 2016. The proposal has also been taken back to all Australian mental health professional organisations individually for reconsideration.
Why such apologies are worth doing
International experience demonstrates that such an apology is only worth doing if it is:
- Perceived by indigenous peoples as sincere
- Understood that it cannot be accepted while the conditions being apologised for substantially continue to persist
- Negotiated through extensive prior consultation with and assistance in framing by the intended group or culture of likely recipients
- Deemed by the indigenous peoples concerned to be culturally appropriate, and
- Expected to have reasonable prospects of being acknowledged and accepted. Forgiveness is not necessarily expected: apology is independent of forgiveness.
Purposes and goals of such an apology
It is likely that such an apology may contribute to:
- Breaking the cycle of fear and distrust which leads Aboriginal people to often do anything to avoid mental health services, until they have extremely florid conditions, which finally cause emergency services to intercept them with high levels of subduing technologies and involuntary hospitalisations.
- The renewed belief that a culturally informed expert mental health workforce might in future be part of the solution, rather than a substantially culturally insensitive workforce which was a large part of the problem.
- The “fast tracking” of culturally congenial, social and emotional health and wellbeing services, including indigenous mental health professionals and peer workers trained in both current clinical mental health care and traditional healing practices working closely together in teams with clinicians, and Indigenous community controlled service delivery systems (eg. Wharerātā Declaration, 2013, Sones R et al, 2010, Gayaa Dhuwi Declaration, 2015).
A proposed template
As part of a proposed template statement of apology, we could 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.
I pay tribute to several expert Aboriginal and non-Aboriginal professional colleagues for assistance with the wording of the template apology, especially including Professors Helen Milroy, Pat Dudgeon, Colin Tatz and Tim Carey, Mr Tom Brideson, Ms Verina Crawford, and Dr Ernest Hunter.
We could apologise for:
- Our professions’ past involvement in any ideologies (eg eugenics) and their essentially racist applications in federal and state laws, policies and practices of successive governments (eg Bostock & Nye, 1934). Arguably, these contributed to removal of children and custodial incarceration of indigenous peoples in large numbers and for long periods in mental health facilities/psychiatric institutions, far beyond the proportion of the general population, alienating and dislocating them further from their families, communities, country and culture (Bhugra D & Bhui K, 1999, Hoberman J, 2013).
- Those past mental health practices which sometimes conveyed pessimistic or hopeless clinical outlooks to indigenous patients and their families, contributing to demoralization, dislocation from their communities, spirit-breaking and suicide (Swan P & Raphael B, 1995; Rosen A, 1994).
- Any of our mental health 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 the asserting of cultural identity, and defiance for the disturbing behaviours of difficult patients.
- Failing to see the value earlier of traditional healing and resilience factors inherent in intact or sustained Indigenous cultures. Only more recently have we begun to see and acknowledge that working with these factors can be crucial for the recovery of indigenous peoples with impairments of social and emotional wellbeing, as well as for our wider society (Rosen A, 2006).
We would take responsibility for our actions and learnings now and in the future, and resolve to work towards making changes that will contribute to improving Indigenous social and emotional health and well-being.
In the process of developing an apology and subsequently, our professions are urged to consult and work together actively with all Indigenous communities towards building culturally appropriate emotional health and well-being services for all Indigenous peoples, and in learning by their example of working in “two ways” together, to improve such services for all our communities (Durie M, 2003, Rosen A, 2006).
In recent years internationally, we have witnessed a season of governmental and organisational public apologies (Tavuchis N, 1993, Lazare A, 2004, Nobles M, 2008 ) including those to indigenous peoples.
If more mental health professionals and organisations engage meaningfully with the process of making apologies to indigenous peoples, in Australia and other places, this may lead to further work on reconciliation between our professions and those individuals and families who have felt damaged more than helped at times by contact with our professions.
• Track the series here.