Aboriginal Social and Emotional Well-being Plan

An integrated approach to Aboriginal mental health

The Aboriginal Social and Emotional Wellbeing Plan is an initiative of Phase 3 of the Victorian Aboriginal Justice Agreement (External link)

For many Aboriginal people, prison provides an opportunity for the department to identify, stabilise and improve mental health through the provision of assessment and treatment services that may not otherwise have been sought in the community.

The plan acknowledges that Aboriginal mental health encompasses all aspects of an individual’s life, including the social, physical, emotional, cultural and spiritual wellbeing of the individual and their community. It recognises the risks that discrimination, unresolved grief and trauma have on mental health and the influence that spirituality, connection to country and strong cultural identity has on building resilience and protecting against poor mental health.

Closing the gap on mental health outcomes between Aboriginal and non-Aboriginal prisoners requires coordinated and holistic service responses linked to aftercare in the community.

The plan identifies five priority areas that the department – in partnership with the Aboriginal community – will focus on to improve the mental health and wellbeing of Aboriginal people while incarcerated and upon their release:

• prevention and health promotion
• culturally capable workforce
• culturally safe and responsive services
• continuity of care
• working from and building an evidence base.

The plan recognises the fundamental role of culture, community and spirituality in Aboriginal wellbeing and aims to support such connections.

It sets out a number of objectives which aim to prevent, stabilise and effectively manage mental illness while in prison, as well as improve transition processes to ensure improvements are maintained upon release.

To meet these objectives, the plan outlines an integrated suite of targeted and measurable service responses designed to have a positive and long lasting impact on the wellbeing of Aboriginal people, including:

• investing in programs that strengthen cultural identity, address trauma, build resilience and promote positive social and emotional wellbeing
• increasing cultural awareness and building the capacity of the prison system to respond to the health and wellbeing needs of Aboriginal prisoners
• embedding Aboriginal cultural values in policies, programs and services for Aboriginal prisoners
• strengthening partnerships with Aboriginal community organisations to support and create linkages for effective transition, and
• improving the monitoring, reporting and evaluation of mental health and wellbeing services to inform future service delivery.

Guiding principles

The priorities and objectives of this plan are underpinned by seven key principles.

Background to the plan

Origins

The third phase of the Victorian Aboriginal Justice Agreement directs that recommendations from the Koori Prisoner Mental Health and Cognitive Function Study – an initiative of the second phase of the Aboriginal Justice Agreement – inform a strategy to improve the mental health and social and emotional wellbeing of Aboriginal prisoners.

Aboriginal over-representation and the prison system

Despite significant efforts to close the gap, Aboriginal prisoners continue to be significantly over-represented in the Victorian prison system. Aboriginal people make up 7.8 per cent of the Victorian prison population, despite accounting for only 0.9 per cent of the Victorian population. They are more likely to be on remand and be serving a shorter prison sentence, with many Aboriginal men and women discharged having spent less than one year in prison. Aboriginal prisoners are also more likely to have had a prior period of imprisonment, with males nearly twice as likely to return to prison within the first two years after release.

Health of Aboriginal prisoners

The Koori Prisoner Mental Health and Cognitive Function Study reported in 2013 that Aboriginal prisoners experience higher rates of diagnosed mental illness, substance use and dependence disorders, as well as life stressors than non-Aboriginal prisoners.

Nearly three-quarters of the male participants and almost all of the female participants sampled had received a lifetime diagnosis of mental illness.

For men and women, the most prevalent illnesses were major depressive episodes and post-traumatic stress disorders. These were particularly significant for the Aboriginal women who participated in the study. The majority of participants with a substance misuse disorder were found to have a co-occurring mental illness.

Poor health can have significant post-release implications. Release from prison is a particularly high-risk time for Aboriginal prisoners. In the weeks following release, Aboriginal prisoners are at increased risk of suicide, self-harm, drug-related hospitalisation and death. Patterns of substance misuse and poor physical and mental health may also be associated with higher rates of recidivism and criminal activity.

Service delivery in the Victorian prison system

There is a mix of publicly and privately managed prisons in Victoria. Justice Health, a business unit of the department, is responsible for prisoner health care and alcohol and other drug treatment services. Justice Health sets the policy and standards for health care in prison and contract manages the delivery of primary, secondary and tertiary health services, alcohol and other drugs programs, and specialist mental health services in public prisons.

Health services at Victoria’s two private prisons (Fulham Correctional Centre and Port Phillip Prison) are delivered as part of the prison operator contracts managed by Corrections Victoria. Justice Health’s standards and clinical audit program also apply to private prison health services.

Corrections Victoria delivers a range of offending behaviour programs alongside a suite of Aboriginal cultural programs. Cultural programs focus on strengthening cultural identity, building connection to culture and strengthening kinship. Programs are based on identified need across the system in close consultation with Aboriginal wellbeing and liaison staff located within prisons.

Developing the plan

A working group made up of government and community organisational representatives were responsible for developing the plan. The Corrections and Justice Health Koori Reference Group – a sub-group of the Aboriginal Justice Forum – oversighted its development (see Appendix on page 22 of the attached document above).

Plan policy context

The plan aligns with broader national and state strategies and frameworks designed to improve the lives of Aboriginal Victorians.

Priority area 1: prevention and health promotion

Cultural programs are integral to supporting Aboriginal prisoners through their period of incarceration and provide an important mechanism to reconnect with their culture and identity. Actions associated with Priority Area 1 aim to increase opportunities for Aboriginal prisoners to strengthen their spirituality and access programs that recognise the role which healing and cultural identity have in developing strong and resilient individuals.

While the strength of the Aboriginal community is recognised, unresolved trauma associated with past practices and policies can have a significant impact on the social and emotional wellbeing of Aboriginal people. Addressing the underlying trauma associated with dysfunctional behaviour is important not only for the wellbeing of the individual and the community as a whole, but also to ensure that such behaviour does not contribute to traumatising subsequent generations.

Importantly, the Koori Prisoner Mental Health and Cognitive Function Study found that resilience is a critical and dynamic influence on the social and emotional wellbeing of Aboriginal prisoners. Strong connection to land, culture and spirituality are known to build resilience and moderate the impact of stressful circumstances on social and emotional wellbeing.

Improving access to healing programs aims to reduce the impact of trauma by restoring, reaffirming and renewing a sense of pride in cultural identity and connection to country. Healing programs encompass a range of practices (traditional and western) and have at their core a focus on culture and spirituality.

Aboriginal spirituality is part of cultural identity and derives from a sense of belonging to the land, to the sea, to the community and one’s culture. Contemporary practice of spirituality and strengthening of culture is commonly undertaken through ceremonies, art, song, story-telling, smoking ceremonies and Welcome to Country.

Increasing opportunities to practice spirituality aims to reinforce and strengthen cultural identity and assist in building strong, resilient individuals.

Priority area 1 will also improve awareness of symptoms of developing mental illness and increase opportunities for early intervention through the provision of culturally relevant health literacy.

Actions to support priority area 1

Commit to the continuation of the statewide Indigenous Arts in Prisons and Community Program across Victoria’s prisons

Lead agency: Corrections Victoria

The statewide Indigenous Arts in Prisons and Community Program (External link) run by The Torch has been shown to improve connection to culture through art. The program will be funded by the Victorian Government to ensure Aboriginal prisoners continue to have access to activities that strengthen culture.

Commit to the ongoing enhancement of cultural programs for Aboriginal prisoners through regular scoping and expressions of interest to the Aboriginal community for new cultural programs

Lead agency: Corrections Victoria

Corrections Victoria recognises that not all cultural programs are the same in their focus and can target a range of cultural needs. Corrections Victoria is committed to the ongoing delivery and enhancement of its suite of cultural programs to ensure their continued responsiveness to the needs of Aboriginal prisoners. Cultural programs with a focus on trans-generational trauma, cultural resilience and kinship connections will be prioritised.

Additionally, through the implementation of the Cultural Wrap Around Model, Corrections Victoria will aim to reduce the risk of Aboriginal reoffending by strengthening the interface between cultural programs and mainstream offending behaviour programs to maximise participation and engagement of Aboriginal prisoners in non-criminogenic and criminogenic programs.

Commit to the introduction of cultural programs that focus on addressing trauma, resilience and kinship connections

Lead agency: Corrections Victoria

Corrections Victoria acknowledges the impact of trauma on the capacity for positive change among Aboriginal prisoners. Positive kinship connections are also critical in sustaining long-term desistance from crime. Programs which build recovery and resilience in each of these domains are expected to be an important contributor to reducing risk of reoffending and reoffending rates. Corrections Victoria will work to embed such programs within its core suite of services and supports to ensure services respond to Aboriginal specific needs.

Consider operational practices with a view to increasing current opportunities for Aboriginal prisoners to connect to Country and practise their spirituality

Lead agency: Corrections Victoria

A number of Victorian prisons provide culturally appropriate places for Aboriginal prisoners to practise their spirituality. Access to these sites may be limited by operational practices. Corrections Victoria will explore options to increase access to these places.

Support future opportunities for Aboriginal prisoners to connect to Country and practise their spirituality

Lead agency: Corrections Victoria

Corrections Victoria will continue to explore options for the expansion of culturally appropriate areas for prisoners to practice their spirituality and consider areas of cultural significance in the design of all new prison infrastructure, including the Hopkins Correctional Centre expansion and the Ravenhall Prison Project.

Actively promote, engage in and support annual NAIDOC week and other events that celebrate Aboriginal culture

Lead agency: Corrections Victoria, Justice Health

Corrections Victoria staff and prison health staff will identify and actively promote opportunities for Aboriginal prisoners to participate in events that recognise and celebrate Aboriginal culture.

Review existing health promotion information and factsheets to ensure cultural relevance

Justice Health will review existing mental health information available to Aboriginal prisoners to assess their cultural relevance. Where required, Justice Health will work with the Department of Health & Human Services and community health organisations to identify culturally appropriate mental health information. This information will include how to recognise deteriorating mental health and how to access support services.

Priority area 2: culturally capable workforce

Priority area 2 aims to build the cultural capacity of the prison workforce to increase rapport and build trust between prison staff and prisoners to support engagement and participation in services.

Actions linked to Priority Area 2 are the first steps in building the capacity of the prison system to deliver culturally safe, respectful and responsive services.

Increasing the understanding of Aboriginal concepts of health, as well as the central role culture plays in health, is crucial to influencing change in the attitudes, behaviour and practices of non-Aboriginal health staff.

Aboriginal prisoners are more likely to access health services and actively participate in treatment if they are confident their cultural identity and needs are respected. It is critical that Aboriginal prisoners believe that health staff will respond to their health needs in a culturally respectful way. It is also important that health staff feel confident in their ability to respond to the health needs of Aboriginal people.

Building the cultural knowledge of non-Aboriginal health staff will be achieved through education and training, as well as the recruitment of a clinical Aboriginal consultant to provide secondary clinical consultation on issues relating to Aboriginal health and wellbeing and support culturally sensitive practice.

Priority area 2 also recognises the clinical skills, understanding and cultural sensitivity that Aboriginal health staff can provide in prison health care. Increasing Aboriginal participation in the prison health workforce will be achieved through scholarships and increasing student placements.

Actions to support priority area 2

Include cultural awareness training as part of induction and professional development activities for all Corrections Officers and health staff

Lead agency: Corrections Victoria, Justice Health

Justice Health and Corrections Victoria will work to ensure that cultural awareness training is available to all prison staff and that staff are encouraged to actively participate in ongoing training as part of professional development activities.

Provide health staff with regular access to cultural safety training that increases understanding of Aboriginal social and emotional wellbeing concepts of health

Lead agency: Justice Health

Justice Health will facilitate training for health staff aimed at increasing understanding of Aboriginal concepts of health and how this understanding can be applied to deliver culturally safe health services. Training will be sourced locally from Victoria and include a focus on the role of Aboriginal Community Controlled Health Organisations to increase awareness of, and strengthen links to, community health services.

Recruit a clinical Aboriginal consultant to provide a secondary consultation service and advice to health staff working with Aboriginal prisoners

Lead agency: Justice Health

Justice Health will trial the employment of a full-time clinical Aboriginal consultant to work across the prison system. The consultant will provide a secondary consultation service and high-level advice on Aboriginal health to prison health staff with a view to building their understanding, confidence and capability to deliver a culturally safe health service. Justice Health will work with its health service providers and community health stakeholders to develop the scope for the position and ensure appropriate supervision and support is in place for the successful candidate.

It is anticipated the position will be trialled in the Melbourne metropolitan region, based at the Metropolitan Remand Centre.

The feasibility of the consultant providing telephone consultations to regional prison health centres will also be explored.

Fund tertiary scholarships for Aboriginal students in a health or mental health related field and structure placements in prison health services

Lead agency: Justice Health, Koori Employment

Justice Health will work with its health service providers and the department's Koori Employment Team to develop guidelines to grant Aboriginal Tertiary Scholarships in a health related field such as nursing or psychology. Guidelines will stipulate that work placements are to be undertaken with prison health services where possible.

Justice Health will work with the Koori Employment Team, universities and health service providers to advertise and manage the positions, as well as to ensure the successful candidates have access to Aboriginal networks, peer mentors and appropriate supervision.

Increase opportunities for Aboriginal students enrolled in a health related field to take up work placements in prison health

Lead agency: Justice Health, Koori Employment

Justice Health will work with its health service providers, the Koori Employment Team, Aboriginal community organisations and universities to encourage and facilitate work placements in the prison health system for Aboriginal students studying in a health related field.

Priority area 3: culturally safe and responsive services 

Creating a culturally safe, respectful and responsive prison system requires upholding and securing the rights of Aboriginal people through systematically embedding cultural values in policy, processes and the way services are delivered as well as how staff interact with Aboriginal people.

Actions in support of priority area 3 aim to provide access to inclusive services that do not compromise the diverse backgrounds and cultural values of Aboriginal people.

Priority area 3 recognises that cultural values and identity play a central role in the accurate assessment and therapeutic response to mental illness. Actions aim to ensure services recognise the diversity and subjective experience of individuals and that treatment pathways to achieve optimal health outcomes will not be the same for all prisoners.

Service responses will consider the complex needs of Aboriginal women, recognising that many will have experienced family violence and sexual abuse. Around 80 per cent of Aboriginal women in prison are mothers and most will be the primary caregiver for their children. Actions associated with Priority Area 3 recognise the significant influence that abuse and separation from children can have on the high rates of depression and post traumatic stress disorder experienced by Aboriginal women.

Recognising the role that Aboriginal culture and experience has in mental health, guidelines for the culturally appropriate assessment and delivery of mental health treatment for Aboriginal prisoners will be developed in partnership with Aboriginal community health organisations. The guidelines will recognise the impact that multiple mental health assessments can have on individuals through reliving trauma and encourage clinicians to seek out and review other resources or information when reviewing mental health history. The guidelines will be complemented by training for mental health staff in the clinical assessment of Aboriginal prisoners.

The interface between cultural and offending behaviour programs will be strengthened through the implementation of the Cultural Wrap Around Model, which will extend the reach of cultural supports, providing a critical opportunity to link cultural strengthening with clinical rehabilitation programs.

Actions to support priority area 3

In partnership with Aboriginal health specialists, develop and implement guidelines for culturally appropriate mental health assessment and treatment processes

Lead agency: Justice Health

Justice Health will engage an Aboriginal health consultant to develop a set of practical guidelines for prison health staff to refer to when assessing the mental health needs of Aboriginal prisoners and making decisions about treatment interventions.

Identify and deliver training for mental health clinicians in the mental health assessment of Aboriginal prisoners

Lead agency: Justice Health

Justice Health will identify suitable training to assist clinicians to accurately assess and diagnose Aboriginal prisoners by improving their understanding of the role of culture and spirituality in mental health. The training will aim to improve the early detection of developing mental illness.

The training will support clinicians to implement the cultural guidelines for assessing mental health through increasing their knowledge of how cultural differences can affect client engagement and symptom presentation in Aboriginal prisoners.

Implement the Cultural Wrap Around Model to ensure a culturally supported approach to the delivery of mainstream programs

Lead agency: Corrections Victoria

The cultural wrap around model will provide a critical link between cultural strengthening and criminogenic rehabilitation programs for Aboriginal prisoners. Prisoners engaged in the cultural wrap around model will complete cultural programs as a prerequisite to participation in offending behaviour programs. Where they are found suitable for an offending behaviour program, cultural support sessions will be offered by the facilitator prior to, during and on completion of the program to provide a cultural overlay.

This model will allow culturally sensitive, responsive and inclusive delivery of mainstream offending behaviour programs to maximise opportunities for positive behaviour change in a culturally safe environment.

Program facilitators will be provided with Guidelines to support the cultural component of offending behaviour programs.

Explore options to improve the identification of Aboriginal women with mental illness

Lead agency: Justice Health

Recognising the complex mental health needs of Aboriginal women, Justice Health will work with prison health services to review criteria for Aboriginal women entering the prison system to undergo a comprehensive mental health assessment. In particular, criteria would aim to identify Aboriginal women experiencing high levels of distress, post traumatic stress disorder symptoms and women with a previous history of mental illness. Such an assessment would be undertaken upon reception into prison, or as identified throughout the period of incarceration.

Review information, fact sheets and forms to ensure material is written in a culturally appropriate language and targeted to the literacy levels of prisoners

Lead agency: Corrections Victoria, Justice Health

Corrections Victoria and Justice Health are committed to ensuring timely and comprehensive access to health services and program information. Material provided to prisoners regarding the prison experience from reception through to release will be reviewed to empower Aboriginal prisoners to actively seek out opportunities to engage with health services, as well as participate in programs that maintain and strengthen their cultural identity and support successful reintegration back into the community.

Priority area 4: continuity of care

The first four weeks following release from prison are a particularly risky time for Aboriginal prisoners, marked by high rates of mortality and hospitalisation.

Priority area 4 aims to support the transition of Aboriginal prisoners by improving the coordination of services in the prison system and strengthening partnerships with community organisations to ensure health and wellbeing are maintained upon release.

In addition to strengthening the capacity of transition programs to help Aboriginal prisoners prepare for release, a pre and post release transition health service will be trialled with a view to supporting access to health care in the community.

Engaging community health services pre release will assist in building a mutual understanding of the needs of Aboriginal prisoners preparing for release, while facilitating and encouraging prisoners to access health care in the community.

Many Aboriginal community health organisations will provide family counselling, specialist alcohol and other drug (AOD) workers, healing services and men’s groups which can help support prisoners on release. Some of these organisations will also have relationships with external services, such as the Sheriff’s Office, that may also help to divert ex-prisoners from common pathways back to prison.

While many Aboriginal prisoners will have a preference to access an Aboriginal community organisation, it is recognised that not all will want to do so. Where this is the case, it is important that options are available to link prisoners leaving custody to appropriate mainstream services.

Actions to support priority area 4

Develop partnerships with Aboriginal community agencies and services to facilitate connections between Aboriginal prisoners and support services post release

Lead agency: Corrections Victoria, Justice Health

There are many Aboriginal community agencies and networks across Victoria. Establishing and maintaining effective linkages with these agencies pre and post release wherever possible will help build the protective factors known to reduce the risks for Aboriginal offenders. Access to general and mental health services after release will contribute to maintaining the health interventions provided while Aboriginal people are in prison.

Pilot an in-reach transitional health service for Aboriginal prisoners to support continuity of health care

Lead agency: Justice Health

Justice Health will work in partnership with mainstream and community health organisations to pilot a transitional health service for Aboriginal prisoners.

Importantly, the pilot will include a pre release component which, along with individualised health management plans and targeted follow up on release, has been identified as a key factor in the successful management of prisoner health upon release.

Ensure the cultural responsiveness of Corrections Victoria’s pre and post release transitional support programs by engaging key Aboriginal stakeholders in the evaluation of potential service providers to ensure alignment with Aboriginal service commitments and objectives

Lead agency: Corrections Victoria

Corrections Victoria is currently in the process of implementing a new strengthened transition and reintegration service delivery model which will ensure responsivity to the specific cultural needs of Aboriginal prisoners. The revised services will reflect the priorities and objectives of this plan and ensure an appropriate service provider is engaged to manage transition programs for Aboriginal prisoners.

Priority area 5: working from and building an evidence base

Priority area 5 aims to build a high quality and reliable evidence base to inform continuous improvement of targeted service responses.

The significant number of Aboriginal people in prison on remand, serving shorter sentences and moving in and out of the prison system creates significant challenges in developing policy and service responses that have a measurable impact.

It is crucial that efforts to improve outcomes for Aboriginal prisoners are evaluated to provide data and evidence of what is working. This is important to ensure that efforts and resources are directed at what is known to have the best chance of achieving desired outcomes.

Actions to support priority area 5 will aim to improve the collection of data relating to the uptake, experience and outcomes associated with participation in health services and programs in prison.

Actions to support priority area 5

Develop an evaluation framework for the Aboriginal Social and Emotional Wellbeing Plan

Lead agency: Corrections Victoria, Justice Health

An evaluation framework will be developed to capture information about the complexity and diversity of Aboriginal prisoners and inform future policy and service responses. The framework will outline a range of qualitative and quantitative measures to assess change across the system. It will aim to capture whether the capacity of the prison system to respond to the needs of Aboriginal prisoners has been enhanced and whether these improvements are translating into better health and wellbeing outcomes.

Ensure the electronic health record has capability to collect data and report on health trends by Aboriginal status

Lead agency: Justice Health

Justice Health is in the process of rolling out an electronic health record across Victoria’s prison system. Justice Health will ensure that business requirements for the electronic health record capture Aboriginal status and allow for reporting of data against Aboriginal status.

Collect, monitor and report on Aboriginal participation in mainstream and Aboriginal cultural programs

Lead agency: Corrections Victoria

Corrections Victoria is committed to the ongoing collection, monitoring and reporting of program participation by Aboriginal prisoners in cultural and mainstream programs. Corrections Victoria has commenced this process by integrating this information into the Corrections Victoria Intervention Management System. This information will inform ongoing demand for programs and monitoring of program access, as well as contributing to the ongoing evaluation of Corrections service delivery.

Justice Health will work with Corrections Victoria to integrate the addition of alcohol and other drug programs into the system to support a single source of information sharing and evidence based service planning for alcohol and other drug services.

Identify opportunities to partner with Aboriginal community organisations and research agencies to continue to build an evidence base relating to the social and emotional wellbeing of Aboriginal prisoners through research and evaluation partnerships

Lead agency: Corrections Victoria, Justice Health

Opportunities to partner with Aboriginal research organisations will be actively sought when considering the evaluation and assessment of prison services and programs.

Implementation, monitoring and reporting

Implementation of the plan will commence in 2015 and continue until June 2018. This will allow sufficient time for the rollout of actions that can be implemented in the immediate future, as well as those that will require an extended lead time to allow for coordination and planning.

Justice Health and Corrections Victoria are responsible for driving the implementation of the plan in partnership with relevant government and community organisations.

Implementation will be monitored by reporting to the Corrections and Justice Health Koori Reference Group and to the Aboriginal Justice Forum.

The plan is due to be completed in June 2018 to coincide with the conclusion and evaluation of phase three of the Aboriginal Justice Agreement. This will allow learnings from the evaluation of the plan to inform future activity for the next iteration of the Aboriginal Justice Agreement.