Mantle of mental health care withdrawn

 TWO LETTERS TO EDITOR
 
 
 Mr Abbott abandons Central Australian communities
 
The Abbott Government has cut the funding for an essential mental health program that is delivered by the Royal Flying Doctor Service.  The program services ten remote Aboriginal communities and more than fifty outstations west of Alice Springs from Docker River and Mutitjulu in the south, to Kintore and Papunya in the north.
 
Mr Abbott has refused to roll over funding for the Northern Territory Medicare Local even though other health organisations have been able to roll over their funding.  This reduction in NT Medicare Local funding has meant that the service provider – the RFDS – is no longer able to deliver this much needed service.
 
The Medicare Local is now looking for another service provider for the mental health services but with the reduced funding it will be more difficult to find a provider.
 
The result is that from the end of this month these communities may not be serviced by trusted mental health professionals and the consequences of this could be dire, could lead to self-harm and other mental health setbacks.
 
Mr Abbott promised to maintain funding that Closes the Gap.  This is yet another example of where he is breaking that promise to Aboriginal people.
 
The cuts to this vital service are shameful and absolutely unjustifiable and are a further example of this government’s lies and broken promises.
 
I call on the Health Minister, Mr Dutton, and the Territory’s own Mr Scullion to explain why the funding for this service, through Medicare Local, was not rolled over to allow the RFDS program to continue.  It does not make any sense and is yet another broken promise.
 
Warren Snowdon
Federal Member for Lingiari
Shadow Parliamentary Secretary for Indigenous Affairs
Shadow Parliamentary Secretary for Northern Australia
 
 
Response from Dr. Craig San Roque, remote areas community psychologist, central Australia:
 
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 Arrernte, Warlpiri, Pintubi region and within Alice Spring. 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’.
 
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, was getting results, they 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.
 
Left: ‘Theresa’ from The Long Weekend in Alice Springs, the graphic novel drawn by Joshua Santospirito adapted from an essay by Craig San Roque. 
 
This work and the clinical flexibility of the RFDS team have 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 has to be held accountable for its 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 central Australian Indigenous situation. Or perhaps there 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 Government 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 should 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.
 
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.
 
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 – and not from within.
 
 
Craig San Roque, Psychologist, Alice Springs.