Authors: Alan Rosen, Tom Brideson
Event: 2016 TheMHS Conference
Subject: symposium,, advocacy, communities, culture & society, social justice, social inclusion
Type of resource: Conference Presentations and Papers
Abstract: Historically, First Nations, Aboriginal or Indigenous 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. Starting by making the case for all Australian mental health professions, institutions and services to apologise to all Aboriginal and Torres Strait Islander peoples, it became clear that such an apology was relevant to all Indigenous peoples. This proposal is presented for your consideration on behalf of the WPA Sections of Public Policy in Psychiatry and Conflict Resolution. If adopted by the WPA, representing the profession of psychiatry, it could begin the process of all mental health professions developing their own apologies to all Indigenous peoples.
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.
We could apologise for:
a) 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. These contributed to removal of children and 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 & Bhui, 1999, Hoberman 2013).
b) 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 & Raphael, 1995; Rosen, 1996).
c) 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.
d) not seeing the value earlier of traditional healing 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 2003, Rosen 2006).
In recent years internationally, we have witnessed a season of governmental and organisational public apologies (Tavuchis 1993, Lazare 2004), but no specific apologies from mental health professionals to indigenous peoples.
International experience demonstrates that such an apology is only worth doing under these conditions:
a) it must be perceived as sincerely meant,
b) it is most unlikely to be accepted while the conditions being apologised for substantially continue to persist, without systematic moves towards resolution,
c) it requires extensive prior consultation with and assistance in framing by the intended group or culture of likely recipients, if it is to be deemed culturally appropriate, and if it is to have any prospect of being acknowledged and accepted (eg Weisz 2013),
d) the parties need not be those originally concerned, or even the individuals directly perpetrating or harmed (except as a social or political body) (Griswold 2007), and,
e) forgiveness is not necessarily expected: it is a freely given gift if the recipients are moved to give it. So apology may be independent of forgiveness: both involve vulnerability, and are voluntary (Griswold 2007). Prescribing forgiveness is futile and impossible (Benziman, 2009, Gale & Dudley, 2012).
It is likely that such an apology may contribute to:
a) the breaking of the cycle of fear and distrust which leads indigenous or First Nations peoples 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;
b) a renewal of trust and a restored faith that if culturally informed, the mental health workforce might be part of the solution, rather than a part of the problem, and…
c) 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, and Indigenous community controlled service delivery systems (eg. Wharerātā Declaration, 2013, Sones et al, 2010, Gayaa Dhuwi Declaration, 2015).