Aboriginal and Torres Strait Islander communities

Aboriginal and Torres Strait Islander family abuse and violence in context

This chapter discusses Aboriginal and Torres Strait Islander FAV. In this chapter we refer to the commonly used Australian Human Rights Equality Commission definition of family violence because it is inclusive of cultural and spiritual abuse:⁸

It is important to recognise that FAV is not part of Aboriginal and Torres Strait Islander culture.^5,9 Aboriginal and Torres Strait Islander FAV is complex, and is influenced by historical factors inherent with European settlement.⁵ (Figure 16.1).

Figure 16.1. Elements contributing to higher rates of family abuse and violence in Aboriginal and Torres Strait Islander communities

Download View full size

It is accepted that high levels of FAV in Aboriginal and Torres Strait Islander communities are attributable to the many interrelated elements that are associated with colonisation, kinship disruption, disconnection from land and culture, and constant trauma.⁵

Factors such as unemployment, poverty and over-incarceration of Aboriginal and Torres Strait Islander peoples also contribute to higher rates of violence.⁹ Furthermore, trauma is complex for Australia’s Indigenous populations, particularly when they have been denied the ability to grieve and heal for a long time.¹⁰

To learn more about intergenerational trauma, watch this short video from the Healing Foundation.

One form of violence stemming from colonisation is lateral violence. The term ‘lateral violence’ describes the way people in positions of powerlessness, covertly or overtly, direct their dissatisfaction ‘inward’: towards each other, towards themselves, and towards less-powerful family members – older people, women and especially children.¹¹ Lateral violence occurs worldwide in all minority communities. It has grown in prominence in Aboriginal and Torres Strait Islander communities in recent years.

Healthcare providers such as GPs and practice nurses need to understand that the removal of children and many subsequent policies have created mistrust of governments, policy-makers and the healthcare profession.^5,9 Although all FAV victims/survivors have reasons for avoiding help-seeking, Aboriginal and Torres Strait Islander peoples have additional reasons than non-Indigenous Australians.^4,12 Barriers specific to Aboriginal and Torres Strait Islander peoples include shame, fear and culturally inappropriate service provision.

Recent evidence suggests that Indigenous peoples (globally) report poor experiences with healthcare providers when accessing care for FAV.² A lack of cultural awareness, problems with communication, mistrust and perceiving the environment to be unsafe contribute to the poor experiences and expectations reported.²

GPs, primary healthcare teams and Aboriginal health services have a role in changing this outcome.

Prevalence

FAV in Aboriginal and Torres Strait Islander communities across Australia is disproportionately high in comparison to the non-Indigenous Australian population.^13,14 Additionally, Aboriginal and Torres Strait Islander women are more likely to experience serious forms of violence such as physical assault.¹⁴ FAV is the biggest single factor contributing to the disparities in health outcomes between Aboriginal and Torres Strait Islander women and non-Indigenous women.¹³ An example of this is higher rates of hospitalisation: in some parts of Australia, 73% of mothers admitted to hospital because of FAV were identified as Aboriginal.¹⁵

Despite the higher rates of violence, the 2014–15 National Aboriginal and Torres Strait Islander Social Survey found that only one in four women who are physically injured seek help from a healthcare professional.

FAV is also responsible for 34% of the total fatal burden observed in Aboriginal and Torres Strait Islander women, a rate that is 10% higher than women who do not identify as Indigenous.¹⁶

Although the main victims/survivors of FAV are women and children, Aboriginal and Torres Strait Islander men are also at increased risk of being victims of family violence, and are nine times more likely than non-Indigenous counterparts to be hospitalised from family-violence related assault (refer to Table 16.1).¹⁷

Source: based on Steering Committee for the Review of Government Service Provision data, Overcoming Indigenous Disadvantage 2016

Much of the violence perpetrated against Aboriginal and Torres Strait Islander women comes from men from a broad range of backgrounds; it is not always perpetrated by Aboriginal and Torres Strait Islander men.

The relationships of the people who are perpetrating the abuse and violence in Aboriginal and Torres Strait Islander families can be complex. As shown in Figure 16.2, people who use or experience FAV can be family members of all sorts, other community members, or even a date.

Figure 16.2. Perpetrators and victims/survivors of Aboriginal and Torres Strait Islander family abuse and violence

Download View full size

Concepts of health

When working with Aboriginal and Torres Strait Islander people, the issues of family abuse and violence are important because their view of health is holistic; it is inclusive of the body and the mind, as well as cultural, spiritual, country (land), environmental and community connection and wellness (Figure 16.3).¹⁸ All these factors, in turn, can impact a person’s health outcomes and, more immediately, impinge on their presentations in primary care settings.

Figure 16.3. Determinants of social and emotional wellbeing¹⁸

Download View full size

Awaiting permission from: Gee G, Dudgeon P, Schultz C, et al. Aboriginal and Torres Strait Islander social and emotional wellbeing. Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice. Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice 2014;2:55–68. 

The next section looks at some of the important elements to consider in GPs’ approach to caring for someone who is experiencing FAV.

The CATCH model

The CATCH (commitment, advocacy, trust, collaboration, health system) model (Figure 16.4) provides a framework for approaching FAV in practice.

Figure 16.4. The CATCH model

Download View full size

In practice, it is important to consider how you can apply the CATCH principles while also meeting the expectations that Aboriginal and Torres Strait Islander peoples have of their healthcare professionals when seeking support for FAV. Three Indigenous-identified expectations include that practitioners:

1. demonstrate cultural awareness
2. work to establish a trusting relationship
3. provide strength though safety.¹⁹

The CATCH principles fit into these expectations as follows:²

• Having a commitment aligns with expectations that practitioners demonstrate cultural awareness, which is gained from a commitment to training and understanding the historical context of Aboriginal and Torres Strait Islander FAV.
• Adopting an advocacy approach is clearly linked with Aboriginal and Torres Strait Islander people’s expectations that practitioners will keep them safe from inappropriate care and institutional control, which can be done by advocating among colleagues and more broadly in society.
• Trust is something that Aboriginal and Torres Strait Islander peoples would like to experience in the relationship and comes from developing a rapport, slowly demonstrating an investment in the relationship, and the ability to have a yarn with the practitioner.
• Collaborating with a team is closely associated with safety because collaborating with team members will offer practitioners a chance to share their new knowledge with others, advocate for better care outcomes, and contribute to policy and practice guidelines that will impact Aboriginal and Torres Strait Islander peoples.
• Health system support recognises that organisations need to support practitioners in the work they do with Aboriginal and Torres Strait Islander peoples by creating learning opportunities, encouraging professional development in the cultural space, and involving Aboriginal and Torres Strait Islander input into workplace policies and procedures.

Refer also to Figure 16.5.

Figure 16.5. Applying the CATCH model to Aboriginal and Torres Strait Islander people’s expectations of care

Download View full size

Responding to Aboriginal and Torres Strait Islander family violence as a practice

As a practice, it is important to ensure that all team members are sensitive to the issue of FAV. Everyone working in the practice team needs to feel confident in their knowledge about how they can support patients and each other if FAV is identified. Following are some whole-of-practice initiatives that may improve awareness and confidence within the practice team.

• Bring the entire team together to discuss FAV to demonstrate its importance to everyone.
• Organise training so that all team members feel equipped to respond to FAV and expand their cultural awareness.
• Identify roles and clearly outline what every staff member is safe to do and the response that falls within their scope of practice.
• Identify strategies the team can implement to support each other and nominate ‘champions’ who will be responsible for maintaining a focus on the area.
• Display posters and provide resources that promote keeping families together and support for FAV so patients know they can discuss these issues.
• Demonstrate that the practice embraces culture by celebrating Aboriginal and Torres Strait Islander peoples. This can be done through clearly displaying Aboriginal and Torres Strait Islander flags, investing in local Aboriginal art for the waiting rooms, and promoting partnerships with Aboriginal organisations.
• Let patients know if the team has Aboriginal or Torres Strait Islander staff members so there is an option to speak to someone who has cultural knowledge.

Working with individual patients and their families

Healthcare workers and non-clinical team members can benefit from incorporating the following elements into their practice when responding to Aboriginal and Torres Strait Islander patients experiencing FAV.

• Demonstrate cultural awareness through an understanding of the history of the Aboriginal Country you practise on and familiarise yourself with their values, beliefs and traditions.
• Establish a rapport with individuals and their families. Work on gaining trust through having a ‘yarn’ and getting to know the individual. It is acceptable to let Aboriginal and Torres Strait Islander people know that you have limited knowledge about their cultures but are willing to learn.
• Establish a safe space for the individual to slowly learn to trust you. Reassure the client that their needs will be prioritised and that you intend on taking an approach that values their connection to family, culture, and country.
• Engage in dadirri – a process of deep listening – in an attempt to build the relationship and enhance feelings of trust. Aboriginal and Torres Strait Islander people often prefer to be heard than to see that a healthcare practitioner is taking notes.
• Ask about fears or barriers to help-seeking that may deter the individual from pursuing support.
• As with any other client, allow the individual to determine their own needs to demonstrate person-centred care. Encourage self-determination by encouraging the individual to contemplate their priorities for the future.
• Following the establishment of trust, when working with women during antenatal period, it is important to ask all patients about FAV because of the elevated risk during this time.
• Link and liaise with Aboriginal health workers, Aboriginal health organisations and specialist FAV services where the client permits you to do so (refer to Box 16.1).
• Encourage healing by working with the individual to identify their strengths, their preferences for healing, and to determine who could help them in their healing journey.
• Advocate for resources for Aboriginal and Torres Strait Islander patients and investments in developing the Aboriginal health workforce.

Working with communities

Healthcare workers and non-clinical team members can also assist individuals, families and communities experiencing FAV by engaging in the following activities.

• Encourage community control and determination by supporting Aboriginal community-controlled health organisations and communities.
• Provide culturally safe, respectful services to the community but also recognise when Aboriginal organisations may be better positioned to provide the care/share the care with your practice.
• Enable the embedding of healing and protective factors into practice by acknowledging the role that culture, spirituality and connection has in recovery and healing.
• Work on Aboriginal and Torres Strait Islander community engagement, and learn more about the country your practice occupies. Develop partnerships with Aboriginal and Torres Strait Islander service providers, organisations and communities.

To learn more about how you can make healthcare accessible, acceptable and respectful for Aboriginal and Torres Strait Islander peoples, you may wish to view the short video from SA Health on a cultural respect framework.

Services for men

Aboriginal and Torres Strait Islander people recognise that it is the entire family who is impacted by FAV. Aboriginal and Torres Strait Islander men experience FAV at much higher rates than non-Indigenous Australian men. In addition, some Aboriginal and Torres Strait Islander men have witnessed or used violence behaviours in their lifetime. Regardless of the type of exposure men have had to FAV, there is a need for FAV responses to include men. To ensure that you are meeting the needs of Aboriginal and Torres Strait Islander men, consider the following inclusive practices:

• Provide a whole-of-family response that considers the needs of each family member, regardless of their role in FAV. This will involve planning so that one practitioner is not responsible for looking after all members of the family. There should be a plan whereby all staff are able to support each other to support the family.
• Encourage men to seek out Aboriginal men’s groups, including men’s sheds and (if required) Indigenous-specific behavioural change programs.
• Encourage men to identify their strengths and the strength they receive from culture and identity.
• Acknowledge that perpetrators of abusive behaviours need to heal also; it is not just those who experience or witness violence who require a journey towards healing.
• Consider some of the factors that may have contributed to the use of violence when responding to perpetrators. Be accepting and supportive of the person but clear that the abusive behaviour is not acceptable. Helping them deal with those factors instead of using abusive behaviours is an important aspect of care.
• Consider referral or encourage self-referral to Dardi Munwurro, which delivers a range of family violence, healing and behaviour change programs and services to Aboriginal families and communities. This organisation now has a 24-hour Aboriginal men’s crisis line 1800 435 799.
• Provide ongoing assessment of the entire family with a focus on healing, strengthening family capacity, keeping family together and encouraging engagement of all family members in promoting family cohesion.

Contemplate the following situations and reflect on whether FAV could be an underlying contributor for presentation. Refer to Figure 16.4. Remember that all members of the practice team can work towards creating an environment that facilitates an appropriate response to the scenarios.

Lisa, an Aboriginal woman aged 27 years, attends your practice. She is experienced sleeping difficulties and has recently been diagnosed with depression.

Trevor, an Aboriginal man aged 61 years, presents with poor liver function related to longstanding drug and alcohol issues.

Angus, a Torres Strait Islander boy aged 12 years, is brought to your clinic because of poor behaviour at school.

• What prompts you to explore the possibility that FAV is occurring in each of these situations?
• How would you respond?
• What actions could you take to initiate discussions?

Lisa is experiencing FAV. She has been with her non-Indigenous partner since they were teenagers, and the first five years of their relationship were wonderful. In the last few – particularly since the birth of their first child – Lisa’s partner has been verbally abusive, intolerant of her lack of sex drive, and is reluctant for Lisa to spend time with her family.

Trevor is not currently experiencing FAV or using abusive behaviours, but admits to experiencing it over many years as a child who was removed from his parents. Spending two years on a mission and then three years with a non-Indigenous family, he had a troubled upbringing and never saw his father again after being removed.

Angus has been having a hard time at school since one of his teachers stated in front of the class that he must only be ‘part Aboriginal’ because he is not dark skinned. Since that day, Angus has also been getting angry at home, especially towards his sisters, who seem to be comfortable with their own identity and connection to culture.

Contemplate the following. How will it inform your practice at the individual and family level?

• The story about Lisa helps us to see how FAV can start in pregnancy and can present in many ways. It reminds us that depression is a frequent presentation of FAV. Lisa may not share this information unless she is asked at a time when she feels safe and comfortable to talk. She may not recognise verbal abuse, sexual coercion and isolation from family as forms of FAV – she may say there is no violence. However, there is abuse and this is likely to be contributing to her depression.
• Trevor’s story is about being an adult survivor of child abuse. He is likely to have had adverse childhood experiences that will have impinged on his health and wellbeing and his relationships as an adult. Reconnection to family and culture may help with his healing. He may or may not wish to talk about what happened as a child.
• Angus’s story is about racism and the abuse of power and its effects. Angus is having difficulty knowing how to manage this situation and how he feels, which is completely understandable. He is angry and dealing with this by becoming involved in lateral violence. It may help Angus to have the racism identified by the healthcare provider, who can also encourage his sense of self and cultural connections.

Summary

Colonisation and ongoing racism contribute to the higher incidence of FAV seen in Aboriginal and Torres Strait Islander communities. All practitioners are encouraged to increase their understanding about the influence colonisation continues to have on generating mistrust in healthcare practitioners and organisations. Doing so creates an opportunity to provide culturally appropriate and safe care.

In attempting to provide appropriate and culturally safe care, the practitioner needs to demonstrate a willingness to invest in the relationship, have a yarn and display deep listening. Aboriginal and Torres Strait Islanders prioritise keeping the family together and they also recognise that FAV has an impact on the whole family. Therefore, it is essential that a whole-of-family response is included in care provision, and that all family members are encouraged to begin a healing journey from their experiences with FAV. To facilitate this journey, the practice team can work in partnership with Aboriginal and Torres Strait Islander health workers and practitioners to improve the likelihood that cultural connection is used as a strength for healing.

• WELLMOB: healing our way – brings together online resources made by and for Aboriginal peoples with a focus on social and emotional wellbeing.
• NATSILS – the national peak body for Aboriginal and Torres Strait Islander legal services.
• The little red yellow black book: An introduction to Indigenous Australia, Bruce Pascoe, Aboriginal Studies Press, 2012.
• Dark emu, Bruce Pascoe, Magabala Books, 2014. 

Aboriginal and Torres Strait Islander resources by state/territory

New South Wales

• The Redfern foundation – offers women and men’s programs to develop strong communities.
• Wirringa Baiya – a statewide community legal centre for Aboriginal peoples.

Northern Territory

• Tangentyere Family Violence Prevention Program – offers support, referrals, resources group and individual sessions for men, women and young people impacted by family violence.
• See NPY Women’s Council (South Australia)

Queensland

• Queensland Indigenous Family Violence Legal Service – provides culturally appropriate legal support for 50 Aboriginal communities.
• DV Connect – provides services for women and men and relevant printed resources.

South Australia

• Ninko Kurtangga Patpangga – a women’s safety service for the southern regional areas.
• Kornar Winmil Yunti Aboriginal Corporation – a culturally appropriate service supporting Aboriginal families in South Australia, providing programs for families, women and men.
• NPY Women’s Council – provides domestic and family violence services as well as social and emotional wellbeing support to all on the Ngaanyatjarra Pitjantjatjara Yankunytjatjara region of central Australia (includes Western Australia and Northern Territory).

Tasmania

• Tasmanian Aboriginal Centre – offers health, family, community and cultural services.

Victoria

• Djirra – provides support and legal advice for Aboriginal women and children experiencing family violence.
• Dardi Munwurro – delivers a range of family violence, healing and behaviour change programs mainly focused towards men, youth and family connections.Victorian Aboriginal Health Service – provides a range of family services and social and emotional wellbeing services
• Burndawan – a resource created with the Aboriginal and Torres Strait Islander people living on Wadawurrung Country. ‘Burndawan’ means safe and the website looks to help families involved in family abuse and violence.

Western Australia

• Aboriginal Family Law services – offers legal services as well as community education, prevention and early intervention programs.
• Relationships Australia WA – Aboriginal Community Support – offers a variety of programs to Aboriginal and Torres Strait Islander families and communities.