Serena
Good evening, everyone, and welcome to tonight's webinar Culturally Safe Gambling Harm Minimisation for Aboriginal and Torres Strait Islander Peoples. We are joined tonight by presenters Ashley Gordon, Nicola Coalter and Dr Tim Senior. My name is Serena and I will be your RACGP representative for this evening. Before we get started, I would like to make acknowledgement of country. We recognise the traditional custodians of the land and sea on which we live and work, and we pay our respects to elders past, present and emerging. I would also like to acknowledge any Aboriginal and Torres Strait Islander colleagues that have joined us online this evening. Just a few housekeeping notes. If you cannot see a panel like the image on the slide, hover your cursor over the bottom section of the share presentation screen and the panel will appear. The control panel provides you with your audio option and most importantly, your Q&A box. We have put everyone on mute to ensure learning will not be disrupted by background noise. Please chat to us and send us your questions using the question box. We will do our best to address all your questions. However, in the interest of time, this is not always possible. If you have any unanswered questions relating to our learning outcomes, please email them through to us. I will post the email address at the end of the session. I would like to formally introduce you to our presenters for this evening. Ashley is an Aboriginal Australian from the Western New South Wales community of Erina, a descendant of the Kamilaroi, Jimba and Barkindji people. He is the executive director of the New South Wales Aboriginal Safe Gambling Services where he manages the Gambling Aware Aboriginal Service which targets Aboriginal communities and Gamble Aware Organisations across New South Wales. He has been involved in the gambling health industry for 25 years. Nicola is a Registered Psychologist with more than 15 years experience working across mental health, gambling harm and community health setting in the Northern Territory. She has worked extensively with Aboriginal and Torres Strait Islander communities, focusing on culturally informed approaches to understanding the addressing gambling harm. Nicola is a co-author of the gambling chapter in the RACGPs National Guide to Preventative Health Assessment for Aboriginal and Torres Strait Islander people. Tim is a GP at the Tharawal Aboriginal Corporation in southwest Sydney. He is a medical advisory to the RACGP in Aboriginal and Torres Strait Islander Health, and is a clinical Senior lecturer in General Practice and indigenous health at the University of Western Sydney. Welcome all the presenters and I will pass it to Tim for the learning objectives.
Dr Tim Senior
Thank you very much. Good evening, everyone. I am coming to you from Tharawal country. Hope you are all keeping well. These are our learning objectives for this evening which is educational speak for what we hope to achieve tonight. By the end of this online CPD activity, we should all be able to define cultural safety and its importance in addressing gambling harm with Aboriginal and Torres Strait Islander peoples, recognise key risk and protective factors influence gambling harm in Aboriginal and Torres Strait Islander communities, explore culturally safe communication strategies to discuss gambling harm in general practice and identify culturally appropriate referral pathways and community led gambling support services, and certainly I am very much looking forward to tonight as well as facilitating because this is an important issue for my patients. Nicola, I will invite you to start off. Thank you very much.
Nicola Coalter
I would like to extend my thanks to Ashley. I am here alongside just to share a little bit of clinical insight from my work in gambling harm and to help translate it into the settings of GPs, how to ask the right question and how to respond in ways that are both clinically and with a little bit more help of actually culturally safe. Thanks for having me.
Ashley Gordon
I have been involved in the gambling health industry for 25 years, but obviously focusing on working with gambling counsellors and financial counsellors, not so much with GPs, so forgive me if I keep saying counsellors or financial counsellors because predominantly that is my biggest stakeholders that I have been focusing on. The first slide I would like to touch on is understanding Aboriginal people. First and foremost, we will not have the time to go in to the cultural awareness across Australia and looking and understanding the past and looking at previous policies from segregation to assimilation to stolen generation. We do not have the time to go into that detail, but it would be great for all Australians to understand our history. Increasing their awareness around what culture means. I really do think that in this country many people do not understand what culture is, what identity means and the values and beliefs that go with that. I think the more people can understand what identity and culture means, the more inclined we are going to be able to understand and work with other people from other backgrounds. I am a big believer in the throw away line of let us treat everybody equally is not something that I believe in. I think the more we can learn about someone's identity and culture, the more we are able then to improve our communication skills and our approach and make sure that they are feeling comfortable and particularly feel culturally safe. For me, what is cultural safety without looking at a dictionary? It is to me about ensuring that people and patients feel culturally safe within a clinic, but also staff are feeling culturally safe and where they work without discrimination in the workplace. I would like to think that when we are working with Aboriginal people that they are able to come through the door and feel culturally safe because through cultural safety, we will be able to create some meaningful change. What does culturally safe mean to other people? I think it opens the door for clients and patients to be able to play a role also in the decision-making process, so obviously that shared decision making is something I believe in this type of setting because if we can do that, we can focus on a patient centred approach, clinically led, evidence-based value driven with the use of storytelling, deep listening and clinical yarning. Clinical yarning to me has been around for a while, but of late it is just been registered as a clinical approach that people can use when working with Aboriginal people. Clinical yarning for me can be done in the community with stakeholder engagement, community consultation. Clinical yarning can happen at screening and assessing someone's health and wellbeing, and you can use clinical yarning in a therapeutic and treatment setting as well. For me, it is about providing opportunities for people to connect. I do feel that we can be too structured, too much about procedure without allowing connection, and I think the more we can get connected with our patients and clients, the more we will get honesty, the more we will get repeat visits, and the more people feel comfortable that they can recognise someone who can support them culturally. The research would suggest that Aboriginal people will walk away from a service if they do not feel connected with the practitioner. We could provide the best service in the world, but if we do not have a connection, people will just walk away, and sadly, that is happening in our Aboriginal communities where they are not seeking help, they are not seeking treatment, they are not engaging health providers, so setting up an environment where people can feel culturally safe and connected and like I said before, ensuring that structure and our procedure does not get in the way. I have got on the slide there about understanding community consultation and relationship building. What does that look like? Where do people learn about how to consult a community? How do we build relationships? Why are we building relationships? How do we understand help seeking behaviours and challenges? The more we can get out and understand and recognise the challenges in our communities and make it easier for people to access help. For me everyone can learn about cultural awareness, can build their knowledge, but to me, that is just the foundation. We also have to recognise Aboriginal people and gambling, which is basically to not tonight's topic. If what is the relationship like with Aboriginal people and to do with gambling harm and we can talk a little bit more in detail as we go through the presentation about what it looks like in Aboriginal communities. Why are not people seeking help? What are the challenges? What are the risk factors? If people feel free, they can add questions as we go. I would like a yarn. That is the way I like to present, but sadly we can only take questions on the side, but feel free to add questions into that. Nicola, do you want to add anything on that first slide?
Nicola Coalter
I would just like to add to that context or just bring it out, not so much about culture, but culture shapes how we talk about gambling, and I think absolutely in a clinical setting that can also impact because it is often not called gambling, it might not be viewed as individual harm, and there is a lot more complex, and I am sure we will dig into some more of this as we go on.
Ashley Gordon
I will add you cannot teach empathy. You cannot teach sympathy, love, care. For me, clinicians and counsellors, need to be authentic and genuine in their approach. Aboriginal people are looking at the person more than the service. The more we can show the character of the clinician, the more inclined we are going to get repeat visits, we are going to build that connection. For us, we do have our walls up and we are looking to build a connection. That is why people in some settings need to ensure that we see a little bit about you, a little bit about your values, your character, that you understand us culturally. I would encourage all GPs, clinicians do not be afraid to show them who you are and what you represent, and I think you will find you will engage more and connect more with Aboriginal clients and patients. Next slide please.
I think I put this slide up to show people, even though most people would know what I am about to say just because people do cultural awareness training, does not make them competent. It is a foundation and a base where we start. We are starting on a journey. Cultural competency is not a destination. It is not an end result. It is an ongoing journey. I have been to more than 200 Aboriginal communities around Australia and I am still not competent. For me, I go into communities to sit, listen, learn, then share. For me, cultural competency is something that we need to embrace and walk the walk in regards to the values we have. Cultural awareness is the knowledge we gain, and we can broaden that the more we grow, the more we interact, but most importantly, if you learn something, do you accept it? Do you appreciate it? Do you acknowledge that a lot of the things that happened in our history and that we can move forward together? Some people get the knowledge they sit through a course, but they do not appreciate or accept it, and that is where it ends. We want to be sure that people respect what they are learning and they want to just to grow because at the end of the day, we all want to live here together. It is one country and I hope that people can one day learn more about cultural awareness that it does not restrict them moving and growing more because through cultural blindness and unbiased cultural bias, we want to make sure that that people do not stop there because we want them to have more connections, more relationships, more engagement with communities, with mob, and understand what cultural identity and cultural safety is, and as we go up, our competency improves through our cultural experiences and practices, particularly when we work in organisations that have policies and vision and great leadership, and like I said, we continue to grow and learn. That is my cultural competency table. I have not had it up and published. I am happy to get people's questions on that one, but that is my definition of a cultural competency looks like.
Nicola Coalter
Ashley, I have seen you present on this before, especially when it comes to laying the foundations about talking about gambling because gambling is such a taboo subject that often is not spoken about. I am up here on Larrakia country, and I have lived most of my life up here and I work up here as well, and like Ashley, I have not been to anywhere near 200 communities, but the value of listening and I understand in a clinical context and setting that can sometimes be challenging in busy medical centres. My practice has just changed from being in a local suburb and GP practice and they are very busy arenas and so that can be really challenging to manage so many things at once, but talking about gambling is really appropriate in these settings.
Ashley Gordon
Sadly, we have looked at gambling as an individual problem that people are experiencing harm need to go and seek help. We are not recognising it as a community concern. Aboriginal and Torres Strait Islander people like to address and tackle issues collectively and gambling unfortunately is not being tackled collectively. It is seen as an individual issue or problem for someone, and there are services out there that can help, but sadly Aboriginal people can do better at recognising how much harm is creating so many people in our communities. Next slide please.
Nicola Coalter
Just to gather some of your thoughts quickly in an activity that everyone can participate in if they choose, if you just grab your smartphone and open your camera app and scan the QR code, you can link into just a couple of questions that we have got and we are happy to share consolidated feedback, but also as we continue on you can think about these questions and I can show them as well at the end. What does cultural safety mean to you in your role as a GP in the work that you do? I will pull up the screen, so it is really clear for everybody to see that QR code. Otherwise just go to the website link, and we can also come back to this when we give people a few moments to complete it. If I just skip across now, I can see that some participants have shared some results already. What does cultural safety mean to them, respect having space where they can talk, power sharing, safe spaces, respect. Respect comes up a bit. Just give it a moment. If anyone else wants to participate, then we will flip back to the screens and Ashley can continue on, and I can also show these at the end if people would like to see them again. Any thoughts on those ones? Ashley.
Ashley Gordon
Sensational. I am reading them. I need glasses though to read some of them.
Nicola Coalter
There is one up here that says making people feel safe and respected and valued. That is what cultural safety means to them. Being open and curious and understanding of differences in views based on community and world experiences in that non-judgemental way.
Ashley Gordon
We all know, historically, Aboriginal people have a problem with going to services and feeling like they are going to be judged, so obviously if we can provide a service where we are not going to judge that they do feel comfortable, they do feel safe and respected because they are thinking, am I going to be culturally understood? Will this person understand me? The other thing around culture safety is, like I said, allowing them to play a role in that intervention, having a say, so it is a two way process of walking through that journey. Whatever treatment, whatever intervention is, can they play a role in that shared decision making. Let us find the next slide. I will put the next one is an engagement slide. It is about understanding do organisations and services have engagement plans? Who are they targeting in the community and why are they targeting? Are we building relationships and connections? but why are we doing so? And I put this there for an important reason around health screening and referral pathways. Now the Aboriginal 715 Health Check is something that I wanted to bring up because there is a template out now that has the gambling question in there basically, have you had an issue with gambling or someone close to you? There is a question there in the 715 but not all Aboriginal Health Services are asking that question. What I am trying to do and I have been trying to do this for many years is say, how can we screen for gambling harm? Sadly, it is not being taken up seriously by our Aboriginal Health services. I know some GPs are asking the question, but again I think the more we can engage with the local stakeholders, build those relationships, not only will you get referrals to you, but you can get referrals to relevant service providers. To me, I think we can screen more for gambling harm in communities.
Nicola Coalter
When we think about that gambling support and gambling harm and even the 715 and we are going to dig a little bit more into that as we go on and talk a little bit of different ways of asking the question, often we know that gambling harm does not happen in a vacuum and we know that if we are not really aware of what is happening in our community around gambling or who and what organisations are trusted around gambling, what programs exist and whether our self a health service feels like a safe space to allow someone to have a yarn about gambling, then those conversations might never begin because often people will not mention gambling. I think as we go on, we will talk a little bit more about gambling and that, but understanding a little bit about some trusted services in your community, some trusted brand names can go a long way in this conversation and engagement piece.
Ashley Gordon
With education and awareness, I often ask many people when you are talking about gambling harm, is it a health condition or is it a financial literacy problem? When people are regularly gambling and obviously losing money. is it the point that they need help with some sort of health condition, or is it the simple fact that they do not know how to budget money? We get confused in many communities and therefore the education awareness is about one upskilling, empowering communities to make those decisions, give them information so they can make the choices that they feel is right for them and for many, and I can say this now, 19% of Aboriginal people in New South Wales and Queensland are experiencing harm from gambling today, and that research was undertaken by myself narrowly and Helen Breen back in the day, but I can say to you that people experiencing harm is way too high. For me, I ask the question, is it around education and skills building over a health concern?
I throw this one in there just to talk about people's brand and image of their organisations. What does it look like in the community? Is it a positive? Now we work with all non gov around New South Wales in particular, AND I just want to put this here. Is it a challenge? Is it a barrier for people to access your service because of the brand and image? Have a think about it, review, talk to people in the community, get their understandings because most of the time your brand and image is based around staff and around people. The staff drive the brand of an organisation and for Aboriginal people is if that brand is positive, then people are going to visit and be happy to visit to that service. I just wanted to mention briefly around how is your brand in the community? What does it look like? Do we review it and do Aboriginal people in particular look at it as a challenge, or is it a positive brand where they feel comfortable to attend that service knowing that they are going to be supported culturally?
Nicola Coalter
I want to think about it from that clinical perspective in the GP medical centre that I worked in. I was often talking to GP's about thinking about their waiting room and their consult space. Does it feel like somewhere that a person from community could sit and feel calm? Does it feel safe enough to talk about gambling without shame and worry or being overheard? We know that for people who have often experienced trauma and feel judged, that that healthcare setting can be a little difficult at times. Often I think of practical things like is there any local artwork up in the waiting room? Is there signage that reflects the community in which the medical centre is serving? Are people on the front desk greeted us warmly when people walk through the door? There is there is little structural things that we can take with those small intentional shifts that can just signal to people that it might be okay for you to come in and sit down in these spaces.
Ashley Gordon
We know for a fact that services where Aboriginal are well represented in attending, it all comes back to not only the brand and the image, but the connections they have within the community because people will speak highly of the service knowing that the staff understand it is welcoming, and they are spreading the word of what the service does and the quality of the service. You can forget about the dollars for marketing if the Aboriginal people in that community are having a positive experience, they will share it around the community.
This one is about location accessibility again, is it the ease of access, do we have outreach and online services? Are our premises culturally inviting? For me, it is just reviewing these. We want all cultures to actually feel welcome. Reviewing your location accessibility is really important because many Aboriginal people in communities using public transport. What does it look like from the road? Is it inviting? Again, recognising that accessibility needs to be easy, needs to be clear, and furthermore, one thing around accessibility I will say is this the one of the major reasons people also do not go to the services is they do not know what to expect when they go. If they do not know if it is free, if it is confidential, well, if those are questions are not answered, people will stay away. The more knowledge people have on the service and the type of services, for example, if it is a gambling counsellor, they may not know what a gambling counsellor is. For a psychologist, most Aboriginal people will not know what that means and what role they do. Trying to be clear with the type of service we have social workers like what do people really mean when they say social work? What is that role? The more we can educate the community on the people there and their roles, they are more inclined. People will access the service. Sadly, we are staying away from services when we do not have enough information.
Nicola Coalter
I can share the case study with volume if you switch the screen over.
Case Study (Bernie’s Story)
I lost my mum and dad real young. No one was around to teach me anything. I left school when I was 15 and had a baby when I was 17. I was going through domestic violence too. I used to find gambling used to help me shut that out. It used to take me to another world. Yeah, in my mind, not half the time I did not realise how much I was paying. I hit rock bottom. When you got money in your hand or in your wallet, first place you think of is pub or club. Where is the machines? Where is the keno? I tried the horses but was not good at that. Thank God for that. Highest I ever won was three and a half grand in one day, but I put all my pension in to win it, and I used to play $5 a bet. I could do $200 cold in two minutes. I used to get wild. People come up talking while you are playing it. It is like the jinx, they jinx you. I used to go up and ask strangers for money, tell them lies. I would go without food. I went without paying my rent up. I lost all respect for my kids because I used to lie to them about when where the money was going, but I give her off there, and I sold my car to go and chase my losses in the pokies, and I lost all that money and I had no car with my six kids. I used to miss out on buying food for them. I knew I was doing wrong, but I used to push it down, deep down, brush it off and then I had a nervous breakdown because of the guilt and shame I was carrying from gambling when I was put in the hospital. It just all came undone. I said I got nowhere else to go. I said, and I do not want to do myself in. I said, I have got kids that need me. I had two choices, one was to give it up and walk away from it and tell everyone, the family or I could keep playing and keep order. I rang that number and I said, "I need help with my gambling." I said, "I have got no food or nothing." She set up a private appointment for me there, and they are there for you. They are not against you and they get paid for it. It is not telling people our stories. It does not matter what colour or race. We are all same mob. I would get my car in three weeks' time. I saved up for a car, a second hand car, but it was a car. Like me and try to do yourself in or anything because it is not going to work. It is the wrong way out. You have got to face your fears. The first fear is admitting that you have got a problem with money. Life is about coming through, standing up, be strong and keep marching forward. If you can, bring a few more with you, yeah, well, that is a big plus because we all got the same destination. Come on. Quick, quick, quick, quick. I have walked this far now. Nothing will me hold me back. Keep going forward. Everyone has got a hole inside of them and you need to fill that gap with love and family. I still have not got a lot of money, but I pay my bills, I keep my food. I have got more quality time with my grandkids and my other kids. It is about time I reclaim what was taken from me, my self-esteem and dignity and my respect.
Ashley Gordon
Thanks, Nicola. Bernie's story is, we have to thank her. She has been with me for a while in regards to sharing her story, but it is so similar to many Aboriginal people that I have worked with and visited and spoken to. That story is not unique. It is very common. For me, we have got to understand that gambling and and and the the frequency of gambling is is often created because of learned behaviour. So many of our young ones are learning very early about gambling. The more remote I go, it could be all about card playing, and when it comes to commercial gambling in large cities and towns, it is obviously poker machines and sports betting and so on, but for us, our young people are learning and in Australia, we have got a huge problem because accessibility is so high. When you learn the behaviour from a young age, it is very hard to break. It is like a cycle of learning. We see so much of this because it may be also related to a learned behaviour from alcohol use or drug use or unemployment or domestic violence. We need to be sure what our young people are seeing because we do learn a lot from our elders, our uncles, our aunties and our families. The other factor we need to talk about is unemployment. We are gambling at its highest. It is where socioeconomic communities reside. People are not gambling in the rich communities. Most of the gambling revenue is coming from unemployed people. We have to face this fact in Australia that it is quite scary, the amount of money being spent by people who have low income. Unemployment is a huge concern. Throw the fact in that many people live in poor communities, even in bush, where there is boredom and there is not much to do and maybe the only place to go is a venue. We have got to look at what is going on in communities. Another problem we have to talk about is how our Aboriginal people coping with stress and anxiety caused by gambling. Of every client that I have seen, no one has ever come to me with just a gambling problem. It has always been with something else. We are always treating the causes that gambling create, but what are the symptoms? Why are people inclined to gamble? Are they gambling to deal with pressure and stress? Are they dealing because of grief and trauma? What are the reasons? I think we can look further into that. The difference between non-Aboriginal people and Aboriginal people is this chart here that I have got on the slide there now is most Aboriginal people, a lot are basically just renting, maybe low income earners, and when they are gambling, many are living paycheck to paycheck. They get income, they spend it, then they get income, spend it. They survive by supporting one another through different families and supporting and borrowing, but there is no crisis. There is no delay. There is nothing to trigger help seeking because people are used to being poor or used to just surviving from week to week. Where is the trigger to say I need to call someone, I need help? So When you see non-Aboriginal people, it might be higher income, and there are usually more investments. There are more bills, there are more things that they are paying. They can clearly see by gambling, there is a point that they reach where they have hit not necessarily rock bottom, they have hit a point where they go, I think I have a problem. I think I could recognise I need help. Recognising it in Aboriginal communities is often delayed and not seen at all because it is normalised. My mum and dad grew up like that. My nan and pop grew up like this. It is just living by paycheck to paycheck week by week. Therefore, seeking help may never eventuate. Did you have anything to add on that one, Nicola?
Nicola Coalter
Look, I think, just to reinforce that we know that gambling does not stand alone. It is more often quietly wrapped up in stories of stress and low moods and money worries, relationship strains and even the thoughts of giving up. As in Bernie's story, she talked about that boredom and weariness and thinking of giving up. As Ashley was saying, we know it. It does not get named. We know it often does not get named across many cultures, but in particular around Aboriginal people for many reasons. When we think of grounding gambling, though, it is hidden beneath this wall of shame and silence across many people. That is why we believe that talking about gambling, about tuning in to what people are saying, noticing and creating that safe space, it is setting it up for these words to potentially be spoken.
Ashley Gordon
We all know, everyone on this call knows that there is poverty in our communities. There is a high shame factor in our community, self-esteem and self-worth, domestic violence, alcohol use. For me, gambling could be playing a role in making things worse. Us as Australians, we as Aboriginal people need to recognise, could gambling be making our lives even more difficult? I just think it is a conversation we need to recognise because alcohol, drugs get us a lot of the blame, but gambling is not really recognised as a serious issue in our communities. Like I said, when you gamble, it ruins your self-esteem even more. It ruins your self-worth even more. It is not helping people who I feel need to start growing and looking to a future other than week to week.
Question there on Bernie's story. If someone wants to add some comment in about Bernie.
Nicola Coalter
I think there may have been some volume issues with Bernie. I am happy to flick over and leave the link with people for Ashley's website and where we can find out a little bit more about Bernie, but we will just flick on over from that one.
Ashley Gordon
We do not have a lot of time, so I am going to rush through a couple of slides. Just recognising that I put in here the first contact. That first experience when people come through the door, what does it look like? What is our intake like? What is our first contact like? Are we being too structured? Are we missing out on connection? Sometimes we do not have the right people for the right position to make sure that they know how to build rapport. They know how to build connections. Everyone knows they need to be people persons. They need to be people who can understand and connect with others. They understand emotional intelligence. They understand relationships. They understand the importance of communication in a two-way process. I just do not think in Australia with most things, we do not recognise the importance of our first contact, particularly when we are basing it all off structure and a procedure and we are missing the opportunity to connect because like I said before, Aboriginal people are used to walking away from the service. It is very important that we fix the first moment, the first interaction so that they can feel culturally safe and connected with our GPs.
Nicola Coalter
This was just back at Bernie's story. We have had some participants say what stood out for them in Bernie's story. Someone said the ability for Bernie to share how long it took her to talk to someone. Someone else has commented there, Ashley, that family and relative motivations and availability of help really kind of stood out for them in Bernie's story.
Ashley Gordon
I know that our work has highlighted that most people will look to self-help first. Then secondly, they will ask a family friend, cousin or someone close to them. I do not think in Australia that we have really equipped our people to be able to support them, to be able to mentor and refer them on to the appropriate services. When it comes to family and friends, they need to know how to help someone, whether it is a gambling problem or a mental health issue. How do we talk? How do we support them? How do we get them to help without being judgemental and criticising. For me, we got to make sure that before we get to treatment that we can provide information because they may not get to treatment. They might not get to help seeking because they do not get the support that is needed.
Nicola Coalter
Something that often happens in our language is, and we have got some responses here, but the mentee is up for people to share what words might harm or what words might help. When we often think of addict or gambling addict, even problem gambler or gambling in problematic ways can increase those burdens of shame and increase the silence. Often words in this arena that can help are talking about gambling harm, money worries, risky gambling. These can soften the conversation at times. If you have got some words that you would like to share around what words might harm or what words might help in this space, feel welcome to jump in on on the mentee. They are happy to share again briefly at the end to capture it all.
Ashley Gordon
Just quickly on this slide, I wanted to show the mental health concern amongst problem gamblers. You can see the connection, around 38% connected with mood disorder, 37.4% with anxiety disorder, 28.8% suffer with antisocial personality disorder, 14% had thoughts about suicide in the last 12 months. I think as health practitioners, as GPs, we need to recognise the close links gambling can have with people struggling with mental health because sometimes it can be missed and it is also closely linked to other drug use. I did not put that slide up there, but just something I wanted to throw in there for people to gaze and absorb.
This one is just around how do we know people are happy with our service? At the end of the day, I will call it client satisfaction. Do we review our services or do we feel our our clients and our patients are happy? What does completion of treatment mean? Are they coming back? Do we feel like they have been satisfied and are we satisfied that we provide the best intervention possible? I just challenge and ask people to always review their procedure and their services because I know that for me, I visit so many services and they are not doing enough reviews for people to see that, some are not coming back. Some people are going for one session and never coming back. It is about the return visits, about the connections, but also it is about the completion of the intervention, how our treatment is looking. It is just being sure that we are challenging what we do and that we are doing them well. Nicola, do you have any on that one?
Nicola Coalter
No, I just wanted to touch base on the next slide. Just examples, again, reinforcing some services that you might be familiar with that can often signal some safety to people. When we think about those clinical spaces and having the odd poster up or pamphlets, we know it does not serve as a safe conversation, and we are getting into that just before we wrap up with how to ask the question next, but just some brand names of good, reputable, trusted places for Aboriginal people to talk about gambling.
Ashley Gordon
I just think it helps that we can work collaboratively with other organisations, other programs, other services in our community that could definitely help your patients and clients. 13YARN to me it is about Aboriginal people in crisis where Mob Strong is all about getting support from people from financial counsellors online. They are both two national numbers and you got Gambleaware, which is predominantly New South Wales and Aboriginal Safe Gambling is my organisation in the dead centre, it is in Victoria.
Here is the question that I have highlighted to get that in the 715 Health Checks. Like I said before, not all health checks have the question but again this could be a question for our GPs on the call. Does that question sit well with you. Have you or someone close to you ever had an issue with gambling? Obviously, if they say yes, is it current? I would like to to seek any feedback around the question. Would they feel comfortable in asking the gambling question? Particularly now knowing that 90% of Aboriginal people are experiencing gambling harm today, throwing the fact how closely it is linked to mental health, and even physical health. Would they ask that question? I would love to get people's feedback because not many GPs are asking that question.
Nicola Coalter
We really appreciate everyone being part of the conversation. Just a few gentle tips around a simple warm question using soft language, not labelling, and remember using your own words when you ask that question as well.
Ashley Gordon
I think we are getting close to the end. This one here is just just focusing on, when I talk about cultural competency, it is not just the staff and what they know and their knowledge and their appreciation for understanding what culture and identity really means, but also organisational cultural competency. What does our organisation look like? What are our policies? What are our strategies? Have we got a diversity inclusion policy? Have we got a Rat Plan? Have we got indigenous employment strategy? What are we doing around our organisational cultural competency? What does it look like? That is closely linked with our leaders, and the more that leaders our our general managers, our CEOs, our practice managers, if they are leading from the front, then things are achieved on the ground. Leaders implement policies, they implement the strategies and making sure that they are making a real difference in community and on the ground. I ask people to just review their organisational cultural competency, and understanding that we can work in collaboration. Do we have partnerships? Do we have MoUs with Aboriginal organisations? Can we work together to provide an effective service for Aboriginal and Torres Strait Islander people? It is all about working together because there are some sensational Aboriginal specific programs. We have got some healing services, we have got smart recovery programs. We have got a lot of people running men's and women's groups. Just about knowing what is happening in communities so we can form those partnerships and provide a better service for our patients.
Nicola Coalter
Ashley, I think you have covered that one well.
Ashley Gordon
All right. We are nearly done, very close.
Nicola Coalter
We have got some time for question and answers at the end, but I think this one is your last slide, Ash.
Ashley Gordon
As I mentioned, it is just about ensuring that all people, no matter what background you are, it is all about growing our cultural capabilities. I actually think this should be on a resume, and people always talk about what capabilities they have in the workplace. Well, cultural capabilities should be something that we look for in when we are hiring and looking at who is part of our organisation because if we have got the cultural capabilities, we have the knowledge and understanding of how to work effectively with our communities, with our patients coming through. What type of cultural awareness training do you receive? I know for a fact that there are some general cultural awareness training courses out there. There are even some online courses out there, but I am a big believer in tailoring your cultural awareness training to your business, to your service, understanding clients that are coming in with particular types of issues and problems, understanding the factors around help seeking and the challenges about people coming through that door. I am a big believer in ensuring that whatever cultural awareness training you are getting, it is tailored and it makes a change for your industry and the people who work with you at your clinics. Nicola, any closing comments?
Nicola Coalter
I think often when it comes to everyone's competency around gambling, it is understanding that often we do not use the words gambling. We might talk about it in having a little poke or pressing the buttons. When we think about gambling and that extra layer of that cultural competency as well, know that even just being able to ask the question is like a brief intervention, and it can often be a question that will get someone thinking and potentially reaching out in different ways.
Ashley Gordon
I think, in closing, I would just like to say many of our our treatments and interventions need to be trauma informed. More focus on relationships, validation and connections. I have said this before, the connection piece is so important for everything, for the patient, and everything for themselves. All intervention basically is about being a good person. If we are being a good person, we are going to connect and people will respond. Thank you everyone.
Dr Tim Senior
Thank you very much indeed. We have got time for questions. If people want to type them into the Q&A box, we will see them as they come through. One of the things that really struck me is the importance of the co-morbidities with mental health problems because I think mental health is seen as a legitimate thing to come and speak to us about in practices in a way that patients coming to practice or even ourselves as practitioners may be more uncomfortable talking about gambling, but I think the fact that it is both a cause and a consequence of mental health problems means it is highly relevant to that. Assuming that we have got a nice culturally safe practice and people are comfortable talking to us and then we ask the question and someone says, yes, what are the next of conversations we can have and and what are the things that you expect you will be doing with people?
Ashley Gordon
For me, it is asking whether they are happy to do something about it because my approach is all about you allow people to acknowledge and recognise that it is a problem. If people can recognise themselves, they are more inclined to take ownership. When we take ownership, you play a role then in your own journey, what you would like to do to get better. Sometimes we do not like being told because they are not acknowledging it themselves. When we can get people to own up and say, would you like help? They say yes, then it is about understanding what is available to us in the community, whether there is gambling help or gambling counselling services, whether it is financial counselling services or whether there are some local Aboriginal specific services like healing programs. It is just about working out what is available in our communities because like I said, it will be a referral that more than likely GPs will have to make to the relevant services in their community.
Dr Tim Senior
Yeah. Anything you would add, Nicola?
Nicola Coalter
Yeah, Tim. Thanks for that one. I think for me remembering that I am a Psych, I am thinking about different ways of connecting and sure, I have a lot more time and a lot more space, but it is often about acknowledging and normalising the conversation. I know GPs do that really well across many arenas. It is being a little bit more curious rather than clinical, so avoiding those clinical terms and talking as you were talking about those other co-occurring issues. What has been worrying you? Can I talk a little bit more or can I ask a little bit more about what has been worrying you? That can often open the door for people? That gentle framing, again, if we think about like Ashley said, mostly it is about being a good person. That gentle framing is, sometimes gambling becomes a way of coping for people, especially with stress and grief and loss and feeling stuck and money problems. Sometimes even asking that question in that way, is this something that rings true for you? Is this something that is happening for you or your family? I think exploring but not pressuring and understanding that even just asking a few questions again is a brief intervention and it can often leave people with this hope that someone heard and someone cares.
Ashley Gordon
When we relate gambling and gambling losses of money, like I said before, it does not trigger. Like if someone is broke and has lost their money, it does not trigger help seeking. We have to relate it back more so than to health and wellbeing? It is more identifiable and people can also recognise that but people will not recognise when they are broke. Some can, not all, but most of the time if people are unemployed and lived in that poor social community lifestyle, then when related to money, harder to seek help. It does not trigger help seeking, but if we are related to health and wellbeing, more inclined, the conversation can flow.
Dr Tim Senior
Yeah, absolutely. It strikes me as being very similar to the sort of motivational interviewing that we would do for people stopping smoking and people using drugs and changing behaviour. We should be confident as GPs that we have the skills to develop people's trust and have those conversations and to ask them exactly those sorts of questions in a way, do you feel this is harming you? What are the things that keep you doing it? What are the things you enjoy about doing it? What are the things that are harmful and particularly harms to people around them as well? I think it is going to be an important thing to uncover and and recognising people's readiness to change. It feels very similar that actually the topic may be new to us, but the skills in exploring it are are ones that we can transfer from other things we already know as GPs.
Ashley Gordon
I know some GPs have said to me also that they find it really difficult to ask because it could be confrontational, it could be difficult. It is very sensitive. It is a sensitive topic that no one wants to talk about, so GPs sometimes do not want to be the ones to ask those really serious and sensitive questions out of fear of what is going to come back at me.
Nicola Coalter
I think it is really important what Tim said, and I just want to wrap up and my final notes would be on motivational interviewing because I was trained by Bill Miller himself, affirm the disclosure and you know how to do that. Ask permission to gently explore more, use open questions and reflect and summarise. You have got those skills and I know you use them in alcohol and tobacco and other drugs.
Dr Tim Senior
Absolutely. The other thing is we are often reluctant to ask if we do not think we can do anything about it. Having those referral pathways that you have introduced is really useful for us that having asked that we have places that we can refer on to people, confident that we can actually help them with that. That is really useful. Thank you very much. I might hand back to Serena. It is 8.28. Really appreciate your time this evening. Really appreciate you writing for everyone's awareness. Ashley and Nicola wrote the chapter in the National Guide to Preventative Health in Aboriginal and Torres Strait Islander Peoples, the latest edition, which was recently published. Really grateful for them doing that. I was involved in some of the writing of that and their social and emotional wellbeing chapter. It is really important work that can really improve the care that we provide Aboriginal and Torres Strait Islander people. It is NAIDOC week coming up in a couple of weeks. I invite you all to go and explore what is happening in your own communities for NAIDOC Week. There are usually some fantastic celebrations to go and meet people in the communities that you are working in. Thank you very much for your time tonight. Really appreciate your expertise and your presentations.
Serena
Thank you. I would like to extend my thanks to Ashley, Nicola and Tim for presenting this evening and also everyone who joined us online. We do hope you enjoyed the session and that you also enjoy the rest of your evening.