Vulnerable children living in some of Australia’s most remote communities will be left without a permanent community mental health service, despite objections from elders, experts and one of South Australia’s own government departments.
Key points:
- Experts say children will not receive adequate mental health support under a fly-in, fly-out service model
- South Australia’s chief psychiatrist says such a model would result in those in need “falling through the cracks”
- The government says that finding staff prepared to live and work in the community is a “challenge”
The ABC has seen a draft of the new model of care of the Child and Adolescent Mental Health Service (CAMHS) in the Anangu Pitjantjatjara Yankunytjatjara Lands (APY), which provides psychiatric and welfare support to children under 18 years of age.
He proposes that the Adelaide staff fly to two communities every fortnight, with another psychiatrist to make a minimum of two trips per year.
Telehealth appointments are described as a way to provide ongoing support.
Two Western-trained employees previously lived and worked at APY Lands for more than a decade, but were laid off without explanation more than a year ago.
With no staff on the APY Lands, Salud SA implemented what it said was a telehealth service and fly-in fly-out last year.
But today Health Minister Chris Picton told the state parliament that no services had been provided on the ground in 14 months.
“The 5th of September [2022] It was the first time those services had been provided in the last 14 months,” Picton said.
“Since then, it has been once every two weeks – there has been a weekly visit from service providers and the finalization of that model of care is underway right now.”
Late last year, South Australia’s chief psychiatrist, Dr. John Brayley, reviewed the program.
Found a FIFO model that would see children “slipping through the cracks” and recommended several changesincluding the doubling of the workforce and insisted that in-country staff remain part of the program.
The new model of care document does not mention Dr. Brayley’s report and fails to follow through on several of his recommendations, including the return of community staff to APY Lands.
Members of the Aboriginal community would work alongside trained workers in the West, and the document outlines a plan to transition the program to Aboriginal staff once training is complete.
The ABC understands that the state Department of Child Protection has also raised concerns about the model.
However, the state government has refused to commit to returning APY Lands workers.
‘They deserve much better’
Pukatja leader Jamie Nyaningu said he had not seen any mental health staff at APY Lands since permanent staff were withdrawn more than a year ago.
Mr. Nyaningu stated that no explanation had been given and he had not been consulted about any of the proposed changes to the CAMHS program.
“Things are bad right now…the children need help,” Nyaningu said.
“The community feels sad that Bobbi and Andrew [the former permanent staff] They have gone.
“I call Andrew and try to find out who is going to help us and if he is going to come back.”
He said it was crucial for mental health staff to live and work in communities in the future.
“We want to see people living on the ground, not flying in and out, [that’s] a waste of time,” he said.
“How are they going to blow up all of our communities?”
Children at risk under the FIFO model
ABC has seen a letter signed by six former CAMHS psychiatrists and sent to Women’s and Children’s Health Network CEO Lindsey Gough detailing several major concerns about the plans.
“A model of care that lacks land-based workers and is not meaningfully collaborative or co-designed with Anangu is culturally unsafe and will deter Anangu from accessing healthcare, contributing to ongoing health disparities and re-traumatization.” of young people, families and workers”. ”, the letter said.
Dr Anthea Krieg has worked extensively in remote Aboriginal communities, focusing on mental health for much of her career.
She was not a signatory to the letter, but agreed that the proposed FIFO model would not work.
“There will definitely be people falling through the cracks…substance abuse rates will be much higher, incarceration rates will be higher and [there will be] kids who just don’t survive,” said Dr. Krieg.
“They deserve much more than what we are giving them.”
Dr. Krieg had researched the mental health and disability support needs of people in APY Lands.
“We found really high rates [of] psychosis and other major mental health problems [compared to the rest of the population]as well as the high rates of brain injuries … as well as the levels of trauma and the problems that sexual abuse and domestic violence have within the community,” he said.
The government has ‘dropped the ball’
Opposition mental health spokesman Tim Whetstone said the state government had “dropped the ball”.
“The previous government took on board and adopted all the recommendations of the Brayley Review, but this current government… [has] clearly did not implement a recommendation. They haven’t listened and it’s showing,” Whetstone said.
“The Brayley Review said we have to have people on the ground to build trust and deal with that mental health issue.”
While in opposition, now Attorney General and Minister for Aboriginal Affairs Kyam Maher agreed.
“Services that are important, that are confidential and sensitive, just won’t work if you fly a couple of times a year and try to do it over the phone,” Maher said in July last year.
However, Maher has now denied that the state government was not listening to elders and experts.
“A model of care cannot exclude people sitting in the field and providing these services face-to-face,” Maher said.
Health Minister Chris Picton said the model was still being developed but would not guarantee a community workforce would return.
“The previous Liberal Government uprooted those [in-community] services and now it’s very difficult to put those services back,” Picton said.
“We want to have as much time for the people in the [APY] Land as possible: Logistically, how can we recruit people to do that is the challenge.”
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