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One year on: What have we learned from the NT intervention?

Monday, 16 June 2008

Croakey writes:

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A shocking abuse of human rights? Or the best opportunity yet for improving the lives of Aboriginal people in the NT?

In public health and medical circles, as in the broader community, debate about the NT intervention has been polarised and often heated.

This is a shame because the complexities of the issues surrounding the intervention merit a considered and multi-layered analysis.

Some of the inadequacies in the current debate are because of the simplistic label “the intervention”, which makes it sounds like one thing when it has many elements. Understanding the impact of these various elements is even more difficult given the diversity of Aboriginal people and communities, and the different ways the intervention is being rolled out in different places.

And it’s even more difficult given the lack of clarity surrounding the intervention’s objectives. It was initially rolled out under the banner of tackling child sexual abuse, but is now being framed as part of the country’s commitment to closing the gaps in life expectancy.

Some experts are also concerned that the intense focus on remote communities is distorting public policy, when most Aborigines live in cities and towns.

As the intervention is reviewed in coming months, it’s a timely opportunity to reflect on the lessons from its first year. And there are plenty.

What are the messages for the Federal and NT Governments, and the community more broadly, from the first year of the NT intervention?

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Dr Garth Alperstein, Child Public Health and Community Paediatrician Monday, 16 June 2008 5:46:56 PM: Drs Roseby and White have made some very astute observations and some very salient points with respect to the NT Intervention, particularly those related to lack of focus on outcomes. To add to their concerns for what has been done, and how it has been done, I would like to add the following. There is minimal, if any scientific evidence to support mass child health checks as a means of improving the health of children at a population level. There is fair evidence that the socioeconomic and physical environment account for 60-70% of the overall health of a population. Even if finding a new health problem and treatment of that health problem improves the health of some children, one must question the wisdom of sending that child back to the very conditions that caused the health problem in the first place. It makes no sense from a rational, logical, moral or economic perspective. If the outcome is better health for Aboriginal children and their families, consideration must be given to what determines better health and invest in those strategies that are beneficial and effective. The determinants are complex and multilayered, and there is fair evidence that health services in general account for only about 25% of the overall health of a population. While health services, particularly primary health care services may be important, the strategies to improve the health of populations, particularly in the longer term, mostly lie outside the domain of the health sector. Aside from the obvious ethical and moral issues, if the government does not seriously address the socioeconomic and environmental factors (often referred to as the social determinants of health), costly health services will continue to chase their tail.
Marlene Hodder Tuesday, 17 June 2008 9:27:20 AM: I am not a medical person although we do have a doctor in our Intervention Rollback Working Group in Mparntwe-Alice Springs that has been active since last September to support communities and individuals dealing with the impact of the Northern Territory Emergency Response. Unintended consequences of the invasionist and racist action is the confusion and stress in communities that do not understand what is happening and why, people who have limited access to resources and mainstream media. People are stressed which has to have a flow-on effect on children. Racism both in town and up the track has increased. People are treated badly on business premises. People are subjected to hounding by police and other security officials. Homes are invaded. Dr. Ngaire Brown stated recently: wellbeing is connected to autonomy. She has hit the nail on the head. With no adequate and appropriate consultation the intervention was doomed from the start.
JamesK Tuesday, 17 June 2008 10:36:12 AM: Marene Hodder: Nortern Territory Emergency Response is a "invasionist and racist action" and "Wellbeing is connected to autonomy"????????!!!!!!!!!
Perhaps to adults who are able to freely abuse children in closed off communities where they themselves are the leadership. Such 'autonomy' is the problem ans has unequivocally been proven to be the problem and is clearly no solution to this catastrophe. Those children are members of the society of which I am a part and I would like our society to see them as such and afford them the same protection afforded all children in our society. That is real autonomy.
I will not even deign to address the "racist" slur. It says so much more about Marlene than about the Northern Territory Emergency Response.
DOM Tuesday, 17 June 2008 2:33:04 PM: There are many problems and fewer solutions. From my understanding of the situation there would have been many more problems and many fewer solutions if it hadn't been for the involvement of the AMA. The Gov't should at the very least acknowledge that, rather than continue to play politics with childrens health
Marlene Hodder Tuesday, 17 June 2008 3:12:58 PM: Well James you certainly sound like someone who believed Brough's rhetoric about the paedophile rings operating in "indigenous" communities and how "opening up" those communities would solve all the problems, not that the communities were closed as such, you just needed permission to visit otherwise it was trespass, just like someone entering your yard but are you able to understand that? I can understand your concern about wanting to protect children - don't we all, including Aboriginal people? Which leads to my next question: Jenny Macklin recently stated that there are 60,000 children in Australia being abused every year. What is being done about them? You might like to ponder on that one.
Autonomy, for your information, in the context I used, related to having some say over what happens in your life. You could put someone in jail where they are clothed, housed, fed - it doesn't necessarily mean you are happy. Would you like your land taken away, your life's work destroyed, your income quarantined, no say over your life???
I'm sorry but I did not use any racist 'slur' in my previous posting. I referred to the racism in setting aside the Racial Discrimination Act in order to impose interventionist legislation on a group (race) of people. Unless you are living in a prescribed area in the Northern Territory and if you are reading only mainstream media then you wouldn't have a clue what I'm talking about.
Jaywalker Tuesday, 17 June 2008 4:03:50 PM: Many of the Aboriginal people I have worked with over the past twenty years in Central Oz are confused, outraged, and angry at the dismantling of twenty years of community development and initiatives. Four old women living in a remote community are convinced that the store keeper is stealing half of their money (they are subject to income management). It is no longer their choice where they do their shopping. To add to the general confusion caused by the NTER, there is a new and unwanted local government Shire system being implemented. There are now two added layers of whitefella bureaucracy that remote Aboriginal communities have to try to negotiate. Between the NTER and the new Shires sytem, Aboriginal people have lost ownership of both local enterprises and community health and safety initiatives such as Night Patrols - when the first one of these was set up in a remote community 20 years ago, it reduced the incidence of domestic violence offences in that community by a whopping 80%. Without community ownership (as opposed to being a community based program), the patrols' safety and effectiveness is compromised to an unacceptable degree. Patrols excel at dispute and crime prevention - something that is not possible for Police. There is no substitute for an operational community owned patrol.
The NTER have provided (for the first time ever) funding to support patrol positions in remote communities - however, as is the way with government, they are imposing a top down bureaucratic model for the running and auspice of the patrols with no regard for the consequences for patrols, and remote community residents. The women's patrol in one remote community is contemplating closing down their service on June 30th rather than operate under the ownership of the Shire. Community and family safety are social determinants of health, and for the best possible outcomes, Aboriginal community intiatives should be supported, not shoe-horned into a culturally alien and inaccessible system set up for administrative expediency.
JamesK Tuesday, 17 June 2008 6:08:12 PM: 'Well James you certainly sound like someone who believed Brough's rhetoric about the paedophile rings operating in "indigenous" communities and how "opening up" those communities would solve all the problems'

Er no Marlene, I believe:

1.WA, The Gordon Report and others:
http://www.dia.wa.gov.au/gordon/faq.html
http://www.abc.net.au/news/stories/2007/08/10/2001763.htm

2.NT and the Sacred Child Report
http://www.nt.gov.au/dcm/inquirysaac/pdf/bipacsa_final_report.pdf

3..SA and the Mullighan Report
http://www.service.sa.gov.au/ContentPages/sagovt/mullighaninquiry.aspx

But please don't allow a peripheral issue like the anihilation of aboriginal culture by unfettered child abuse get in the way your Brough bashing; except er....... :

4.http://www.theaustralian.news.com.au/story/0,25197,23811855-5013172,00.html
Lateline cleared over Mutitjulu
Ashleigh Wilson | June 05, 2008
ABC's Lateline has been given the all-clear over its coverage of the troubled central Australian Aboriginal community of Mutitjulu.
In a 47-page report, the ABC's independent complaints review panel found no breach of editorial policies in 29 out of 30 complaints against the program, which eventually led to the former Howard government's intervention into NT Aboriginal communities.
The complaints were lodged by residents of Mutitjulu, a small community in the shadow of Uluru, following Lateline stories in mid-2006 that reported how girls were trading sex for petrol.
The findings exonerate the program following sustained attacks by the NT Government, online publisher Crikey and the National Indigenous Times.

5."More than anything, the Lateline experience underscores the difficulties involved in breaking through the insiders' club that has acted as gatekeeper as conditions have spun out of control in many remote Aboriginal communities. Vocal critics of media reporting, including, ironically, the editor of the National Indigenous Times, Chris Graham, have done little to demonstrate they are in fact serious about improving the living conditions of those they claim to care most about.
The rearguard action against Lateline has come from many of the same people who have yet to recognise that the corrupt ways of the Aboriginal and Torres Strait Islander Commission were a tragedy for most indigenous Australians and rightly belong in the past. Brian Johnstone, a former media adviser for ATSIC under Geoff Clark and Ray Robinson, and long-time press secretary of senator and accused sex offender the late Bob Collins, railed against Lateline in his NIT column. The thinness of the complaints made against Lateline, particularly given the subsequent findings of the Little Children Are Sacred report that it spurred, is further proof that the campaign against openness, including calls to retain the permit system for access to indigenous communities, is based on mischief, not merit."
http://www.theaustralian.news.com.au/story/0,25197,23817543-25209,00.html

7. TACKLING indigenous disadvantage was being hindered because tens of thousands of people employed in the "Aboriginal industry" were simply collecting their salary and serving out time instead of tackling the hard issues, according to leading Aboriginal academic, Stephen Hagan a lecturer at Toowoomba's Southern Cross University
http://www.theaustralian.news.com.au/story/0,25197,23757179-12332,00.html

8.'Remove children' plea at Aurukun: Several members of Aurukun's community justice group, led by Martha Koowarta, widow of a local land rights hero, are urging outsiders to take children from age nine for their safety and education.
http://www.theage.com.au/news/national/remove-children-plea-at-aurukun/2008/03/13/1205126111240.html

9. APY leaders call for Mal Brough:Indigenous leaders in South Australia's troubled desert lands have delivered a rebuke to federal and state Labor by appealing to former Howard minister Mal Brough to head an independent intervention into their communities.
http://www.theaustralian.news.com.au/story/0,25197,23733362-5013404,00.html
Lastly with regard to "'I'm sorry but I did not use any racist 'slur' in my previous posting": You characterised the NTER as an 'invasionist and racist action" but according to you that is not a racist slur. No further comment.
Wolfnephew Wednesday, 18 June 2008 12:30:03 AM: Night Patrols are not a panacea. Occasionally they have been consistently effective. Often they have been extremely variable. Without the presence of an adequate & sympathetic police presence to support & protect them they are usually not sustainable at any level of activity. Little old ladies & other volunteers often are not a match for determined grog runners from prominent local families, their dope dealing sons & thuggish accomplices. These activities are highly profitable and bring loyal political followings to those prepared to take the risks & exploit their vulnerable countrymen.

As one of these comments mentions, secure comfortable incarceration is not a sustainable or appropriate response to the problems; but nor is the simple nostrum of "autonomy" proposed by another correspondent. Autonomy, without the support of necessary factors such as safety & security, is a formula for a Hobbesian nightmare. How does autonomy deal with violent misogynist thugs, dangerous addictions, poverty or a myriad of other issues? It can't, and Ngaire & Marlene need to think a bit more deeply about the mix of determinants that produce benefits. There are hundreds of things that influence wellbeing, and in the final analysis, autonomy is one of the scores of more important ones, but there is no scientific evidence to say that on its own it is any more influential than many others. If people who were terrorised, ignorant and underfed become safe, educated and well served by decent primary health care services, they are likely to become much better off regardless of the fact that some aspects of their autonomy have been tinkered with in certain ways.

Dr Garth Alperstein is correct to question the wisdom of sending kids back to the same environment, but his summation ignores the fact Brough's plan included massive investments in changing the home environments: hundreds of millions to improve housing, more hundreds of millions to improve other services (including health services), vast amounts to help create safe secure communities & homes, radical measures to greatly reduce the quantum of addictive substances flowing through the veins of older family members, vastly improved education, & economic development & employment creation measures on significant scales. Not all of these projects were perfectly designed, but it is a bit rude to imply that no attempts were being made to address just about every social, economic & environmental factor involved with the social determinants of health. Besides, the controls enacted by Brough (some small & temporary but important limitations on how welfare recipients can spend some of their money, some temporary limitations on the power of traditional owners over small but important portions of their land) does not constitute "no say over your life" in any balanced sense.

As for the situation where "Four old women living in a community are convinced that store keeper is stealing half their money ", the only sensible & responsible reaction to this misunderstanding would presumably be to explain to the four old women that they have got it quite wrong, and that at least some politicians have at last realised that they have an obligation to take effective steps to overcome some of the dreadful problems which their predecessors have permitted to become entrenched to the great detriment of the vast majority of remote area Aboriginal people. Any such steps are bound to inconvenience or offend at least some people.

As Marlene says, homes are being invaded by crude & sometimes vicious police under cover of their new powers (usually for the purpose of catching clever illegal grog runners & consumers, evasive dope dealers & users, and people breaking DV restraining orders), but it would be dishonest if it was also not admitted that the overall rate of harm has shifted radically away from the extreme end of the spectrum: there is now much less violence & harm, even if a bit more violence is being produced by police. I am not arguing that the cops should not be brought under better control & held accountable, I am just asking for a bit of perspective here & an admission that there is now far less violence, grog consumption, homicide, suicide, serious assault and other harms accruing to Aboriginal men, women and children than was the case prior to the Emergency Intervention, despite the excesses of some police.

As for the AMA, just about everybody will probably be better off without its contentious and often overly self-serving participation in this mess.

On permits: community areas of towns built mainly with very considerable amounts of public funds should not be construed as the equivalent of private "yards". To do so is dishonest & silly.

Protection of children: Macklin is taking action to enact national provisions foreshadowed by Brough last year, to come down hard on child neglecters and abusers of all colours, via the we
Ray Wednesday, 18 June 2008 12:52:47 PM: Dysfunctional behaviour can be expected where individuals have nothing better to occupy their time. Welfare handed out in these circumstances, tends to exacerbate the problem. If that climate is allowed to continue in NT Aboriginal settlements, as favoured by the anti-interventionists, then the problem cannot fix itself and will only get worse. The interventionist approach implemented by the previous Government and supported by rational Aboriginal leaders, is a genuine attempt to improve life in those centres, and should be allowed to continue because of the resulting positives. It should be complemented by constructive solutions such as the one proposed by Gary Johns, namely “addressing employment with policies to encourage Aborigines to enter the real economy even if it means starting at the bottom of the ladder”, as reported in today’s The Australian. The anti-interventionists probably would oppose this policy, as it would call for Aborigines to move out of the centres of despair to areas where there are employment opportunities. If African refugees can and do move to Australian centres to seek employment, then there is no good reason why Aborigines cannot do likewise, particularly with relevant incentives.
Sally T Wednesday, 18 June 2008 7:49:57 PM: I worked for a while at Batchelor Institute in Alice Springs - women would come in from remote communities to study - at the end of the week we would give them one of those end of course evaluation surveys with questions like "What worked? and "What could we do better?" A common response to the first question was "security guard" also "no humbug" and "washing machine".

The whole intervention debate reminds me of Maslow's Hierarchy of Needs - Psychologist, Abraham Maslow suggested that human beings had to achieve basic needs before they could move on to a higher level of need, ending with the need for "self acutalisation". Of course self determination, autonomy and self actualisation are important - but you're only able to pursure those things after you have fulfilled more basic needs like shelter and security. Its not either / or - its first things first.

I believe that one of the reasons that non-Aboriginal staff are so offended by attacks on Aboriginal people's liberty and independence is because they take simple things like food, shelter and security for granted. If they lived in constant fear of violence and abuse and in a state of grief and shock, they may be more willing to see the value in things like income management and additional policing.

BTW - I worked with Bob Durnan in Alice - I found him to be one of the more informed, balanced and committed individuals there. If he says the intervention is largely working, I believe him.
Dr Andrew White, paediatrician Thursday, 19 June 2008 9:28:53 AM: As well as concerns about lack of outcomes from the child health checks, other concerns include:
- Social services and interventions to assist children and families were not improved despite child abuse being the reason for the intervention in the first place.
- The Australian Government follow up services were only provided for children referred after AG child health checks while children who were on existing waiting lists were excluded.
- There has been much miscommunication and duplication between the bureaucracies in Darwin and in Canberra. An example of waste was the NT Government chartering flights to communities for a clerical worker to copy data collected by the child health check teams to enter on a Darwin data-base whilst the AG was taking the same data to Canberra.
And here are 10 quick ideas of some more effective ways governments could invest in improving the health of Aboriginal Children. (The "little Children are Sacred" report also made some recomendations which were ignored by the AGI)
1. Quality child health programs in communities to provide continuous primary and secondary preventative services for ear health,nutrition, skin disease etc rather than once per year checks.
2. Sustainable dental services available to all indigenous children in the NT.
3. High quality antenatal care services which include social support and education.
3. Training and improving existing health staff and services. Short term staff should only be used when longer term staff cannot be found and must always leave the existing service in stronger shape than when they arrived and should never again be paid at significantly higher rates than the long termers.
4. Assist health staff to build positive relationships with families and communities.
5. Provide accessible and high quality early child education services for preschool children.
6. Improve the acoustics of all classrooms and install soundfield systems.
7. Invest in community based programs focusing on healthy children and families using principles of community develpment, and dont remove funding after a year or two.
8. Programs to reduce childrens exposure to tobacco smoke,and prevent children starting to smoke.
9. Quality services to help parents care for children and allow early non punitive intervention where problems are identfied.
10. Quality services to help individuals and families deal with issues including,family violence,drug and alcohol addictions, and mental health problems
Rani Thursday, 19 June 2008 8:34:21 PM: JamesK, your post has all the hallmarks of an individual very much sucked in by the appalling rhetoric of the former government. Health/wellbeing has no relationship with self-determination (autonomy as Ms Hodder has said)? Ever looked at the life expectancy of Zimbabweans? Or Burmese? Clearly people living in complete autonomy, with total decision-making capacity over their lives, no? D'oh!

The simple facts regarding the NTER are now laid plain for all to see. These being, the banning of alcohol with limited or no treatment measures in place to assist people with serious alcohol addition. Not only is this medically dangerous, it has been proven ineffective in reducing alcohol abuse at a population level, and is ethically and morally reprehensible when considered part of a so-called 'intervention' designed to improve the health and wellbeing of children and their families. The abolishing of CDEP for what can only be described as purely ideological purposes. For a government that constantly banged on about the scurge of passive welfare and its responsibility to taxpayers, this smacks of the very paternalism alluded to by Ms Hodder, and makes no sense either from an economic or social policy standpoint. The insinuous, and insidious linking of child abuse to Aboriginal communities was a particularly salient selling point to the wider Australian community. And into the bargain perhaps forever linked 'Aboriginal' with child abuse in the minds of most people - I see evidence of this in your post. The inquiries you point to are informative documents, but please remember that to the best of my knowledge, no such wide-ranging inquiries have been undertaken in the general and total Australian community. So trying to paint child abuse as a uniquely Aboriginal problem is highly disingenuous at best. What else? Oh yes, the funding. Surely something as important as a 'national emergency' which, incidentally was the clarion call of the former prime minister, is deserving of more than one year's worth of funding?!! This fact alone suggests the motives for the intervention were never about children. Were never about Aboriginal health. A fact indeed confirmed by Alexander Downer on ABC's Insiders on November 25 last year. He somewhat bitterly acknowledged that the government had expected a poll bounce from its NTER, and seemed remiss, not because his government had patently failed to deliver on Aboriginal health, but because the expected poll bounce never eventuated. Arrogance extraordinaire!

Other aspects of the NTER that were reprehensible include the failure to consult with existing services and with Aboriginal communities from the outset. Anyone who has even the most rudimentary understanding of how to implement sustainable, appropriate services in Aboriginal communities knows that if people do not 'own', do not have control over, and are not included in decisions about programs for them, THESE PROGRAMS FAIL. We now know that the NTER was cobbled together in a period of 48 hours. National emergency? Pfffft! Please continue to worship at the feet of Brough if you choose, but those of us who understand about public health policy do not miss him. Nor, I suspect, do the majority of Aboriginal communities in the NT. The Little Children Are Sacred report you identified had many recommendations for action. How many of these found their way into the 'national emergency' to help Aboriginal children? If you are familiar with the inquiry report I will let you inform other readers of this important fact.

And finally your misguided 'Aboriginal industry' rant. How typically and disturbingly uninformed. Those in the 'Aboriginal industry' you seek to deride include hard-working, committed health workers, social workers, community workers and volunteers. This is perhaps the most uninformed remark in your contributions. Tackling disadvantage is hindered by the constant failure of state and federal governments to properly fund and resource Aboriginal community-controlled programs over the longer term. The flawed behaviour of the individual people you refer to had scant if any impact whatsoever in terms of the general Aboriginal population.
JamesK Thursday, 19 June 2008 10:39:03 PM: FOR RANI:

1.Please read my post before ranting. I have not said what you say I have. Pease read the references I supply

2.Please read today's Age newspaper:
http://www.theage.com.au/national/rudd-says-nt-aboriginal-communities-feel-safer-20080619-2tjd.html

(The above is a reference Rani, an internet address) -if that is too difficult, here is a sample:

Rudd says NT Aboriginal communities feel safer

"Prime Minister Kevin Rudd says Northern Territory Aboriginal communities feel safer as a result of the controversial commonwealth intervention.

Mr Rudd today told parliament the intervention, launched one year ago, had been a success.

"Many families in remote communities are reporting that they feel safer because the increased police presence, reduction in alcohol consumption,'' he said.

The quarantining of welfare payments had resulted in money being spent on kids instead of cigarettes and booze, he said.

"Women in many of these communities say that the new income management arrangements mean that they can buy essentials for their kids.''

School nutrition programs in 49 communities had led to a small increase in attendance and more than 11,000 child health checks had taken place, he said.

"This is a very important finding, follow up treatment, including surgery, is underway.''

Mr Rudd said the government was committed to the intervention and its review, announced earlier this month.

"The government's determined to move ahead in doing what we can to close the gap between indigenous and non-indigenous Australians.''

Opposition Leader Brendan Nelson said the coalition supported the review, due to be completed by September."

3.You are not very intelligent, are you, Rani?
Rani Friday, 20 June 2008 12:53:04 AM: Ahhh JamesK. How did I know to expect an ad hominem response from you?

This is a health blog. If you want to engage readers you will need to either a) bring yourself quickly up to speed with regards the latest public health evidence, or b) engage the peer-reviewed evidence in turn to prosecute your own agenda. Sadly (yet predictably) you've chosen neither except to quote a puff piece from a newspaper.

Besides, you haven't answered my question: how many of the Ampe Akelyernemane Meke Mekarle
recommendations made it into the NTER?

I await your response.
JamesK Friday, 20 June 2008 2:53:55 AM: Ever heard of the psychological term 'projection' Rani? You accuse me of playing the man instead of the argument, but:
"JamesK, your post has all the hallmarks of an individual very much sucked in by the appalling rhetoric of the former government"
"Please continue to worship at the feet of Brough if you choose, but those of us who understand about public health policy do not miss him"
"And finally your misguided 'Aboriginal industry' rant. How typically and disturbingly uninformed."
(by the way Rani, show me my 'Aboriginal industry' rant . I have not made one to my knowledge)

There are 97 recommendations of the Sacred Child Report and I commented on these in yesterday's article from Sophie Black. Many were thankfull y ignored many were acted on.

The quoted "puff piece from a newspaper" was from the Age reporting Rudd's report to parliament yesterday. But perhaps his rhetoric is too appalling for you also? "The simple facts regarding the NTER are now laid plain for all to see" but not apparently by you. That is because it is you who is prejudiced and not me.

I produced 9 references. Since you are one of "those of us who understand about public health policy", (who is guilty of "Arrogance extraordinaire!", I wonder?), it should be you and not me sharing the peer reviewed scientific articles that support your bigotry.

You suggest that child abuse is in some way an inappropriate topic on this board. I do not agree. It is quite plain that it is far more important that you grandstand than contribute to this critical debate. The NTER is directed at child abuse primarily and that is as it should be. The only programs that have already proven to have failed are the ones you, apparently, want reinstated!

Provide an argument to support your position Rani because so far you have not. Given the position in June 2007 was unacceptable (are you with me so far Rani? Or do we fail to have even that as a basis for discussion?) provide alternative solutions with supporting arguments rather than diatribes. Come on Rani astonish me. Rani, I believe you are a charlatan and troublemaker. The reason there has been so much unnecessary child sufferings is because of entrenched blind bigotry and ignorance. And because those that should have known better turned a blind eye. Brough did not. Good for him and good for Rudd!

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One year on: What have we learned from the NT intervention?

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