• Podsoc #69

Aboriginal mental health:

In conversation with John van der Giezen

[Transcript available in the tab below]

In this podcast, John van der Giezen discusses his work in Aboriginal mental health in Western Australia.

John van der Giezen has over twenty-five years experience as a social worker, working with disadvantaged people with a particular focus on working with Aboriginal people and in mental health settings, both government and non government. He has been involved in the establishment of several new programs including Ruah Inreach, Aboriginal Community Support Service and the Specialist Aboriginal Mental Health Service. He was instrumental in lobbying for the review of the Mentally Impaired Defendants Act, 1996 and was a member of the Review Panel.

John has an extensive history of working at a high level to improve services in the areas of accommodation and mental health with a particular focus on Aboriginal people. He has contributed his time to Management Committees within the accommodation, community legal services and mental health law sectors for over thirty years, including ten years as a Director of Access Housing, a major non government accommodation service in WA.

John provides extensive training in the areas of Aboriginal Mental Health and cultural security to clinicians and at three universities in WA. He has twice been nominated for Human Rights awards for his work in the Aboriginal community. He is a current finalist nominee for the AASW’s WA Social Worker of the Year Award. Currently he works as a Senior Social Worker at the Specialist Aboriginal Mental Health Service.

Recommended citation – APA6th

Fronek, P. (Host). (2014, June 12). Aboriginal mental health: In conversation with John van der Giezen [Episode 69]. Podsocs. Podcast retrieved Month Day, Year, from http://www.podsocs.com/podcast/aboriginal-mental-health/.

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  2. Transcript

Transcription Podsocs 69: Aboriginal Mental Health: In Conversation with John van der Giezen

Thank you to James Attard for this transcription

[musical intro to 00.10]

Hello, and welcome to Podsocs, the podcast for social workers on the run. Brought to you by a bunch of social workers from Griffith University in Australia. I’m Tricia Fronek, one of that bunch, and we’re just basically really glad you found us. So, happy listening.

Tricia: On Podsocs today, we’ve got John van der Gieze. John is a social worker from Western Australia who works in specialist Aboriginal mental health service.

Welcome to Podsocs John.

John: Thank you.

Tricia: Very nice to have you on the show. Maybe you could tell us a bit about your work in Western Australia.

John: Okay. I’ve been a social worker for about 25 years, thereabouts. I’ve worked in probably half of that time in non-government agencies and half in government. Mostly mental health related and quite varied positions, drop-in centres in the inner-city, working on the streets inner-city as well, starting new agencies, starting new services both in non-government mental health and then Aboriginal mental health. For the last 12 years or so in the health department here, the last 2 and a half years with the specialist Aboriginal mental health service. Up to that point it was about a 10 year project to get that service off the ground which I’d been involved in. I think I must get a little bored with just day to day work because I keep on taking projects which go on and on and on.

Tricia: You like a challenge.

John: Oh, I don’t know whether I enjoy the challenge because it can be really frustrating but I think I learned fairly early in my career things don’t happen in a hurry. It takes a great deal of lobbying, it takes a great deal of effort to locate funding sources and actually get things started. You don’t always get what you want but you get something fairly close. I think there’s some projects that I’m still working on 15 years down the track.

Tricia: What’s some of the issues in Aboriginal mental health?

John: It’s not that different from Aboriginal health in general and I think, I do quite a lot of education with clinicians now and one of the things I try and get across to people is that the damage the stolen generation has done, the damage that the 1905 Act here in WA, which wasn’t repealed until 1963, which controlled every aspect of people’s lives and continue to do so in one way or another because of the trauma it’s caused. One of the problems with it is, I think, there’s been a direct link to health outcomes from the whole stolen generation problem in that there is very little trust in government agencies of any type. Particularly facility based services which don’t work particularly well for Aboriginal people, they’re not particularly approachable.

Tricia: And there would be a terrible fear of being locked up, I imagine.

John: It’s a strong old culture so those stories survived and a lot of the stories we hear people’s concerns when a relative has a mental health problem. It’s the stories we hear, the stories people would have experienced in the 1950s when yes they would have been locked up for a very long time. People still have those fears very strongly. So, often a lot of the ground we’re doing is you know very basic education on how things are now and how the system works. There’s no you’re loved one isn’t going to be locked up indefinitely and just talk through that whole process of an assessment. I think unfortunately what happens is that nobody really knows or acknowledges these fears and there is a lot of assumptions made about well, people will know how the system works, so we don’t need to explain. That’s very rarely the case, in fact it’s probably rarely the case with anyone, there’s just assumptions made - well you’ve shown up to our service so you will know how things work we don’t need to spend the time explaining to you. Often if that is not done at the basic, if that groundwork isn’t done, people aren’t going to have the confidence to engage and get the benefit of the services.

Tricia: So it isn’t just battling issues or explaining issues or helping people understand the issues about mental health itself. It’s also around the system and what it actually means to be involved in that system.

John: Yes, very much so, just about any aspect of it right down to explaining what medications are for and the reason for taking them long term and not just until you feel better. I know this is a perennial problem and it’s one of the reasons why we’re in trouble with antibiotics, because people take the antibiotics until they feel better and don’t finish the course and you start developing resistance. It’s exactly the same, if you’re not explaining things in detail and getting across to people what to expect, what to expect from an illness, what their relatives are going to experience, what the medications are about, the reasons for taking them even when you are feeling better then you’re probably not going to get a great result. The reasons for regular reviews with the doctor, for example, what we tend to do is that we go into quite an intensive education phase after we first had contact with the family and that’s with the individual but also with their immediate family and their extended family. Just so that person develops the knowledge about what’s happening with them, what to expect but also they get the support of their family to keep that engagement going.

Tricia: And John is that done at home?

John: Yes. Yes, it’s always done at home. Occasionally, we will start if someone has been hospitalised if we haven’t seen them before. In that case we will continue at home. Almost invariably start at home and to the surprise of a lot of clinicians rarely inside the house, it’s usually sitting out in the front yard under a tree, the backyard or in the carport because people do require their privacy and houses are invariably overcrowded. So, that it reserves people’s privacy it’s usually outside, or walking somewhere or driving somewhere.

So one of the things people don’t understand, I’ve had discussions with the non-Aboriginal clinicians who feel that people don’t want them around because they’re use to getting invited into the houses and that rarely happens. I can give an example of one family I worked with for about 12 years and I’ve been invited into their house once during that time and that was because they were very proudly showing off some new furniture but up to that point and subsequently I knock on the door but we do our business outside.

Tricia: So that could be for a range of reasons and really nothing to do with accepting or not accepting the clinician who is visiting.

John: It’s rarely about not accepting someone who is visiting. It’s just the way it is but that’s not necessarily explained and once against people can make assumptions about that. Often that assumption is well obviously they don’t want us here because we weren’t invited in and we didn’t get a cup of tea.

Tricia: So it that some of the issues you cover in the training that you do for professionals?

John: Very definitely. Yes. I think it is a pretty essential part of the training actually just to explain how things work out there in the community for people. I mean there are a lot of reasons why that happens that way, not all of which I will go into but usually, and this is something people can accept, it’s about people’s need for privacy around their personal problems. That’s something people can relate to most easily. There’s various levels of training I do, I’ve just completed about 7 or 8 sessions with non-medical staff in one of the big hospitals here because they didn’t have the access to computers to do cultural awareness training which is mandatory training now. I found them an absolute joy to train because they were very open. Anything from a 1 hour training, which I usually decline to do training for an hour, usually I insist on at least 2 preferably 3 hours. I also do a 4 day training for clinicians and I think in all of these to some extent I talk about Aboriginal history pre-settlement, history since settlement, politics around settlement, a lot of the forgotten history, the history that’s ignored around the conflict and that probably takes up about half of the day because it is really important. I think it’s important to for people to recognise how attitudes have been formed.

Tricia: And it is so important and it really isn’t that long ago but I think a lot of times for people who aren’t Aboriginal it’s probably the most difficult thing to grasp because people often think well that’s the past what’s that got to do with now. So it makes it a very difficult thing to really understand because you haven’t gone through that yourself.

John: Yeah, it is quite difficult and people are quite often shocked. We rarely get negative attitude about it though which I think I kind of expect but it rarely happens. So, we do a lot of that history and you know the thing is that I like to put it in context that people can relate to. For example, the last recorded massacre of Aboriginal people was, in WA at least was in 1923. I know from speaking with some elders that it wasn’t the last but it was the last one which was historically recorded. To keep it in some context for people I say well both of my parents were alive then. This is not ancient history this happened in my parents’ lifetime. So, I try to relate things to people the way people will understand it and pointing out that you know 1963 isn’t that remote either and the control over people’s lives was just amazing, we go into quite some detail about that. It’s not unusual for memories of that time to be very strong, the removal of children etcetera because you know you still visit households here where you have 2, 3, 4 generations of Aboriginal family living in the one household and the stories are still strong. It’s rare to go to a household where the removal of children hasn’t been a real issue for people there, either having been removed themselves or their parents or their brothers and sisters being removed. So, it’s you know it’s very much contemporary.

Tricia: So, what sort of things do people want to know in training? I mean do people raise particular dilemmas that they come across in practice?

John: They do and usually I find it’s because they haven’t really followed the cultural protocols. If I’m visiting a family I haven’t been to before I’m very aware of that I need to speak with Elders first up and I mean as a matter of course you try to do that anyway. You acknowledge the Elders first and speak with them. I’m quite use to having someone referred to me and I may have 3, 4, 5 home visits before I actually see the person who’s been referred because I know that people are going to be asking who you are and asking questions around the community - is this guy okay, and if someone vouches for you and says yeah they’re fine then you usually get the go ahead. It’s quite clear when you get it. Unfortunately, systems aren’t setup that way. Community nursing would just show up and ask for the individual and things don’t work that way in an Aboriginal family. Individuals are a very hard thing to locate and access and work with because that’s not how life operates. It’s always about the extended family. It’s always about the family contributing to decision making so there is an expectation that they’ll be informed and quite often there’s the way medical systems are setup to work very specifically with an individual and it’s quite difficult for them to see or know you need to work the family here.

So one of the things I do talk about in the training is how you respect Aboriginal people need for consultation and their need for confidentiality, because their expectation of confidentiality is probably much higher than our clinical expectations. Which sounds like a bit of a contradiction but there is also that need to consult with the family and one of the things that they won’t tell you is that decision making is a family function rather than an individual. So to put someone on the spot to make a decision is not the way to go, you need to talk about what options there are, discuss the consequence of the options and that doing nothing is an option but has its own consequences, and leave people to make a decision. What I’ve found is that people most of the time, the majority of the time, will make the decision that you would have chosen for them but because you’re not in imposing something on them it’s going to work much better.

Tricia: And that raises that big issue about time too, doesn’t it? That working with Aboriginal people takes much longer because of those things?

John: Yes it does. Yeah. Also the relationship, you really have to you work much more on your reputation. If you’ve got a good reputation in the community all sorts of things happen that are much more easily than if nobody knows you. If you can’t form a positive relationship with that person and with their family, it’s probably very difficult for things to go the way that you think they should be going. So you have to spend a fair bit of time developing the relationships with the person and with their family so that they feel they’ve got some trust. You also have to recognise that they may well have other priorities so I think this is where social workers are very well placed for working in this way, we usually have a very good knowledge of resources and if we don’t know how to do something immediately we know someone who can or make a phone call and get an appointment happening and it helps a lot if you actually know someone there because that means quite a lot to people. Oh I know someone at this agency if you went there and spoke with so and so I could make a phone call now to setup an appointment and that problem will be sorted out. All these little things develop a lot more confidence in you.

Tricia: So there’s several things you’ve talked about John that I just want to highlight.

John: Sure.

Tricia: One is certainly that, and this is the difference between Aboriginal and non-Aboriginal people, the difference between the individual focus and the family focus, and how important it is to really put that upfront so that you know this is the way you have to go. The difference in time and the difference in relationship because we’re trained, or clinicians are trained, to have fairly strong boundaries between the practitioner and your client. Whereas with Aboriginal families they often need to know who you are, who you know, where you come from, which is very very different and it can pose dilemmas for practitioners. Do you have comments on that?

John: It can, I think one of the things in my training in social work is you never give too much of yourself, too much information about your own life etcetera to protect yourself and keep those boundaries. But if you’re not prepared to give something it’s going to be very difficult. I mean an example of that is just the protocols of communication. Here very definitely, I’m sure it varies, but it’s actually quite rude to visit someone, or even to just speak to them, without having a yarn first. You don’t get down to business, this is something I’ve found is quite common in a lot of cultures actually you spend some time talking first and it doesn’t have to be about much but five minutes, ten minutes just talking before you get down to business and that’s the polite way of doing it but no one is going to tell you you’re being impolite.

Tricia: No.

John: But it does kind of colour the relationship and the number of times, if I’ve got someone going in for an appointment with a doctor they’ve never seen before I usually try and catch the doctor beforehand and actually say look make a longer appointment, spend ten minutes talking and their reaction usually is oh but I always talk with people. I say yeah I know but talk about the weather, talk about the football, and talk about the family.

Tricia: And do some listening as well.

John: Yes. For a number of reasons, one it’s the right way to do business and secondly, it allows people to see you as another human being rather than just someone on the other side of a desk who is going to do things to you. Which is usually what they fear.

Tricia: And it is about that trust building isn’t it? Because if you take into account the history, the fear about the institutional nature of treatment that it’s really important to build that trust and also for us not to make promises we’re not going to keep as well.

John: And I mean one of the other things I tell people particularly if you take people to an appointment explain to them what’s going to happen. Explain they might be waiting a while. I do the same if I’m taking someone into a hospital for the first time. I’ll explain in detail what triage is, that there might be waits because they need to prioritise but if you’re waiting long enough someone’s going to offer you a cup of tea or if you’re waiting through lunchtime you’ll get fed and then the eternal questions from multiple people. First you’ll see a nurse who’ll ask you these questions and then you’ll see another nurse and maybe a registrar who’ll ask you the same questions and if you go to a ward it happens again. All of which we all find frustrating but recognise all of this is part of the process but I explain that to people as well look I know it’s frustrating, I know it’s difficult to put up with but people are asking these questions and asking them again and again because they’re being very careful about your health. They don’t want to make mistakes. Usually that explanation is enough for people to relax a little bit into the process I suppose.

Tricia: They understand what it’s about.

John: And understand, yeah. So, you have an expectation of what’s going to happen so it’s not such a surprise. Yeah, even right down to yes you can have visitors, yes you may be going to a secure ward but it’ll be very rare that that’ll be for more than a week and the reason for that is to protect you or to protect others that’s because people care about what they’re doing.

Tricia: Because it can very much feel like prison that period.

John: When people have that very dated view of what happens in a mental health system in the fear of being locked up forever it’s very real and it’s very frightening. Even without that I think it’s quite a frightening experience. So, people do need some reassurance and need some understanding. If you can give them some understanding of what’s going to happen things generally go a lot smoother. People will tell you if they know but they won’t tell you if they don’t know. So, the assumptions don’t go away, oh everything’s fine you know they’ve been nice and compliant or they’re not therefore they’re very difficult. Yeah, I think, you know, the way I like to think about it part of that process is educating Aboriginal people on how things happen when you’re coming into a big system like that but it’s also my education of clinicians goes along the same lines really. Don’t assume that people have knowledge of what you’re doing, be aware that you probably slip into using jargon and people don’t understand you, so be very aware of that. Be very aware that people are going to be quite terrified which I think is very easy to lose sight of that when you’re constantly working in a hospital. Which a lot of people seem to do, I don’t think I’d like to work in exclusively just in a hospital, I’ve sort of only worked in community as well as, yeah.

Tricia: John, the other thing that strikes me is that often people perhaps don’t follow through with an action that we would consider in their best interest but that’s often because there is competing demand. Some other person in the family might need them, there might be some other crisis and that’s very different to how we view problems sometimes and it’s important to not write people off. You know if they don’t come to an appointment or fail to do something it doesn’t necessarily mean that the person is this horrible phrase of non-compliant but it can be about competing demands and which one is most urgent at that particular time.

John: Yeah, there’s lots of demands on Aboriginal people and I can remember very clearly a conversation myself and an Aboriginal colleague had with the financial counsellor who was just endlessly frustrated with trying to provide advice to one of our clients. My Aboriginal colleague pointed out that the problem the financial counsellor was experiencing is that the client couldn’t keep to her budget but always had what she called an excuse, she’s always got an excuse but we can’t get out of this fix. So, my colleague asked well what are the excuses and it was well family had needs and I had to help out. He just had a very simple answer for her, “sorry that’s sharing and we won’t be able to stop her from doing that. That’s her responsibility to her family and it will always take priority”, and it does. People, you know, people see that as a negative often but they rarely see the positives. I do I see the positives. In mental health it’s not unusual to see non-Aboriginal people pretty much completely isolated from their families and unsupported out there. That’s extremely rare, extremely rare. I can’t think of a case where that’s happened over a long term an Aboriginal person with a mental health person may not have tenure on their accommodation but they’ll always have a roof over their head. It may mean they’re moving from household to household, at times, particularly when they’re becoming unwell but they’ll always have food to eat and have shelter and they’ll have the support of that family. Although that might be very difficult for people and put them under a lot of stress too. There’s real advantages there for people and if you can access that in your work it’s a powerful thing.

Tricia: So you have to see the strengths to start with and actually use them.

John: There’s enormous strengths.

Tricia: Yeah.

John: Yeah.

Tricia: Now John, you won’t believe we’re out of time.

John: Already?

Tricia: Already. And John I know this embarrasses you but I want to wish you luck in the Western Australian AASW Social Worker of the Year awards next week because you’re one of the finalists. So good luck.

John: Ah yes I am. Yeah, thank you.

Tricia: John, thank you so much.

John: You’re welcome.

[Musical outro 26.44 to END]

Interview ENDS: 27.08