Part three: Opportunities to strengthen the national effort to close the gap

The deep-seated and complex nature of Indigenous disadvantage calls for policies and programs which are patient and supportive of enduring change... A long-term investment approach is needed, accompanied by a sustained process of continuous engagement...

The new policy framework developed by COAG (as reflected in the National Indigenous Reform Agreement and the Closing the Gap strategy) represents a comprehensive, coherent and ambitious agenda for reform. The key challenge from this point lies not so much in further policy development as in effective implementation and delivery.

Strategic Review of Indigenous Expenditure 2010^[111]

(a) The responsibility of Australian governments

Aboriginal and Torres Strait Islander peoples’ responsibility for their health is one side of the national effort to close the gap. The other half belongs to Australian governments: to provide the support needed so Aboriginal and Torres Strait Islander peoples can exercise that responsibility.

The national effort to close the gap sits at the juncture where these two areas of responsibility overlap. In this space, the gap will close with both parties working in partnership. With ‘green shoots’ evident, as set out in part two, it is critical at this stage that the national effort continues to build on successes, and be strengthened over time. Strengthening this effort is the focus of this part of the report.

The Close the Gap Campaign welcomed Prime Minister Abbott’s May 2013 speech at the Sydney Institute (as Leader of the Opposition). In his speech, he declared he was ‘reluctant to decree further upheaval in an area [i.e. Indigenous Affairs] that’s been subject to one and a half generations of largely ineffectual reform’.^[112] In doing so he was recognising the insufficient good, and sometimes harm, that decades of an ever-changing policy landscape in Indigenous Affairs had caused.

The Campaign also welcomed the promise of continuity in the Coalition’s September 2013 Indigenous health platform:

The Coalition will work collaboratively with State and Territory Governments, as well as the community health sector through existing national frameworks, to ensure that our efforts to close the Indigenous health gap achieve the real and lasting outcomes that all Australians expect.

Aboriginal and Torres Strait Islander Health continues to be an urgent priority for the Coalition. We have a long and proud record of improving Indigenous health outcomes and we remain fully committed to achieving health equality between Indigenous and non- Indigenous Australians within a generation...

Continued investment in clinical health services for all Indigenous Australians will remain a priority for the Coalition. However, the Coalition is also determined to address the social determinants of health that will be key to improving Indigenous health outcomes.

The Coalition has provided in-principle support for Closing the Gap initiatives and will maintain the funding in the Budget allocated to Closing the Gap in Health...^[113]

The Campaign also welcomed the Australian Labor Party^[114] and Australian Greens Indigenous Affairs^[115] election platform. Both committed to continuing the national effort to close the gap. As a consequence the Australian public went to the election with consensus support from all major parties for the national effort to close the gap.

In August 2013, the Campaign Steering Committee released a position paper, Building on the Close the Gap Platform, Commitments for an Incoming Government, which called for policy continuity from the new Australian Government, irrespective of which party was elected to power. It also highlighted opportunities to strengthen the national effort to close the gap into the future. A summary of these calls, updated to reflect the current state of affairs, is set out below. The remainder of this part of the report elaborates on these opportunities.

Opportunities for the new Australian Government to strengthen the national effort to close the gap

Continuing the close the gap initiatives

• Complete the implementation of the Health Plan in genuine partnership with Aboriginal and Torres Strait Islander peoples and their representatives at the national level by:

• Establishing a clear process that ensures a national implementation strategy is developed;

• Finalising a national implementation strategy within 12 months. This strategy should include service models, address health infrastructure needs, contain strategies to ensure financing over long periods, and build the health workforce, as well as develop measurable benchmarks and targets to monitor progress; and

• Moving to an implementation phase, by the securing of the necessary funding to fully implement the plan.

• Forge an agreement through the COAG process on a new National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes.

• Forge an agreement through the COAG process on a new National Partnership Agreement on Indigenous Early Childhood Development to ensure the seamless continuation of programs.

Building on the close the gap platform

• Focusing on expanding health services to meet need, particularly in the areas of mental health, maternal and child health and chronic disease. This should include a systematic inventory of service gaps, planning to close these gaps on a region-by-region basis and with a focus on health services in all areas of Australia. Further steps could also be taken to improve access to medicines. E-health systems should be utilised to enhance continuity of care.

• Developing a dedicated Aboriginal and Torres Strait Islander mental health plan and otherwise implementing the National Aboriginal and Torres Strait Islander Suicide Prevention Strategy and completing and implementing the Social and Emotional Wellbeing Framework and the planned AOD strategy.

• Developing a whole-of-government mechanism across sectors and portfolios to drive an integrated response to health issues and their social and cultural determinants, including the impacts of intergenerational trauma.

• Developing specific COAG Closing the Gap Targets in relation to incarceration rates and community safety in partnership with Aboriginal and Torres Strait Islander peoples and their representatives, as well as state and territory governments.

• Developing formal mechanisms that ensure long-term funding commitments, including the national partnership agreements, are linked with progress in closing the health equality gap.

• Developing a new administrative mechanisms to determine the appropriate Aboriginal and Torres Strait Islander share of mainstream health programs on a basis that reflects both the population size and an index of need. Utilising the funds to produce the best return on investment.

• Introducing and passing legislation to formalise a process for national monitoring and reporting on efforts to close the gap in accordance with benchmarks and targets. This legislation should include a requirement for this process to be undertaken in partnership with Aboriginal and Torres Strait Islander peoples and their representatives. It should also have a sunset clause of 2031 – the year after the date by which all parties have committed to close the gap in health equality.

(b) Continuing the closing the gap initiatives

There are two developments that together will determine whether the national effort to close the gap stays on course and whether Aboriginal and Torres Strait Islander health equality is achieved by 2030:

• The implementation of the Health Plan; and

• The renewal with adequate funding of the expired National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes and the soon-to-expire National Partnership Agreement on Indigenous Early Childhood Development.

The July 2013 launch of the Health Plan marked the fulfillment of a major commitment made by all signatories to the Close the Gap Statement of Intent. It completed a year of intense work by a Strategic Advisory Group (SAG), a plan-development partnership forum comprising the NHLF and Australian governments, co-chaired by Jody Broun, the then Co-chair of the NHLF (also then Co-chair of the National Congress of Australia’s First Peoples and the Campaign Steering Committee), and a senior representative from the (then) Department of Health and Ageing.

The SAG process provided a precedent for partnerships between the Australian Government and the NHLF. While there are lessons to be learned from the process and a review of its operations is timely, it nonetheless provides a platform to build on for future planning partnerships at the national level.

The Health Plan is a framework document that emphasises a whole of life approach with focus on a number of priority areas. The National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes and the Health Plan are complementary and action on both is essential. If supported by necessary funding and effectively implemented, the Health Plan will play a critical role in closing the health gap.

The next step is the development of a national implementation strategy for the Health Plan that sets out detailed and comprehensive commitments, with measurable targets and benchmarks to monitor progress over time. This needs to be developed in partnership with the Aboriginal and Torres Strait Islander leadership and other stakeholders. A new partnership vehicle that builds on the precedent set by the SAG could be established to that end.

As noted, the previous SAG had been co-chaired by an NHLF Co-chair and a representative from the Department of Health and Ageing under the previous machinery of government arrangements. However, with its reach across so many areas of Indigenous Affairs policy (see below), there are strong arguments to support the fact that the Department of Prime Minister and Cabinet may be a better partner in implementation than the Department of Health. Wherever the development of the implementation phase of the Health Plan occurs, the Australian Government must ensure those charged with responsibility for this work, including public servants and service providers, have the necessary health planning and service provision capacity.

It is equally critical for the new Australian Government to strike an agreement with the states and territories through the COAG process on a new National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes, and maintain the pledged minimum Commonwealth investment of $777 million from July 2013 – July 2016, which was made in the 2013-14 federal Budget by the previous Government^[116] and supported by the new Australian Government while in Opposition.^[117] We will continue to monitor the striking of this agreement as a major Campaign focus.

We also note the expiration of the National Partnership Agreement on Indigenous Early Childhood Development in June 2014 and call on the Australian Government to begin negotiating its renewal with at least the current levels of funding.

The risk of not continuing to support these and other national partnership agreements is that over time their cumulative impact will dissipate and the hard won gains in critical areas, as set out in part two, may then begin to reverse. The Close the Gap Campaign believes this would be an unacceptable course of action as it would also represent a squandering of the over two billion dollars of investment in these areas in the past five years through the two mentioned national partnership agreements.

Despite competing economic agendas, we must as a nation find the resources to maintain the momentum of existing efforts and build on the successes. However, there are also opportunities for the new Australian Government to strengthen and shape the national effort to close the gap, as discussed below.

(c) Building on the close the gap platform

Strengthening access to services and medicines

As discussed previously, the national effort to close the gap is one that requires ensuring Aboriginal and Torres Strait Islander people enjoy equal opportunity to be as healthy as other Australians. This requires an emphasis on strengthening health services such as mental health, mothers and babies and chronic disease-related services. Where necessary, additional services should be put in place.

Such an opportunity presents itself through the implementation of the Health Plan, as discussed previously. In relation to this, the Campaign Steering Committee advocates for a structured process whereby, on the basis of agreed service models, a national inventory of health services gaps is conducted on a regional basis. Planning would then take place to ensure gaps are closed - also on a region-by-region basis. This would, optimally (as a default position), involve the strengthening and expansion of existing ACCHSs with additional services and the establishment of new ACCHSs. Alternatively it could involve partnership agreements between ACCHSs and mainstream service providers to enable services to be provided through ACCHSs.

In view of the most recent estimates of life expectancy showing a persistent gap across urban, rural and remote areas,^[118] it is essential to focus on health services in all areas of Australia. Investment should generally be in those services which have been shown to perform best in the identification of risk factors, performance of health checks, care planning and the management of Aboriginal and Torres Strait Islander patients.

E-health systems should be utilised to monitor and enhance continuity of care against benchmarked standards for both mainstream and ACCHS providers.

Further enhancements could also be made to improve access to medicines by Aboriginal and Torres Strait Islander people through the Closing the Gap PBS co-payment measure.^[119]

Key issues that need addressing include eligibility status and the interaction between programs and mobility of people living in remote areas. One solution to consider is attaching eligibility to the patient and not to location or prescriber - as is the current position.

Mechanisms are needed to enable the suite of PBS medicines programs to complement each other to better meet people’s needs with particular regard to travel between remote and urban areas, and between hospital and home, whilst still maintaining access to their PBS medicines.

ACCHSs in remote locations cannot currently provide both Closing the Gap prescriptions and medicines under the s 100 Remote Aboriginal Health Service Program (RAHSP). These services should be able to provide services at their own discretion based on the needs of the patient whether under the s 100 RAHSP or the Closing the Gap PBS co-payment measure.

Hospitals should be able to issue people with discharge Closing the Gap scripts. Prescriptions from hospitals are excluded from this measure, even if the patient is already registered for the measure.  This change would assist with the continuity of care for patients regardless of location or health care setting.

A dedicated Aboriginal and Torres Strait Islander mental health plan and alcohol and other drug strategy and implementation of other related key strategic documents

Two areas that are yet to receive dedicated attention through the national effort to close the gap are mental health and AOD. AATSIHS results provide a timely reminder that mental health and harmful AOD use remains a crisis in many Aboriginal and Torres Strait Islander communities.

As a ‘family stressor’, mental illness among family members or friends was reported by 16% of Health Survey respondents. High levels of mental illness among friends and families were reported by 18% of respondents in non-remote areas and 8% of respondents in remote areas.^[120]

Of concern self-reported high and very high rates of psychological distress have increased from 27% - 30% over 2004-5 and 2012-13.^[121] There were also significant differences in the proportion of men and women who had experienced high or very high levels of psychological distress (24% compared with 36%). Rates of high/very high psychological distress were significantly higher for women than men in every age group, apart from those aged 45–54 years.^[122]

As discussed in its 2013 Shadow Report, the Campaign Steering Committee supports an overarching goal to close the mental health gap between Aboriginal and Torres Strait Islander people and the non-Indigenous population through the implementation of the Health Plan and other strategic documents.^[123] Mental health is considered in Health Plan under the Priority Area ‘Mental Health and Social and Emotional Wellbeing’ where a goal is to enable Aboriginal and Torres Strait Islander people to ‘have the best possible mental health and wellbeing’.^[124]

In relation to AOD, we have noted significant reductions in Aboriginal and Torres Strait Islander smoking rates in part two of this report. Despite this improvement, Aboriginal and Torres Strait Islander people aged 15 years and over are still 2.6 times more likely to be daily smokers.^[125] In relation to alcohol consumption, in 2012-13 approximately 20% of Aboriginal and Torres Strait Islander people aged 18 years and over exceeded the lifetime risk guidelines. It should be noted that whilst this is a similar proportion as non-Indigenous Australians it has significant negative health impacts that need to be addressed as part of AOD strategy.^[126] Further, in 2012-13 one in five (22%) Aboriginal and Torres Strait Islander people aged 15 years and over said that they had used an illicit substance in the previous year.^[127] This also needs to be addressed in the strategy.

If Aboriginal and Torres Strait Islander people are to enjoy the same opportunities to lead a healthy and full life as other Australians, the gaps in both these areas must close - but there is currently no overarching strategic response to achieve this. Addressing the mental health gap will also contribute to the closing of other gaps and forms of Aboriginal and Torres Strait Islander disadvantage. Of particularly note are the high rates of incarceration, harmful alcohol and substance use and poverty that are entwined in compounding negative cycles with mental health conditions.^[128]

Significant opportunities are presented in the new Indigenous Affairs space. Listed in the table below are six strategic responses that touch on the Aboriginal and Torres Strait Islander mental health and AOD space. Against them is an indication of their stage of development and implementation.

This cumulation of responses demonstrates that the Health Plan, as a mental health plan, must not be implemented in isolation. In that regard, we welcome that a key strategy of the Health Plan is to implement both the Roadmap for National Mental Health Reform and the Social and Emotional Wellbeing Framework.^[129] The Health Plan should also support the anticipated new AOD strategy.

Noting that all six relevant strategic documents are either in a late-development or pre-implementation stage, the Campaign Steering Committee further supports the development of a dedicated national Aboriginal and Torres Strait Islander mental health strategy with the goal of closing the health gap as a vehicle for the implementation of all six (to the degree they pertain to Aboriginal and Torres Strait Islander mental health) over 2014.

In this way the risk of scattered and diffuse responses to mental health in our communities is turned into an opportunity, enabling all six strategic responses to work together towards a common goal and avoid duplication.

A whole-of-government coordination mechanism

The Health Plan and the COAG Closing the Gap Agenda commits government to action on the social and cultural determinants of health including education and employment. A whole-of-government approach led by the Prime Minister is required to coordinate and drive complementary action across jurisdictions and sectors. Such is the opportunity presented by the new machinery of government for Indigenous Affairs.

The Campaign Steering Committee welcomes that, since the election, Prime Minister Abbott has brought together within the Department of Prime Minister and Cabinet a dedicated Office for Indigenous Affairs under a dedicated Minister for Indigenous Affairs.

The dedicated Office comprises significant elements of the Aboriginal and Torres Strait Islander health program. Responsibility for the ACCHSs continues to reside in the Department of Health (formerly the Department of Health and Ageing) in a new Indigenous and Rural Health Services Division (that replaces the former Office for Aboriginal and Torres Strait Islander Health). However almost all the Indigenous programs operated by the previous Department of Families, Housing, Community and Indigenous Affairs have moved to Prime Minister and Cabinet.

The diagram below summarises these changes at time of writing.

Machinery of government changes around Aboriginal and Torres Strait Islander health

The Campaign Steering Committee calls on the Australian Government to capitalise on these changes to the machinery of government. That is, by developing a whole-of-government mechanism at least across the Department of Prime Minister and Cabinet, Department of Health and the Department of Social Services to drive an integrated response to closing the gap including health issues and their social and cultural determinants.

Bureaucratic reform should ensure that public servants working in Aboriginal and Torres Strait Islander health are, preferably, Aboriginal and Torres Strait Islander people, but otherwise have the requisite technical skills and service delivery experience particularly in ACCHSs. The changes to the machinery of government for Indigenous Affairs provide an opportunity to make these improvements.

Develop COAG Closing the Gap Targets in relation to incarceration rates and community safety

The overrepresentation in imprisonment and crime victimisation rates for Aboriginal and Torres Strait Islander people requires urgent, coordinated action from government. The Campaign Steering Committee proposes that this action should include the setting of nationally agreed targets.

It has been reported that Aboriginal and Torres Strait Islander women are 31 times – and men 25 times – more likely than other Australians to be admitted to hospital as a result of family violence-related assaults.^[135] The Campaign Steering Committee is of the view that personal safety and freedom from abuse are a critical determinant of the social and emotional wellbeing of Aboriginal and Torres Strait Islander people.^[136] Concerted action led by empowered Aboriginal and Torres Strait Islander communities is critical if these shocking statistics are to be reduced as part of the national effort to close the gap.

One in four people in the prison system today is an Aboriginal and/or Torres Strait Islander^[137] - even though they comprise only one in 33 of the total population. The incidence of mental health conditions and substance abuse problems among the prison population is apparent. A 2009 survey of New South Wales prisoners found that 55% of Aboriginal and Torres Strait Islander men and 64% of women reported an association between drug use and their offence. In the same sample group, 55% of men and 48% of women self-reported mental health conditions.^[138] In an even more recent Queensland study, at least one mental health condition was detected in 73% of male and 86% of female Aboriginal and Torres Strait Islander prisoners; with 12% of males and 32% of females diagnosed with Post-Traumatic Stress Disorder.^[139]

Prison itself has many health and health-related impacts. Not the least of these are mental health impacts^[140] but there are other indirect impacts on health and wellbeing. A prison record can be a major barrier to employment and families with members in prison are put under tremendous financial and emotional stress with the major impact being felt by children.

A target to reduce imprisonment rates should be introduced,^[141] and investing in mental health and drug and alcohol services be considered as a justice reinvestment measure.^[142] Justice reinvestment refers to policies that divert a portion of the funds for imprisonment to local communities where there is a high concentration of offenders. The money that would have been spent on imprisonment is reinvested into services that address the underlying causes of crime in these communities.^[143]

Overall, Aboriginal and Torres Strait Islander people have significantly lower access to mental health services, private or public, than other Australians.^[144] Consequently it makes sound policy and economic sense that investing in mental health services for them is an avenue to explored through justice reinvestment programs.

Guaranteed funding for the duration of the national effort to close the gap – and beyond

In relation to this, the Close the Gap Campaign calls for:

• Formal mechanisms that ensure long-term funding commitments, including the national partnership agreements, are linked with progress in closing the health equality gap.

• New administrative mechanisms to determine the appropriate Aboriginal and Torres Strait Islander share of mainstream health programs on a basis that reflects both the population size and an index of need and the way to spend the funds to produce the best return on investment.

To be sustainable over the long-term it is essential that funding be tied to efforts to close the gap. Long-term policy requires long-term funding models.

We must now also take the next step, and secure an equitable share of mainstream funding to closing the gap. This may require the development of a new mechanism to determine the appropriate Aboriginal and Torres Strait Islander share of mainstream health programs on a basis that reflects both the population size and an index of need. It must also ensure the most effective services to receive those funds for service delivery in terms of access and quality of service.

Other sources of new funding are evident and would support policy objectives such as lowering the Aboriginal and Torres Strait Islander imprisonment rate as discussed above. A recent cost-benefit analysis by the National Indigenous Drug and Alcohol Committee reported that $111,458 per offender could be saved by diversion to community residential rehabilitation programs when compared to the costs of imprisonment.^[145] This form of modelling supports the justice reinvestment argument that imprisonment simply does not make good economic sense, and – conversely - that investing in mental health services in our communities does.

However, it is important to make the right kinds of investment. This includes in, wherever possible, ACCHSs. It is also critical to train more Aboriginal and Torres Strait Islander people to work at all levels of the health system to meet needs, and also to ensure that the non-Indigenous workforce is culturally competent.

Formalise monitoring and reporting arrangements

The national effort to close the gap must involve a coordinated and planned national response across federal, state and territory governments through the COAG process if it is to be successful. A national issue requires a national response. This national response must be monitored against benchmarks and targets so that we know whether we are on track to close the gap.

One of the issues that the Campaign has grappled with since 2008 has been the lack of reliable data against which to measure the COAG Closing the Gap Targets. As noted, this year marks the first that an update on Aboriginal and Torres Strait Islander life expectancy has been available. In addition to this, AATSIHS data is welcome and demonstrates the need for the national effort to close the gap, without shedding light on high level outcomes. Such data and reporting issues are evident across the health system. There is still a need for good information systems and regular review across the national effort to close the gap to see what is working and what is not, and to fine-tune responses if necessary.

In response, the Close the Gap Campaign calls on the Australian Government to introduce and pass legislation to formalise a process for national monitoring and reporting on efforts to close the gap in accordance with benchmarks and targets for the duration of the national effort.

This legislation should include a requirement for this process to be undertaken in partnership with Aboriginal and Torres Strait Islander peoples and their representatives. It should also have a sunset clause of 2031 – the year after the date by which all parties have committed to close the gap in health equality.

^[111] See above note 25, pp 11, 15.
^[112] Abbott, T. (Opposition Leader), Address to the Sydney Institute, 2013. URL: http://www.liberal.org.au/latest-news/2013/03/15/tony-abbott-address-sydney-institute-sydney (Accessed 14 January 2014).
^[113] Liberal Party, The Coalition’s Policy for Indigenous Affairs, 2013, p 6. URL: http://lpaweb-static.s3.amazonaws.com/Coalition%202013%20Election%20Policy%20%E2%80%93%20Indigenous%20-%20final.pdf (Accessed 14 January 2014).
^[114] Australian Labor Party, National Platform, 2011, see in particular pp 155-185. URL http://www.alp.org.au/national_platform (Accessed 14 January 2014).
^[115] Australian Green Party, Aboriginal and Torres Strait Islander People (undated web page). URL: http://greens.org.au/first-peoples (Accessed 14 January 2014).
^[116] Budget Overview, Commonwealth of Australia, 2013, p 36. URL: http://www.budget.gov.au/2013-14/content/overview/html/overview_36.htm (Accessed 14 January 2014).
^[117] See above note 113, p 6.
^[118] See above note 61.
^[119] The following section regarding improving access to medicines through the Closing the Gap PBS co-payment is drawn from: The Pharmacy Guild of Australia, Position Paper: Closing The Gap Pharmaceutical Benefits Schedule Co-payment Measure (CTG PBS Co-payment) – Improving access to Pharmaceutical Benefits Schedule Medicines for Aboriginal and Torres Strait Islander people, 2013. URL: http://iaha.com.au/wp-content/uploads/2013/06/20130429-CTG-position-paper_436824_2.pdf (Accessed 14 January 2014).
^[120] See above note 66, Family stressors. URL: http://www.abs.gov.au/ausstats/abs@.nsf/Latestproducts/C0E1AC36B1E28917CA257C2F001456E3?opendocument (Accessed 14 January 2014).
^[121] As above, Psychological distress. URL: http://www.abs.gov.au/ausstats/abs@.nsf/Latestproducts/9F3C9BDE98B3C5F1CA257C2F00145721?opendocument (Accessed 14 January 2014).
^[122] As above.
^[123] See above note 78, p 19.
^[124] See above note 3, p 20.
^[125] See above note 66, Tobacco Smoking. URL: http://www.abs.gov.au/ausstats/abs@.nsf/Latestproducts/39E15DC7E770A144CA257C2F00145A66?opendocument (Accessed 14 January 2014).
^[126] As above, Alcohol consumption – Lifetime and single occasion risk, http://www.abs.gov.au/ausstats/abs@.nsf/Latestproducts/3D7CEBB5503A110ECA257C2F00145AB4?opendocument (Accessed 14 January 2014).
^[127] As above, Illicit substance use, http://www.abs.gov.au/ausstats/abs@.nsf/Latestproducts/DE7BD4BEC2293FD4CA257C2F00145B19?opendocument (Accessed 14 January 2014).
^[128] National Mental Health Commission, A Contributing Life, the 2012 National Report Card on Mental Health and Suicide Prevention, Commonwealth of Australia 2012, p 41. URL: http://www.mentalhealthcommission.gov.au/our-report-card/2012-report-card.aspx (Accessed 14 January 2014).
^[129] See above note 3, p 22.
^[130] As above.
^[131] See above note 5.
^[132] See above note 4.
^[133] Fourth National Mental Health Plan An agenda for collaborative government action in mental health 2009–2014, Commonwealth of Australia, 2009. URL: http://www.health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-f-plan09-toc (Accessed 14 January 2014).
^[134] Roadmap for National Mental Health Reform 2012-22, Council of Australian Governments, 2012, p 17.
^[135] Steering Committee for the Review of Government Service Provision (Productivity Commission), Report on Government Services 2011 2011. URL: http://www.pc.gov.au/gsp/rogs/2011 (Accessed 14 January 2014).
^[136] See Gee, G., Dudgeon, P., Schultz, C., Hart, A. & Kelly. K., ‘Social and Emotional Wellbeing and Mental Health: An Aboriginal Perspective’. Chapter 4, In Dudgeon, Milroy and Walker (eds) Working Together: Aboriginal and Torres Strait Islander Mental Health and Wellbeing Principles and Practice – Revised Edition, Commonwealth of Australia, (in press).
^[137] Australian Bureau of Statistics, Prisoners in Australia, Aboriginal and Torres Strait Islander Prisoners (cat. no.4517.0), 2012. URL: http://www.abs.gov.au/ausstats/abs@.nsf/Products/F1D32866F5634F83CA257ACB001316BA?opendocument (Accessed 14 January 2014).
^[138] Indig, D., McEntyre, E., Page, J., Ross, B., 2009 NSW Inmate Health Survey: Aboriginal Health Report Appendix of Results, NSW Health, 2010, p 69 (Table 5.6.33). URL: http://www.justicehealth.nsw.gov.au/about-us/publications/inmate-health-survey-aboriginal-health-report-appendix.pdf (Accessed 14 January 2014).
^[139] As above, p 81 (Table 6.1.2).
^[140] Heffernen, E., Andersen, K., Dev, A., Kinner, S., ‘Prevalence of mental illness among Aboriginal and Torres Strait Islander people in Queensland prisons’ (2012) 197(1) The Medical Journal of Australia 37. URL: https://www.mja.com.au/journal/2012/197/1/prevalence-mental-illness-among-aboriginal-and-torres-strait-islander-people (Accessed 14 January 2014).
^[141] See National Congress of Australia’s First Peoples, National Justice Policy, 2012, p 9. URL: http://nationalcongress.com.au/wp-content/uploads/2012/10/CongressJusticePolicyCommentDraft.pdf (Accessed 14 January 2014).
^[142] Calma, T. (Aboriginal and Torres Strait Islander Commissioner), Social Justice Report 2009, Australian Human Rights Commission, 2010, chapter 2. URL: http://www.humanrights.gov.au/publications/social-justice-report-2009 (Accessed 14 January 2014).
^[143] As above.
^[144] Holland, C., Dudgeon, P, Millory H. for the National Mental Health Commission, The Mental Health and Social and Emotional Wellbeing of Aboriginal and Torres Strait Islander Peoples, Families and Communities - Supplementary Paper to A Contributing Life: the 2012 National Report Card on Mental Health and Suicide Prevention, 2013, p 21. URL: http://www.mentalhealthcommission.gov.au/media/56367/27%20May%202013%20FINAL%20SUPPLEMENTARY%20PAPER%20(2).pdf (Accessed 14 January 2014).
^[145] National Indigenous Drug and Alcohol Committee, An economic analysis for Aboriginal and Torres Strait Islander offenders - prison vs residential treatment, Australian National Council on Drugs research paper no.24, 2012, p xi. URL: http://www.nidac.org.au/images/PDFs/NIDACIpublications/prison_vs_residential_treatment.pdf (Accessed 14 January 2014).