What GPs are missing in Indigenous suicide

In April, another heart wrenching tragedy caught the nation’s attention, with the death of a 10-year-old Aboriginal child in state care.
 
But the news cycle went on, and although leading Indigenous mental health organisations called for more investment in mental health support for Aboriginal and Torres Strait Islander children in state care, the response was another coronial inquiry while recommendations from the 1997 Bringing Them Hope report remain unimplemented.
 
It comes after the Centre for Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention released its own report last year, highlighting that coronial recommendations are repeatedly being ignored at the same time as young Indigenous people experience a lack of cultural safety in mainstream services.
 
According to available data, Aboriginal and Torres Strait Islander people are 2.5 times as likely to die from suicide as non-Indigenous Australians.
 
The situation is worse for those in the child protection system – where Indigenous Australians are disproportionately represented and at far greater risk. In these settings, the suicide rate for Aboriginal and Torres Strait Islander children is 4–12 times higher than non-Indigenous children.
 
newsGP spoke to Nyamal woman Dr Tracy Westerman, from the Pilbara in Western Australia, who has been working in Aboriginal health and suicide prevention for over 20 years and trained more than 50,000 practitioners across Australia.
 
She believes ‘significant cultural barriers’ exist in Australia’s mental health care system, including general practice, that need to be addressed.
 
‘If you’re not Indigenous, trying to extract really sensitive, distressing information from a patient is actually really challenging,’ she said.
 
‘Training just teaches people to be very Eurocentric and monocultural in how they go about doing even basic counselling or basic communication and so often what happens is, unwittingly, people are being taught things that actually don’t help, and they shut people down.
 
‘That’s something that, whether you’re a GP or a psychologist or a social worker, people generally struggle with.’
 
This lack of cultural competency means non-Indigenous practitioners can often miss vital indicators.
 
‘What we’re finding is that people will become distressed and suicidal and will literally have different risk factors and different risk indicators and they also have different things that actually are protective factors,’ Dr Westerman said.
 
‘Often what happens is, a GP will do entry level training for better mental health outcomes and get told to do the wrong things.’
 
Her advice is to work with existing Aboriginal medical services and cultural liaisons to aid in suicide prevention.
 
‘These people can extract information from your Indigenous clients purely because they share more in common,’ she said.
 
‘We know that the more you can actually reduce the cultural barriers the greater the outcomes are for patients.
 
‘If you’re struggling culturally, you’re only going to extract about 5% of the story and that’s a real problem when you’re dealing with health industries.’
 
The value Dr Westerman places on these shared commonalities is supported by US research showing that racial concordance – in this case an African-American physician treating a African-American  newborn patient – halved mortality rates, which are usually three times the rate of Caucasian children. 
 
‘Recent work has emphasised the benefits of patient–physician concordance on clinical care outcomes for underrepresented minorities, arguing it can ameliorate outgroup biases, boost communication, and increase trust,’ the study states.
 
Despite all the challenges associated with providing culturally appropriate care, Dr Westerman said the role of GPs remains ‘incredibly critical.’
 
‘Not just around suicide and mental health but generally,’ she said.
 
‘Aboriginal people across this country are absolutely so grateful when they have a GP in their community.
 
‘I’ve seen situations in remote communities where a GP comes and people are lined up around the block.’
 
Other improvements can also be made, including greater mental health screening and data collection, which Dr Westerman has established for at-risk Aboriginal and Torres Strait Islander youth and adults, and is about to go digital.
 
‘We will have actual suicide behaviour and mental health data on Aboriginal people in real time for the first time,’ she said.
 
‘This is significant to closing the gap and has not had a cent of government support for it.’
 
Her other current focus is to find a home for students graduating from the recently established Westerman Jilya Institute for Indigenous Mental Health by creating the first national Indigenous psychology treatment centre, which was recently knocked back for funding.
 
‘The idea behind the treatment centre is it is quite literally our best opportunity to close the gap and address the issues that people struggle with,’ she said.
 
‘To have a national Indigenous psychology treatment centre that’s actually been driven by Indigenous clinical psychologists, for the first time in the country, you would think it was a no brainer.’
 
But why are the suicide rates so high for Aboriginal and Torres Strait Islander people, and especially those who are young and in care? Dr Westerman says it’s not just the effects of colonisation – a term she thinks is often thrown around without proper context.
 
‘People use universal terms, like colonisation, but the average practitioner doesn’t know how to prevent that or how to address that when you’ve got a distressed Aboriginal person in front of you,’ she said.
 
‘What you’re actually looking at here is intergenerational trauma, which is obviously a byproduct of it, but at the origins of all this stuff is forced removal from families.
 
‘It’s very clear that if you forcibly remove the child from their primary attachment figures, the outcomes there, it’s almost impossible to recover.’
 
The latest Productivity Commission data shows that in 2023, 43.7% of children aged 0–17 years old in out‑of‑home care were Aboriginal and Torres Strait Islander – an increase of 3.7% from 2019.
 
Dr Westerman also says most Indigenous suicides tend to be highly impulsive.
 
‘Aboriginal people, when they become suicidal, lack distress tolerance skills and that’s a byproduct of detachment and trauma,’ she said.
 
‘We need to be better at giving GPs and [other] practitioners actual risk indicators, and also explaining to them what risk looks like so they can be more responsive to it and understand when it presents.’
 
GPs seeking more information can find Dr Westerman discussing culture-bound syndromes on YouTube.
 
The RACGP also has a host of Aboriginal and Torres Strait Islander health practice resources and guidelines on its website, with the next edition of the National Guide to a preventive health assessment for Aboriginal and Torres Strait Islander people due for release later this year.
 
If you or anyone you know needs help, you can contact Lifeline on 13 11 14 or Beyond Blue on 1300 224 636 for 24/7 crisis support.
 
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Aboriginal and Torres Strait Islander health culturally safe healthcare Indigenous Australians mental health psychology suicide rates