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Pain nurses: Alternatives to cannabis

Rhonda Wilson MHN:

Live radio conversation this morning – more on #cannabis # pain topic here…

Originally posted on Rhonda Wilson MHN:

What would I know? An informed perspective.

I began nursing in 1987. Since then I have looked after many, many people with chronic pain, cancer, drug/substance use problems (including cannabis), and mental health problems – all in rural and regional settings in Australia. I have studied nursing a lot (to Doctoral level – currently under examination) & I have practiced nursing a lot. I have published about cannabis misuse too (Wilson, 2014). I have gained a significant experience over the years, and I continue to learn about how to care for people more effectively so that they can enjoy a positive quality of life, health and well-being at whatever stage of life they are at (including the dying stage).

I know about pain from personal and carer perspectives too. I have nursed my own mother with terminal cancer. I have the personal experience of being close to friends who have…

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Hope therapy – 66 years worth!

I visited my local secondhand bookshop yesterday… A treat on a Saturday morning. I came across a 1948 publication “The therapy of the neuroses and psychoses” Samuel Henry Kraines MD. 642 pages of history!

I couldn’t help but purchase this book, having just submitted my PhD about young rural people and their experiences of emerging mental health problems… of which psychosis is but one… I have just come up with a stack of new ideas and knowledge about the topic and I thought it might even be interesting to glimpse back into the past to see how far (or not) we have come.

Hope it seems is a timeless central element of recovery for helping people with mental health problems… important then and now – a pleasing finding!!!

No doubt it will be a eye opener to peruse this book – page three has me intrigued already!

“Polysyllabic diagnoses and mysterious terminology temporarily intrigue many persons but of course offer no cures. … probably the most important element in therapy …is the sustaining, driving, curative therapy of hope which the sympathetic and understanding physician (I say nurse!) can give.” (Page 3).

Some things are timeless! Here’s to more hope !
And… Who doesn’t love big long unpronounceable words to describe our ills! Surely the longer the word the better the sympathy !

Buy-a-Bale: Practical support for farming people when it is needed.

Originally posted on Rhonda Wilson MHN:

Charity week at Robb College, UNE this week beginning 30 June 2014: Young people serving the community

This post is a shout out for a residential university college I am affiliated with -Robb College, University of New England, Armidale.  If you are on campus at UNE or in Armidale, NSW this week and some in brown overalls asks you to donate – DO! It is for a great cause.

photo credit: http://www.buyabale.com.au/hay-distributions

Almost 200 young people live at Robb College each year while they study at UNE. I am privileged to get to know many of them – cheering them on as they work their way towards professional futures. It is a lot of fun… each year I am amazed at the caliber of the young people I meet at Robb. Sometimes older people are quick to dismiss young people, blaming them for societal ills… But, each year the…

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Pain nurses: Alternatives to cannabis

What would I know? An informed perspective.

I began nursing in 1987. Since then I have looked after many, many people with chronic pain, cancer, drug/substance use problems (including cannabis), and mental health problems – all in rural and regional settings in Australia. I have studied nursing a lot (to Doctoral level – currently under examination) & I have practiced nursing a lot. I have published about cannabis misuse too (Wilson, 2014). I have gained a significant experience over the years, and I continue to learn about how to care for people more effectively so that they can enjoy a positive quality of life, health and well-being at whatever stage of life they are at (including the dying stage).

I know about pain from personal and carer perspectives too. I have nursed my own mother with terminal cancer. I have the personal experience of being close to friends who have had or do have cancer (some who have died). I am familiar with chronic pain in my own life. I have a personal experience of human pain on many levels, as many others will also have. I have compassion for people who experience pain, and I actively work towards fine tuning this compassion for others so that I can serve others (personally or professionally) with the care and kindness that is needed in times of pain.

This blog is not intended to be an exhaustive expose about everything I know (or about everything anyone else knows) about cannabis and/or chronic or terminal pain care. The intention is to provide an informed perspective based on my accumulation of professional and personal experiences of pain care and substance use care in rural and regional contexts. There will be those who agree with me, and those who don’t. I think it is an important time for discussions about this topic – and this blog is in part a contribution to a public conversation about cannabis and a treatment of pain. You will find lots of hyperlinked information about this topic throughout the blog – it is lengthy this time – but the topic is big too!

The key issues:

How the cannabis is used is the question? And, what component? Some components of the cannabis plant may have beneficial effects and these can be developed as carefully prepared pharmacological formulary preparations that isolate the good helpful components and remove the harmful (eg psychoactive) components to reduce the risk of harm to people. These types of products have been developed as an oral spray (Nabixol for example) targeting specific health conditions and they are stringently tested and retested in clinical trials to demonstrate therapeutic effect and to ensure that harm is minimal. This is evidence based practice in regard to prescribing, administering and dispensing any medication. The challenge here is that you can’t easily do this with crude cannabis. Crude cannabis is leaf or wax/oil substances derived from the plant. There is a gap in the analysis process at this level and the rigour is ambiguous – and you can’t remove the harmful components. The medical cannabis debate gets a bit tricky to follow her at times… but it is the use of crude cannabis that is the key issue which is currently being debated in NSW. There has not been sufficient investigation to warrant the support of changes in cannabis legislation to date – there is no evidence on which to base the practice. And it is this lack of supporting evidence that underpins a call for caution at his time. The evidence to support the pharmaceutical Nabiximol – a synthetic cannabis product as an oral spray is undergoing pharmaceutical trials – but the evidence to support wider use is not yet available (study completion Dec 2015). Thus we are a long way from having an evidence base to support medical crude cannabis. There is no medical or health basis which can support a change in legislation at this time.

  • Smoking Cannabis is not a strategy for pain management. Legislation of cannabis is not warranted at this time.
  • Legalizing cannabis for medical treatment places moral & ethical burdens on nurses, pharmacists and doctors who are responsible for the prescription, administration and dispensing of a drug that has insufficient evidence as a basis for practice at this time.
  • Any form of legalization of cannabis will provide some traction for business entrepreneurs to apply market pressures to extend to non-medical use.
  • Chronic pain nurses could do far more to reduce the burden of human pain, but they would need more funded time to do so. Trials should be conducted to ensure that all other possibilities have been exhausted first.
  • The health literature clearly states that there are profound linkages between cannabis use and mental health problems, and that young people are especially vulnerable in this regard. There is strong evidence indicating that cannabis is linked to significant harm for people.
  • Society has an obligation & responsibility to care for our sick people – those with chronic pain/ cancer. Administering cannabis may short-change sick and vulnerable people, if all other measures are not previously exhausted – such as expert pain nursing care.
  • Funded Australian research should be the source of evidence on which to base Australian decisions about the use or not of cannabis for medical purposes. This should include a range of alternatives to cannabis use as the central strategy to manage pain. This should be a prologue to any change, without it, legislation will have no firm basis on which to proceed with legalization.
  • There are no magic pills or potions to cure pain – FACT

Cannabis: a bull-in-a-china-shop to pain/cancer care

There are no easy answers to mitigate the human pain (especially related to cancer or chronic pain) on this scale, and cannabis seems like a quick fix; a tidy solution to nasty problem – but it isn’t. There is simply not enough evidence to support this practice. If the Bill before NSW parliament is approved it will place nurses, doctors and pharmacists in a dubious position of condoning and administering, prescribing and dispensing ‘medications’ that would also cause harm – a serious consideration. It will also place NSW Health in the incongruent circumstance of maintaining a register of people who are eligible to consume cannabis. Such a tacit endorsement of consumption of cannabis will have flow through impacts whereby NSW Health will have to also take responsibility for condoning the consumption of hazardous material which could cause harm to people. We as a society, and as health service providers, need to take responsibility for managing that harm. It will cost the State money to do that – money that could be channeled to establishing a stronger team of specialist pain care nurses who may be able to mitigate much of the pain that is the core issue in this debate. There are alternatives – and the ‘shiny thing’ (cannabis) that attracts popular appeal – may not be the most useful, effectiveness and economic solution (nurses) to this problem (pain and nausea).

We need to consider very carefully what we are getting ourselves into if this Bill proceeds. And to question whether there is more harm than good on offer in this Bill for the most vulnerable people, some of whom will be nearing the end of their lives. Like a bull in a china shop – using cannabis to address pain, will cause a range of other problems that are unpleasant and may detract from precious moments of well being. A high price to pay. However, a more considered and planned approach to pain management may be less disruptive and troublesome overall – for example; expanding the nursing capacity to address the problems as part of an overall strategy.

I urge voters for this Bill to consider the responsibility of voting on this matter with extreme caution. The decision and outcomes will have a range of consequences – some will be unintended… but there is still time to return the Bull to the paddock, and not let it loose where it will wreak havoc.

Popular opinion V considered rigorous evidence

We have not yet exhausted the possibilities that excellent nursing care has to offer to people at home where they are often in pain. For instance, palliative care nursing has much to offer in reducing pain and other health problems experienced by people with terminal conditions such as cancer. Perhaps our health services need more of these experts delivering care and the point of need in people’s homes? Nurses are expert in providing pain management care – but it takes time, and our health budgets don’t like that the most important pain relief work takes time to deliver.

Cannabis is a much wished for quick fix that poses more risks and harm than overall good to the wider population. I am not yet convinced that the evidence to support cannabis legislation on medical grounds is sufficient therefore I don’t support the use of cannabis for pain management. BUT I DO support more research to understand the issues better and I support and advocate for nurses to have enough time to administer the non- pharmacological strategies in their professional clinical scope more effectively. Our current legislations are sufficient for now and are flexible enough to accommodate research producing more evidence to improve pain care in the future including research about cannabis and pain.

Over the years, I have looked after many palliative people with pain, nausea, vomiting, constipation…. it is awful. The most horrible of times for people to endure… but my practice experience has shown me that there is a great deal of scope to improve what we do, rather than reaching for a quick fix that will ultimately rob people with little quantity of time, of their quality of life/time. There is a great deal of interprofessional collaboration
working towards preventing and managing pain in Australia, and a lot of positive news and community engagement. There is a strong evidence-based discourse in pain management and the expert views should not be dismissed hurriedly so as to rush through legislation changes because crowd wisdom deems it should be so, despite thin evidence.

Nurses Tips

Here are some nursing tips for coping with the nasty experiences of pain as a sample of starting points for care:

Pain tips

 

Nausea & Vomiting tips

 

  • Eat small amounts frequently
  • Food should be warm or cold not too hot.
  • Small and frequent fluids
  • Crushed ice – or frozen drinks – eg soft drinks/ cola or fruit juice
  • Ask for wafers instead of tables
  • Ginger… tea, crystalline
  • Clean your teeth – look after your oral hygiene
  • Sit upright to eat – not lying in bed or slouching in a
  • Managing chemo side effects
  • For some – cannabis causes nausea & vomiting: Cannabinoid hyperemesis syndrome.

Constipation tips

 

  • Toilet 10 – 20 minutes after eating
  • Fibre
  • Fruit
  • Positioning while sitting on the toilet
  • Getting enough fluids
  • Some exercise might help – even short walks
  • Talk to your pharmacist – they will have some over the counter products to choose from.
  • Ask you pharmacist for a medication review…they will understand the implications of the ways that the medications you take interact with each other, andthey may be able to find improvements.
  • Talk to a dietitian
  • What is normal

Withdrawal from cannabis is not pleasant… but there is help to get through that…

For people who do use cannabis regularly to address their unresolved chronic pain problems, and find that the side effects are not helpful, there is help available to quit. Though it may not be pleasant for a few days – but that can be planned for, so that the discomfort are minimized. But, better not to start in the first place and double the woes… Here is a list of what people commonly experience in withdrawal from cannabis:

  • Anger
  • Aggression
  • Irritability
  • Anxiety
  • Nervousness
  • decreased appetite or weight loss
  • restlessness
  • sleep difficulties
  • chills
  • depressed mood
  • shakiness
  • sweating.

Here is a check list to help in deciding if cannabis use is problematic. And another one to determine the level of dependency. If you are a clinician reading this you might like to see the National Cannabis Prevention and Information Centre – Management of Cannabis Use Disorder and Related Issues: Clinician’s Guide to assist you in help others further. And here is a guide to a brief motivational intervention.

Cannabis and Big Business – Market Open… (kind of like the card game Billionaire!)

Muddying the waters… commercial interests: Australia’s ABC TV recently screened a Foreign Correspondent episode which highlighted the commercial influences of the cannabis industry, and which demonstrated the vulnerability of decision making about legalizing this drug. This episode revealed interviews with business people who have found a soft landing place in ‘medical’ cannabis usage and have used this platform as a springboard to campaign for decriminalization of cannabis to the whole population. The soft entry point to the market is enticing to business markets and from a business planning perspective. It is clear that there is money to be made in bucket loads… However, at what price to the wider society? What price – especially to young people who are most vulnerable to the adverse side effects of cannabis? Sometimes, with devastating mental health consequences which might take a year or two to resolve… or worse, trigger an underlying mental illness vulnerability which has lifelong implications. Surely there are lessons learnt with tobacco? Big business is a significant motivator for pressure to adopt legalization…

Cannabis has been considered for other health conditions and not been endorsed

Nabiximol oral spray (synthetic cannabis) has previously been considered by the Australian Dept of Health for the treatment of severe spasticity due to multiple sclerosis. Clinical trials were conducted and reported in the literature with outcomes that were not sufficiently generalisable to practice and with little evidence of clinical significance. That means that the proof that it was an effective treatment is minimal, and perhaps overstated. About half to two fifths of the participants in the trails reported adverse effects of using Nabixmol included gastro intestinal problems such as nausea, nervous system disorders and psychiatric disorders. Finally, the outcome was that in terms of comparative safety, Nabixmol appeared to be inferior to standard care. Had the submission to PBS scheme in Australia been successful, the estimated cost per year would have been $10-$30 million.

What if?

  • $10-$30 million was diverted to establishing a specialist Pain Care Nurse scheme throughout Australia? Not unlike McGrath Foundation Breast Care Nurses. What if a Charity was able to partner with health service to build a sustainable future for Pain Care Nurses to address this significant health problem in Australia…? What if…?
  • We can make what we have work better? What if?
  • We don’t need new legislation that will open window and loop holes that don’t need opening just now… what if?
  • We wait for good quality evidence to inform our practices… what if?

A different view

There will be people who don’t like my view. I don’t mind a range of views – that is a good thing. I am continuing to listen, learn, think and consider this topic – but I don’t want to be swayed by crowd wisdom if there is not convincing evidence to support a change of this magnitude. I hope that we (society) can find new and innovative ways resource and deploy much more compassionate care to people with extreme and enduring pain. Careful consideration is warranted, the stakes are high at a population health scale. Caution is warranted at this stage.

I hope that this blog contributes to more innovative thinking by others about this topic. The tips and ideas contained in the blog are not specific health advice, but are general in nature – most of the links are freely available on the Web – use at your own discretion and check with a health professional if you are unsure.

References and further reading & viewing

Recent media about this topic:

http://www.abc.net.au/local/stories/2014/05/29/4014607.htm?&section=news

http://www.abc.net.au/local/stories/2014/05/27/4013099.htm?site=newengland

http://www.abc.net.au/local/audio/2013/05/22/3765113.htm?site=newengland

Wilson, R. L. (2014). Mental health and substance use. In N. Proctor, H. Hamer, D. McGarry, Wilson R. L. & T. Froggatt (Eds.), Mental Health: A person centred approach. Melbourne: Cambridge University Press.

 

 

Buy-a-Bale: Practical support for farming people when it is needed.

Charity week at Robb College, UNE this week beginning 30 June 2014: Young people serving the community

This post is a shout out for a residential university college I am affiliated with - Robb College, University of New England, Armidale.  If you are on campus at UNE or in Armidale, NSW this week and some in brown overalls asks you to donate – DO! It is for a great cause.

photo credit: http://www.buyabale.com.au/hay-distributions

Almost 200 young people live at Robb College each year while they study at UNE. I am privileged to get to know many of them – cheering them on as they work their way towards professional futures. It is a lot of fun… each year I am amazed at the caliber of the young people I meet at Robb. Sometimes older people are quick to dismiss young people, blaming them for societal ills… But, each year the young people I meet at Robb give me great hope and inspiration for the future. The young people I know are community minded and service driven, and I admire them for that. Each year at Robb there is a major fund raiser for charity and each year I am astonished at the hard work that goes into raising vital funds for many important causes. For the last few years the residents of Robb have been raising charity funds with a nude calender. This year the cause is Buy-A Bale to support farmers who have had a tough time with drought. Please consider buying a calendar to support the charity drive over the next few weeks... and add you voice of encouragement to the development of service in the lives of these young people, as well as the farmers who receive the help.

If you would like to know more about Robb College and their charity Buy-A-Bale here are the links:

Social media and health care – endless new possibilities to promote health :)

Twitter… facebook…blogs… so much potential for good!

I do get excited about finding new ways to promote health and well-being to people using social media! I am working on a couple of e-health projects at the moment that I hope will make meaningful contributions to rural people in particular! 

I was excited to read the latest edition of the Collegian journal online yesterday which is a special issue all about health, nurses and social media. Heaps of reading excitement – some of it free! Here is the link:

http://www.collegianjournal.com/current

Look out for the Wilson papers – I have a couple of them in this issue! 

Happy tweeting… blogging… and updating! 

 

May 26 – National Sorry Day. Embracing the possibilities of new solutions to old problems

May 26 – National Sorry Day. Embracing the possibilities of new solutions to old problems

Today we remember the inequalities of the past and resolve to work towards a fairer and stronger future for Australian Aboriginal and Torres Strait Islanders people. Resolving to deliver a…

…A future where we embrace the possibility of new solutions to enduring problems where old approaches have failed.

….A future based on mutual respect, mutual resolve and mutual responsibility.

Prime Minister Kevin Rudd, 26 May 2008 had this to say…. Sorry…

(Prime Minister) (9:00 AM) —I move:

That today we honour the Indigenous peoples of this land, the oldest continuing cultures in human history.

We reflect on their past mistreatment.

We reflect in particular on the mistreatment of those who were Stolen Generations—this blemished chapter in our nation’s history.

The time has now come for the nation to turn a new page in Australia’s history by righting the wrongs of the past and so moving forward with confidence to the future.

We apologise for the laws and policies of successive Parliaments and governments that have inflicted profound grief, suffering and loss on these our fellow Australians.

We apologise especially for the removal of Aboriginal and Torres Strait Islander children from their families, their communities and their country.

For the pain, suffering and hurt of these Stolen Generations, their descendants and for their families left behind, we say sorry.

To the mothers and the fathers, the brothers and the sisters, for the breaking up of families and communities, we say sorry.

And for the indignity and degradation thus inflicted on a proud people and a proud culture, we say sorry.

We the Parliament of Australia respectfully request that this apology be received in the spirit in which it is offered as part of the healing of the nation.

For the future we take heart; resolving that this new page in the history of our great continent can now be written.

We today take this first step by acknowledging the past and laying claim to a future that embraces all Australians.

A future where this Parliament resolves that the injustices of the past must never, never happen again.

A future where we harness the determination of all Australians, Indigenous and non-Indigenous, to close the gap that lies between us in life expectancy, educational achievement and economic opportunity.

A future where we embrace the possibility of new solutions to enduring problems where old approaches have failed.

A future based on mutual respect, mutual resolve and mutual responsibility.

A future where all Australians, whatever their origins, are truly equal partners, with equal opportunities and with an equal stake in shaping the next chapter in the history of this great country, Australia.

Mr Speaker, there comes a time in the history of nations when their peoples must become fully reconciled to their past if they are to go forward with confidence to embrace their future. Our nation, Australia, has reached such a time. That is why the parliament is today here assembled: to deal with this unfinished business of the nation, to remove a great stain from the nation’s soul and, in a true spirit of reconciliation, to open a new chapter in the history of this great land, Australia.

Last year I made a commitment to the Australian people that if we formed the next government of the Commonwealth we would in parliament say sorry to the stolen generations. Today I honour that commitment. I said we would do so early in the life of the new parliament. Again, today I honour that commitment by doing so at the commencement of this the 42nd Parliament of the Commonwealth. Because the time has come, well and truly come, for all peoples of our great country, for all citizens of our great Commonwealth, for all Australians—those who are Indigenous and those who are not—to come together to reconcile and together build a new future for our nation.

Some have asked, ‘Why apologise?’ Let me begin to answer by telling the parliament just a little of one person’s story—an elegant, eloquent and wonderful woman in her 80s, full of life, full of funny stories, despite what has happened in her life’s journey, a woman who has travelled a long way to be with us today, a member of the stolen generation who shared some of her story with me when I called around to see her just a few days ago. Nanna Nungala Fejo, as she prefers to be called, was born in the late 1920s. She remembers her earliest childhood days living with her family and her community in a bush camp just outside Tennant Creek. She remembers the love and the warmth and the kinship of those days long ago, including traditional dancing around the camp fire at night. She loved the dancing. She remembers once getting into strife when, as a four-year-old girl, she insisted on dancing with the male tribal elders rather than just sitting and watching the men, as the girls were supposed to do.

But then, sometime around 1932, when she was about four, she remembers the coming of the welfare men. Her family had feared that day and had dug holes in the creek bank where the children could run and hide. What they had not expected was that the white welfare men did not come alone. They brought a truck, two white men and an Aboriginal stockman on horseback cracking his stockwhip. The kids were found; they ran for their mothers, screaming, but they could not get away. They were herded and piled onto the back of the truck. Tears flowing, her mum tried clinging to the sides of the truck as her children were taken away to the Bungalow in Alice, all in the name of protection.

A few years later, government policy changed. Now the children would be handed over to the missions to be cared for by the churches. But which church would care for them? The kids were simply told to line up in three lines. Nanna Fejo and her sisters stood in the middle line, her older brother and cousin on her left. Those on the left were told that they had become Catholics, those in the middle Methodists and those on the right Church of England. That is how the complex questions of post-reformation theology were resolved in the Australian outback in the 1930s. It was as crude as that. She and her sister were sent to a Methodist mission on Goulburn Island and then Croker Island. Her Catholic brother was sent to work at a cattle station and her cousin to a Catholic mission.

Nanna Fejo’s family had been broken up for a second time. She stayed at the mission until after the war, when she was allowed to leave for a prearranged job as a domestic in Darwin. She was 16. Nanna Fejo never saw her mum again. After she left the mission, her brother let her know that her mum had died years before, a broken woman fretting for the children that had literally been ripped away from her.

I asked Nanna Fejo what she would have me say today about her story. She thought for a few moments then said that what I should say today was that all mothers are important. And she added: ‘Families—keeping them together is very important. It’s a good thing that you are surrounded by love and that love is passed down the generations. That’s what gives you happiness.’ As I left, later on, Nanna Fejo took one of my staff aside, wanting to make sure that I was not too hard on the Aboriginal stockman who had hunted those kids down all those years ago. The stockman had found her again decades later, this time himself to say, ‘Sorry.’ And remarkably, extraordinarily, she had forgiven him.

Nanna Fejo’s is just one story. There are thousands, tens of thousands, of them: stories of forced separation of Aboriginal and Torres Strait Islander children from their mums and dads over the better part of a century. Some of these stories are graphically told in Bringing them home, the report commissioned in 1995 by Prime Minister Keating and received in 1997 by Prime Minister Howard. There is something terribly primal about these firsthand accounts. The pain is searing; it screams from the pages. The hurt, the humiliation, the degradation and the sheer brutality of the act of physically separating a mother from her children is a deep assault on our senses and on our most elemental humanity.

These stories cry out to be heard; they cry out for an apology. Instead, from the nation’s parliament there has been a stony and stubborn and deafening silence for more than a decade; a view that somehow we, the parliament, should suspend our most basic instincts of what is right and what is wrong; a view that, instead, we should look for any pretext to push this great wrong to one side, to leave it languishing with the historians, the academics and the cultural warriors, as if the stolen generations are little more than an interesting sociological phenomenon. But the stolen generations are not intellectual curiosities. They are human beings; human beings who have been damaged deeply by the decisions of parliaments and governments. But, as of today, the time for denial, the time for delay, has at last come to an end.

The nation is demanding of its political leadership to take us forward. Decency, human decency, universal human decency, demands that the nation now step forward to right a historical wrong. That is what we are doing in this place today. But should there still be doubts as to why we must now act, let the parliament reflect for a moment on the following facts: that, between 1910 and 1970, between 10 and 30 per cent of Indigenous children were forcibly taken from their mothers and fathers; that, as a result, up to 50,000 children were forcibly taken from their families; that this was the product of the deliberate, calculated policies of the state as reflected in the explicit powers given to them under statute; that this policy was taken to such extremes by some in administrative authority that the forced extractions of children of so-called ‘mixed lineage’ were seen as part of a broader policy of dealing with ‘the problem of the Aboriginal population’.

One of the most notorious examples of this approach was from the Northern Territory Protector of Natives, who stated:

Generally by the fifth and invariably by the sixth generation, all native characteristics of the Australian aborigine are eradicated. The problem of our half-castes—

to quote the Protector—

will quickly be eliminated by the complete disappearance of the black race, and the swift submergence of their progeny in the white …

The Western Australian Protector of Natives expressed not dissimilar views, expounding them at length in Canberra in 1937 at the first national conference on Indigenous affairs that brought together the Commonwealth and state protectors of natives. These are uncomfortable things to be brought out into the light. They are not pleasant. They are profoundly disturbing. But we must acknowledge these facts if we are to deal once and for all with the argument that the policy of generic forced separation was somehow well motivated, justified by its historical context and, as a result, unworthy of any apology today.

Then we come to the argument of intergenerational responsibility, also used by some to argue against giving an apology today. But let us remember the fact that the forced removal of Aboriginal children was happening as late as the early 1970s. The 1970s is not exactly a point in remote antiquity. There are still serving members of this parliament who were first elected to this place in the early 1970s. It is well within the adult memory span of many of us. The uncomfortable truth for us all is that the parliaments of the nation, individually and collectively, enacted statutes and delegated authority under those statutes that made the forced removal of children on racial grounds fully lawful.

There is a further reason for an apology as well: it is that reconciliation is in fact an expression of a core value of our nation—and that value is a fair go for all. There is a deep and abiding belief in the Australian community that, for the stolen generations, there was no fair go at all. There is a pretty basic Aussie belief that says it is time to put right this most outrageous of wrongs. It is for these reasons, quite apart from concerns of fundamental human decency, that the governments and parliaments of this nation must make this apology—because, put simply, the laws that our parliaments enacted made the stolen generations possible. We, the parliaments of the nation, are ultimately responsible, not those who gave effect to our laws. The problem lay with the laws themselves. As has been said of settler societies elsewhere, we are the bearers of many blessings from our ancestors and therefore we must also be the bearer of their burdens as well.

Therefore, for our nation, the course of action is clear, and therefore, for our people, the course of action is clear: that is, to deal now with what has become one of the darkest chapters in Australia’s history. In doing so, we are doing more than contending with the facts, the evidence and the often rancorous public debate. In doing so, we are also wrestling with our own soul. This is not, as some would argue, a black-armband view of history; it is just the truth: the cold, confronting, uncomfortable truth—facing it, dealing with it, moving on from it. Until we fully confront that truth, there will always be a shadow hanging over us and our future as a fully united and fully reconciled people. It is time to reconcile. It is time to recognise the injustices of the past. It is time to say sorry. It is time to move forward together.

To the stolen generations, I say the following: as Prime Minister of Australia, I am sorry. On behalf of the government of Australia, I am sorry. On behalf of the parliament of Australia, I am sorry. I offer you this apology without qualification. We apologise for the hurt, the pain and suffering that we, the parliament, have caused you by the laws that previous parliaments have enacted. We apologise for the indignity, the degradation and the humiliation these laws embodied. We offer this apology to the mothers, the fathers, the brothers, the sisters, the families and the communities whose lives were ripped apart by the actions of successive governments under successive parliaments. In making this apology, I would also like to speak personally to the members of the stolen generations and their families: to those here today, so many of you; to those listening across the nation—from Yuendumu, in the central west of the Northern Territory, to Yabara, in North Queensland, and to Pitjantjatjara in South Australia.

I know that, in offering this apology on behalf of the government and the parliament, there is nothing I can say today that can take away the pain you have suffered personally. Whatever words I speak today, I cannot undo that. Words alone are not that powerful; grief is a very personal thing. I ask those non-Indigenous Australians listening today who may not fully understand why what we are doing is so important to imagine for a moment that this had happened to you. I say to honourable members here present: imagine if this had happened to us. Imagine the crippling effect. Imagine how hard it would be to forgive. My proposal is this: if the apology we extend today is accepted in the spirit of reconciliation in which it is offered, we can today resolve together that there be a new beginning for Australia. And it is to such a new beginning that I believe the nation is now calling us.

Australians are a passionate lot. We are also a very practical lot. For us, symbolism is important but, unless the great symbolism of reconciliation is accompanied by an even greater substance, it is little more than a clanging gong. It is not sentiment that makes history; it is our actions that make history. Today’s apology, however inadequate, is aimed at righting past wrongs. It is also aimed at building a bridge between Indigenous and non-Indigenous Australians—a bridge based on a real respect rather than a thinly veiled contempt. Our challenge for the future is to now cross that bridge and, in so doing, to embrace a new partnership between Indigenous and non-Indigenous Australians—embracing, as part of that partnership, expanded Link-Up and other critical services to help the stolen generations to trace their families if at all possible and to provide dignity to their lives. But the core of this partnership for the future is the closing of the gap between Indigenous and non-Indigenous Australians on life expectancy, educational achievement and employment opportunities. This new partnership on closing the gap will set concrete targets for the future: within a decade to halve the widening gap in literacy, numeracy and employment outcomes and opportunities for Indigenous Australians, within a decade to halve the appalling gap in infant mortality rates between Indigenous and non-Indigenous children and, within a generation, to close the equally appalling 17-year life gap between Indigenous and non-Indigenous in overall life expectancy.

The truth is, a business as usual approach towards Indigenous Australians is not working. Most old approaches are not working. We need a new beginning—a new beginning which contains real measures of policy success or policy failure; a new beginning, a new partnership, on closing the gap with sufficient flexibility not to insist on a one-size-fits-all approach for each of the hundreds of remote and regional Indigenous communities across the country but instead allowing flexible, tailored, local approaches to achieve commonly agreed national objectives that lie at the core of our proposed new partnership; a new beginning that draws intelligently on the experiences of new policy settings across the nation. However, unless we as a parliament set a destination for the nation, we have no clear point to guide our policy, our programs or our purpose; we have no centralised organising principle.

Let us resolve today to begin with the little children—a fitting place to start on this day of apology for the stolen generations. Let us resolve over the next five years to have every Indigenous four-year-old in a remote Aboriginal community enrolled in and attending a proper early childhood education centre or opportunity and engaged in proper preliteracy and prenumeracy programs. Let us resolve to build new educational opportunities for these little ones, year by year, step by step, following the completion of their crucial preschool year. Let us resolve to use this systematic approach to building future educational opportunities for Indigenous children and providing proper primary and preventive health care for the same children, to beginning the task of rolling back the obscenity that we find today in infant mortality rates in remote Indigenous communities—up to four times higher than in other communities.

None of this will be easy. Most of it will be hard, very hard. But none of it is impossible, and all of it is achievable with clear goals, clear thinking and by placing an absolute premium on respect, cooperation and mutual responsibility as the guiding principles of this new partnership on closing the gap. The mood of the nation is for reconciliation now, between Indigenous and non-Indigenous Australians. The mood of the nation on Indigenous policy and politics is now very simple. The nation is calling on us, the politicians, to move beyond our infantile bickering, our point-scoring and our mindlessly partisan politics and elevate this one core area of national responsibility to a rare position beyond the partisan divide. Surely this is the unfulfilled spirit of the 1967 referendum. Surely, at least from this day forward, we should give it a go.

Let me take this one step further, and take what some may see as a piece of political posturing and make a practical proposal to the opposition on this day, the first full sitting day of the new parliament. I said before the election that the nation needed a kind of war cabinet on parts of Indigenous policy, because the challenges are too great and the consequences too great to allow it all to become a political football, as it has been so often in the past. I therefore propose a joint policy commission, to be led by the Leader of the Opposition and me, with a mandate to develop and implement—to begin with—an effective housing strategy for remote communities over the next five years. It will be consistent with the government’s policy framework, a new partnership for closing the gap. If this commission operates well, I then propose that it work on the further task of constitutional recognition of the first Australians, consistent with the longstanding platform commitments of my party and the pre-election position of the opposition. This would probably be desirable in any event because unless such a proposition were absolutely bipartisan it would fail at a referendum. As I have said before, the time has come for new approaches to enduring problems. Working constructively together on such defined projects I believe would meet with the support of the nation. It is time for fresh ideas to fashion the nation’s future.

Today the parliament has come together to right a great wrong. We have come together to deal with the past so that we might fully embrace the future. We have had sufficient audacity of faith to advance a pathway to that future, with arms extended rather than with fists still clenched. So let us seize the day. Let it not become a moment of mere sentimental reflection. Let us take it with both hands and allow this day, this day of national reconciliation, to become one of those rare moments in which we might just be able to transform the way in which the nation thinks about itself, whereby the injustice administered to the stolen generations in the name of these our parliaments causes all of us to reappraise, at the deepest level of our beliefs, the real possibility of reconciliation writ large: reconciliation across all Indigenous Australia; reconciliation across the entire history of the often bloody encounter between those who emerged from the Dreamtime a thousand generations ago and those who, like me, came across the seas only yesterday; reconciliation which opens up whole new possibilities for the future.

It is for the nation to bring the first two centuries of our settled history to a close, as we begin a new chapter. We embrace with pride, admiration and awe these great and ancient cultures we are truly blessed to have among us—cultures that provide a unique, uninterrupted human thread linking our Australian continent to the most ancient prehistory of our planet. Growing from this new respect, we see our Indigenous brothers and sisters with fresh eyes, with new eyes, and we have our minds wide open as to how we might tackle, together, the great practical challenges that Indigenous Australia faces in the future.

Let us turn this page together, Indigenous and non-Indigenous Australians, government and opposition, Commonwealth and state, and write this new chapter in our nation’s story together. First Australians, First Fleeters and those who first took the oath of allegiance just a few weeks ago—let us grasp this opportunity to craft a new future for this great land, Australia. Mr Speaker, I commend the motion to the House.

Honourable members applauding—

A big gap between rural mental health care and Indigenous people? You decide…

Rural Mental Health Professionals – even though it is a very tough job, with few resources, and bucket-loads of human pain to alleviate…. Never lose sight of hope and always remember to care.

Photo credit: Mark Saddler 2014

photo credit Mark Saddler 2014 

This is a very sad story from my research which motivates me to never lose sight of the value of excellence in mental health clinical practice, and that the important thing that mental health clinicians do is that they help PEOPLE. 

This is a story that should be told. Future research should be undertaken to understand how a view can be formed by any rural Australian mental health professional that a gaol is a suitable location to receive adequate mental health care, and to explain why adequate mental health care cannot be achieved in small rural communities. Further, what is it that motivates such a person or people to celebrate the gaoling of a mental health client with a cake? The dialogue presented below does not require any further interpretation for it to be clear in its meaning. The text is challenging and has evoked tears and emotional responses among readers’ to date. It should serve to challenge mental health professionals to find more effective ways to improve care for the vulnerable in our community, and to ensure fairness and equity for rural people. An Aboriginal woman tells a story from her life experiences…


“ …I listened to a mental health worker tell a mother that her son is better off in gaol. …do you know what they do? (Emotion welling in her tone). After they send a kid to gaol…they buy morning tea. Chocolate cake! And celebrate… the mental health staff. (Loud anger filled tone). Yep. An orange cake today or a tea cake? 

The mental health workers said to me: ‘Are you coming’? ‘Are you coming to have cake’? ‘To celebrate? He is GONE, he is off our hands’. 

… all those kids have SO many problems and SO many issues, the mental health people don’t know how to address them, and I think they are just leaving them down there (in gaol) to get them out of the way. …they are getting sent (quiver in her voice) for so long, by the time they get out, the next generation is coming through. And it is just going to go on like a cycle. 

But, how could they buy morning tea? (Disgust in her tone) …and celebrate when a kid goes to gaol? 
Mmmmmm sad… (a long silent reflective pause).There is a BIG gap between the mental health workers and the client.”