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Miles Little Lecture | Otter.ai

Miles Little Lecture

Catherine Sanderson56min

Diego Silva

00:04

Hello and welcome to a special edition of the SHE research podcast. I'm your host, Diego Silva. Before introducing our episode today, I want to acknowledge that we're recording on the unceded territory of the Gadigal people of the Eora Nation. Despite the results of the October 14th referendum, this is and will continue to be Aboriginal land, whether we'd like to, those of us who are not Aboriginal, acknowledge it or not I pay my respects to those who have and continue to care for Country.

Diego Silva

00:36

Today is a bit of a different episode, we're going to listen to a recorded lecture by Professor Maree Toombs that she gave as part of Sydney health ethics annual miles little lecture. Professor Toombs is a professor here at the University of Sydney in the School of Public Health. She specialises in mental health and issues around Indigenous persons. She's a amazing speaker, as you'll see in her talk is called "Get in the back seat I'm driving, when facilitated co design methodologies lead the way in advancing research translation for First Nations people". Also, as it happens, this is the first Miles Little lecture named after Miles Little that has occurred after Miles's passing on September 30. For those of you who may not know, Miles was this amazing human being, surgeon, literally one of the smartest people I knew. Also super, super nice, like really kind guy. And anytime I meet someone who's like ridiculously intelligent and kind, I get a little upset because I'm like, choose a lane, you know, be one or the other. You can't be both, but he was a both, you know, he's annoyingly really nice, really warm, really generous with his time. And like I said, super smart. He was the guy who founded the sort of earlier version of Sydney health ethics, VELiM at time, and really is sort of integral to the history of bioethics in Australia. He also spoke a lot and wrote a lot about communication and conversation and dialogue, was one of the things that he kind of went back to time and time again, which is why it made a lot of sense to have Maree as the guest speaker, talking about codesign. At the Miles Little lecture, Kathryn McKay, our colleague, Kathryn McKay, read from an essay that Miles published with Chris Jordans and

Diego Silva

02:48

Emma Jane says, about a year ago. So I want to actually read a couple of passages because I think it really does a good job of introducing Maree's talk. So this is from a paper in Bioethical Inquiry the Journal Bioethical Inquiry published last year, and it's on discourse communities, in the discourse of experience. In Mles and colleagues write, we are surrounded by discourse communities, which make up the society in which we live. A discourse community can be defined as a group of people with sufficiently common interests to use a vocabulary of words and concepts, whose meaning are accepted and whose definitions are assumed, that are brought to bear on the subject of discourse. They go on to note, each of us belong to a number of discourse communities. We belong to religious, or churches, to trades or professions, to political organisations, belief systems, family groups, sporting affiliations and so on. Each affiliation carries its own language rules. A discourse community is not of course a sharply defined group, its margins will almost always be blurred and pluralistic societies. Nevertheless, discourse communities exert considerable influence in most people's lives. Humans are both social and societal, and group membership is important to most, we like to belong and belonging to a community of discourse is important. To be known, to have particular political, social, aesthetic or sporting affiliations is to declare membership of groups that quote, speak the same language. There is comfort in belonging. There's also risk. Commitment to a discourse community provides support but demands a certain degree of conformity. If acceptance by the community is to be assured. Membership of a discourse community, therefore potentially constrains what we think or at least say what we think.

Diego Silva

04:48

That can and has distinguish heteroglossia is the presence in the discourse or texts of a multiplicity of social voices and a wide variety of their links and interrelationships. Always more or less dialogue-ised. Heteroglossia implies the importance of context over text, the capacity to move meaning from context, to context and the recognition of many nuances. It denies the monoglossic, hegemony, pardon of meaning, as defined by powerful groups. It it the demotic centrifugal force in language.

Diego Silva

05:26

I really love that passage. It's a great paper. I think it sort of speaks eloquently to what we all kind of experience, what we all kind of know intuitively, but it's good to sort of articulate clearly. This idea that we belong to groups, and that belonging to groups is part of what makes us human. And it comes with benefits and risks. It also comes with assumed knowledge, and what's the importance of that knowledge, and I think this fits really well with Maree's talk, which is fundamentally about community, engaging with community and listening, deep listening with community. Which I think is something that as academics, sometimes we struggle to do, some of us do better than others. I certainly struggle with it. So I think that it is really fitting that Maree was the speaker for this year's Miles Little lecture. The year that Miles passed. Without further ado, here's Professor Toombs talk.

Professor Maree Toombs

06:33

So I'd like to acknowledge the traditional custodians of this land that we are on today, the Gadigal people of the Eora nation and pay respect to their elders past, present and emerging and particularly to those emerging leaders coming through because we have a battle ahead of us at the moment in terms of a referendum that has put us back at least 20 years, in my opinion. So I just want to acknowledge that.

Professor Maree Toombs

07:19

All right, so I'm going to take you on a little journey today there's going to be two parts to this. The first part is around history as it sets up where and why we are today in terms of mental health and suicide. And then I'll give you two case studies and I will finish off with probably my most favourite project that I've ever done, and it's called the mob van a mobile outreach Boomerang, we do come back. And if the when I show you what it looks like, you'll understand why but if that sits on my gravestone, somewhere, I'll be very happy. Alrighty, so how long have Aboriginal peoples been in this country for? Do you know? Okay, at least Absolutely. And if we were to look at what that looks like in a timeline, using this room, as an example, we would take about a centimetre of this space to actually describe how long non Indigenous peoples have been here. And we've had to pivot in a very critical way to that, to to be able to live within the framework that's been prescribed for us. And I wanted to take you through this little bit of a history lesson only. What drove me to do this was actually the fact that I'm becoming more and more aware that we actually don't know the history of our own country, we don't know pre contact, which is amazing. We are the oldest surviving civilization in the world. We didn't get there or here by accident, okay, we had very complex frameworks and discrete, beautiful cultures that held their own autonomy within each of our countries. And actually, if we can just go back to the previous slide for a moment. If you think about Europe, there's about 46 to 48 countries in Europe, we have 250 countries. Each one of those countries is its own unique culture with its own language, its own ways of doing things and its own systems. So and each one of those countries has its own language and dialects. So, to understand that sort of helps, I hope, to describe the impact that colonisation has had on Aboriginal and Torres Strait Islander peoples. And these are just some of the things that we've had to pivot around and towards during our times, I suppose. And these are policies so I'm not sharing these with you to make you feel guilty. It's just a history. And the history is just so present. And, you know, touching our noses that it feels uncomfortable because we're still living it. And a lot of these policies have been around since my birth. So I was born in 1970. So the assimilation policy, the self-determination policy, we think about Eddie Mabo, and the things that he did around native title. And incidentally, he and his wife were married on my non Indigenous family's property in far north Queensland. So that's a bit of a trip, I can tell you. We have the Stolen Generations, we have missions, we have reserves, we have a whole range of, of policies that have been imposed on us that have led to what we have today. And that is a very strong, but weak, sense of who we are. And a lot of that has been because we have had that taken away from us. And so I just wanted to highlight highlight this, in terms of the presentation that I will be giving, also to point out the 1967 referendum. So once again, not in my lifetime, but my parents met in 1967. And just to give you an idea of what that referendum meant, so we were not counted. We were considered flora and fauna because the land was vacant, apparently. And my father who's a white man met my mother who was a black woman, and they ran away together, it was very romantic. And they took off down to the snowy mountains from Queensland, but because my mother was still under the Act, to under government policy, the police were able to go and get her and bring her back to Queensland. So really, really recent stuff. And within my family, I can give you a story for every single part of of these policies that are in front of you.

Professor Maree Toombs

12:16

All right, so who am I and how did I end up here? So I didn't finish year 12. In fact, I was considered the naughtiest kid at school, which I was really proud of. And in my year 12 book, you know, how you get those books like the yearbooks because I dropped out, I think in March had said, This is Maree Anderson, if you don't know who she is, that's okay, she's never here. I thought that was amazing. So with that, I left school. Hello. I left school. Sorry, that's just one of my good buddies. I left school and I was a fruit picker, which is a terrible job. And I think I was earning about $90 a week. And I thought, There's got to be something better than this. I'll do waitressing. And so I did that for a while. And I thought there's got to be something better than this, but I just don't know what it is. And so my beautiful grandmother and aunt did a major intervention on me when I was 22 years old. And they had fraudulently enrolled me into a bridging programme at the University of Southern Queensland, please don't report them. University of Southern Queensland up in Toowoomba up on the Darling Downs. And yeah, they got me over to their house with the promise of scones and a cup of tea and said, "You're going to university". And I thought they were hilarious. I'm like, are you serious. And so I went because I do whatever my grandmother tells me to do. And I did this bridging programme, went through, got a bachelor of education, primary school, and then found myself running that particular bridging programme that I went through. And lots and lots of steps along the way, but ended up getting a PhD around recruitment and retention of Aboriginal students and found that social and emotional well being kept flagging as one of the biggest barriers to people actually completing those programmes. So a lot of trauma. And in my programme 28 of us started and only two of us this finish. So I had a sense of guilt around well, what what is going on here. University of Queensland tapped me on the shoulder and said, we want you to be our director of Indigenous health. And it was a token roll because they were about to be

Professor Maree Toombs

14:45

a they were they were going through accreditation for their medical programme. And they were not meeting criteria for anything Indigenous and so I got parachuted in to fix the problem. So their Medical school wasn't shut down. But it was a wonderful opportunity because I met this amazing man called Professor Jeff Nicholson. And he is an endocrinologist. He came from Perth. And he knocked on my door one day, as I just completed my PhD, and said are you Toombs-ee? And I'm like, Yes. And who are you? And he said, my name is Professor, Jeff Nicholson, and I want to do some stuff around, you know, trying to help you fellas and your health issues. And I got a bit prickly. I'm like, What do you mean, you fellas and your health issues. And so I said that to him? And he said, Well, I've been working in this space for a long time. And he said in the comorbidity and mortality rates are dreadful, so I could hear and see the heart coming through. And I said to him, Well, I don't like research. And we're over researched. And I don't want to do this. And he said to me, Well, what if I give you a car? Two weeks, you go yarn with mob all over the place? He says, I'll put you up in all the nicest hotel motels in western Queensland, I'm like bonus not. And I said, Okay, so I did a two week driving trip and went out and saw my family called into a couple of relatives houses. But jokes aside, I went and I met with people. And I just sat down and said, Look, what's going on. I've been given this remit, I've been asked to come and yarn with you mob. And you can tell me to bugger off. Or you can tell me what you need. And I can try and do something about that. So, overwhelmingly, it was all about mental health, and youth suicides. So they were the big items that kept coming up. And what was fascinating about this yarn was community was saying, we don't even know what mental illness means in terms of a Western framework, first, a traditional framework. And people wanted a blanket prevalent study around common mental disorders, which blew my mind, because I thought, really, but that was what it was. And so we went for our first grant. And we went for our first grant, which was an NHMRC, back in 2013. And it was pure prevalence. And, and Brian and I are actually playing in this space at the moment, my little friend off the back there. But, we got the grant based on pure prevalence within that area that I'd gone and yarned with people around, I didn't have a track record. But my boss did. He had something like 500 publications and $30 million worth of grants. I was like, Geez, he's more than his cowboy hat, which he had on that day when he walked into my room. And, and we found a team that came in Indigenous, non-Indigenous researchers, and they put me up front. So they put me forward as the lead. So as the chief investigator on that grant, with no experience in terms of prevalence or research, but with all the experience in the world, of being an Aboriginal woman in the place where I'm DNA'd to. And so we got the grant it was $1.3 million. It was like, giddy up. Let's go. So I'm going to take you through that first grant now.

Professor Maree Toombs

18:35

So 544, people agreed to be interviewed using the DSM four, which is a diagnostic mental health tool. And if you think about those numbers, and what we actually had to do to get those numbers, we had to recruit people to sit down with a psychologist, and actually be diagnosed with a common mental disorder. Okay, so if someone walked up to you into in a waiting room or a bingo hall, we actually recruited 90 people from a bingo hall. I think it's called housie down here, but I think you know what I'm meaning. Yeah. I would say no, but 544 people said yes. And it was because they knew about the study. We had heard their voices. We'd gone and got the funding. They knew we had the funding, and they were there, ready to go. So on the day we went into this discreet little Aboriginal community called Toomilah and Boggabilla, they're on the Queensland New South Wales border, and they're about 10 kilometres apart from each other. We rolled into town with psychologists and Indigenous health workers and a whole range of people. And we're sitting in Boggabilla and it's 42 degrees. And our little friend Margie. I'll show you a photo of it a minute, is from that community. And she goes, where are these buggers? So with that she's driven down Toomilah where the the bingo was on and walked in and grabbed the mic. And she's like, right you lot you said you wanted this, this study, we got all these people down there at Boggabilla we'll get a bus, we'll bring you down, but come and sign up. And they'll Oh, okay, and you don't mess with Margie. So everybody jumped on the buses and in cars and came down. And we recruited 90 people that day. And I think that's fantastic. And that's the power of just including people. And the outcomes of this where we did a pilot initially, because this is a very western tool as well. We did a pilot with 50 participants initially, and asked them what they thought of the tool. And I will just throw in a little kind of side note here. We were not in really remote communities. So we were working with people that actually had English as a first language, which 80% of us do. And so we went through the pilot study, I may have done it as well. And I may have mild OCD, but apparently that's what researchers have anyway. So I don't want that. But yeah, we went through that whole process. And we found that there were a couple of questions that weren't appropriate for the diagnosis that they were sitting behind. However, culturally, the answers to those questions were different. And so that question, in particular that I'm talking about is do think you have special powers. Okay, so in Western society, a special power means you've probably got some type of a psychosis or you've got, you know, start looking at things like schizophrenia or bipolar affective disorder in Aboriginal peoples. Everybody said, yes, in that pilot study, everybody 544 people said yes to that question, including me, and it's cultural. So for me, if I go on to country, I'm not meant to be on, I get this feeling like I'm going to die if I'm on a man site, men's site. So that's my thing. But for others, it could be a whole range of things. So we made sure that that was understood within the process. The interviews went from 30 minutes to five hours. And many people found this extremely therapeutic. And all the interviews were conducted by clinical psychologist students in terms of recruiting into the study. And then clinical psychologists actually use the DSM four to conduct the interviews.

Professor Maree Toombs

22:49

So what we found compared to the rest of the population, so the general population, our population, we had a 6.7 fold for any mood disorder, 3.5 fold for anxiety, 5.4 for substance use, and 4.2, for any common mental disorder. So we were way above what the national average was saying for us at 2.5%. And we could not get this paper published in Australia. Couldn't get it published. One of the journals, Medical Journal of Australia said, "Can't you give us some good news?" And it's like, oh, this is a prevalence paper. These are the facts. So it was rejected by every paper we tried or journal in Australia. So we ended up getting it published in the British Medical Journal of Psychiatry, which has a much higher impact factor anyway. And it's been picked up in guidelines and Queensland Health use our results a lot. But yeah, so that was our first study. And there's Margie. So don't mess with Margie. She's beautiful, but very influential. I have known her to sell the same painting to three different Aboriginal medical services. And then they had to bid against each other to actually get it. She's good. And, and then we've also got the beautiful Ruth there who was one of our clinical psychologists, an incredible woman.

Professor Maree Toombs

24:20

All right, then we got another grant. So we used the outcomes of that prevalence study to as a platform to start to do some real work with communities. So it's one thing to know what's going on, but it's another thing to actually be able to do something about it. So we knew that there were really really, really high rates of self medicating with drugs and alcohol as a secondary diagnosis to major depressive disorder and anxiety. Those accumulated accumulatively really lift the rates of risk to suicide, but likewise to self harm and a whole range of other issues, including including not looking after other comorbidities. So we leveraged off that and started applying for a number of a number of grants, including this one here. I-ASIST. So it was a targeted call through NHMRC. We received $804,000. So it was a little grant. But wait to see the impact. Amazing. And it was called INSIST. So indigenous suicide intervention training. What was the s for something else anyway, in no insist. Community after we got the funding said, You know what it sounds like incest. And we're like, oh my gosh, so we changed it to I-ASIST, so I'd had a name change. So, but the vision for this is bringing life saving skills and building community capacity for Aboriginal and Torres Strait Islander communities. And the whole purpose of this particular grant was to develop a suicide intervention training programme for Aboriginal peoples to Aboriginal peoples, and we didn't want to get into organisations and stakeholders, we actually wanted to crack the concrete and draw the rubble away and actually get in underneath that and get to the community that are in these places at two o'clock in the morning. Stakeholders go home community are living in these places and spaces 24/7. And the driving force behind this was twofold. First of all, it was based around an elder, an Auntie that I met through consultation up around Rockhampton, and she had lost two children and three children, grandchildren to suicide. And she said, "Our kids don't kill themselves between the hours and nine, between the hours of nine and five, we need help". And that was huge for me. The second piece around this was my own personal story. And you're I overshare. But that's what we do, we share and we hear story. So I went off to do a programme called ASIST And you might see this says I-ASISTis a gold standard suicide intervention training programme that comes out of Canada. And it's the only client, only one of its kind in the world. And just to set this up. So you can do suicide awareness training, or suicide prevention training. But that someone says to me, I'm thinking about suicide, I go, Oh, and I throw it over there, to lifeline or to a psychologist or to a doctor, but I handball it, I don't want to deal with that. That's scary. Intervention is sitting down with the person in real time. And asking the question, are you thinking about suicide? Are you thinking about killing yourself? I know, these are tough words, but and I'm used to saying this, so if I'm upsetting anybody, I'm sorry. But we have to have these direct conversations with communities otherwise, we don't know what we're doing. Because I might say you thinking about doing something silly? And you say yes. And it might be that you're gonna go and dye your hair pink. Okay, it's very different to a conversation about suicide. So during the ASIST training, day two we'd learn, the models so asking, noticing, asking, looking and then supporting. I knew without a doubt, my own brother was at risk of suicide. And he had been sending out all the warnings. And I'm like, you know, pretending it's not happening, or I'm handballing it over to our parents, or, you know, I'm ringing him up and saying, look what's going on, but not wanting to really know in the same token, because I didn't know what to do. And so, day two of this training, I tried to ring my brother, and he doesn't pick up so I sent him a text message. And you know, it goes something like, you're gonna think I'm crazy. I'm doing this suicide intervention training. And are you thinking about killing yourself? Sent. And I'm thinking, well, what's the worst that can happen? He says, No, I can go home. Everything's okay. Came back immediately. How did you know? And I'm like, pick up the phone and I've worked through the the framework of ASIST, and he did exactly exactly what the framework said he would do. And he is the biggest nonconformist, but he walked through it like a little lamb. And I was like, This thing works. So I just about crashed, tackled the trainer, the lead trainer the next day, and I said we have to work together. And the model itself is so intuitive to Aboriginal people. The rest of it is crap. What can we do about this? And he's, he had grown up around Aboriginal communities, he actually got it. It took us six years to get in front of the Canadian company Living Works and convince them that this was a good idea. There were two changes of CEOs. And so the third CEO that came in, got it. And since then we've been sailing. And so I'm going to walk you through what it looks like.

Professor Maree Toombs

30:31

So we took the western model, Canadian and all with all of its language. And we iteratively worked the programme in all of the communities that we went into. And so in the early days, we we got in front of 600 responders, we called them or people that we could train, we pride, we provided the training for free as part of the grant. And we did yarning circles at the beginning and at the end of it to A, understand whether this was culturally appropriate. What other resources did we need to actually set people up in communities to make this successful? And how did we break that concrete? How do we break the concrete and get rid of all of these other stakeholders that are, like getting in the way so there's a lot of gatekeeping over Aboriginal peoples in Aboriginal funding, and we'll get to the voice and referendum later. But one of the things that failed in that not getting over the line was that it will continue being the same where these non Indigenous stakeholders get big buckets of money, and they don't distribute it the way that it should be done. So these are the results 600 responders trained 140 interventions in three months. So we did a pre and post evaluation looking at confidence levels, and directly around interventions. So there's a $1 value that comes out of out of the federal government that says for one suicide, it costs the Australian community $4 million. So we did 140 interventions in three months, so times that by 4 million. And we're way ahead of the game in terms of that little $840,000 grant that we got.

Professor Maree Toombs

32:32

77% of people had a personal and lived experience with suicide. So we were very conscious of the fact that we didn't want to cause any more harm. And I'll take you through the model that we developed to, to not want to try to not cause harm in a moment. I'm 55% did a suicide intervention in six months. And then also, we got cited in the NICE international guidelines. I don't even know what they I had to look them up. But apparently, it's a big deal and it helped me get my promotion to Level E. So go those guidelines woo hoo. So basically, the model that we developed took the foundation of ASIST. We call it Indigenous ASIST. And based off what communities had said, across 90 communities nationally, they wanted to firstly have a community consultation collaboration, where we went in at least three months before we went in to do training to actually connect with community, build relationships, but also work out what those individual communities needed in terms of resources. So some communities, for example, wanted a translator. So we've just run a workshop, for example, out of Alice Springs in another place called Tea Tree. And in consultation with those groups, they needed a translator because English can be third, fourth, fifth or even sixth language. Some of these communities also wanted traditional healers, and other support mechanisms. Some communities did not want non Indigenous people coming to their training as well. So there were a whole lot of different things and factors that people wanted. Some communities had wrong way business, meaning that some groups actually couldn't be with each other. And so we had to factor in those things as well. But as you'll see here, 90 communities and organisations were consulted prior to the launch of this programme. In 2021, 6000 people we're up to about six and a half thousand people to date have now been trained in I-ASIST nationally and Canada and the US are looking at this as well may want to roll it out. And that's the protocol. So Community Engagement, Committee Unity connection, that piece then was really about making sure that we have space to yarn with mob about their own lived experience around suicide, before we go in and start talking about suicide for two days. So the ASIST programme, then non Indigenous version is just two days, in and out. For us, it's two to three months beforehand, going in and setting up for the workshop, that community connection piece, which connects people with their own stories and lived experience, and also gives people an opportunity to opt out if they find that the topic and everything's too heavy. In those 6500 people that we've trained, and in the pilot, we've only had one person opt out, and she was actually somebody I knew, and but everybody else has gone nope, nope, this is really important they've come in to do it.

Professor Maree Toombs

35:59

When they walk out of that community connection session, they're ready to come in the next day to learn the life saving skills of suicide intervention. And that's how we set it up. They do their two days of training. And then we offer ongoing support for the trainers for the participants, because there's lots of support for the person at risk of suicide. But when you do one of these interventions, and I've done four now actually did one on an Uber driver about three months ago, and he was thinking about suicide, and he was ready to go. And I just knew it, we had this intervention in the car and about a six minute taxi or Uber ride. Yeah, you get really good at it when you know what you're looking for. So, but ongoing support for people like myself and other trainers, because this is really tough. Okay, we also have ongoing support around training and upskilling, our train the trainers of which we currently have 14 nationally, and we're trying to grow that. And we're chasing funding at the moment to set up a training centre because this is a social enterprise model. So we want our train the trainers to have their own ABN. We want them to be able to deliver this in their own communities and receive the funding that the federal and state governments throw at places like lifeline to go directly to these these trainers and cut out the middleman. So it's a it's a way of getting people out of poverty as well. So we're really, really aiming for that.

Professor Maree Toombs

37:31

Okay, and this is the governance structure. We have some of the biggest heavyweights in Australia on our governance committee, including the beautiful Professor Pat Dudgeon, which you have probably heard of, and other big, heavy hitters as well. So this is heavily supported by community. It's heavily supported by government. And it's heavily supported by Indigenous academics and Kickass. Academics, I'll say in this country. All right. So just quickly, the specific requirements are it has to be delivered by an Indigenous Australian. Okay. You can have a non Indigenous code trainer, but they need to be somebody that the Indigenous trainer knows really, really well. And they have to undergo cultural safety training as a bare minimum. But we generally only accept people who have been working in Aboriginal communities for a long period of time, because the whole thing is, do no harm. And this fellow here, I've got to share this story. I may not get to the mob band. But this guy here was one of our participants out at a place called Okie. And on the day two of the two day training, people are asked to go home and do some homework. And it's self care. So I always go and buy lipstick, because I love lipstick. That's my sort of self care wherever I am, unless I'm in a really remote town. And then I might go try and get myself a nice glass of wine or something. I don't know. Everybody's got their thing. This guy went home and painted this incredible framework of how he actually saw theI-ASIST programme. And that's his beautiful little daughter. And they just randomly showed up at my work one day, he was looking really sheepish, because he did an original painting and then living works, who we now work with commissioned him to paint like what he had painted on, you know, a rough piece of board into something beautiful that we use. And so the model that I showed you is the I-ASIST framework is a framework, but this painting is its intention. So he showed up and presented that for his homework and it looks like this. So In the centre there, with the dots around it, they're are knowledge keepers are custodians that learn how to be a I-ASIST trainer. So they come and they do a five day workshop, they then take that knowledge and information back to their communities. And the blue represents water. And water is a really important base for all Aboriginal and Torres Strait Islander peoples. So they take that knowledge back to their communities. And they share that through the training that they deliver, which creates helping hands so the more people in community that know these skills, the safer the communities are, and really quick example Cherbourg up in west of Brisbane, that's where my family were actually sent to. But Cherbourg 1200 people they had 11 young people take their lives in 11 months during COVID. We went in there and saturated that community with I-ASIST . And it's got a younger brother called Safe yarn. And we went 18 months without a single suicide. And that community then set up stickers that they put on doors and letter boxes that signified to kids and anybody in that community if they were feeling that they were having thoughts of suicide, or they just needed a hug or whatever, they could knock on that door, anytime, day or night. And so 18 months without a suicide, we've had one in the last 12 months, so still a lot better than 11 in 11 months. The piece in between on the top and the bottom there that represents the safety net. So we want all of Australian Aboriginal Torres Strait Islander communities and towns and spaces and places where Aboriginal and Torres Strait Islander peoples live

Professor Maree Toombs

41:54

adequately supported through this programme through networks that facilitate north, south, east and west. And over there in the final area is an acknowledgment of those that have passed due to suicide and they've gone to their dream time. And that nails it. That's exactly what this is. And yeah, and that guy is absolutely incredible. All right, here's some of our people that we trained, we got some videos done as well, because the Canadian videos were very Canadian. So we got some funding from we got some funding from Primary Health Network in Melbourne. And we have some professional actresses here that was actually filmed at my brother's house in in Melbourne, which is hilarious. And there's some other people are and these young people up there on the right hand side. They're all actors and actresses at a at an academy in Brisbane. And they did the first kind of like pilot version of those videos as well. And we use those to then do the professional ones. So this, this little clip was shown at the launch of I-ASIST, and we had 3000 people show up for it. So it was a webinar. And we had politicians Ken Wyatt at that point was the Minister for Aboriginal Affairs.

Professor Maree Toombs

43:22

Yer - hit the button

VIDEO

43:27

So my daughter's name is Pierre and Pierre was 32 when she died mental health was a tough one and I didn't have any asist training, exposure. If you've got asthma, you know where to go. If you got diabetes, you know where to go. But if you're in trauma and suicide thoughts, you have nowhere to go. The others may take your life in time. But this one takes your life in moments.

VIDEO

44:02

Hi, my name is Maree Toombs and today I'm very proud to introduce you to a world first Indigenous led suicide intervention training programme. This programme came about through an NHMRC grant that we spent the past four years working with communities nationally and have landed on this amazing programme that we call I- ASIST. I- ASIST came about through initially getting some funding through the National Health and Medical Research Council to look at a way to work with Aboriginal and Torres Strait Islander communities to reduce the rates of suicide. The big issues that are confronting us is the high rates of Aboriginal and Torres Strait Islander suicide.

VIDEO

44:50

We understand that what suicide was

VIDEO

44:54

during my time doing the non Indigenous version of ASIST that I became very, very aware that my own brother was at risk of suicide. Through doing the programme, I was actually able to conduct an intervention on him and it gave me the tools that I needed to understand what to do. Once I realised the capacity of this programme. I bugged the daylights out of living works, and particularly Shane Connell, to see if we could work with this programme in Aboriginal communities.

VIDEO

45:28

At Living works, we're incredibly proud of the development of I-ASIST, not only because of the life saving skills that will be able to be delivered for communities across Australia, but because I-ASIST is truly co designed and community led.

VIDEO

45:44

We took the programme into multiple communities across Australia. And we spoke to the framework of the programme, which is really intuitive to the way that we do culture because it was on a level that they totally knew and could relate to As Indigenous leadership is grounded in Indigenous Knowledges, I-ASIST enables skills to be taught in a culturally safe and inclusive environment, it teaches the skills to save lives.

VIDEO

46:15

While this is designed for Indigenous people or those closely supporting Indigenous people. Through it's unique protocols and cultural nuances, it provides a vastly better learning experience, resulting in positive engagement.

VIDEO

46:26

It speaks of story, it speaks of deep listening, and it speaks of empowering the individual and the community to work together to keep somebody safe from suicide. The education gave people the knowledge of being able to ask like are you okay? have noticed that you're, you're like you're different to how you normally are. I think once people know, when you're either a trainer or trained in this, you're then a person that they can go to. It's really taught me to be able to use my ears and listen and to be able to sit in people's pain and be able to respond in an effective manner. And I have been able to save a number of lives so far

VIDEO

47:06

When you're in that moment with somebody, and you're not sure of what to say or what to do. Do this training because it will help you and it will help save lives. I-ASIST is a tool that we can take back to our mob and take back to our community and train them to be confident and be ready to provide an intervention to prevent suicide. The wonderful thing about this programme is it's the first of its kind in the world, but two it's a social enterprise model,

VIDEO

47:36

It will create employment opportunities for Indigenous trainers to be able to work within their communities to be a resource in developing these skills.

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47:44

This programme is a celebration of the efficacy and self determination that Aboriginal peoples have, and how we when we come together collectively able to do great things. We applaud the continuation of I-ASIST the and it will make a difference for our communities. It provides a holistic way to approach suicide so that one day, we can say that we have zero suicide in our communities.

Professor Maree Toombs

48:14

Okay, and all I did was get some to get some money and facilitate that that is all that community like and I'm just so proud of them. All right, the mob then I will rush through this, but this is a this is just I love this little van. So 2012 I got my first bit of funding $298,000 to, um, through health workforce Australia. I don't know if you remember those guys. But anyway, I got some funding. And it was to set up a mobile health clinic for medical students and allied health students to provide primary health care in an underserved Aboriginal area. So I lived in Toowoomba for 25 years, because of my husband and I'll blame him for that. And it was actually the space out of the whole of Australia that voted no the most 15% said yes in that community so I ain't going back. But just outside of Toowoomba, there's a community called Warwick so and it's quite a large rural town, so about 20,000 people. And there's a lot of mob that come into that place from other areas further out. So they come in from Gundawindy and Toomalah and a heap of places and spaces. And they said look, we really need a clinic down here. So I approached Queensland Health and the Warwick hospital and was told by the superintendent I don't even know what they're called I should I sit on that board now. But anyway, whatever they're called. We have no Aboriginal people in this community and I'm like, you do. Well, we don't see them. The only ones that we see show up in the emergency department and they're acute, and they usually die. And I was like, what is this guy like, what the hell? And so I said, Well, if we get if we like, bring this van down here, and let's just see if there's people around, can we put it at the hospital? And the answer was no. So I think you're getting the gist of this community. So I approached the local council and they said the same thing. We don't have many Aboriginal people in this town. If Queensland health won't house it, you can put it in the park in the middle of town, but it's on you. If it's vandalised, if it's whatever it's on you. We'll stick it under a light. And that's the best we can do. And so I went back to the community and said, Look, this is the go, what do you reckon they're like, bring it down.

Professor Maree Toombs

50:53

So we got it all designed and it looked like that and when we drove it from Brisbane, back to Toowoomba, and then down to Warwick, holy Dooley the looks we got and people up like noses stuck to their windows looking at it because the first time something like this had really been put together. And we got into Toowoomba. And I've got to try and say this without crying, but we're driving down the main drag and this bunch of Aboriginal kids saw it and they started chasing us. And I'm like pull over and they've got their phones and we pulled over and they're lying all over the jeep and posing and photos. And then they said is this for us? And I said, you bet this is for you. And so we just knew at that point that this was going to work. So it's down at Warwick, it's in the park, and we had a two Aboriginal Health Workers, a GP that we'd pulled out at one of the clinics in Toowoomba, the Aboriginal Medical Service and some other staff and we set up shop day one. One elder walk past gave us a bit of a look and a wink and kept going and a kid showed up and kicked his ball over near us. So we're like, Would you like a lollipop? You wouldn't do that now, but it was a cute little kid. And he trotted off the next day. We were bombarded. So within three months, we had 900 Aboriginal and Torres Well, I think we had two Torres Strait Islander peoples on the book but predominantly Aboriginal people accessing that van we had kids that had never been vaccinated. We had women that had never had access to contraception and, and women's health programmes or anything. So these people were, whilst in a fairly rural accessible area to get good health, were not accessing it because the services were culturally unsafe.

Professor Maree Toombs

52:50

So the state government heard about the success of this and they funded us $3 million to set up a fixed clinic. And we went back to Queensland Health and said, hey, can we use your dodgy rundown crappy little building down the road? I didn't say that. But it was a rundown crappy little building down the road, Queensland Health. And said can we use that to set up this clinic? They took a month to deliberate and they came back and I swear down they said yes, but your clients cannot use our toilets. And I was like, game on Game on. So, I went and found the flashiest building that I could find in that town. And it had a glass lift with a gold chandelier in it. And, and we we set this thing up and we set up and it became really successful. So we ended up with three and a half thousand people on the books within two years of opening that clinic. And we then negotiated with a builder who was looking for someone to like purposely bid out something that he would build. So we went go for it. And we ended up with this beautiful clinic that we launched in I think it was 2016 I'm actually not sure and that is a state of the art. We have seven doctors that work out of that some are registrar's some are senior doctors it has dental chairs, and a lot of the non Indigenous peoples that live in Warwick come there because it's far superior to anything else that they receive. So I'll leave it there but that that's a story in itself. I did get my revenge. Well let's well let's not call it... No it is a revenge. I got my revenge on that particular hospital because I now sit on the Darling Downs Health Service Board. And it's one of our hospitals. And they run the minute we go and do a meeting down at Warwick, but things have changed a lot. But yeah, I'll leave it there. So thank you very much.

Diego Silva

55:15

So that's it. Thanks for listening to Professor Tombs conversation. Thanks for listening to this episode of The SHE research podcast. I hope you enjoyed it. This is the last one for the year. We'll we'll reconvene and we'll see you again early next year. You can find this episode with its transcripts attached. The SHE pod is produced by she network and edited by Regina Botros. Thank you, Regina, for all your amazing work this year. You can find our other episodes and Spotify, radio public, anchor or wherever you get your podcasts that's quality. Thanks for listening. Miss you Miles. Goodbye.

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