Evaluation of the Bringing them home and Indigenous mental health programs

9.2 The BTH Program

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9.2.1 A flexible approach extending beyond the mainstream clinical counselling model

A critical issue raised about the BTH program was the need to ensure that services are offered in a broad range of ways which extend beyond the mainstream clinical counselling model (and may not even be labelled as 'counselling' to clients at all). This is critical in order to appeal to as broad a range of clients as possible, particularly groups which are 'harder to reach' such as first generation Stolen Generations members and men.

They [men] hold it in a lot more than we do – women sit down and cry about it, but men don't.
(BTH client)

This approach should offer group activities – including in community settings in which participants are comfortable – as well as one-to-one counselling. This may encompass for instance, barbecues or fishing trips, trips to the bush or river or men's groups. These activities can include 'sitting around and having a yarn' which is in effect a group counselling session. These are widely considered to be healing activities.

Men's camps, it's an essential need, some of these brothers been in the big house [prison] a few times, some come out a bit screwed up culturally, take their frustration out on their family. Sometimes you have to get out of the community, talk about the problems. … a lot of us don't talk honestly with our wives because it's too hard.
(BTH client)

I went to the camp run by the health service which was only for the lost and Stolen Generations people for our region. We learnt about attachment, bonding and self-protecting techniques. We had yarn up sessions and were able to speak to a qualified psychiatrist who had done the cultural awareness training provided by the health service. It was run by Indigenous people who had an understanding of our issues. We all had the same type of issues – removal, kids being removed and drug and alcohol. I am so happy that we now have dedicated workers and more appropriate healing approaches to support the Stolen Generations people and to meet our needs so we don't feel so isolated and alone anymore.
(BTH and Link-Up client) Top of page

A number of BTH services conduct at least some of these group healing activities (eg Katherine in NT, East Gippsland in Victoria and Taree in NSW), but some do not conduct any. Those services which do so agreed that they often attract a different client base to the one-on-one counselling sessions. These low-level activities can mean that 'counselling' takes place in a context that is perceived as more relaxed, informal and safe than a one-on-one counselling session. Stolen Generations members who have lived in institutions may also find particular comfort in conducting group activities with others who have been through that experience. Group activities also provide an opportunity for participants to find out more about the BTH service and in some instances decide to attend for one-to-one counselling at a later stage.
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The consultations with BTH staff and clients also indicated that it is important for BTH services to adopt a very flexible approach to service delivery, including being available at short notice to clients when they wish to see a Counsellor, and also being open to clients 'dropping in' to the service on an informal basis without an official appointment. The Katherine BTH service and the Stolen Generations Organisation in Victoria reported that members of the local Stolen Generations group, including many first generation members, often just drop into the service for an informal chat with a Counsellor over a cup of coffee, rather than coming for a formal one-to-one counselling session.

Another critical factor for both Link-Up and BTH services is offering services on an outreach basis.

I don't like going into a medical service and sitting around. [The BTH Counsellor] knows I can't go anywhere. He comes to my house when I really need it. … I say can you be here in five minutes and he'll come over.
(BTH client)

The consultations suggested that practices vary considerably in relation to the provision of outreach work. Some BTH services do this very well – for instance, some conduct regular outreach work to prisons (eg Shepparton, Melbourne) including some who have dedicated positions solely for this activity (eg Sydney, Adelaide). This is highly desirable, given that, as noted in chapter 5, prisons tend to have a high proportion of first and second generation Stolen Generations members.Top of page

Overall, most BTH services offer at least some outreach work, while some do very little or none. Most services acknowledge that ideally they would do more of this. Factors which appeared to promote greater use of outreach included having:

• a smaller geographical catchment area for the service (eg the Katherine, and the Victorian BTH services, which cover relatively small regional areas)
• ready access to a vehicle, preferably a designated vehicle for the sole use of the program
• a larger number of staff in the team, meaning staff absences are easier to manage.

It is important to note that there are duty of care issues to staff involved in conducting outreach work – for instance, two workers may need to be sent out for safety reasons in some instances.
BTH services should also promote contact with or development of good relationships with Stolen Generations organisations, including attending or complementing their activities as appropriate. For example in Katherine the BTH service allows the local Stolen Generations group to use their premises for their regular meetings, invites members to attend group activities, and as noted above members of the group often drop into the service to talk informally to a BTH Counsellor. A representative from one Stolen Generations group which has generally had a poor relationship with the local BTH service also expressed a desire for a BTH Counsellor to attend the organisation's premises on a monthly basis to provide services to members. There would also be scope for BTH Counsellors to attend other group activities organised by Stolen Generations groups.

GPP10:

BTH services should adopt a flexible approach to service delivery that extends beyond the mainstream clinical counselling model. This includes conducting group activities in community settings, encouraging clients to drop into the service on an informal basis, being available at short notice, and offering services on an outreach basis. BTH services should liaise closely with Stolen Generations organisations to ensure that services meet the needs of these groups' members.

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