Evaluation of the Bringing them home and Indigenous mental health programs

8.1.2 Variable skill levels of Link-Up and BTH staff

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There was much discussion (and some contention) amongst those consulted as to the skills and qualifications necessary for both Link-Up workers and BTH Counsellors, particularly the latter. The standard BTH contract with services does refer to a requirement that BTH staff 'have the appropriate qualifications and/or skills, or are trained and supported to work in this field', but does not provide any more specific requirements. In the consultations, stakeholders emphasised the need for both formal, university-based, 'western style' education, and culturally appropriate, Aboriginal-specific, narrative-based training.

The consultations clearly indicated that there are variable levels of skills and qualifications amongst staff employed for the Link-Up and BTH programs, with some having very high levels of skills/ qualifications, some having very low levels, and others having skills between these two ends of the spectrum.

For instance, a key activity undertaken by Link-Up staff is accessing records to trace clients' family members that they have been separated from. It was reported that AIATSIS and various other record agencies have found that Link-Up staff are not making the most effective use of AIATSIS's enquiry service and in turn other record-holding agencies.

Only a minority of BTH Counsellors have mental health qualifications

One issue of concern in relation to variable staff skill levels, as noted in chapter 6, is that only a minority of BTH Counsellors have formal mental health qualifications in counselling or psychology. This conclusion is supported by both the consultations and data from the BTH Questionnaire for the financial years 2001-2002 through to 2004-2005. The latter data source shows that:

• In both 2003-2004 and 2004-2005, the majority of BTH Counsellors had some type of degree, diploma or formal training ie a psychology, mental health, social work or other degree; a diploma or certificate in mental health; or a mental health nurse (which requires some specific training after the generic nursing training).
• The education levels of BTH Counsellors were high in the period 2003-2004 and 2004-2005, with around 75% of counsellors holding academic qualifications. However, only a minority (45% in 2003-2004 and 41% in 2004-2005) of counsellors held formal qualifications in a mental health discipline ie psychology, social work or mental health degree, a diploma or certificate in mental health, or a mental health nurse.
• Over the four year reporting period (2001-2002 through to 2004-2005), there have been marked decreases in the number of BTH Counsellors with diploma/certificates in mental health or who are mental health nurses, and some increase in the proportion holding a psychology degree (see figure 8.1).
• The proportion of BTH counsellors with appropriate skills and experience, as judged by the community, also declined markedly over the four reporting periods: 64% in 2001-2002, down to 41% in 2004-2005 (see figure 8.2).

Associated with the fact that only a minority of BTH Counsellors have formal mental health qualifications, most BTH staff do not operate as 'counsellors' in the formal or Western sense (although many do act in this capacity at an informal, and often more culturally appropriate, level). In rural and remote areas in particular, where it is difficult to attract skilled staff and where health and community services cannot meet demand, BTH Counsellors often perform a de facto community worker role. Some BTH staff without mental health qualifications deliberately call themselves, for instance, 'BTH support workers' rather than counsellors to avoid giving community members the misleading impression that they are qualified counsellors.

Skills and life experience clearly cannot be discounted in selection of BTH Counsellors. The majority of BTH clients are also not suffering from clinical mental disorders (as discussed in chapter 5). Nonetheless, in the consultants' view, the fact that most BTH Counsellors do not hold formal mental health qualifications is a concern for a large national counselling initiative such as this. This is particularly true given that the issues being dealt with (Stolen Generations issues) are so complex, demanding and inter-generational. It is unlikely that this situation would occur in a major national mainstream counselling program on similarly complex issues (eg relationship counselling or sexual assault).

Ideally each BTH Counsellor employed should possess both formal mental health qualifications and cultural sensitivity skills. However, this may not always be possible – for example, non-Aboriginal people may be available with formal qualifications (only), and Aboriginal people may be available with cultural sensitivity skills (only). In our view, the critical issue here is ensuring that there is an appropriate mix of skills within each BTH team to ensure that both formal mental health qualifications and cultural sensitivity skills are represented and shared between team members, to ensure that the service delivered is both clinically rigorous and culturally appropriate. Further, where the BTH Counsellor is non-Aboriginal, it would be preferable for the Counsellor to work with an Aboriginal team member in counselling situations.

If both sets of skills are not represented within each BTH team, it is more likely that other problems will arise, including:

• services not best meeting clients' needs
• services being more prone to provide a more generic Aboriginal SEWB program versus a counselling program targeting the Stolen Generations (a common problem, discussed in chapter 6)
• staff being at higher risk of experiencing burn-out
• services being more likely to need to refer clients on to other counselling services for support. Given the lack of Aboriginal SEWB services available other than the BTH program (discussed in chapter 5), this somewhat defeats the purpose of having the BTH Program to provide culturally appropriate counselling services (except for cases where clients have clinically defined mental illness and require specialist care).

There are similar issues regarding the need for a mix of formal qualifications and cultural sensitivity skills for Link-Up staff also (although there was less discussion of this amongst those consulted).

The inclusion of a mix of skills within staff teams, a relatively new concept now recognised at a national policy level, is consistent with the Social Health Team. The Social Health Team refers to the co-opting of various specialist skills from primary health care settings into a team to address the SEWB (as well as health and physical well-being) needs of clients in a holistic manner.

Figure 8.1: Type of formal qualification held by BTH counsellors, 2001-2002 to 2004-2005

*The number of counsellors in this category is not available for 2001-2002 or 2002-2003.

Text version of figure 8.1

Figures in this description are approximate as they have been read from the graph.

Type of qualification	2001-2002	2002-2003	2003-2004	2004-2005
Social work degree	7	17	16	17
Psychology degree	9	16	21	16
Mental health degree	4	2	4	4
Mental health nurse	6	5	3	1
Diploma/certificate in mental health	32	12	5	5
Other diploma/certificate	27	19	21	27
Other degree	6	8	10	8
None*	*	*	27	26

Figure 8.2: BTH Counsellors with appropriate skills and experience (as judged by the community) and personally affected by stolen generations practices

Text version of figure 8.2

	2001-2002	2002-2003	2003-2004	2004-2005
Community people with appropriate skills	64	53	41	41
Personally affected by Stolen Generation practices	45	29	32	31

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