Evaluation of the Bringing them home and Indigenous mental health programs

8.1.3 Reasons for recruitment and retention problems

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The consultations and BTH Questionnaire data provide a consistent picture of the range of issues that contribute to the difficulties Link-Up and BTH services experience in recruiting and retaining appropriately skilled and qualified staff. These issues include:

• The combinations of quite specific skills which are ideally required for these positions. As discussed above, those consulted felt that there was a need for both formal, university-based education and culturally appropriate, Aboriginal-specific narrative-based training for Link-Up and BTH workers. It was also noted that Link-Up staff need skills both in working with Aboriginal clients and in desk research type skills (to enable record-searching). Stakeholders noted that it can be difficult to find staff with the combination of all the skill sets required.
  
  
• The nature of the work is emotionally stressful, considering the traumatic nature of the issues clients may have been or are currently experiencing.
  
  
• Caseloads are too large. The level of demand for the services delivered through BTH and (particularly) Link-Up Services was consistently said to exceed the capacity of these services to respond adequately and promptly, given the number of staff employed, leading to inordinately heavy caseloads. The average case load for a mental health worker in a mainstream service is 25, whereas the case loads of BTH and Link-Up staff can exceed 80.
  
  
• Community expectations of workers are very high. Aboriginal staff can face particularly high demands to meet community expectations, be on duty '24/7' and act as a 'one-stop shop' for Aboriginal people in the community. There may also be further complications for Aboriginal staff arising from family and other connections with clients and potential clients in the community.
  
  
• Salaries in some locations are uncompetitive, considering the skills required of workers. One factor contributing to this for BTH services is the marked variations in the proportion of funding retained by ACCHSs for each Counsellor position to cover management/overheads costs. OATSIH provides a set amount of funding for each Counsellor – $95,818 in the 2006-2007 financial year – which needs to include all costs associated with that position. In some locations the proportion retained by the ACCHS for management/overheads (after on-costs such as superannuation) may be up to a half, which greatly reduces the amount of funds available for BTH Counsellors' salaries. One OATSIH State office reported receiving complaints about major disparities in salary rates amongst workers – the lowest salary paid was $11,000 for a part-time position and the highest $74,000 for a FTE (with most positions funded at an average of $41,000). This would leave an average of $53,000 retained by the ACCHS for management and overheads. The recognised standard in the community services sector is for auspice organisations to retain 15% of funds for management/ overheads.
  
  
• Access to professional training and support is variable and often inadequate. This issue is discussed in more detail later in this chapter.
  
  
• Particularly acute problems exist in regional and remote areas, due to factors such as a general workforce shortage, limited professional and personal opportunities for staff (including professional isolation and limited access to staff development opportunities), lack of suitable housing and greater problems associated with personal connections with clients in the community etc.
  
  
• Aboriginal people are very aware of the huge impacts on workers' individual SEWB while employed in these positions.

One BTH Counsellor summarised many of the above challenges of the job:

The AMS, Indigenous community, government and mainstream have no idea what we go through in these positions. There are high expectations from everyone. You never get the positive comments about the work you do. Only get the negative comments and some people just don't understand that you can't deal with more than 30 or so Indigenous clients at one time. This would never be allowed in the mainstream. Mainstream would stipulate the amount of clients you can provide a service to. In black affairs, it is all about provide a service to everyone who wants it even if you are only one person for hundreds of people. What about my SEWB?

It is clear that the difficulties recruiting and retaining staff for the Link-Up and BTH Programs is part of a much broader problem involving a shortage of Aboriginal people with appropriate skills and qualifications relevant to these programs. This in turn is linked to a range of issues including:

• Aboriginal people experience much higher levels of educational disadvantage, connected to their much higher levels of disadvantage on a range of other indicators.
• Aboriginal SEWB is only a relatively new and undeveloped field (as discussed in chapter 4 and appendix B).
• Generic mental health qualifications do not give adequate coverage of Aboriginal SEWB issues, and there is a lack of good career paths for those working in the Aboriginal SEWB field. For those workers with skills or qualifications in this area good career paths are primarily only available if they go into the mainstream mental health system.
• There is a lack of specific training available for people wanting to become BTH Counsellors.

Aboriginal status of BTH Counsellors

The problems discussed above can make it more difficult to employ Aboriginal staff. Stakeholders consistently emphasised the importance of life experience and empathy with issues affecting Stolen Generations clients in the employment of BTH Counsellors. At the very least, it was said to be preferable to recruit Aboriginal individuals to Link-Up and BTH positions. While this is generally desirable for any Aboriginal program, it appears particularly critical for these programs, given that they connect so closely to the self-identity and cultural experiences of Aboriginal people. (It should be noted however that on occasion Aboriginal clients may prefer a non-Aboriginal BTH Counsellor due to concerns about confidentiality and/or personal connections with the counsellor.)

The proportion of Aboriginal counsellors has declined somewhat over time (72% in 2001-2002 down to 62% in 2004-2005), as shown in figure 8.3.

The consultations indicated a tension here, in that where services are stricter about requiring formal qualifications (eg for BTH positions), it is harder to find Aboriginal staff who meet these criteria. For example, one service which has adopted this stricter approach does not have any Aboriginal staff amongst the three BTH Counsellors employed.

Figure 8.3: BTH counsellors who are Aboriginal

Text version of figure 8.3

Proportion of BTH counsellors who were Aboriginal:

• 2001-2002 - 72%
• 2002-2003 - 66%
• 2003-2004 - 63%
• 2004-2005 - 62%

Stolen Generations experiences of BTH counsellors

Connected with the issue of Aboriginal status, is the issue of whether it is desirable for BTH Counsellors to have personal experiences as Stolen Generations members. The consultations indicate that some, but certainly not all, of the Aboriginal BTH Counsellors have this experience. Data from the BTH Questionnaire indicates that the number of counsellors who had been directly affected by Stolen Generations practices declined over the four reporting periods (45% in 2001-2002 to 31% in 2004-2005).

The consultations indicated that BTH Counsellors having their own Stolen Generations history can have both advantages and disadvantages. On the one hand, it can be beneficial in giving workers greater understanding of the experiences of their clients, and some clients with BTH Counsellors having this history commented favourably on this fact.

On the other hand, a Stolen Generations history can also be a disadvantage, if workers have not fully dealt with or resolved their own issues. This can contribute to a higher risk of staff burnout and more blurring of boundaries in terms of who is the client requiring assistance. It is therefore important to ensure that where applicants for BTH positions do have their own personal Stolen Generations histories, they are far enough advanced on their own personal healing journey to be in a position to effectively assist clients of the service without their own issues interfering with this process.

This is a common issue with many service delivery areas dealing with personal problems (such as substance abuse) – they tend to disproportionately attract people with their own experiences of that issue, which can give them greater empathy with client's problems as well as greater risk of burnout.

Gender of BTH counsellors

In terms of the gender of BTH Counsellors, data from the BTH Questionnaire indicates that the number of female BTH counsellors has consistently outnumbered the number of male counsellors since 2001-2002. While there was a significant drop in the proportion of male counsellors in 2002-2003, this has since been remedied. The proportion of female BTH Counsellors remains at around two-thirds of the total workforce. (These trends are illustrated in figure 8.4.)

In one view, the predominance of female BTH Counsellors is not a major concern given that there is a significant and similar predominance of female BTH clients – as reported in chapter 5, around two-thirds of BTH clients are female. However, it may also be that the predominance of female counsellors is contributing to the predominance of female clients. The consultations indicated that ideally clients should be offered a choice of a male or female counsellor (and Aboriginal or non-Aboriginal) in order to meet client needs, and that at least some clients will have a strong preference for a counsellor of the same sex as themselves.

Having male counsellors available may therefore be an important factor in increasing the proportion of male clients. As discussed in chapter 9, male clients tend to be a 'harder to reach' group, and similarly to first generation Stolen Generations members, can tend to prefer counselling approaches other than the traditional one-to-one clinical model (eg group activities in community settings).
For example, one BTH service which temporarily had a male (non-Aboriginal) BTH Counsellor acting informally in the role while the position was vacant found that there was a marked increase in the number of Aboriginal men (particularly first generation Stolen Generations members) approaching the service during that time. All these male clients came to the service by word-of-mouth through other male clients and through Aboriginal community activities.

However, the total number of BTH Counsellors in any one service may place some constraints over whether clients can be offered a choice of both Aboriginal status and/or gender.

GPP7:

In most instances, Aboriginal clients prefer to see an Aboriginal BTH Counsellor. In some instances this may not be possible, or clients may prefer to see a non-Aboriginal BTH Counsellor. Where possible, client preferences should be accommodated. Likewise, clients should also have a choice of a male or female BTH Counsellor, as appropriate.

Figure 8.4: Gender of BTH counsellors

Text version of figure 8.4

Gender	2001-2002	2002-2003	2003-2004	2004-2005
Female	60	72	68	67
Male	40	28	32	33

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