Health and wellbeing

Our shared commitment

Self-determining, healthy and safe Aboriginal people and communities.

Holistic approaches to Aboriginal health and wellbeing are critical to improving outcomes. This includes not only considering the physical, mental and social determinants of Aboriginal health, wellbeing and safety, but also the cultural determinants, such as connection to culture and Country. While many Aboriginal Victorians report good health, health inequities remain.

Together, government service providers, Aboriginal organisations and communities must take significant steps to ensure that all Aboriginal Victorians have access to high-quality, culturally safe and responsive health care services. Improving overall health outcomes and having a good quality of life is a basic necessity to ensure all Victorian Aboriginal communities can thrive.

Goal 11: Aboriginal Victorians enjoy health and longevity

Overview

Measures under Goal 11 have remained stable

Historically Aboriginal Victorians have experienced shorter lives due to the ongoing effects of colonialisation.  Reversing that trend is key to a more self-determined future.

Lung cancer was diagnosed in Aboriginal Victorians more than any other cancer between 2016-2020.  Promisingly, rates of daily smoking are decreasing year on year.  There have also been minor decreases in the number of potentially preventable hospitalisations.

Concerningly, less Aboriginal Victorians reported they were in excellent or very good health in 2020.  Some of that may be attributed to the COVID-19 pandemic.

Data note                                                                            

The following measures rely on datasets that are infrequently collected. No new data was available at the time of reporting.

• Measure 11.1.1 Life expectancy at birth, by sex

Goal 11 directly aligns with the following Closing the Gap Outcome and Target

Outcome 1 People enjoy long and healthy lives

• Target 1 Close the gap in life expectancy within a generation, by 2031.

Closing the Gap – How Victoria is tracking nationally

Outcome 1: Nationally, Aboriginal and Torres Strait Islander males born in 2015–2017 are expected to live to 71.6 years and females to 75.6 years, and non-Indigenous males and females to 80.2 years and 83.4 years respectively.

Nationally, based on progress from the baseline, the target shows improvement but is not on track to be met for males or females.

Aboriginal and Torres Strait Islander estimates of life expectancy are currently not produced for Victoria due to the small number of Aboriginal and Torres Strait Islander deaths reported.

 

11.1 Improve Aboriginal health status, quality of life and life expectancy

Measure 11.1.2 Proportion reporting ‘excellent or very good’ health status, by sex

Aboriginal Victorians were less likely to report they are in excellent or very good health in 2020 than 2019. Age standardised results for self-assessed health status from the Victorian Population Health Survey (VPHS) have declined to 29.7 per cent of respondents, down from 32.2 per cent in 2019. Historic results for Aboriginal Victorians for this question have not had a consistent trend, so the decline in 2020 may be attributed to variation in response. 

Continued effort is required to increase survey response rates and make sure Victorian Aboriginal voices are heard in a culturally appropriate way within health reporting.  The 2020 VPHS was conducted in September of 2020 during the COVID-19 pandemic and results may have been affected.

Measure 11.1.3 Rate of daily smoking

Smoking is the leading cause of lung cancer and contributes to poor health outcomes.

The proportion of adult Aboriginal Victorians who said they are daily smokers has dropped from 30.6 per cent in 2019 to 22.0 per cent in 2020, according to the VPHS.  This decline is part of a longer-term trend of reduced daily tobacco smoking for Aboriginal Victorians.  If this trend continues Aboriginal and non-Aboriginal rates of daily smoking should reach parity in the coming years. 

Measure 11.1.4 Rate of hospitalisations for potentially preventable causes (vaccine preventable, acute, chronic and all)

The rate of hospitalisations for potentially preventable causes declined for Aboriginal Victorians by 15.8 per cent to 54.8 hospitalisations per 1,000 people. This is the first significant decline since 2012-13. When breaking down the causes of potentially preventable hospital visits chronic illness accounts for 55.1 per cent of hospital separations. For all causes recorded separations in the past year have declined with vaccine related and acute related separations both declining to 4.1 and 21.1 separations per 1,000 population respectively.  A separation is the process by which an episode of care for an admitted patient is completed.

While this decline is promising, Aboriginal separations at hospitals for potentially preventable causes is still at a historic high.  When comparing the long-term trend against the non-Aboriginal population; while the rate of Aboriginal separations has grown 53.5 per cent since 2007-08 the non-Aboriginal rate has decline 20.0 per cent.  There are many potential causes for this, including the ongoing effects of colonisation, dispossession, and systemic racism mean that life expectancy for Aboriginal Victorians is significantly lower than for non-Aboriginal Victorians.  Preventative medicine and culturally safe medical practices are critical to reversing this trend.

Measure 11.1.5 Incidence of selected cancers

Aboriginal Victorians were twice as likely to be diagnosed with cancer than their non-Aboriginal peers between 2016 and 2020.  The most common cancer types diagnosed for Aboriginal Victorians were lung, breast, prostate, and bowel which account for 46.1 per cent of all cancer diagnoses.  Since the 2012 to 2016 reporting period, the incidence of lung cancer among Aboriginal Victorians has grown by 66.9 per cent to 232 in the 2016 to 2020 reporting period.  For non-Aboriginal Victorians, lung cancer grew only 11.4 per cent in the same period.  Some of this may be attributed to increases in self-identification of Aboriginal Victorians.   

Measure 11.1.6 Rate of emergency department presentations for alcohol or drug-related harm

The rate of Aboriginal Victorians of all ages presenting at the emergency department for alcohol or drug related harm increased each year since 2018-19 and more than tripled since 2008-09, reaching 39.3 per 1000 presentations in 2020-21. When looking at Aboriginal Victorians aged 15-24, the rate of presentations at the emergency department for the same cause almost doubled since 2008-09, reaching 21 per 1000 presentations in 2020-21. However, unlike the rate for Aboriginal Victorians of all ages presenting to the emergency department, the rate of Aboriginal Victorians aged 15-24 presenting at the emergency department decreased each year since 2018-19.

The rate of non-Aboriginal Victorians presenting at the emergency department for the same cause has remained significantly low, relative to non-Aboriginal people. The latest reported rate for non-Aboriginal Victorians of all ages and non-Aboriginal Victorians aged 15-24 was 5.4 and 5.5 per 1000 presentations respectively in 2020-21.

In Victoria, Aboriginal and Torres Strait Islander people experience fatal overdoses at a rate more than three times higher than non-Aboriginal people.[1]

 

[1] ‘Coroners Aboriginal Engagement Unit and Coroners Prevention Unit (2023). Fatal overdose among Aboriginal and Torres Strait Islander people, Victoria, 2018-2021.’

Measure 11.1.7 Specialist alcohol and other drug treatment services provided to Aboriginal Victorians

Since 2018-19, the rate of closed episodes of care for alcohol and other drug treatment increased each year for services accessed by both Aboriginal and non-Aboriginal Victorians. In 2020-21, this rate was 11 times greater for Aboriginal Victorians than non-Aboriginal Victorians. Increases in closed episodes of care may suggest that once treatment is sought, it is effective at reducing the need for future treatment.  Counting rules for this measure mean that a treatment episode is considered closed where any of the following occurs: treatment is completed or has ceased; there has been no contact between the client and treatment provider for 3 months; or there is a change in the main treatment type, principal drug of concern or delivery setting.

Lockdown restrictions and increased alcohol sales during the COVID-19 pandemic may have contributed to an increase in risky drinking and use of alcohol and other drug services. Ensuring that the risk of alcohol and other drug related harm is reduced for the community requires a greater focus on increasing protective factors and preventative measures, as well as ensuring access to high quality, culturally safe alcohol and other drug treatment services.

 

Goal 12: Aboriginal Victorians access the services they need

Overview

Measures under Goal 12 have worsened

Universal health services provided to Aboriginal people have often not met the standard of cultural safety and tolerance of differing viewpoints that we expect of government services.  This has led in the past to a distrust of and an underutilisation of key medical services.

General health checks and health assessments for Aboriginal people over the age of 55 have decreased in the past year.  A greater number of Aboriginal Victorians are accessing aged care services, disability services and breast cancer screening. 

Data note

All measures under this goal are reported on.

Goal 12 directly aligns with the following Closing the Gap Outcome and Target

The National Agreement does not contain outcomes and targets that align with this VAAF goal. Victoria is pursuing more ambitious and comprehensive goals under the VAAF, which are reported on in this chapter and the Data Dashboard.

Closing the Gap – How Victoria is tracking nationally

Not applicable.

 

12.1 Improve access to health and community services for all Aboriginal Victorians

Measure 12.1.1 Proportion who received a health check or assessment by age

The count and proportion of all age groups who receive a health check or assessment have declined in 2021-22.  The largest decline in number is within the 0-14 age range with 2,304 persons checked a decline of 23.4 per cent.  There are similar declines for the other age cohorts with the number of Aboriginal Victorians aged 15-54 and 55+ receiving health checks declining 22.9 per cent and 15.4 per cent respectively.  Although it should be noted that the number of health checks on the three age cohorts (0-14, 15-54, 55+) have increased nine times, three times, and five times respectively their level at the baseline year of 2007-08.

Measure 12.1.2 Participation rates for cancer screening

The BreastScreen Australia program actively invites women aged 50-74 years to participate in the program. Aboriginal Victorian participation rates for breast cancer screening in the target age range (50-74 years) have been increasing from 2019-20 to 2020-21. This is compared to a decrease in the overall Victorian breast screening participation rate during this period as breast screening services were paused between 25 March and 11 May 2020. Upon resumption of service delivery there was a reduced screening capacity under additional infection control measures. Both 50-69 and 50-74 year old Aboriginal women’s participation in screenings increased by over 4 per cent to 32.9 and 33.5 per 100 people respectively with 40+ women remaining stable at 20.5 per 100 people. The long-term trend is also positive with Aboriginal women aged 40+ participation growing by 79.8 per cent for 40+ year olds (from 11.4 per 100 people in 2008-09), 62.0 per cent for 50-69 year olds (from 20.3 per 100 people in 2008-09) and 17.9 per cent for 50-74 year olds (from 28.4 per 100 people in 2014-15).  Breast cancer remains one of the highest detected cancers.  Early detection is key to provide adequate treatment and increase survivability.  

 

 

Measure 12.1.3 Proportion and number accessing the National Disability Insurance Scheme (NDIS)

As of December 2022, 5,599 people identifying as Aboriginal in Victoria had access to the NDIS. The proportion of these with an approved plan was 94.5 per cent (5,289) compared to 96.0 per cent for people identifying as non-Aboriginal.  A high number of people with access to the NDIS have an Aboriginal status not stated (27,592). To understand the full extent of access to the NDIS and the potential need for NDIS services, more needs to be done so that people with a disability feel safe to identify as Aboriginal.

Measure 12.1.4 Number and proportion accessing aged care services

The number of Aboriginal Victorians accessing aged care services has increased in 2021-22 to 1,215; a 22.6 per cent annual growth.  This represents 10.7 per cent of all Aboriginal Victorians. Over the longer term the number of Aboriginal Victorians in aged care has almost doubled since 2014-15 with 629 people accessing aged care services.  Culturally safe aged care facilities are an important part of late-stage life care.

 

Measure 12.1.5 Number and proportion of people aged 55 years or over who had an annual health assessment

In 2021-22, 1,440 older Aboriginal Victorians received an annual health assessment. This is a decline from 1,588 in 2019-20.  Over the longer term, the results are more positive with the number of assessments increasing 11.9 per cent since 2016-17 (1,287 people) and 158 per cent since 2011-12 (558).  There are many factors to consider when understanding the fluctuations of health assessments.  Long term trends can be understood to be both increased safety for Aboriginal Victorians to identify to health care professionals, a general aging of the Aboriginal population, and increased need for services.  The recent declines in health assessments were during the height of the COVID-19 pandemic and may have been affected by lockdowns, travel restrictions and the need to not overwhelm frontline medical services. Overall, annual health checks provided by ACCOs have been widely successful and the trend in the number of health assessment may change in future.

Measure 12.1.6 Services implement strategies, partnerships and campaigns, and offer care and support that is inclusive and address the needs of Aboriginal people who are LGBTIQ+

Victoria’s first whole-of-government LGBTIQ+ strategy, Pride in our future: Victoria’s LGBTIQ+ strategy 2022–32 was launched in February 2022. Priority area 2 is Equitable, inclusive, and accessible services. Implementation of the strategy is underway, including action to support Aboriginal and Torres Strait Islander lesbian, gay, bisexual, trans and gender diverse, intersex, queer, sistergirl and brotherboy (LGBTIQ+SB) communities. See below case study and further detail under Victorian Government investment and action section.

 

Goal 13: Health and community services are culturally safe and responsive

Overview

Measures under Goal 13 have worsened or remained stable

 

Data note

The following measures rely on datasets that are infrequently collected. No new data was available at the time of reporting.

• Measure 13.1.2 Proportion reporting positive client experience of GP services

Closing the Gap – Relevant Outcomes and Targets for Goal 13

The National Agreement does not contain outcomes and targets that align with this VAAF goal. Victoria is pursuing more ambitious and comprehensive goals under the VAAF, which are reported on in this chapter and the Data Dashboard.

Closing the Gap – How Victoria is tracking nationally

Not applicable.

13.1 Increase the cultural safety and responsiveness of services

Measure 13.1.1 Proportion reporting experiences of racism in the health system

Aboriginal Victorians experience racism at three times the rate of non-Aboriginal Victorians. For the 2020 VPHS, 16.5 per cent of Aboriginal respondents said that they had experienced racism in health settings in the past 12 months. This is compared with 5.3 per cent for non-Aboriginal respondents. It is difficult to determine the long-term trend for this measure using the VPHS as there are reliability issues with the results for 2018 and the question was not asked in 2019. 

Measure 13.1.3 Hospitalisations where patients left against medical advice/ were discharged at own risk

808 Aboriginal Victorians left hospitals against medical advice or were discharged at their own risk in 2021-22. This is a 1.1 per cent decline from 2020-21.  When analysing the long term trend the number of discharges has increased 34.2 per cent since 2017-18 (602 discharges) and 149.4 per cent since 2011-12 (324 discharges).  When analysing the rate of discharges per 1000 population it is clear that Aboriginal Victorians are discharged at their own risk at much higher rates than non-Aboriginal Victorians. In 2021-22 11.9 people per 1000 Aboriginal Victorians left hospitals against medical advice compared with 2.5 non-Aboriginal Victorians per 1000; a rate 4.8 times higher.

There are many factors to consider when understanding the cause of patients leaving hospital against medical advice. As per Measure 13.1.1, Aboriginal Victorians experience racism in health settings at 3 times the rate of non-Aboriginal Victorians. The impact of intergenerational trauma, distrust, and Western modes of care likely also influence experiences in the health care system.

 

Measure 13.1.4 Number and proportion of Aboriginal people employed in the health or social services sector

In 2021, 3,643 people employed in the health or social services sector in Victoria identified as Aboriginal.  The proportion of all workers in the sector who identify as Aboriginal has steadily increased since 2006 to 0.8 per cent of employees in 2021.  When comparing this to the proportion of Victorians who identify as Aboriginal, the gap to population parity (the proportion of people employed reflecting the proportion of the population) has not changed significantly since 2006. Increases in the number of Aboriginal people employed in the health and social services sector is due to increased self-identification of Aboriginal people in general. Increasing the number of Aboriginal health and social care workers is a priority in the AHWP Action Plan including the opportunity to offer more scholarships and training programs.

 

Goal 14: Aboriginal Victorians enjoy social and emotional wellbeing

Overview

Measures under Goal 14 have varied in performance

Aboriginal concepts of social and emotional wellbeing recognise that many factors contribute to holistic wellbeing, including connection to Country, culture, family and community.

For example, there has been an increase in Victorian Aboriginal people accessing clinical mental health services alongside a significant decrease in the proportion reporting they had high or very high levels of psychological distress.

Data note

The following measures rely on datasets that are infrequently collected. No new data was available at the time of reporting.

• Measure 14.1.3 Proportion reporting strong social networks they can draw on in times of crisis
• Measure 14.1.4 Proportion of Aboriginal Victorians with a disability that have strong social support networks

Historical data for these measures is available on the Data Dashboard, which can be accessed via the First Peoples – State Relations website at www.firstpeoplesrelations.vic.gov.au/report-data-dashboard

Goal 14 directly aligns with the following Closing the Gap Outcomes and Targets

Outcome 14 Aboriginal and Torres Strait Islander people enjoy high levels of social and emotional wellbeing

• Target 14 Significant and sustained reduction in suicide of Aboriginal and Torres Strait Islander people towards zero.

Closing the Gap – How Victoria is tracking nationally

Outcome 14: In 2021, the suicide age-standardised rate for Aboriginal and Torres Strait Islander people was 27.1 per 100 000 people (for NSW, QLD, WA, SA and the NT combined).

Nationally, based on progress from the baseline, the target is worsening.

Current reporting is only for jurisdictions which have adequate levels of Indigenous identification in line with national reporting guidelines.

 

14.1 Improve Aboriginal mental health and social and emotional wellbeing

Measure 14.1.1 Proportion reporting ‘high or very high’ levels of psychosocial distress

The proportion of Aboriginal Victorians aged 18 and above who reported high or very high levels of psychological distress in the 2020 VPHS was down to 31.8 per cent from 45.9 per cent in 2019. This is a reversal of trend from the previous three years with Aboriginal respondents experiencing high psychological distress growing 83.8 per cent from 2017 until 2019.  When comparing with the non-Aboriginal population; Aboriginal Victorians are 1.4 times more likely to report high or very high levels of psychological distress. Many factors including experiences of racism, and financial and housing stress are linked to mental health.    

Measure 14.1.2 Rate of self-harm related emergency department presentations (by 15–24 years, and all)

Since 2008-09 the rate of self-harm-related emergency department presentations for Aboriginal Victorians of all ages has increased dramatically. Due to changes in the methodology of identifying self-harm there has been a significant increase in 2018-19 (up by 11.6 per 1000 presentations).  In 2020-21 the rate of self-harm presentations increased to an all-time high of 21.2 presentations per 1,000. This is five times the rate for non-Aboriginal Victorians, which was 4.2 per 1000 presentations.

Similarly, the rate of self-harm-related emergency department presentations for Aboriginal Victorians aged 15 to 24 years old increased in 2020-21. The rate increased from 38.7 per 1000 presentations in 2019-20 to 42.2 per 1000 presentations in 2020-21. The rate of self-harm-related emergency department presentations for non-Aboriginal Victorians aged 15-24 also increased but is significantly lower than Aboriginal Victorians with the rate in 2020-21 being 13.56 presentations per 1000 people.

Measure 14.1.5 Number of Aboriginal Victorians receiving clinical mental health services

 In 2020-21, Victorian Aboriginal people accessed community mental health services more than ever before with 1200.0 contacts per 1,000 people. This is a 0.01 per cent increase since 2019-20 and is 4.4 times more than the number of times non-Aboriginal Victorians accessed community health care services.  The number of times non-Aboriginal Victorians accessed community mental health care services per 1000 non-Aboriginal Victorians decreased by 0.09 per cent since 2019-20. When analysing long term trend contacts with community mental health services from Aboriginal Victorians have increased 66.7 per cent since 2016-17.

Increased contacts with community mental health services does not necessarily represent a decrease in the wellbeing of Aboriginal Victorians but could be as a result of greater access to cultural safe services.

 

 

Domain 4: Victorian Government Investment and Action

The key Aboriginal Governance Forums for realising outcomes in this Domain are the Aboriginal Strategic Governance Forum and the Victorian Aboriginal Health and Wellbeing Partnership Forum.

The Victorian Government is working with service providers, Aboriginal organisations and communities to ensure that all Aboriginal Victorians have access to high-quality, culturally safe and responsive health and wellbeing services.

 

 

Cross portfolio

Aboriginal Workforce Fund delivery and evaluation

In 2022, the Aboriginal Workforce Fund (AWF) continued to deliver critical workforce development support to Aboriginal organisations that provide services in the DFFH portfolio.

The AWF is led by a Steering Committee made up of experienced, respected Aboriginal community services leaders who bring broad representation with a plurality of interests. Organisations in scope for the AWF and the funding allocation methodology were determined by the Steering Committee. The allocation methodology was based on indicative workforce size, with a simple equity weighting to redistribute funds from larger organisations to smaller ones. It was inclusive, non-competitive and focused on self-determined outcomes.

The Steering Committee also devised an Aboriginal-led evaluation. The procurement process involved carefully managing probity, adding protection of cultural intellectual property and data sovereignty to the RFQ documentation, and emphasising capability criteria over pricing. The experience has highlighted the opportunity to make changes to broader DFFH procurement processes. For example, by considering: a procurement panel arrangement for Aboriginal organisations.

In November 2022 an Aboriginal consultancy began delivering a process and effectiveness evaluation of the AWF. Findings and recommendations are due in August 2023.

 

Disability

Victoria’s submission to the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability (Royal Commission)

The Victorian Government provided a submission to the Royal Commission in October 2022.  The submission emphasised the Victorian Government’s commitment to self-determination and its support for Victoria’s Treaty and truth-telling process. Specifically, the submission recommended that:

• all jurisdictions  should support the self-determination of Aboriginal people with disability and the role of ACCOs in policy, governance and service delivery
• the NDIS Commission should update the NDIS Practice Standards and Quality Indicators to incorporate a focus on culturally safe service provision to Aboriginal people. 

Review of the Disability Act 2006

The Victorian Government is reviewing the Disability Act 2006 following the full roll out of the National Disability Insurance Scheme (NDIS).

The Disability Inclusion Bill (the Bill) would create a new principal Act to drive whole-of-government action and accountability for advancing disability inclusion.

The Bill would:

• recognise the right to self-determination of Aboriginal people with disability
• continue to ensure that members of the Victorian Disability Advisory Council reflect the cultural and Aboriginal backgrounds of people with disability
• acknowledge the intersectional barriers to inclusion experienced by Aboriginal people with disability.

An exposure draft of the Bill was released in September 2022, accompanied by public consultation and communications campaign that engaged with Aboriginal-led organisations and peak bodies, among others. The Government is considering the consultation feedback to inform future options for legislative reform.

Funding for Stronger ACCOs, Our Way

Funding to VACCHO to support Victorian ACCOs to develop and embed the skills and business plan that are required for registration as an NDIS service provider. This will in turn grow the number of Aboriginal workers delivering NDIS supports and build NDIS market capability to respond to the needs of Aboriginal people with disability. VACCHO is working with a consultant and several ACCOs to create and implement business plans and embed management systems to support them as NDIS service providers.

Health and wellbeing

The Aboriginal Health and Wellbeing Partnership Forum (AHWPF) is the lead decision-making body for Aboriginal health and wellbeing in Victoria and is co-chaired by the Minister for Health and VACCHO.  It is designed to enable strategic collaboration between the Aboriginal community-controlled health sector, the mainstream health sector and government.

In 2022, the Forum developed the Victorian Aboriginal Health and Wellbeing Partnership Agreement (the Agreement). 

The Agreement is a commitment from the AHWPF members to work together to reform the healthcare system.  

The Agreement commits members to uphold self- determination as a key principle, to work in an open and transparent manner and share information, knowledge and resources in a way that ensures accountability to shared priorities.

Accompanying the Agreement is an Action Plan that will be updated every two years, outlining the priority actions for government, the mainstream health system and the Aboriginal sector to achieve the reform priorities identified by the AHWPF. Significant community consultation informed the development of the Action Plan 2023-2025, and government is committed to ensuring all actions are implemented.

These actions are important steps along the journey towards a shared vision of better health and wellbeing for all Aboriginal Victorians, in a health system where there is no wrong point of access for any Aboriginal person

Responding to COVID-19

The COVID-19 Keeping Aboriginal Victorians Safe, Supported and Connected funding program delivered $12m to Aboriginal health organisations to support responses to urgent and emerging care needs of Aboriginal people with COVID-19 and their households, and to provide general health care in the home. Thirty submissions from Aboriginal community-controlled organisations were supported throughout this program.

As part of the Victorian COVID-19 Outbreak response management plan, the COVID-19 Aboriginal Infoline was extended through to the end of 2022. The COVID Positive Pathways Program (CPP) was extended until mid-2023, with a refocus on priority community cohorts, including Aboriginal and Torres Strait Islander community members. 

The COVID-19 Aboriginal Infoline and CPP provided a tailored resource to connect Aboriginal community members with access to information, and connection to culturally safe health services.

Response to 2022 Victorian floods

During the 2022 Victorian floods, the needs of First People were not necessarily met by existing mainstream emergency responses, including managing chronic health needs, accessing medication and ensuring emergency relief and recovery spaces. 

As a result, a funding initiative of $2 million was allocated for ACCHO flood response and recovery, with six ACCHOs in the flood affected regions invited to apply. The purpose of the funding was to ensure Aboriginal communities could continue to access culturally safe health and wellbeing services with minimal disruption during and after the floods.

To date, flood related activities by the relevant ACCHOs have included:

• Workforce support for ACCHO clinical and outreach staff
• Emergency and outreach support activity and resources, including urgent and ongoing healthcare access, family/children's holistic health and mental health support
• The purchase of clinical equipment and resources to support provision of health services, and water and mosquito-borne disease safety and support activity
• Access to local swimming pool/leisure centres to support safe water activities and mitigate risk of flood affected water hazards
• IT and other infrastructure including back up power supplies, establishment of satellite clinics and increased telehealth capacity.

DFFH also received $2 million to support Aboriginal communities following this major emergency. DFFH’s Aboriginal Self-Determination and Outcomes branch has led engagement with Aboriginal Controlled Community Organisations and Traditional Owner groups through the Aboriginal Flood Relief and Recovery Community Forum (a joint initiative with Emergency Recovery Victoria) on the priorities within communities which require resourcing.

To date, $0.8 million of the DFFH $2.0 million has been provided to Aboriginal Community Controlled Organisations, such as Rumbalara and Murray Valley Aboriginal Cooperative to provide culturally safe support to alleviate personal hardship including:

• Emergency food, clothing and temporary accommodation
• Repair or replacement of essential items of furniture and personal effects
• Essential repairs to housing, including temporary repairs, and repairs necessary to restore housing to a habitable condition
• Removal of debris from residential properties
• Personal and financial individual and/or group counselling support for those who have been affected by the October 2022 floods.
• The remaining DFFH funding is under consideration for distribution to Aboriginal-specific agencies once consultation with communities has been finalised.

ACCHOs partnered with Victorian Government agencies and Local Government Authorities and other relevant stakeholders in communications and engagement strategies. This was to ensure information about emergency responses, health risks and disaster payments were disseminated to community.

Key investments

• The 2022/23 State Budget provided funding to support equitable cancer care and prevention. $262,215 in funding has been provided to VACCHO to support activities to increase human papillomavirus (HPV) uptake in adolescents to reduce HPV-related cancers, which includes cervical cancer.
• $4.48m ICT funding to Aboriginal community-controlled health organisations to increase ICT infrastructure and capacity and enhance the delivery of health services and programs.
• $1.1m ‘Strong Voice’ funding to contribute to the implementation of the VACCHO Strategic Plan: On Solid Ground (2021- 2026).
• $700k over five years, commencing 2022/23 for Royal Melbourne Hospital’s  First Nations Dermatology Telehealth service to sustain the service model and expand the service to two sessions per week. RMH is working closely with VACCHO to develop and promote the Dermatology Telehealth service model of care.
• $349.6 million to expand bed-based forensic mental health services at Thomas Embling Hospital, delivering 82 additional beds through a dedicated 34-bed women’s precinct and a 48-bed men’s facility, for completion in 2024. The redevelopment will ensure a culturally appropriate design is achieved for Aboriginal and Torres Strait Islander people.

Mental health, alcohol and other drugs

Implementing the Royal Commission into Victoria’s Mental Health System (Royal Commission)

The Victorian Government is proudly working in partnership with the VACCHO, local Aboriginal community-controlled organisations and mainstream mental health services to deliver on the Royal Commission’s recommendations for improving Aboriginal social and emotional wellbeing. This is building on the strength and advocacy of Aboriginal communities and leaders; the vision set out in Balit Durn Durn, VACCHO’s submission to the Royal Commission into Victoria’s Mental Health System; and Balit Murrup, the Victorian Government’s 10-year Aboriginal Social and Emotional Wellbeing Framework 2017-2027.

Building a strong, skilled and supported Aboriginal mental health workforce

To support the delivery of Royal Commission recommendation 33.2, the Victorian Government has committed funding for the phased recruitment of 10 dedicated Koori Mental Health Liaison Officer positions that will be employed within selected Infant, Child, and Family Mental Health and Wellbeing Services. Building the capacity of the Aboriginal Mental Health workforce will help provide more responsive and culturally safe mainstream mental health services and provide better mental health outcomes for Aboriginal families and communities.

Statewide Aboriginal social and emotional wellbeing team expansion

The Victorian Government has committed recurrent funding to ACCHOs to establish and expand multi-disciplinary Aboriginal social and emotional wellbeing teams, with statewide coverage by 2025. The inaugural round of funding in 2021-22 for social and emotional wellbeing teams’ expansion saw the creation of 50 new positions across the ACCHO sector.  

Social and emotional wellbeing services for children and young people

To implement Royal Commission recommendation 33.3, ACCHOs for the first time are receiving funding to access and commission specialist services for children and young people. 

Supporting ACCHOs to deliver and commission self-determined social and emotional wellbeing services marks a shift away from a crisis driven response to mental illness. Commissioning enables ACCHOS to also focus on prevention, early intervention and healing. 

Balit Durn Durn Centre

The Balit Durn Durn Centre of Excellence in Aboriginal Social and Emotional Wellbeing (Balit Durn Durn Centre) was launched in May 2022 and supports best practice, research, and evaluation in social and emotional wellbeing.

Key achievements include:

• Providing leadership and support to the Aboriginal Community Controlled Health (ACCHO) sector in supporting readiness to establish and expand social and emotional wellbeing teams
• Establishing an Expert Advisory Group to steer the co-design process for the establishment of a culturally appropriate, family-oriented service for infants and children who require intensive social and emotional wellbeing supports
• Leading the co-design for the establishment of two Aboriginal healing centres, to be established by 2026.

Cultural Safety: in Infant, Child, and Family Mental Health and Wellbeing Services

The Royal Commission recommended the Victorian Government support Infant, Child, and Family Mental Health and Wellbeing Services to improve access for Aboriginal people (recommendation 33.2). Funding has been allocated across 13 Infant, Child and Youth Mental Health and Wellbeing Services to support either basic or in-depth cultural safety training, aligned with the broader cultural safety framework. 

Strong Brother Strong Sister

Strong Brother Strong Sister delivers a social and emotional well-being and suicide prevention program for Aboriginal and Torres Strait Islander children and young people from ages 4 to 26 in the Geelong area. In 2021-22, Strong Brother Strong Sister provided mentoring, youth groups, counselling and cultural activities to 189 participants.

Royal Commission into Defence and Veteran Suicide

Victoria is participating in the Commonwealth-led Royal Commission into Defence and Veteran Suicide (RCDVS). The RCDVS was established in July 2021 to inquire into systemic issues and risk factors relevant to defence and veteran suicide. In October 2022, the RCDVS advised that it is interested in hearing from First Nations people about their experience with the Navy, Army or Air Force.

Health-based response to Public Intoxication

Current laws in Victoria make being drunk in a public place a criminal offence. In 2019, the Victorian Government committed to decriminalising public drunkenness and replacing the current criminal justice response with a health-led approach. This means putting the right programs in place to help people who are intoxicated in public access the support they need to stay safe. The health-based model will help divert people away from a police response and increase their access to health and social services.

The model prioritises services for the Aboriginal community, in acknowledgement of the disproportionate impact public drunkenness laws and police interactions have on Aboriginal people. This reform was achieved through the strong and sustained advocacy from the Aboriginal community to end Aboriginal deaths in custody.

Key investments

• The 2022-23 Victorian State Budget included $3.5 million over two years to enable Aboriginal communities to co-design suicide prevention and response initiatives, in line with the principles of Aboriginal self-determination. This funding builds on the record 2021-22 funding of $116 million for Aboriginal social and emotional wellbeing to implement the recommendations in the Royal Commission into Victoria’s Mental Health System interim and final reports.
• The 2022-23 Victorian State Budget investment includes funding to support:
• the establishment of an Aboriginal-led suicide and self-harm prevention advisory panel to advise on targeted efforts for Aboriginal clients and families, and areas of most need (led by the Balit Durn Durn Centre) 
• an in-depth analysis of Aboriginal suicides in Victoria, as well as a review to improve real-time surveillance and response in partnership with the Coroners Court of Victoria and the Balit Durn Durn Centre. 

Equality

Since 2019-20, DFFH has funded Koorie Pride Victoria to the amount of $320,000 for its establishment and growth as a peak body supporting Aboriginal and Torres Strait Islander lesbian, gay, bisexual, trans and gender diverse, intersex, queer, sistergirl and brotherboy (LGBTIQ+SB) communities.

Due to disruptions caused by the coronavirus (COVID-19) pandemic, funded activities were delivered from 2022. 

Key activities undertaken in 2022 included:

• capacity building workshops for the Dardi Munwurro Brother to Brother crisis line, upskilling the service to better support LGBTIAS&B mob.
• supported the Wathaurong Health Service to be inclusive of LGBTIQAS&B mob in their strategic planning. 
• delivery of a sector-wide yarning event (see case study under Measure 12.1.6)