Recommendations 8 & 16: access to counselling and therapeutic services

First posted on 27 August 2008 under Mullighan Inquiry.
This article has been updated and archived.
Tags: child protection & mental health

Summary

The Mullighan Inquiry uncovered disturbing gaps and weaknesses in the delivery of counselling and therapeutic services to Anangu children. In April 2008, it recommended that long-term funding be provided to enable victims of sexual abuse to access appropriate therapeutic services. It also recommended that there should be “a substantial increase” in the delivery of therapeutic services to those Anangu who were sexually abused as children.[i]

In early August 2009, the State Government allocated $2.8 million over four years to establish permanent therapeutic services on the APY Lands.[ii] Two years later – as of 11 August 2011 – these services were being delivered to more than 300 children and young people in nine APY communities.[iii]

The Paper Trail

Overview

In June 2007, the South Australian Parliament established an Inquiry into the incidence of child sexual abuse on the APY Lands. The statutory purposes of the Mullighan Inquiry included:

  • identifying and reporting on the consequences of child sexual abuse for APY communities, and
  • reporting on any measures that should be implemented to address those consequences “to the extent that these matters are not being addressed through existing programs or initiatives.”[iv]

The final report of the Inquiry – completed in April 2008 – concluded that child sexual abuse on the APY Lands was “widespread”[v] and “cyclical;” that is, some people who were abused as children had become abusers.[vi]

The Inquiry also found that children who had been sexually abused were likely to engage “in dangerous levels of drug and alcohol use.” It noted that a greater level of substance abuse creates, in turn, more opportunities for both the perpetrators of sexual abuse and the suppliers of alcohol and other prohibited substance. The Inquiry warned that such a spiral of abuse had the potential to destroy a “generation of children” and with them the “long term viability” of the communities themselves.[vii]

In response to this situation, the Inquiry emphasised the importance of providing children who have been sexually abused with a “prompt and appropriate” therapeutic response from suitably-qualified experts,[viii] and noted that it was likely:

that many Anangu children who are sexually abused … will require psychiatric, psychological and counselling services from time to time throughout their lives.[ix]

The Inquiry found that if a therapeutic intervention was going to be successful it would need to be “conducted in a safe place” often away from the family environment or the community.[x]

As directed by Parliament, the Inquiry attempted to assess the adequacy of existing services and programs. It reported that it had:

been unable to ascertain the precise number of children who … did not receive mental health treatment or counselling following the alleged abuse but it is certainly the vast majority … It is likely very few Aboriginal children who were sexually abused received any therapeutic services.[xi]

The Inadequacy of Existing Services

At the time of the Inquiry, children on the APY Lands who had been sexually abused could ostensibly and primarily access therapeutic services in one of two ways:

  • from a team of specialists employed by the Children and Adolescent Mental Health Services (CAMHS), and
  • from the Child Protection Services unit located at the Women’s and Children’s Hospital (CPSWCH).

Since May 2006, the Department of Health’s Children and Adolescent Mental Health Services (CAMHS) had provided clinical assessments of children on the APY Lands.[xii]  This work had seen an Adelaide-based team of mental health specialists travel to the APY Lands every two to three months. The Inquiry found that during the course of their week-long visits, the CAMHS team had “stumbled into the problem of child sexual abuse without adequate skills and resources”[xiii] and that its subsequent endeavors had been hampered by poor working-relationships with both Families SA and the Nganampa Health Council.[xiv]

As to the therapeutic services available through Child Protection Services attached to the Women’s and Children’s Hospital (CPSWCH), the Inquiry found that this service was already “overstretched and unable to provide the service that is required.”[xv] Although CPSWCH was responsible for providing services to the APY Lands, it did “not have the resources to provide services to children on the Lands unless they are removed to Adelaide.”[xvi] At the time of the Inquiry, a lack of funding to cover the cost of accommodating and caring for children removed from the APY Lands meant, in effect, that abused children from Anangu communities were rarely able to access this service.[xvii]

Drawing together the evidence presented, the Inquiry concluded that:

there must be a prompt and appropriate therapeutic response to [the] sexual abuse of a child. That response must be provided by suitably trained people … Without such a response it is likely that many sexually abused children will suffer lifelong adverse consequences.[xviii]

On 30 April 2008, the Mullighan Inquiry recommended (Recommendations 8 and 16):

That the necessary long-term funding be provided to allow Families SA to provide the required therapeutic services to children and young people on the Lands who have been sexually abused.[xix]

That there be a substantial increase in services on the Lands for persons with mental health issues and for persons who have been sexually abused as children who require therapeutic services.[xx]

The Government’s Preliminary Response to Recommendations 8 and 16

On 24 July 2008, the then Minister for Aboriginal Affairs and Reconciliation (Hon Jay Weatherill MP) tabled the Government’s Preliminary Response to the Children on Anangu Pitjantjatjara Yankunytjatjara (APY) Lands: Commission of Inquiry report in the South Australian Parliament.

Although the Preliminary Response expressed either “support” or “in principle support” for 35 of the Inquiry’s 46 recommendations, it only “noted” Recommendations 8 and 16.

In relation to both of those recommendations, the Preliminary Response stated:

The Taskforce of State and Commonwealth officers, established to respond to the Inquiry Report, will evaluate the level of need, and the capacity of existing services to meet that need, and will give further consideration to this recommendation.[xxi]

The Paper Tracker notes that the Preliminary Response did not adequately address the core of either recommendation, specifically the need to:

  • provide “the necessary long-term funding” for the required therapeutic services (Recommendation 8), and
  • substantially increase therapeutic services (Recommendation 16).

Recommendation 8

The Government’s Preliminary Response to Recommendation 8 also included the following statement:

[CAMHS] currently provides ongoing therapeutic counselling services through visits by a team of four mental health workers, including psychiatry and Aboriginal consultants, to the APY Lands on a regular basis. Week long visits are undertaken 8-10 times per year.[xxii]

The Paper Tracker notes that this statement did not address the Mullighan Inquiry’s finding that the CAMHS team was under resourced and lacking in specialist expertise in some areas.[xxiii]

On 7 August 2008, the Paper Tracker asked the Department of Health for some additional information on CAMHS’ work on the APY Lands.[xxiv]

In a reply dated 25 August 2008, the Department advised that:

  • current funding for the visiting service was $290,000 per annum,
  • the CAMHS team completed seven week-long visits to the APY Lands in 2007,
  • four visits had been completed in the first eight months of 2008, with another four planned for the remainder of the year, and
  • the multidisciplinary team comprises a psychiatrist, a senior social worker and an Aboriginal consultant.[xxv]

The Department also provided the Paper Tracker with the following information on the APY visits:

During the visits CAMHS’ staff provide mental health assessments for children and young people with emotional and behavioural concerns including children and young people with self harming and suicidal behaviour. This has incorporated general assessment of risk and mental health trauma for referred children who have been sexually abused. CAMHS works with the available systems and communities on the APY Lands to support the children and young people.

Considerable training and development and consultations have been undertaken with a range of service providers including education and Nganampa health staff to enable them to better support children with mental health issues and children who are demonstrating sexualised behaviour.[xxvi]

Despite this information, the Paper Tracker remained concerned that the CAMHS team was under resourced and lacked specialist expertise in some areas.

Recommendation 16

The Government’s Preliminary Response to Recommendation 16 also provided information on some existing and proposed services. For example:

The Government has … funded specific initiatives on the APY Lands.  These include direct funding of $270,000 to Nganampa to employ two mental health practitioners, with one based on the Lands full-time and the other based in Alice Springs fifty per cent of time.[xxvii]

The Paper Tracker understands that this funding was originally allocated in response to a recommendation made in March 2004 by Dr Jonathan Phillips, then Director of the State’s mental health programs[xxviii] and, as such, cannot be considered a response to the core of Recommendation 16; that is, that existing services be substantially increased.

As part of its Preliminary Response to Recommendation 16, the SA Government also reported that the Commonwealth Government had:

committed $1.3 million over three years under the Personal Helpers and Mentors Program which will aid the recovery of people on the APY Lands severely affected by mental illness, and help connect them to essential services.[xxix]

On 4 September 2008, the Paper Tracker asked the Federal Department of Families, Housing, Community Services and Indigenous Affairs for further information on this announcement.[xxx] More than eight months later, the Department provided a written update on its efforts to establish this program on the APY Lands.[xxxi]

Click here to read the Department’s advice (file size: 70KB)

The Paper Tracker understands that the primary aim of the program is to support people who have a mental illness. While the APY Personal Helpers and Mentors Program is not specifically designed to support past victims of child sexual abuse, given the link between childhood trauma and mental illness, those Anangu who were sexually abused as children may receive some support from this program.

The Government’s Full Response to Recommendations 8 and 16

On 30 October 2008, the then Minister for Families and Communities (Hon Jennifer Rankine MP) tabled the Government’s Full Response to the Children on Anangu Pitjantjatjara Yankunytjatjara (APY) Lands: Commission of Inquiry report in the South Australian Parliament.[xxxii]

As was the case with the Preliminary Response, the Government did not express support for either Recommendation 8 or Recommendation 16 but only noted these recommendations. In each case, the Government commented:

This recommendation will remain under review as services are provided.[xxxiii]

While the Full Response did contain some additional information on the work of CAMHS (Recommendation 8) and Nganampa Health Council (Recommendation 16), this new information did not address the substantive issue raised by the Mullighan Inquiry.[xxxiv] That is, the need to allocate long-term funding for the development and delivery of appropriate counselling and therapeutic services.

On 6 May 2009, the Paper Tracker – through UnitingCare Wesley Adelaide – issued a media release highlighting the need for additional funding to be allocated in line with the recommendations of the Mullighan Inquiry.

Click here to read our media release [File size: 28KB]

Permanent CAMHS presence on the APY Lands

On 5 and 6 August 2009, the State Government’s Children and Adolescent Mental Health Services (CAMHS) advised the Paper Tracker that:

  • it had “been funded through the Closing the Gap National Indigenous Partnership program for permanent workers on the APY Lands,”
  • the funding, provided by the State Government, was $2.8 million over four years,
  • this funding would cover the cost of a coordinator, two clinicians, Anangu workers and a part-time administrative position,
  • “as yet unbuilt housing” had been allocated for this work which should be available by mid 2010,
  • it hoped to have these permanent services “operational from early 2010 (subject to the usual difficulties in recruitment),” and
  • the existing visiting service would continue to operate after the permanent service had been established.[xxxv]

On 28 April 2010, CAMHS further advised the Paper Tracker that:

  • staff for two of the new positions have been recruited (namely the Coordinator and one of the two clinicians),
  • while the Coordinator had commenced work, the clinician was not due to begin until the middle of May 2010,
  • the first of the two staff houses on the APY Lands was due to be completed in July 2010, and
  • the existing visiting team was continuing to make two trips to the APY Lands each school term.[xxxvi]

On 24 November 2010, the State Government provided an update on the establishment of CAMHS’ APY Lands-based team. This included noting that:

  • the team’s Coordinator now oversees the service’s “visiting and Lands-based clinical response,”
  • one clinician – employed in June 2010 – was “undertaking clinical work,” and
  • recruitment for the second clinician “is underway.”[xxxvii]

Intensive response in Amata

On 16 December 2010, the South Australian Government announced plans to expend $1.05 million providing “temporary therapeutic services” in Amata.[xxxviii]

The Government explained that this funding would provide:

a once-off intensive intervention response to the Amata community, addressing the therapeutic needs of children.[xxxix]

The Government subsequently noted that:

  • there had been “a significant number of children within the community involved in sexualised behaviour” and
  • this “12 month response” had enabled government services “to carry out forensic and therapeutic interventions with children and families”.[xl]

On 17 January 2011, the State Minister for Health (Hon John Hill MP) advised the Paper Tracker that:

  • community meetings had been held in Amata “to discuss the services with community members, and to engage the support and partnership of families”,
  • therapeutic activities had commenced and would “continue over the next six months”,
  • activities included “camps, group work, community workshops and the professional development of staff in the community”,
  • it expected “all children” in Amata to benefit from the delivery of these temporary therapeutic services,
  • the Children, Youth and Women’s Health Service had “developed an evaluation framework” to assess the “effectiveness of these interventional services”, and
  •  this evaluation framework would commence “in early 2011.”[xli]

Client numbers (added 29 January 2012)

In August 2010, “239 children and young people from the APY Lands” were clients of the Child and Adolescent Mental Health Services (CAMHS).[xlii]

As year later, this number had risen to 307 (i.e. a 30% increase in 12 months).[xliii]

On 16 January 2012, the SA Government advised the Paper Tracker that CAMHS had delivered mental health services to 9 APY communities during 2011; specifically Amata, Iwantja (Indulkana), Kaltjiti (Fregon), Kanpi, Mimili, Nyapari, Pipalyatjara, Pukatja and Watarru.[xliv]

Click here to read the Government’s full advice (file size: 251KB)

This article was last updated in January 2012. It has been archived and will no longer be updated. It will, however, remain accessible online as a source of background information for anyone wishing to undertake further research on this issue. Information included in the article was current at the time it was archived. Keep in mind, however, that Ministerial changes and names of departments, among other things, may have since changed.


[i] Recommendations 8 and 16 in Mullighan, E. April 2008, Children on Anangu Pitjantjatjara Yankunytjatjara (APY) Lands: Commission of Inquiry – a report into sexual abuse, pxx & pxxii.

[ii] McEntee, P (CAMHS). 5 August 2009. Email to J. Nicholls; McEntee, P (CAMHS). 6 August 2009. Email to J. Nicholls.

[iii] Government of South Australia. November 2011. Third Annual Report by the Minister for Education and Child Development to the Children on Anangu Pitjantjatjara Yankunytjatjara (APY) Lands Commission of Inquiry – A Report into Sexual Abuse, p69. Also: Mondy, G (SA Health). 16 January 2012. Letter to Rev. P. McDonald.

[iv] Schedule 2, 2(2)(e), Commission of Inquiry (Children in State Care) (Children on APY Lands) Act 2004.

[v] Mullighan, E. April 2008, Children on Anangu Pitjantjatjara Yankunytjatjara (APY) Lands: Commission of Inquiry – a report into sexual abuse, pxiii.

[vi] Mullighan, E. April 2008, Children on Anangu Pitjantjatjara Yankunytjatjara (APY) Lands: Commission of Inquiry – a report into sexual abuse, pxiv. The Inquiry found that “141 particular children had been sexually abused” on the APY Lands between 1980 and June 2007, with the bulk of that abuse having occurred since 2000. It is likely, but not certain, that more 85% of the 141 particular cases identified occurred in 2000 or after. This uncertainty arises from the fact that the report of the Inquiry does not clearly and consistently differentiate between the 141 cases examined and the 269 allegations of child sexual abuse associated with those cases. The report of the Inquiry notes that the number of allegations that it investigated was “not a true indication of the extent” of child sexual abuse occurring on the APY Lands. See: Mullighan, E. April 2008, Children on Anangu Pitjantjatjara Yankunytjatjara (APY) Lands: Commission of Inquiry – a report into sexual abuse, pxiii.

[vii] Mullighan, E. April 2008, Children on Anangu Pitjantjatjara Yankunytjatjara (APY) Lands: Commission of Inquiry – a report into sexual abuse, pxiv.

[viii] Mullighan, E. April 2008, Children on Anangu Pitjantjatjara Yankunytjatjara (APY) Lands: Commission of Inquiry – a report into sexual abuse, pxiv & p167.

[ix] Mullighan, E. April 2008, Children on Anangu Pitjantjatjara Yankunytjatjara (APY) Lands: Commission of Inquiry – a report into sexual abuse, p167.

[x] Mullighan, E. April 2008, Children on Anangu Pitjantjatjara Yankunytjatjara (APY) Lands: Commission of Inquiry – a report into sexual abuse, p143.

[xi] Mullighan, E. April 2008, Children on Anangu Pitjantjatjara Yankunytjatjara (APY) Lands: Commission of Inquiry – a report into sexual abuse, p141 & p166, including footnote 1.

[xii] Mullighan, E. April 2008, Children on Anangu Pitjantjatjara Yankunytjatjara (APY) Lands: Commission of Inquiry – a report into sexual abuse, p163.

[xiii] Mullighan, E. April 2008, Children on Anangu Pitjantjatjara Yankunytjatjara (APY) Lands: Commission of Inquiry – a report into sexual abuse, p165 and p219.

[xiv] Mullighan, E. April 2008, Children on Anangu Pitjantjatjara Yankunytjatjara (APY) Lands: Commission of Inquiry – a report into sexual abuse, p142-4, and p165.

[xv] Mullighan, E. April 2008, Children on Anangu Pitjantjatjara Yankunytjatjara (APY) Lands: Commission of Inquiry – a report into sexual abuse, p167.

[xvi] Mullighan, E. April 2008, Children on Anangu Pitjantjatjara Yankunytjatjara (APY) Lands: Commission of Inquiry – a report into sexual abuse, p144.

[xvii] Mullighan, E. April 2008, Children on Anangu Pitjantjatjara Yankunytjatjara (APY) Lands: Commission of Inquiry – a report into sexual abuse, p147-8.

[xviii] Mullighan, E. April 2008, Children on Anangu Pitjantjatjara Yankunytjatjara (APY) Lands: Commission of Inquiry – a report into sexual abuse, pxiv.

[xix] Mullighan, E. April 2008, Children on Anangu Pitjantjatjara Yankunytjatjara (APY) Lands: Commission of Inquiry – a report into sexual abuse, pxx.

[xx] Mullighan, E. April 2008, Children on Anangu Pitjantjatjara Yankunytjatjara (APY) Lands: Commission of Inquiry – a report into sexual abuse, pxxii.

[xxi] Government of South Australia, July 2008, “Response by the Minister for Aboriginal Affairs and Reconciliation to the ‘Children on Anangu Pitjantjatjara Yankunytjatjara (APY) Lands Commission of Inquiry: A report into sexual abuse’,” p[8]. In the Preliminary Response the Government also commented that it was likely that its “increased intervention in child protection matters on the Lands” would “increase demand for services, including therapeutic services” and “change the nature of, and demand for, therapeutic services for people sexually abused as children” (Government of South Australia, July 2008, “Response by the Minister for Aboriginal Affairs and Reconciliation to the ‘Children on Anangu Pitjantjatjara Yankunytjatjara (APY) Lands Commission of Inquiry: A report into sexual abuse’,” p[8] & p[16]).

[xxii] Government of South Australia, July 2008, “Response by the Minister for Aboriginal Affairs and Reconciliation to the ‘Children on Anangu Pitjantjatjara Yankunytjatjara (APY) Lands Commission of Inquiry: A report into sexual abuse’,” p[8].

[xxiii] The Paper Tracker also notes that the frequency of the team’s visits – as reported in the Preliminary Response – seems to be at odds with other government statements. For example, on 1 July 2008, the Department of Health released a major report: South Australia: Our Health and Health Services 2008 in which it suggested that the CAMHS team will visit the APY Lands “every two months” (or six times a year). This appears to be inconsistent with the Government’s Preliminary Response which states that visits will undertaken 8 to 10 times a year. (SA Department of Health, July 2008, South Australia: Our Health and Health Services 2008, p201).

[xxiv] McDonald, P. 7 August 2009. Letter to T. Sherbon (Health).

[xxv] Government of South Australia, July 2008, “Response by the Minister for Aboriginal Affairs and Reconciliation to the ‘Children on Anangu Pitjantjatjara Yankunytjatjara (APY) Lands Commission of Inquiry: A report into sexual abuse’,” p[8].

[xxvi] Robinson, P. 25 August 2008, Letter to Rev. P McDonald.

[xxvii] Government of South Australia, July 2008, “Response by the Minister for Aboriginal Affairs and Reconciliation to the ‘Children on Anangu Pitjantjatjara Yankunytjatjara (APY) Lands Commission of Inquiry: A report into sexual abuse’,” p[16].

[xxviii] Phillips, J. 22 March 2004, “Internal Memorandum” to the Minister for Health, p4.

[xxix] Government of South Australia, July 2008, “Response by the Minister for Aboriginal Affairs and Reconciliation to the ‘Children on Anangu Pitjantjatjara Yankunytjatjara (APY) Lands Commission of Inquiry: A report into sexual abuse’,” p[16].

[xxx] Nicholls, J. 4 September 2008. Email to K. Kudinoff.

[xxxi] FaHCSIA. 29 May 2009, “Update – Personal Helpers and Mentors (Pham) Program on the APY Lands.”

[xxxii] See: “Papers”, 30 October 2008, Hansard, House of Assembly, Parliament of South Australia, p753. The Government’s Full Response is entitled: “A Report into Sexual Abuse-Children on Anangu Pitjantjatjara Yankunytjatjara (APY) Lands Commission of Inquiry-Implementation Statement by the Minister for Families and Communities.”

[xxxiii] Government of South Australia, 30 October 2008, “Implementation Statement by the Minister for Families and Communities to the Children on Anangu Pitjantjatjara Yankunytjatjara (APY) Lands Commission of Inquiry,” p15 & 28.

[xxxiv] See: Government of South Australia, 30 October 2008, “Implementation Statement by the Minister for Families and Communities to the Children on Anangu Pitjantjatjara Yankunytjatjara (APY) Lands Commission of Inquiry,” p14-15 & 27-28.

[xxxv] McEntee, P (CAMHS). 5 August 2009. Email to J. Nicholls; McEntee, P (CAMHS). 6 August 2009. Email to J. Nicholls.

[xxxvi] McEntee, P (CAMHS). 28 April 2010. Email to J. Nicholls; also McEntee, P (CAMHS). 21 April 2010. Email to J. Nicholls.

[xxxvii] Rankine, J. November 2010. Second Annual Report to the Parliament of South Australia by the Minister for Families and Communities on the ‘Children on Anangu Pitjantjatjara Yankunytjatjara (APY) Lands Commission of Inquiry – A Report into Sexual Abuse,” p23 and p30.

[xxxviii] Government of South Australia. December 2010. Mid-Year Budget Review 2010-11, p24. Also: Foley, K. 16 December 2010. “Mid Year Budget Review 2010-11,” media release.

[xxxix] Government of South Australia. December 2010. Mid-Year Budget Review 2010-11, p24.

[xl] Government of South Australia. November 2011. Third Annual Report by the Minister for Education and Child Development to the Children on Anangu Pitjantjatjara Yankunytjatjara (APY) Lands Commission of Inquiry – A Report into Sexual Abuse, p69.

[xli] Hill, J. 17 January 2011. Letter to Rev. P. McDonald.

[xlii] Mondy, G (SA Health). 16 January 2012. Letter to Rev. P. McDonald.

[xliii] Government of South Australia. November 2011. Third Annual Report by the Minister for Education and Child Development to the Children on Anangu Pitjantjatjara Yankunytjatjara (APY) Lands Commission of Inquiry – A Report into Sexual Abuse, p58.

[xliv] Mondy, G (SA Health). 16 January 2012. Letter to Rev. P. McDonald.

The Paper Tracker works hard to provide accurate and up-to-date information. We will correct any inaccurate information as soon as it is brought to our attention. Please contact us if you have additional information or can provide us with an update.