Culture as Medicine Day2 for 2012: Hearing Voices

Today I gave the keynote address at the International Healing Voices Conference in Melbourne.   The conference was organized by Voices Vic (for Victoria, the state in which Melbourne lies).   Speakers came from around the world -- Ron Coleman (who started the Hearing Voices Network in the U.K.); a woman from Auckland, New Zealand; Eleanor, a young woman/psychologist/voice hearer from Australia, and more.   Unlike most mental health conference, where the attendees are mostly practitioners of various kinds, this conference was mostly "patients".   And was it different!   The energy was so upbeat!   The conference was all about hope and recovery.   People told inspiring story after story of being severely mentally ill and recovering to the point of becoming a practicing psychologist, for example.   I'll start with Eleanor's story.

By all appearances Eleanor was an aspiring young psychologist.   She could have help her own at any professional meeting.   She was attractive, articulate, well-dressed, well-spoken -- the kind of graduate any psychology program would be proud to proclaim.   However, once upon a time, she had been a patient in the mental health system.   She heard voices that tortured her.   Once she tried to drill a hole in her head to let the voice out.   She wasn't trying to harm herself.   She just really believed that the voice would leave if it had an exit pathway.   Her longest hospitalization had been for 5 months and she had more of them than she could count or remember.   She had connected with the Hearing Voices Movement and had learned how to manage her voices.   Slowly but surely the positive voices gained sway over the negative voices.   Eventually her mind became more peaceful and she was able to return to her University studies.   She could concentrate and learn again and went on to complete a doctorate in clinical psychology and to become a licensed psychologist.

As so many people have told me, Eleanor reported that the medications only made her worse.   The drugs didn't touch the voices.   They just made her completely unable to think.   Being unable to think prevented her from doing the cognitive therapy she needed to do to learn how to manage the voices.   Being unable to think left her in complete misery.   Eleanor told us that she wasn't against medication or anything that helped people.   She would have been happy to take a drug that worked.   However, she said, "I'm against forcing people to take drugs that don't work and make them worse and prevent them from working through the problem."   For that she received a standing ovation from the audience.   I was impressed.   This was not an anti-psychiatry group.   This was a group of pro-active consumers demanding realism of outcome.   They were angry with a mental health system which pretended to help when it didn't and actually made them worse.

However, I have gone ahead of myself.   The conference began with a welcome from its organizer, a woman named Indigo, who also heard voices.   Then the "Welcome to Country" was given by an aboriginal man from the people who originally inhabited the area that is now known as Melbourne.   He played an amazing concert on a digeridoo that he had made.   Then, to my surprise, a North American aboriginal man came out to dance.   He was Ojibway from Minnesota.   The music started and to my surprise it was a Lakota song.   He didn't dance.   He waited and waited.   Then he looked at Indigo puzzled.   "You put on the wrong song," he said.   He went to the podium and clicked the correct song on the computer.   Ojibway words filled the room instead of the Lakota.   I had known that song and was singing along.   However, I knew Ojibway wouldn't dance necessarily to Lakota.   That's been a rivalry for hundreds of years.   In 1420, the Lakota attempted to defeat the Ojibway in the area around Thunder Bay, Ontario.   The Lakota suffered a miserable defeat.   I'm reminded of that every time I visit Thunder Bay.

Next came the official welcome and address from the Chair of the Agency funding Voices Vic, which was delivered by a man named Quinn from Prahan Mission.   To my surprise, our host, Tony Gee, had worked with Quinn in the past at other agencies.   Tony is the Chair of Life Is ". Foundation, which is one of the collaborators in our Australian Cross Cultural Exchange.   Life Is" has a mission of preventing suicide and assisting those left behind by a suicide to heal.   Then came my talk.   I'm going to share what I had to say, but first more observations from the conference.

The strong indigenous presence also contributed to making this a different kind of conference than others I have attended.   We heard often that aboriginal healers were not afraid of voices.   Hearing voices is normal and honored in the aboriginal community.   One hears the voices of the ancestors, the voices of spirits, the voices of the animals and of nature.   To be a voice hearer is a privilege and an honor.   Aboriginal elders were present from diverse parts of Australia to share how they assisted people who heard frightening and terrifying voices.

All this converged on the subject of my talk -- that hearing voices is an ordinary human experience that we all have.   What's different is the spin we put on the voices and the voices to which we give our attention.   I showed brain imaging slides for "hearing voices", "people with the diagnosis of schizophrenia who were not at the moment hearing voices, and so called "normal controls".   I joked with the audience about not knowing where they could have found a room full of normal people, since they were so rare.   The imaging studies suggested that the only difference was in the frontal lobes.   The frontal lobes are what we use to make up stories about our voices.   One story is that these are just our own thoughts.   Then we call those people with intrusive and disturbing thoughts "OCD".   We spare them the psychosis diagnosis because they know the thoughts are their own despite their disturbing and even terrifying nature.   In other stories, the Voices are Ascended Masters trying to take over one's mind for the purpose of eternal punishment.   In the indigenous story, some of these voices are the whispters of the ancestors, some of them come from the spirits, and one's job is to listen carefully to all the voices and practice discernment.   An elder told us never do anything a voice tells you to do if it will hurt you or someone else.   Good spirits wouldn't tell you to hurt anyone or hurt yourself.   They're funny and they make you feel good.   My suggestion is that hearing voices isn't abnormal and isn't even worthy of treatment or diagnosis.   Instead, people suffer due to the stories they create or absorb about what the voices mean and who they are and also for being fixated on negative voices that criticize, castigate, berate, wheedle, and excoriate their listener. I suggested that this tendency to focus on the negative voices is related to painful life experiences which was in keeping with Eleanor's talk (came after mine) in which she reported that people who experience trauma are 46 times more likely to receive a psychotic diagnosis than those who don't.   Eleanor's trauma was being raped and molested repetitively in a day care center run by pedophiles.   She told us her home life otherwise was atraumatic and that her parents had been loving and warm, but she had had no way to express her traumatic experiences since they occurred when she was so young and they just kept building inside of her like a pressure cooker ready to explode which she finally did during her second year at college.

I suggested that the work with voices was to make sure all voices are heard and none are necessarily more privileged than others even when those inner voices match the broader messages of the dominant culture.   I introduced Bakhtin, Hermans, and dialogical self theory to the group.   The Russian, Mikhail Bakhtin, is easily one of my favorite philosophers.   In one often quoted passage, he described the mind as a room filled with a cacophony of polyphonous voices, each arguing with the other, each trying to achieve ascendency, some forming shifting coalitions to win out over others (sounds like the U.S. Congress to me!).   He thought Doestoevsky had done the best job describing the mind in this manner, especially in Crime and Punishment, in the way in which Raskolnikov's mind is presented.

Hermans and his colleagues have taken this further into a mature psychological theory which matches the concepts of social constructionism and critical constructivism.   The mind consists of many "me's".   Each "me" emerges to manage a particular relationship and collection of stories related to that relationship.     More about this tomorrow!

Culture as Medicine in Australia Day 1

Day 1: Australia 2012

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I arrived yesterday in Australia.   Today is Day 1 of the Australian Journey.   We begin by my presenting at Life Is" Foundation, Native American Culture and spirituality.   My job was to share some aspects of Native North American culture and spirituality with people in Melbourne.   This is part of our fundraising mechanism for the work we are planning to do in East Gippsland.   I am not going to say much about my presentation, because I have written about Native American Culture and spirituality at length.   Rather, I'd like to talk about what emerged from the dialogue at the presentation.

I learned a bit about the politics of "Welcome to Country".   In Australia, it is common to open events with a "Welcome to Country" address.   In this procedure, an aboriginal person who comes from a group native to the land upon which one stands comes and welcomes delegates or attendees or members of an event to the land as one of the original people who inhibited that land.   Typically the person chosen to offer the "Welcome to Country" tells of his or her ancestors who lived on that land and sings a song or two, speaking in the language of the land and then translating into English.   Typically that person is paid to come and provide the "Welcome to Country".   However, it's easy to imagine the political intrigues associated with this practice.   Though an aboriginal person welcomes outsiders to his or her country, typically he or she owns none of the country.   The symbolism of a disenfranchised person being paid to welcome outsiders to a country he or she no longer owns is not lost on we outsiders.   It smells of co-opting.

We couldn't find a local to welcome me to country in Melbourne, so we chose not to use someone from a neighboring territory but rather to acknowledge the original holders of the land and to note that none of them were available to welcome me to country.   Therefore, we acknowledged the original people of the land and their ancestors and wished that they could be present with us.   Of course, two people from a neighboring aboriginal group were critical of the lack of "Welcome to Country" by an aboriginal person.   We should have contracted with them.   That didn't make sense to me, since they weren't from the land where we were speaking.   Thus, politics emerge.

"Welcome to Country" aside, we heard important information.  

Aboriginal people were first counted as citizens in the 1971 Census. Since then, censuses have shown a significant increase in people identifying as Aboriginal and/ or Torres Strait Islander peoples:

• Between the 1991 and 1996 Census there was a 33% increase recorded in the numbers of Indigenous peoples.
• Between the 1996 and 2001 Census there was a 16% increase.
• Between the 2001 and 2006 Census there was an 11% increase. ^[6]

Despite the increases in the numbers of people identifying as Indigenous in censuses, however, there are still believed to be significant undercounts occurring. In the 2006 Census, Indigenous status is unknown for 1,133,466 people, comprising 5.7% of the total number of people surveyed. ^[9]

2.1 Size and characteristics of the Indigenous population

In the 2006 Census, 455,028 people identified themselves as being of Aboriginal and/ or Torres Strait Islander origin, comprising 2.3% of the total population. ^[11]

There were approximately 409,729 people of Aboriginal origin (90% of the total) and 29,239 of Torres Strait Islander origin (6%). A further 19,552 people (4%) identified as of both Aboriginal and Torres Strait Islander origin. ^[12]

Where Indigenous peoples live

Table 1 below details the percentage of the total number of Indigenous peoples that lives in each State and Territory, and the proportion of each State and Territory's population that is Indigenous.

Table 1: Location of Indigenous peoples - by State and Territory (2006) ^[22]

Percentage of the total Indigenous population living in a State or Territory
Percentage of the State or Territory's total population that is Indigenous

New South Wales

28.7
2.2

Victoria

6.0
0.6

Queensland

28.3
3.6

South Australia

5.0
1.7

West Australia

15.1
3.8

Tasmania

3.3
3.4

Northern Territory 

12.9
31.6

ACT

0.8
1.2

Language and culture

Indigenous cultures today reflect both traditional elements and the influence of non-Indigenous cultures. The 2006 Census reported:

• 86% of Indigenous respondents reported speaking only English at home, which is about the same as the non-Indigenous population (83%);
• 12% of Indigenous respondents reported speaking an Indigenous language at home; with three quarters of those recording they were also fluent in English;
• Many Indigenous peoples are bilingual; however, the pattern varies with geographical location with 56% of respondents living in remote areas reported speaking an Indigenous language, compared with one per cent in urban centres;
• Older Indigenous peoples (over 45 years) are more likely to speak an Indigenous language than younger Indigenous peoples. (Of those Indigenous peoples aged 45 years and over, 13% speak an Indigenous language, compared with 10% of 0-14 year olds);
• Indigenous languages are more likely to be spoken in the centre and north of Australia than in the south. ^[30]

Health

Self reported health status

In the NATSIHS 2004--05:

• 43% of Indigenous respondents aged 15 years and over reported their health as very good or excellent;
• 35% reported their health as being good; and
• 22% reported their health as fair or poor.

After adjusting for differences in the age structures of the Indigenous and non-Indigenous populations, Indigenous Australians were twice as likely as non-Indigenous Australians to report their health as fair or poor in 2004--05.

Indigenous Australians aged 15 years and over in non-remote areas were more likely than those in remote areas to report fair or poor health (23% compared with 19%). ^[33]

  Life expectation and mortality

Under the life expectation estimation formula adopted by the ABS in 2003, ^[34] Indigenous males' life expectation was estimated to be 59.4 years over 1996-2001, while female life expectation was estimated to be 64.8 years: a life expectation inequality gap when compared to the general Australian population of approximately 17 years for the same five year period. The ABS has not released a life expectation estimate for Indigenous peoples for the years 2002 on. ^[35]

The gap in life expectation between Indigenous and non-Indigenous Australians exists in part because of the dramatic increase in life expectation enjoyed by the non-Indigenous population over the past century. Over the period 1890 -- 1997, for example, it has been estimated that, for the non-Indigenous population, women's life expectancy increased around 26 years; while for males, 28 years. In contrast, while figures are not available, much smaller gains appear to have occurred in the Indigenous population contributing to the development of a 17 year life expectation gap. ^[37]

Text Box 1: International comparisons in Indigenous peoples' life expectancy 

Approximately 30 years ago, life expectation for Indigenous peoples in Canada, New Zealand and the United States of America was, like Indigenous peoples in Australia today, significantly lower than that of the respective non-Indigenous populations of those countries.

However, significant gains in life expectation by Native Americans and Canadians and the Maori have been made in recent decades. Today, Australia has fallen significantly behind in improving the life expectation of its Indigenous peoples. Although comparisons should be made with caution (because of the way different countries calculate life expectation) data from the late 1990s suggests Indigenous males in Australia live between 8.8 and 13.5 years less than Indigenous males in Canada, New Zealand and the USA; and Indigenous females in Australia live between 10.9 and 12.6 years less than Indigenous females in these countries. ^[41]

(a) Mortality

For the period 2001--05, among the residents of Queensland, Western Australia, South Australia and the Northern Territory (jurisdictions where the data is deemed reliable), deaths recorded as being of an Indigenous person accounted for 3.2% of all deaths, higher than their presence as a percentage of the total population (as noted, estimated at 2.5%). ^[42]

In Queensland, Western Australia, South Australia and the Northern Territory combined, approximately 75% of Indigenous males and 65% of Indigenous females died before the age of 65 years. In contrast, in the non-Indigenous population 26% of males and 16% of females died aged less than 65 years. ^[43]

For the period 2001--05, Indigenous infant deaths represented 6.4% of total Indigenous male deaths and 5.7% of total Indigenous female deaths compared with 0.9% and 0.8% of the total for non-Indigenous male and female infant deaths. ^[44]

(b) Years of life lost

Years of Life Lost (YLL) is an indicator of premature mortality.

A 2003 study on the burden of disease and injury among Indigenous peoples found there were an estimated 51,475 YLL due to disease and injury for the Indigenous population, or approximately 4% of the total YLL for disease and injury for the total Australian population. ^[45] This is significantly higher than their presence as a percentage of the total population.

Cardiovascular disease was the leading cause of years of life lost accounted for around one-quarter of total YLL among Indigenous peoples; followed by cancer (14% of YLL); unintentional injuries (11%), intentional injuries (9%) and diabetes (7%). ^[46]

5.3 Infant and child health

(a) Low birth weight infants

Indigenous infant and child health is significantly poorer than that of non-Indigenous infants and children. A 'low birth weight baby' weighs less than 2,500 grams at birth ^[47] indicating, among other things, foetal malnutrition. There is a growing body of evidence that suggests a malnourished foetus will program its body in a way that will incline it to chronic diseases later in life. ^[48]

Approximately twice as many low birth weight infants were born to Indigenous women compared to those born to non-Indigenous women over 2001 and 2004. ^[49] The ABS reported in 2005 that since 1991 there appears to be no change in both the rates of low birth-weight infants being born to Indigenous women and the mean birth weights of those infants. ^[50]

(b) Infant mortality

After significant reductions to the Indigenous infant mortality rate in the 1970s and 1980s, there was a levelling out of the rate in the mid 1990s. The decline is believed to have halted because of the generally poorer health of Indigenous mothers; their exposure to risk factors; and the poor state of health infrastructure in which infants were raised. ^[51] http://www.blogger.com/blogger.g?blogID=1856550366954823610#editor

The infant mortality rate is expressed as the number of deaths in the first year per 1,000 births in a population. The ABS concluded in 2001 that no reliable Indigenous infant mortality rate national trend (either for better or worse) was identifiable, largely because of the poor quality of data. ^[52] In jurisdictions where the data is deemed reliable, for the period 2001 to 2005, approximately two to three times the number of Indigenous infants died before their first birthday, as non-Indigenous infants. ^[53]

5.4 Chronic diseases

Chronic diseases, and in particular cardiovascular disease, are the biggest single killers of Indigenous peoples and an area where the Indigenous and non-Indigenous health equality gap is most apparent.
The rates of death from the five main groups of chronic diseases compared to the non-Indigenous population over 2001-05 is set out in Table 2 as a Standardised Mortality Rate (SMR). The SMR is calculated by dividing recorded Indigenous deaths by expected Indigenous deaths (with the latter based on the age, sex and cause specific rates for non-Indigenous Australians). ^[54]

Table 2: Indigenous Deaths, main causes, 2001-05 - Standardised Mortality Rate. ^[55]

Cause of Death
Males SMR
Females SMR

Diseases of the circulatory system

3.2

2.7

Neoplasms (including cancer)

1.5

1.6

Endocrine, nutritional and metabolic diseases

7.5

10.1 

Diabetes

10.8

14.5

Diseases of the respiratory system

4.3

3.6

Diseases of the digestive system

5.8

5.1

Communicable diseases

Communicable diseases in Indigenous peoples reported as multiples of the rates in the non-Indigenous population (2004-05) ^[57]

Communicable disease
Detected in Indigenous peoples at...

Hepatitis A

11.7 times the rate detected in the non-Indigenous population

Hepatitis B 

5.4 times the rate detected in the non-Indigenous population

Meningococcal infection

7.8 times the rate in the non-Indigenous population

Salmonellosis

4.3 times the rate in the non-Indigenous population

Chlamydia Infection

7.9 times the rate detected in the non-Indigenous population

Tuberculosis

1.6 times the rate in the non-Indigenous population

Social and emotional well being

The NATSIHS 2004-5 was the first Indigenous-specific survey by the Australian Bureau of Statistics that aimed to measure the emotional and social health of Indigenous adults. In this, more than half the adult Indigenous population reported being happy (71%), calm and peaceful (56%), and/ or full of life (55%) all or most of the time. Just under half (47%) said they had a lot of energy all or most of the time. ^[60] And Indigenous peoples in remote areas were more likely to report having had these positive feelings all or most of the time, than were Indigenous peoples living in non-remote areas. Conversely, about 15% of the total number of adults who were asked felt these things only a little of the time, or none of the time. Results again were better for Indigenous peoples in remote areas. ^[61]
The NATSIHS 2004-5 also included five questions designed to highlight psychological distress. Responses showed that almost one in ten Indigenous adults reported feeling nervous all or most of the time. When asked how often they felt without hope, 7% said that they had this feeling all or most of the time. Similarly, 7% said that they felt so sad that nothing could cheer them up, all or most of the time. A higher proportion of the Indigenous population reported feeling restless (12%) and/ or that everything was an effort all or most of the time (17%). ^[62]

The Western Australian Aboriginal Child Health Survey collected data on approximately 5,000 Indigenous children over 2000-01. It reported that one in four Aboriginal children were at high risk of developing serious emotional or behavioural difficulties. This compares to about 1 in 6 or 7 of non-Aboriginal children. ^[63]

Mental health

Data on hospitalisations for mental and behavioural disorders provide a measure of the use of hospital services by those with problems related to mental health. In 2005--06 there were more hospitalisations of Indigenous males and females than expected based on the rates for other Australians for most types of mental and behavioural disorders. ^[64] In particular, hospitalisations for 'mental and behavioural disorders due to psychoactive substance use' were almost five times higher for Indigenous males and around three times higher for Indigenous females. ^[65]

Hospitalisation rates for intentional self-harm may also be indicative of mental illness and distress. In 2005--06, Indigenous Australians were three times more likely to be hospitalised for intentional self-harm than other Australians. ^[66]

Disability 

In the 2006 Census of Population and Housing, a total of 19,600 Indigenous peoples (approximately 4% of the total Indigenous population) were recorded as requiring assistance with core function activities (self-care, mobility and/ or communication) on a consistent basis. The level of assistance required by the Indigenous population was twice as high as that required by the overall Australian population. ^[79]

Income

In the 2006 Census, the mean equivalised gross household income for Indigenous persons was $460 per week, which amounted to 62% of the rate for non-Indigenous Australians ($740 per week). ^[82] ^top

Employment

Participation in the labour force

The labour force participation rate for the non-Indigenous population was 63% in 2001 compared with 65% in 2006. When adjusted to include only people aged 15-64 years, the disparity in labour force participation widens further. In 2001 there were 54% of Indigenous peoples in this age group in the labour force compared with 73% of the non-Indigenous population. In 2006, 57% of the Indigenous population in this age group was participating in the labour force compared with 76% of the non-Indigenous population. ^[87]
Labour force participation rates for Indigenous peoples declines with remoteness, with a 57% participation rate in major cities compared with 46% in very remote areas. ^[88]

Nationally, 46% of all Indigenous peoples aged 15-64 years were not in the labour force in 2001. This figure dropped to 43% in 2006. (This indicates that they were not actively engaged in the labour market, for reasons including carer responsibilities, illness, disability or lack of market opportunities.) In 2002, 27% of the non-Indigenous population in the same age group were not participating in the labour force, while in 2006 this figure dropped to 24%. ^[89]

Education

Educational attainment among Indigenous peoples continues to improve. Between 2001 and 2006, the proportion of Indigenous peoples aged 15 years and over who had completed Year 12 increased from 20% to 23%. There was also an increase in the proportion of people who had completed a non-school qualification (20% to 26%).

^top

9. Housing and homelessness

Between 2001 and 2006 the proportion of Indigenous home owner households increased from 31% to 34%. The proportions of Indigenous households renting from Indigenous or mainstream community housing organisations and those renting from private or other providers, fell by around two percentage points between 2001 and 2006, while the proportion of Indigenous households renting from state housing authorities remained relatively unchanged over this period. ^[102]

In comparison, 69% of the estimated 7 million other Australian households were home owners (with or without a mortgage) 26% were renting and 2% had other tenure types. ^[103]

Generally speaking, in remote areas, Indigenous peoples are less likely to own their home than in urban centres.

Indigenous People and the Criminal justice systems

The Royal Commission into Aboriginal Deaths in Custody (RCIADIC) reported in 1991. At that time, Aboriginal people made up 14% of the total prison population and were up to 15 times more likely to be in prison than non-Aboriginal people. The Report made a large number of recommendations to address this issue. ^[122] 

Despite this, the number of Indigenous prisoners has increased significantly over the 17-years since the RDIADC. Indigenous prisoners represented 24% of the total prisoner population (6139 males and 567 females) ^[123] as of the 30^th June 2008, a proportion unchanged from the previous year. ^[124] The ABS notes that caution must be taken in interpreting the increases in the percentage of Indigenous peoples in the prison population, the increase may be due to alterations in the method of data collection and/ or the willingness of Indigenous prisoners to participate and identify themselves as Indigenous. ^[125]

Incarceration rates for women generally have increased more rapidly than for men and the increase in imprisonment of Indigenous women has been much greater over the period compared with non-Indigenous women. ^[130] The Indigenous female imprisonment rate has increased by 34 % between 2002 and 2006 while the imprisonment rate for Indigenous men has increased by 22%. ^[131]

Indigenous women are also 23 times more likely to be imprisoned than non-Indigenous women while Indigenous men are 16 times more likely to be imprisoned than non-Indigenous men. ^[132]

Child protection

Both the 1994 and 2002 surveys report that 8% of Indigenous respondents aged 15 years or over at the time of the surveys, had been taken away from their natural family. ^[143] The incidence of removal increased slightly with age, (perhaps reflecting greater numbers of removals in the past):

• 10% of Indigenous respondents aged 25 years or over reported that they had been taken away from their natural family.
• 10% was recorded for the closest equivalent age cohort group (35 years or over) in the NATSISS 2002.

In the NATSISS 2002, 38% of respondents reported that they had either been removed themselves and/ or had relatives who, as a child, had been removed from their natural family. The most frequently reported relatives removed were grandparents (15%), aunts or uncles (11%), and parents (9%). ^[144]
The intergenerational impacts of past child removal practices are reflected in the higher numbers of substantiation orders, child protection orders and child removal orders being made in the present day in relation to Indigenous children.

The intergenerational impacts of past child removal practices ^[145]

Among all of the Aboriginal children and young people living in Western Australia, 35.3 per cent were found to be living in households where a carer or a carer's parent (e.g. grandparent) was reported to have been forcibly separated from their natural family.

It was found that carers who had been forcibly separated from their natural families (compared with carers of Aboriginal children who had not been forcibly separated) were:

• 1.95 times more likely to have been arrested or charged with an offence
• 1.61 times more likely to report the overuse of alcohol caused problems in the household
• 2.10 times more likely to report that betting or gambling caused problems in the household
• Less than half as likely to have social support in the form of someone they can "yarn' to about problems
• 1.50 times more likely to have had contact with Mental Health Services in Western Australia.

Further, Aboriginal children whose primary carer had been forcibly separated from their natural family were found to be 2.34 times more likely to be at high risk of clinically significant emotional or behavioral difficulties than children whose carers were not forcibly separated.

Bibliography

---

^[1] Australian Bureau of Statistics, National Aboriginal and Torres Strait Islander Social Survey 2002, ABS cat no 4714.0 (2004).
^[2] Australian Bureau of Statistics, National Aboriginal and Torres Strait Islander Health Survey 2004-05, ABS cat no 4715.0 (2005).
^[3] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008).
^[4] Australian Bureau of Statistics, Population Distribution, Aboriginal and Torres Strait Islander Australians 2001, ABS cat no 4705.0 (2002) p 7-15.
^[5] For further information, see also Australian Human Rights Commission, Face the Facts (2008). At: http://www.humanrights.gov.au/racial_discrimination/face_facts/index.html (viewed 22 January 2009).
^[6] Australian Bureau of Statistics, Population Characteristics, Aboriginal and Torres Strait Islander Peoples 2006, ABS cat no 4713.0 (2008) p 12.
^[7] Australian Bureau of Statistics, Population Characteristics, Aboriginal and Torres Strait Islander Peoples 2006, ABS cat no 4713.0 (2008) p 12; Australian Bureau of Statistics, Population Characteristics, Aboriginal and Torres Strait Islander Peoples 2001, ABS cat no 4713.0 (2001) p 12.
^[8] Australian Bureau of Statistics and Australian Institute of Health and Welfare, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2003, ABS cat no 4704.0 (2003) p 245.
^[9] Australian Bureau of Statistics, Population Characteristics, Aboriginal and Torres Strait Islander Peoples 2006, ABS cat no 4713.0 (2008) p 10.
^[10] Australian Bureau of Statistics Population Characteristics, Aboriginal and Torres Strait Islander Peoples 2006, ABS cat no 4713.0 (2008) p 15.
^[11] Australian Bureau of Statistics, Population Characteristics, Aboriginal and Torres Strait Islander Peoples 2006, ABS cat no 4713.0 (2008) p 12.
^[12] Australian Bureau of Statistics, Population Characteristics, Aboriginal and Torres Strait Islander Peoples 2006, ABS cat no 4713.0 (2008) p 19, table 2.2.
^[13] Australian Bureau of Statistics, Population Characteristics, Aboriginal and Torres Strait Islander Peoples 2006, ABS cat no 4713.0 (2008) p 9.
^[14] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 79.
^[15] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 79.
^[16] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 80.
^[17] Australian Bureau of Statistics and Australian Institute of Health and Welfare, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2005, ABS cat no 4704.0 (2005) p 74.
^[18] Australian Bureau of Statistics, Population Characteristics, Aboriginal and Torres Strait Islander Peoples 2006, ABS cat no 4713.0 (2008) p 14-15.
^[19] Australian Bureau of Statistics, Yearbook 2008, ABS cat no 1301.0 (2008) p 198.
^[20] Australian Bureau of Statistics, Population Characteristics, Aboriginal and Torres Strait Islander Peoples 2006, ABS cat no 4713.0 (2008) p 15,(unnumbered graph).
^[21] Australian Bureau of Statistics, Population Characteristics, Aboriginal and Torres Strait Islander Peoples 2006, ABS cat no 4713.0 (2008) p 14.

^[22] Australian Bureau of Statistics, Population Characteristics, Aboriginal and Torres Strait Islander Peoples 2006, ABS cat no 4713.0 (2008) p 16.
^[23] Australian Bureau of Statistics, Population Characteristics, Aboriginal and Torres Strait Islander Peoples 2006, ABS cat no 4713.0 (2008) p 12.
^[24] Australian Bureau of Statistics, Population Characteristics, Aboriginal and Torres Strait Islander Peoples 2006, ABS cat no 4713.0 (2008) p 13.
^[25] Australian Bureau of Statistics, Population Characteristics, Aboriginal and Torres Strait Islander Peoples 2006, ABS cat no 4713.0 (2008) p 27.
^[26] Australian Bureau of Statistics, Population Characteristics, Aboriginal and Torres Strait Islander Peoples 2006, ABS cat no 4713.0 (2008) p 27.
^[27] Australian Bureau of Statistics, Population Characteristics, Aboriginal and Torres Strait Islander Peoples 2006, ABS cat no 4713.0 (2008) p 28.
^[28] Australian Bureau of Statistics, Population Characteristics, Aboriginal and Torres Strait Islander Peoples 2006, ABS cat no 4713.0 (2008) p 27.
^[29] Australian Bureau of Statistics, Population Characteristics, Aboriginal and Torres Strait Islander Peoples 2006, ABS cat no 4713.0 (2008) p 27.
^[30] Australian Bureau of Statistics, Population Characteristics, Aboriginal and Torres Strait Islander Peoples 2006, ABS cat no 4713.0 (2008) p 35-37.
^[31] Australian Bureau of Statistics, National Aboriginal and Torres Strait Islander Survey 1994 -- Detailed Findings, ABS cat no 4190.0 (1995) p 4.
^[32] Australian Bureau of Statistics, National Aboriginal and Torres Strait Islander Health Survey 2004-05, ABS cat no 4715.0 (2005).
^[33] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 9.
^[34] There are long-standing issues pertaining to the identification of an Aboriginal and/or Torres Strait Islander person as the deceased on death certificates that prevent definitive statements being made about Indigenous peoples' life expectation, hence the reliance on life expectation estimation formulas to arrive at figures. In 2006, it was estimated that only 55% of the deaths of Indigenous peoples were correctly identified. Australian Bureau of Statistics, Deaths 2006, ABS cat no 3320.0 (2006) p 69, Table 9.1.
^[35] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 154.
^[36] United Nations Development Program, Human Development Report 2005 (2005) p 220, Table 1.
^[37] F Baum, The New Public Health (2002) p 198.
^[38] Australian Bureau of Statistics, Deaths 2006, ABS cat no 3320.0 (2006) p 9.
^[39] Australian Bureau of Statistics, Australian Social Trends 2002, ABS cat. no. 4102.0 (2002) p 83-85.
^[40] Australian Bureau of Statistics, Deaths 2006, ABS cat no 3320.0 (2006) p 8.
^[41] I Ring and D Firman, "Reducing Indigenous mortality in Australia: lessons from other countries', Medical Journal of Australia (1998) 169, p 528-533.
^[42] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 156-7.
^[43] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 156-7.
^[44] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 156-7.
^[45] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 159.
^[46] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 159.
^[47] Australian Bureau of Statistics and Australian Institute of Health and Welfare, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2005 (2005) p 79.
^[48] National Health and Medical Research Council, Nutrition in Aboriginal and Torres Strait Islander Peoples, an information paper (2000) p 21.
^[49] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 83.
^[50] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 84, Graph 6.6.
^[51] N Thomson, "Responding to our "Spectacular Failure"', in N Thompson, The Health of Indigenous Australians, (2005) p 490.
^[52] Australian Bureau of Statistics, Deaths 2001, ABS cat. no.3320.0 (2002) p 23.
^[53] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 94.

^[54] Standardised mortality rate is observed as Indigenous deaths divided by expected Indigenous deaths, based on the age, sex and cause specific rates for non-Indigenous Australians: Australian Institute of Health and Welfare, Australia's Health 2008, ABS cat no 8903.0 (2008) p 76.

^[55] Australian Institute of Health and Welfare, Australia's Health 2008, ABS cat no 8903.0 (2008) Table 3.4.
^[56] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 130.
^[57] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 121, Table 7.34.
^[58] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 133.
^[59] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 134.
^[60] Australian Bureau of Statistics, National Aboriginal and Torres Strait Islander Health Survey 2004-05, ABS cat no 4715.0 (2005) p 3.
^[61] Australian Bureau of Statistics, National Aboriginal and Torres Strait Islander Health Survey 2004-05, ABS cat no 4715.0 (2005) p 3.
^[62] Australian Bureau of Statistics, National Aboriginal and Torres Strait Islander Health Survey 2004-05, ABS cat no 4715.0 (2005) p 3.
^[63] S Zubrick, S Silburn, D Lawrence and others, The Western Australian Aboriginal Child Health Survey: The Social and Emotional Wellbeing of Aboriginal Children and Young People, Curtin University of Technology and Telethon Institute for Child Health Research (2005) p 30.
^[64] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 111.
^[65] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 111.
^[66] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 111.
^[67] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 139.
^[68] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 139.
^[69] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 139-140.
^[70] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 144.
^[71] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 144.
^[72] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 144.
^[73] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 145.
^[74] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 140.
^[75] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 141.
^[76] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 141.
^[77] Department of Families, Housing, Community Services and Indigenous Affairs, Review of the First Phase of the Petrol Sniffing Strategy (2008). At http://www.facsia.gov.au/indigenous/petrol_sniffing_strategy_review/p02.htm (viewed 19 January 2009).
^[78] Department of Families, Housing, Community Services and Indigenous Affairs; Department of Health and Ageing; and others, Submission to the Senate Inquiry into Petrol Sniffing and Substance Abuse in Central Australia, 22 August 2008, p 8. At http://www.aph.gov.au/SENATE/COMMITTEE/clac_ctte/petrol_sniffing_substance_abuse08/submissions/sub14.pdf (viewed 19 January 2009).
^[79] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 55.
^[80] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 55.
^[81] Australian Bureau of Statistics, Population Characteristics, Aboriginal and Torres Strait Islander Peoples 2006, ABS cat no 4713.0 (2008) p 81.
^[82] Australian Bureau of Statistics, Population Characteristics, Aboriginal and Torres Strait Islander Peoples 2006, ABS cat no 4713.0 (2008) p 103.
^[83] Australian Bureau of Statistics, Population Characteristics, Aboriginal and Torres Strait Islander Peoples 2006, ABS cat no 4713.0 (2008) p 103.
^[84] Australian Bureau of Statistics, Population Characteristics, Aboriginal and Torres Strait Islander Peoples 2006, ABS cat no 4713.0 (2008) p 104.
^[85] Australian Bureau of Statistics, Population Characteristics, Aboriginal and Torres Strait Islander Peoples 2006, ABS cat no 4713.0 (2008) p 107.
^[86] Australian Bureau of Statistics, Population Characteristics, Aboriginal and Torres Strait Islander Peoples 2001, ABS cat no 4713.0 (2001) p 65; Australian Bureau of Statistics, Population Characteristics, Aboriginal and Torres Strait Islander Peoples 2006, ABS cat no 4713.0 (2008) p 80.
^[87] Australian Bureau of Statistics, Population Characteristics, Aboriginal and Torres Strait Islander Peoples 2006, ABS cat no 4713.0 (2008) p 80.
^[88] Australian Bureau of Statistics, Population Characteristics, Aboriginal and Torres Strait Islander Peoples 2006, ABS cat no 4713.0 (2008) p 66.
^[89] Australian Bureau of Statistics, Population Characteristics, Aboriginal and Torres Strait Islander Peoples 2006, ABS cat no 4713.0 (2008) p 81.
^[90] Australian Bureau of Statistics, Population Characteristics, Aboriginal and Torres Strait Islander Peoples 2006, ABS cat no 4713.0 (2008) p 83 and 104.
^[91] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 16-17.
^[92] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 16-17.
^[93] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 16-17.
^[94] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 16-17.
^[95] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 16-17.
^[96] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 20.
^[97] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 22.
^[98] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 24.
^[99] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 24.
^[100] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 25.
^[101] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 29-30.
^[102] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 30.
^[103] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 30.
^[104] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 30.
^[105] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 30.
^[106] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 37.
^[107] The Canadian model is sensitive to both household size and composition and uses the following criteria to assess bedroom requirements:

• there should be no more than two people per bedroom;
• a household of one unattached individual may reasonably occupy a bed-sit;
• couples and parents should have a separate bedroom;
• children less than five years of age, of different sexes, may reasonably share a bedroom;
• children five years of age or over, of the opposite sex, should not share a bedroom;
• children less than 18 years of age and of the same sex may reasonably share a bedroom; and
• single household members aged 18 years or over should have a separate bedroom.

Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 40.
^[108] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 40-41.
^[109] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 41.
^[110] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 41.
^[111] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 41.
^[112] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 42.
^[113] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 43.
^[114] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 43.
^[115] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 42.
^[116] Australian Bureau of Statistics, Housing and Infrastructure in Aboriginal and Torres Strait Islander Communities 2006 (Reissue), ABS cat no 4710.0, (2007) p 87.
^[117] Australian Bureau of Statistics, Housing and Infrastructure in Aboriginal and Torres Strait Islander Communities 2006 (Reissue), ABS cat no 4710.0, (2007) p 56, Table 4.9.
^[118] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 43.
^[119] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 43.
^[120] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 43.
^[121] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 42.
^[122] Royal Commission into Aboriginal Deaths in Custody, National Report (1991) volume 1, para. 9.3.1. At: www.austlii.edu.au/au/other/IndgLRes/rciadic (viewed 19 January 2009).
^[123] Australian Bureau of Statistics, Prisoners in Australia 2008, ABS cat no 4517.0 (2008) p 22, table 8.
^[124] Australian Bureau of Statistics, Prisoners in Australia 2008, ABS cat no 4517.0 (2008) p 6.
^[125] Australian Bureau of Statistics, Prisoners in Australia 2008, ABS cat no 4517.0 (2008) p 6.
^[126] Australian Bureau of Statistics, Prisoners in Australia 2008, ABS cat no 4517.0 (2008) p 6.
^[127] Australian Bureau of Statistics, Prisoners in Australia 2008, ABS cat no 4517.0 (2008) p 6.
^[128] D Weatherburn, B Lind, B Hua and J Hua, "Contact with the New South Wales court and prison system: the influence of age, Indigenous status and gender' (2003) Crime and Justice Bulletin 78(1) p 4-5. At click here='_blank' (viewed 19 January 2009).
^[129] Australian Bureau of Statistics, Prisoners in Australia 2008, ABS cat no 4517.0 (2008) p 8.
^[130] M Cameron, "Women Prisoners and Correctional Programs', AIC Trends and Issues in Crime and Criminal Justice, no 194, Australian Institute of Criminology (2001) p 1.
^[131] Steering Committee for the Review of Government Service Provision, Overcoming Indigenous Disadvantage: Key Indicators 2007, Productivity Commission (2007) p 128.
^[132] Steering Committee for the Review of Government Service Provision, Overcoming Indigenous Disadvantage: Key Indicators 2007, Productivity Commission (2007) p 129.
^[133] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 228.
^[134] M Lynch, J Buckman, and L Krenske, AIC Trends and Issues in Crime and Criminal Justice, Australian Institute of Criminology and Queensland Crime and Misconduct Commission, Issues paper 265 (2003).
^[135] M Lynch, J Buckman, and L Krenske, AIC Trends and Issues in Crime and Criminal Justice, Australian Institute of Criminology and Queensland Crime and Misconduct Commission, Issues paper 265 (2003) p 2.
^[136] Australian Medical Association, Undue Punishment? Aboriginal People and Torres Strait Islanders in Prison: An Unacceptable Reality, Australian Medical Association Report Card Series (2006). At https://fed.ama.com.au/cms/web.nsf/doc/WEEN-6PU9BH/$file/Indigenous_Report_Card_2006.pdf (viewed 19 January 2009).
^[137] T Butler, L Boonwaat and S Hailstone, National Prison Entrants Bloodborne Virus Survey Report 2004, Centre for Health Research in Criminal Justice and National Centre for HIV Epidemiology and Clinical Research (2005), p 5. At http://www.justicehealth.nsw.gov.au/publications/bbv_survey.pdf (viewed 19 January 2009).
^[138] T Butler, L Boonwaat and S Hailstone, National Prison Entrants Bloodborne Virus Survey Report 2004, Centre for Health Research in Criminal Justice and National Centre for HIV Epidemiology and Clinical Research (2005), p 5. At http://www.justicehealth.nsw.gov.au/publications/bbv_survey.pdf (viewed 19 January 2009).
^[139] A Kariminia, T Butler, S Corben, M Levy, L Grant, J Kaldor and M Law, "Extreme cause-specific mortality in a cohort of adult prisoners- 1988-2002: a data linkage study' (2007) 36(2) International Journal of Epidemilogy 310, p 314.
^[140] A Kariminia, T Butler, S Corben, M Levy, L Grant, J Kaldor and M Law, "Extreme cause-specific mortality in a cohort of adult prisoners- 1988-2002: a data linkage study' (2007) 36(2) International Journal of Epidemilogy 310, p 310.
^[141] M Lynch, J Buckman, and L Krenske, AIC Trends and Issues in Crime and Criminal Justice, Australian Institute of Criminology and Queensland Crime and Misconduct Commission, Issues paper 265 (2003) p ix .
^[142] J Joudo and J Curnow, Deaths in Custody in Australia: National deaths in Custody program annual report 2006, Australian Institute of Criminology, Technical and Background paper no. 85 (2006) p xiii.
^[143] Australian Bureau of Statistics, National Aboriginal and Torres Strait Islander Health Survey 2004-05, ABS cat no 4715.0 (2005) p 2.
^[144] Australian Bureau of Statistics, National Aboriginal and Torres Strait Islander Health Survey 2004-05, ABS cat no 4715.0 (2005) p 5-6.
^[145] Kulunga Research Network and the Telethon Institute for Child Health Research, Submission to the Senate Committee Inquiry into the Stolen Generation Compensation Bill 2008, April 9, 2008. At www.aph.gov.au/SENATE/committee/legcon_ctte/stolen_generation_compenation/submissions/sub42.pdf (viewed 19 January 2009).
^[146] For a detailed explanation of care and protection classifications and statistics see: Australian Institute of Health and Welfare, Child Protection 2001-02 (2003) ch 1.
^[147] The ABS cautions that data for Tasmania, however, should be interpreted with caution due to the low incidence of child protection workers recording Indigenous status at the time of the substantiation: Australian Bureau of Statistics, Population Distribution, Aboriginal and Torres Strait Islander Australians 2001, ABS cat no 4705.0 (2002) p 222. 

^[148] Australian Bureau of Statistics, Population Distribution, Aboriginal and Torres Strait Islander Australians 2001, ABS cat no 4705.0 (2002) p 223, Table 11.2.
^[149] The ABS cautions that SA data should be interpreted with caution due to the high proportion of investigations not finalised by 31 August 2006 (the cut-off date for the processing of investigations for inclusion in the data for that year).
^[150] Australian Bureau of Statistics, Population Distribution, Aboriginal and Torres Strait Islander Australians 2001, ABS cat no 4705.0 (2002) p 223, Table 11.3.
^[151] P Anderson and R Wild, Ampe Akelyernemane Meke Mekarle - Little Children are Sacred, Report of the Northern Territory Board of Inquiry into the Protection of Aboriginal Children from Sexual Abuse (2007).
^[152] P Anderson and R Wild, Ampe Akelyernemane Meke Mekarle - Little Children are Sacred, Report of the Northern Territory Board of Inquiry into the Protection of Aboriginal Children from Sexual Abuse (2007), p 6. ^[153] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 225, Table 11.4. ^[154] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 225, Table 11.4.
^[155] Australian Institute of Health and Welfare and Australian Bureau of Statistics, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS cat no 4704.0 (2008) p 225.
^[156] Access Economics for Reconciliation Australia, An overview of the economic impact of Indigenous disadvantage, (2008) p 5-6 (extracts). At click here (viewed 19 January 2008).