Introduction to cultural safety issues

Key terms

Before we start, here are three key terms you will need as you work through this course:

• Cultural safety: Cultural safety encompasses a reflection on individual cultural identity, recognition of the impact of personal culture on one’s professional practice and the effect cultural issues have had on clients and broader society. Culturally safe work practices empower clients and enable them to contribute to the achievement of positive outcomes as a result of engagement.
• Cultural awareness: Cultural awareness alerts you to the fact there are cultural differences between you and your client and across your client grouping, and helps you to expand your consciousness of critical cultural issues. 
• Cultural competence: Cultural competence means having the skills and knowledge needed to perform effectively in cross-cultural situations. It can help individuals to adapt their approach to meet diverse clients' needs better. 

As you work through this module you may come across some inconsistencies in the use of these terms as there is no central consensus on how they are defined in Australian and international literature. However the above definitions are a strong foundation for their application across a range of different environments. That said, where an article specifically provides an alternative definition, the alternative definition supplied is to be applied in that context. 

In counselling and community services practice, cultural safety is more than cultural awareness or cultural sensitivity. Cultural safety encompasses both a reflection on individual cultural identity and a recognition of the impact of personal culture on one’s own professional practice as well as a recognition of the impact that cultural issues have had on clients and wider society. Culturally safe work practices empower clients and enable them to contribute to the achievement of positive outcomes as a result of engagement.

As mentioned in the extract above, cultural safety is a concept defined with reference to the experience of people who received the service, instead of by the practitioners or service provider. It requires practitioners and services to not only be culturally aware and competent, but also have an ongoing commitment to engage recipient of services to determine and improve their experiences of safety.

Promoting cultural safety is critical when working with Aboriginal and/or Torres Strait Islander peoples. The colonial history of Australia experienced by the Aboriginal and Torres Strait Islander peoples has been full of injustice, discrimination, and persecution. While there is a growing recognition of the injustices committed against these communities, much of the disadvantage remains today. As a support services worker, it is important for you to enhance your understanding of the Aboriginal and Torres Strait Islander cultures and provide culturally safe and appropriate services to them. A starting point for developing cultural safety is to better understand the diversity of Aboriginal and/or Torres Strait cultures.

KNOWLEDGE CHECK

The Australian Bureau of Statistics (ABS, 2018) estimated resident Aboriginal and Torres Strait Islander population of Australia as of 30 June 2016 was 798,400 people, or 3.3 per cent of the total Australian population. This represents a 19 per cent increase in the Aboriginal and Torres Strait Islander population estimates from the estimate of 669,900 for 30 June 2011. Among the Aboriginal and Torres Strait Islander population in 2016, 91 per cent of people (727,500 people) identified as being of Aboriginal origin only, 5 per cent (38,700) were of Torres Strait Islander origin only, and 4 per cent (32,200) were of both Aboriginal and Torres Strait Islander origin.

Whilst they are often addressed in a collective term, Aboriginal peoples and Torres Strait Islander peoples are culturally very different and diverse. Each culture has their own languages, kinship structures, cultural practices and ways of life. It is important to acknowledge and celebrate the diversity of Aboriginal and Torres Strait Islander peoples.

Australia’s First Nations peoples are estimated to have arrived on the Australian continent over 60,000 years ago (Broome, 2019, p. 5). Aboriginal and Torres Strait Islander peoples are recognised as the oldest continuous cultures on Earth.

The population of Aboriginal people before the arrival of the British in 1788 is estimated to be between 300,000 to 950,000, with “approximately 260 distinct language groups and 500 dialects spoken” at the time (Dudgeon et al., 2014, p. 4). Connection to land is central to Aboriginal peoples. They are connected to the land through their stories, knowledge, culture and traditions. Aboriginal peoples lived in small family groups with each family group living in a defined territory. Groups had their own distinct history and culture. Membership within a family or language group was based on birthright, shared language, cultural obligations and responsibilities.

Torres Strait Islander peoples and cultures are distinct from Aboriginal peoples on mainland Australia. According to the Torres Strait Regional Authority (n.d.), there are eighteen islands and two Northern Peninsula Area communities in the Torres Strait. “The first inhabitants of the Torres Strait migrated from the Indonesian archipelago 70,000 Strait Island Regional Council, n.d.a).

Torres Strait Islander peoples have a strong connection to the sea and traditionally engaged in trade with other islands and with people of Papua New Guinea. The culture of Torres Strait Islanders is complex – it varies between each island or community; consists of Australian, Papuan and Austronesian elements; with a range of languages spoken among Torres Strait Islanders (Torres Strait Island Regional Council, n.d.b).

Like Aboriginal peoples of mainland Australia, Torres Strait Islander peoples have a strong communal and village life centred on hunting, fishing, gardening and trading. Cooking and hunting is distinct to the Torres Strait culture and is taught from a young age. “Inter-island trading consisted of food, weapons and artefacts and represented a key aspect of intergroup relationships. Some islands were better able to support gardening and crops and, for others, fishing provided the main food source. Other islands, due to their size and vegetation, provided wildlife and game” (Dudgeon et al., 2014, p.11).

As you have learned earlier in this topic, respecting and embracing diversity is essential for effective cross-cultural communication. This is even more important when working with Aboriginal and Torres Strait Islander peoples given the historical, social, political and economic issues facing these communities, and their engagement with services.

KNOWLEDGE CHECK

Planning, delivering, and evaluating services to Aboriginal and/or Torres Strait Islander clients can be a complex task for counsellors and community services organisations. The social problems experienced by Australia’s First Nations populations are often deeply embedded in the colonial history of the country and, as such, need to be approached with consideration of the historical, social, community, family, and individual factors of the clients you are engaging with.

Some of the historical, social, political, and economic factors that may impact on service delivery to Aboriginal and/or Torres Strait Islander peoples include:

• Impact of European settlement. European settlement in Australia was fraught with injustice and brutality toward the Aboriginal and Torres Strait Islander peoples of the land. The first and most devastating action of the British was to commence clearing of trees to make way for tents, storage areas, gardens and dwellings. They also built structures to contain water along the rivers. By doing this, they denied Aboriginal peoples’ land and cultural rights. They prevented access to traditional lands and helped themselves to the natural resources that belonged to the traditional owners. Conflicts between the settlers and the Aboriginal peoples led to wars, deaths, and massacres. Many Aboriginal people were forced by the colonial authority to work as labourers and domestic workers, creating a cycle of extreme poverty. Moreover, Aboriginal peoples were exposed to diseases such as measles, small pox and influenza that led to extremely high death rates. This has led to distrust of western systems and people in general.
• Loss of land and culture. Aboriginal and Torres Strait Islander peoples were forced off of their traditional lands. This posed many challenges to peoples’ way of life, including many traditional hunter-gatherer lifestyles. Many Aboriginal Australians were forced onto missions (also sometimes referred to as reserves), where the colonial authorities forbade them to speak their own language or maintain their own cultural practices. If they refused to move from their traditional lands, they were often met with violence – in many cases quite extreme violence. At the same time as entire communities were being removed from their homes, Aboriginal and Torres Strait Islander children were being removed from their families and sent to colonial institutions and foster families with European backgrounds where they were not allowed to have contact with their families and home communities, and frequently experienced psychological, physical and/or sexual abuses – this is commonly known today as the Stolen Generation. Such policies resulted in the loss of traditional culture, as these children were expected to adopt European lifestyles (e.g., dress, language, religion, and cultural values). Racism and discrimination.
• Racism and discrimination are evidenced at both the formal policy level (i.e., the systemic level), and in personal attitudes and negative stereotyping of Aboriginal and/or Torres Strait Islander peoples (i.e., the individual level) among wider Australians. Racism and discrimination refer to being treating unfairly because of your race, colour, ethnic background, descent, or nationality. Despite the existence of anti-discrimination laws in Australia (e.g., Racial Discrimination Act, Human rights and Equal Opportunity Commission Act, and various pieces of State legislation), Aboriginal and Torres Strait Islander peoples continue to experience racism and discrimination. Additionally, many of these policies were developed from a western perspective with little to no consultation from Aboriginal or Torres Strait Islander peoples. In fact, some people argue that racism and discrimination are embedded in the Australian Constitution, which still does not recognise Aboriginal and Torres Strait Islander people as people (Australian Human Rights Commission, 2011).
• Past and present power relations. Throughout the 1800s and 1900s the states and territories had policies or enacted legislation that placed extensive control over Aboriginal and Torres Strait Islander peoples’ freedom of movement, practice of their culture, social interactions and economic participation, including the right to open a bank account, access to welfare payments, employment, working conditions and wages of Indigenous workers. Aboriginal and Torres Strait Islander workers were often not able to access wages and were extremely underpaid, and subsequently essentials including food, housing and access to health care. The extent of control made Aboriginal and Torres Strait Islander peoples vulnerable to physical and sexual abuse, financial abuse, and systemic abuse relating to access to services and abuse of power. Many generations of Aboriginal and Torres Strait Islander peoples were trapped into a life of complete control, with no freedom or opportunities to pursue the life they wanted. As a result of both past colonisation and continuing discrimination, many Aboriginal and Torres Strait Islander peoples live in situations of socio-economic disadvantage. They continue to experience higher rates of homelessness, poverty, and unemployment than non-Indigenous Australians (Australian Institute of Health and Welfare, 2015). In addition, Aboriginal and Torres Strait Islander communities experience higher rates of substance use and abuse, family violence, incarceration, suicidality, poor nutrition, and obesity which contribute to higher rates of both physical and mental illnesses amongst them (Australian Bureau of Statistics, 2016). Within such context, Aboriginal and Torres Strait Islander peoples may not feel safe and able to engage with services built under systems that symbolic an imbalance in power relations.

The extract below from Williams (1999) helps to explain the colonial history and how it relates to power relations in Australia in more detail:

“Unsafe cultural practice is any action that diminishes, demeans or disempowers the cultural identity and wellbeing of an individual or group” (Williams, 1999, p. 28). Past unsafe cultural practices are a major factor in many Aboriginal and Torres Strait Islander peoples’ distrust of services and this past experience continues to affect relationships between these clients and community services organisations. Taking a historical perspective can help workers understand how the experiences of Aboriginal and Torres Strait Islander peoples may affect their relationships with formal social service systems. For example, the National Aboriginal Community Controlled Health Organisation (NACCHO; 2011), explains that “while Aboriginal and Torres Strait Islander people know they have a right to access health services they need, and receive responsive, respectful and quality care, they cannot be confident they will experience this due to the frequent previous experiences of racism in the health system” (pp. 11 – 12). In the context of Aboriginal and Torres Strait Islander peoples in Australia, it is likely that at some point in their life, they have had a negative experience with some type of service provider. Due to negative experiences in the past, they may fear mainstream authority figures or have a distrust of community services more broadly.

It is also important to keep in mind that Aboriginal and Torres Strait Islander peoples tend to experience higher rates of trauma as a result of colonialism. Symptoms of trauma can be passed from parent to child and can still impact Aboriginal and/or Torres Strait Islander children today – a process known as intergenerational trauma. Of course, Aboriginal and Torres Strait Islander peoples today can also experience direct trauma as a result of their treatment by, and place within, wider Australian society. Whilst trauma affects everyone differently, it has a potential to affect a person’s thoughts and behaviours in a variety of ways, including their ability to:

• Make decisions. Painful or traumatic experiences can alter the brain in lasting ways. Particularly when there has been repeated exposure to trauma in earlier years, a person’s brain is shaped to function with anticipation of danger, despite the absence of threat. As such, people who have experienced trauma may have poorer concentration, attention and judgment. They are prone to making poor decisions, such as overreacting to a rather normal situation. This means that people who have experienced trauma may experience more difficulty making decisions (or make decisions very impulsively) and/or their decisions will often be influenced by fear or anxiety.
• Communicate. Trauma has the potential to affect how a person communicates and relates to other people. Intrusive thoughts of trauma can impact a person’s ability to pay attention and/or listen carefully when communicating with another. If trauma has impacted more than one member of a family, as it often does in Aboriginal and Torres Strait Islander families, it may cause difficulties that can extend outside of the family. “In a family, each member will react to the traumatic event in their own way. If family members don’t understand each other’s experience, then misunderstandings, communication breakdowns and other problems can result” (State Government Victoria, 2015). As a support services worker, you need to be aware of potential issues in communication and work toward establishing a trusting relationship with your clients in order to overcome communication barriers.
• Understand. Trauma can make people feel exhausted, confused and/or numb, which can impact their understanding when engaging with other people. Trauma may cause difficulty in processing information. Someone who has experienced trauma may need more time to think about what is being said to them.
• Retain information. Trauma can affect memory in many ways. Intrusive thoughts, difficulty concentrating, and other physical symptoms such as sleeplessness can affect a person’s ability to retain information after experiencing a trauma. It is important to recognise difficulties in memory as a normal consequence of trauma. Be patient with clients who may have experienced trauma and work with them to develop strategies to help with retaining information, such as using visual aids.

Remember that not all Aboriginal or Torres Strait Islander peoples identify as traumatised, and those who do may have very different experiences in terms of both what caused their trauma, and the resulting symptoms. When working with individuals whom you suspect may be experiencing the impacts of trauma or intergenerational trauma, make sure that you don’t make assumptions or jump to conclusions. Talk with the client and work with them to determine how they see and define their own experience.

While it is important to understand the history of injustice experienced by Aboriginal and Torres Strait Islanders peoples and the current impact of past and present power relationships, it is also important to reflect upon their strength and resiliency to overcome, persevere, survive, and even thrive. The Aboriginal and Torres Strait Islander populations have played an instrumental role in their self-determination. Indeed, as Bin-Sallik (2003) states, “There is no doubt that one of the greatest victories against colonialist oppression was Indigenous Australians’ resistance to forced assimilation, which led to the Federal Government abandoning its genocidal assimilation policy” (p. 23).

Support services workers engaging with Aboriginal and/or Torres Strait Islander populations need to be sensitive to the historical, political, social, and emotional issues that may be affecting them. The impact of European settlement, the loss of land and culture, racism and discrimination, and power relations are all issues that greatly impact upon the worldview of Aboriginal and Torres Strait Islander peoples. Additionally, the processes of colonisation have had a continued influence on the development and implementation of social programs – which tend to be dominated in western philosophies and structures. These factors may all impact upon Aboriginal and Torres Strait Islander peoples’ willingness and comfort in engaging with such programs.

Unfortunately these experiences have profound impacts on health, mental health and social and emotional wellbeing, for individuals, families and communities. There are observable links between the past and the experiences of Aboriginal and Torres Strait Islander peoples, families and communities today. Compared to non-Indigenous Australians, Aboriginal and Torres Strait Islander peoples are more likely to experience the following challenges.

In general, Aboriginal and Torres Strait Islander peoples suffer poor health than non-Indigenous Australians. As you can imagine, the economic disadvantages and over-representation in justice system can have severe impacts on their health and wellbeing, as well as their access of services. Moreover, there are known disparities in access and use of health services among the communities, as compared to non-Indigenous Australians, due to a range of factors such as remoteness, affordability, past experiences of racism, stigma, shame, and cultural safety of services (Australian Institute of Health and Welfare, 2021).

This sheds light on the context for which we need to promote cultural safety for Aboriginal and Torres Strait Islander peoples in workplaces and service delivery. This is not only an ethical responsibility, but also a legal one.

A Note on the Legislative Context for Cultural Safety

Earlier in this topic, you have learned a range of legal considerations relevant to working with diverse people, including human rights and anti-discrimination laws. Fundamentally, cultural safety is a recognition of human rights of Aboriginal and Torres Strait Islander peoples to a safe environment. Specifically, the United Nations Declaration on the Rights of Indigenous Peoples clearly states the rights of Aboriginal and Torres Strait Islander peoples to live a life with self-determination and free from discrimination. The Declaration also emphasises on working in conjunction with the peoples to improve their economic and social conditions, including to combat prejudice and eliminate discrimination. The Australian Government announced its support for the Declaration in 2009, hence there is an expectation for governments, organisations, and practitioners to ground their practice in a human rights framework.

In addition, various federal and state-based anti-discrimination laws are set out to protect individuals from being discriminated over their characteristics, including race or cultural identity. Hence, providing a safe and discrimination-free workplace and service environment to Aboriginal and Torres Strait Islander clients and staff is an essential part of complying with these legislative requirements.

Some of the key legislation implemented in order to protect the cultural safety of Aboriginal and/ or Torres Strait Islander people include:

• Aboriginal and Torres Strait Islander Act 2005
• Aboriginal Land Rights Act 1976 (Commonwealth) or relevant state/territory Acts
• Native Title Amendment Act 1998 (Cth)
• Aboriginal Cultural Heritage Act 2003 (Qld)
• Racial discrimination Act 1975
• Aboriginal Protection Act 1869

Cultural safety is also increasingly being recognised as a standard of practice and an essential part of service delivery to Aboriginal and Torres Strait Islander peoples. Evidently, cultural safety has been incorporated in a number of policy frameworks and guidelines within health and community services engaging with Aboriginal and Torres Strait Islander peoples, such as:

• National Framework for Health Services for Aboriginal and Torres Strait Islander Children and Families.
• Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy 2020-2025.
• Cultural Respect Framework 2016-2026 for Aboriginal and Torres Strait Islander Health.
• National Aboriginal and Torres Strait Islander Health Plan 2021-2031.

It is important that support services workers and services recognise current industry developments and broader national frameworks and use these to improve service delivery and practice.

KNOWLEDGE CHECK

This topic introduced you to a brief history of the colonisation of Australia and the lasting impact it has had for Aboriginal and Torres Strait Islander peoples. You were introduced to the concept of cultural safety and provided with the knowledge and understanding needed to promote cultural safety on both a personal and organisation level, which we turn to in the following sections.

1. Australian Bureau of Statistics. (2016). Aboriginal and Torres Strait Islander people with a mental health condition. 4714.0 - National Aboriginal and Torres Strait Islander Social Survey, 2014-15. https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4714.0~2014-15~Feature%20Article~Aboriginal%20and%20Torres%20Strait%20Islander%20people%20with%20a%20mental%20health%20condition%20(Feature%20Article)~10
2. Australian Bureau of Statistics. (2018). Estimates of Aborginal and Torres Strait Islander Australians. https://www.abs.gov.au/statistics/people/aboriginal-and-torres-strait-islander-peoples/estimates-aboriginal-and-torres-strait-islander-australians/jun-2016
3. Australian Human Rights Commission. (2011). Constitutional Reform Fact Sheet: Recognising Aboriginal and Torres Strait Islander people in the Constitution. Sydney, NSW: Australian Human Rights Commission.
4. Australian Institute of Health and Welfare. (2015). The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples: 2015. https://www.aihw.gov.au/reports/indigenous-australians/indigenous-health-welfare-2015/report-editions
5. Australian Institute of Health and Welfare. (2021). Cultural safety in health care for indigenous Australians: monitoring framework. https://www.aihw.gov.au/reports/indigenous-australians/cultural-safety-health-care-framework/contents/summary
6. Australian Institute of Health and Welfare & National Indigenous Australians Agency (2020). Aboriginal and Torres Strait Islander Health Performance Framework – Executive summary. https://www.indigenoushpf.gov.au/Report-overview/Overview/Executive-summary
7. Bin-Sallik, M. (2003). Cultural Safety: Let’s name it! The Australian Journal of Indigenous Education, Vol. 23: pp. 21 – 28.
8. Broome, R. (2019). Aboriginal Australians: A history since 1788 (5th eds.). Allen and Unwin.
9. Dudgeon, P., Wright, M., Paradies, Y., Garvey, D. & Walker, I. (2014). Aboriginal Social, Cultural and Historical Contexts. In P. Dudgeon, H. Milroy, & R. Walker, Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice (2nd ed.). Attorney-General’s Department, Commonwealth of Australia.
10. National Aboriginal Community Controlled Health Organisation. (2011). Creating the NACCHO Cultural Safety Training Standards and Assessment Process. Braddon, ACT: Canberra Secretariat.
11. State Government of Victoria. (2015). Trauma and Families. Melbourne, VIC: Department of Health and Human Services. Retrieved from www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Trauma_and_Families
12. State Government of Victoria. (2019). Part 1: Aborginal and Torres Strait Islander cultural safety framework. https://www.health.vic.gov.au/health-strategies/aboriginal-and-torres-strait-islander-cultural-safety
13. Torres Strait Island Regional Council. (n.d.a). Torres Strait History. Retrieved on January 18, 2022, from http://www.tsirc.qld.gov.au/our-communities/torres-strait-history.
14. Torres Strait Island Regional Council. (n.d.b). Culture, protocols & heritage. Retrieved on January 18, 2022, from http://www.tsirc.qld.gov.au/our-communities/culture-protocols-heritage
15. Torres Strait Regional Authority. (n.d.) Community profiles. Retrieved January 18, 2022, from https://www.tsra.gov.au/the-torres-strait/community-profiles
16. Walker, R., Schultz, C., & Sonn, C. (2014). Cultural competence – transforming policy, services, programs and practice. In P. Dudgeon, H. Milroy, & R. Walker, Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice (2nd ed.) (pp. 195-220). Attorney-General’s Department, Commonwealth of Australia.
17. Williams, R. (1999). Cultural Safety – what does it mean for our workplace? Australia and New Zealand Journal of Public Health, Vol. 23(2): pp. 213 – 229.