Name

Address

Occupation

Special Commission of Inquiry into the Drug 'Ice'

STATEMENT OF CORINA KEMP

20 June 2019

Corina Kemp

2-4 Sulphide Street, Broken Hill NSW

Aboriginal Mental Health Drug and Alcohol Clinical Leader

On 20 June 2019, I, Corina Kemp state:

1. This statement made by me accurately sets out the evidence that I would be prepared,

if necessary, to give in court as a witness. The statement is true to the best of my

knowledge and belief and I make it knowing that, if it is tendered in evidence, I will

be liable to prosecution if I have wilfully stated in it anything that I know to be false,

or do not believe to be true.

Background

2. In 2012, I commenced working in the Far West Local Health District as an Aboriginal

Mental Health Drug and Alcohol Trainee. In 2014, I completed my Aboriginal Mental

Health Drug and Alcohol Traineeship. In the course of my Traineeship I was hosted by

Maari Ma Aboriginal Health Service, I completed clinical placements with the Far West

Local Health District Mental Health Drug and Alcohol Services, I spent three weeks at

the Community Mental Health Team, the Child and Adolescent Mental Health Service,

six weeks at the Mental Health Inpatient Unit and four weeks at the University

Department of Rural Health.

3. In 2015, on completion of the Traineeship, I accepted a position with the Child and

Adolescent Mental Health Service. In August 2015, I accepted the role of the Child and

Adolescent Mental Health Service Team Leader.

4. In July 2018 I was seconded to the position of Aboriginal Mental Health Drug and

Alcohol Clinical Leader for the Far West Local Health District, and settled in that role

in November 2018. In my current role, I complete weekly outreach clinical visits to

Wilcannia working with people living with a mental illness or disorder and provide

intervention and prevention strategies to people living with drug and alcohol problems.

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5. I coordinate the quarterly Psychiatry visits to Wilcannia and provide Cultural supports

to the Mental Health Drug and Alcohol Community Teams when working with

Aboriginal Torres Strait Islander People and their families.

6. I understand ATS to include Ice, speed, cocaine, ecstasy and any stimulant drug that

gives a person a high.

7. The use of ATS in my Local Health District has a number of impacts on a variety of

people in the community:

a. Individuals - It can be difficult to engage and help an Aboriginal person to

identify they have a problem and their need to seek help. There is a lack of

educational opportunities and Aboriginal young people are turning to drugs

rather than completing their schooling. Aboriginal young people are at risk of

suicide by overdose (or other methods).

b. Aboriginal children often progress from sniffing petrol to smoking marijuana,

and then using heavier drugs (such as ATS).

c. Some young females engage in prostitution and other activities to fund their

ATS use.

d. Families of ATS users - If an ATS user does not wish to receive treatment,

there is nothing the Health system can do unless the person is willing to

voluntarily seek help. The Mental Health Drug and Alcohol Services have no

special grounds to compulsorily treat any person without their consent, unless

sectioned and person is then brought in involuntarily.

e. There is a lack of family supports for ATS users, often resulting in family

dysfunction. Children are forcibly removed from families and are at risk of long

term health problems.

f. Drug use by mothers during pregnancy can result in lower birth weight.

g. Community - There is an increase in crime rates to enable ATS users to

support their drug use.

h. Aboriginal people that use ATS are abusing their bodies and do not consider

their holistic health or the long-term impacts of these drugs.

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i. Supports - Aboriginal people will not seek help as they are scared of being

removed from their land, culture and kinship. There is a cultural disconnection

from land and culture (a cultural way of healing). Aboriginal people fear

disconnection from kinship, losing contact with family and being locked away

in institutions. This stems from Aboriginal people being petrified of authority

and worried about consequences if anyone finds out about their ATS use.

j. There is a need for a Rehabilitation Centre closer to home.

k. Aboriginal ATS users require Elder supports, culturally appropriate programs

and supports, and identified positions or identified human resources in

specialised areas such as drug and alcohol.

8. Patients report using Ice, and report they smoke or inject the drug.

9. Patients report occasional or daily use of ATS, and they can last up to two or three

days without stimulant drugs. For some patients, smoking marijuana does not provide

enough stimulation which leads to use of other drugs including ATS.

10. In my experience, patients report using ATS at parties, when their friends or family

are using, and report use as a result of peer pressure. Patients are raised or are

exposed to the drugs and see drugs as a normal lifestyle.

Harms

11. We see referrals/admissions to mental health for depression, anxiety, mild psychosis,

schizophrenia, drug and or alcohol dependence related to ATS use.

12. The number of Aboriginal people presenting with a mental health issue varies per

month. I am unable to provide data in relation to the number of presentations that are

ATS related.

13. During a Mental Health Drug and Alcohol Triage and/or Mental Health Drug and Alcohol

Assessment a screening is completed asking whether consumers use drug and alcohol,

14. We explore with the consumer the types of drugs or alcohol and length of time they

have been using.

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Comorbidities

15. We see ATS users with comorbidities including self-harm, suicidal ideation, paranoia,

and visual and auditory hallucinations.

16. Consumers who have used ATS have had suicide attempts and report having suicidal

ideation due to the increase in stress they experience when they cannot access ATS.

17. There is a lack of resources for ATS users with comorbidities, including access to and

delivery of employment and housing services. There is also a lack of funding into

training, and a lack of availability of courses to put young men and women into a trade.

18. Cultural dispossession (taking people hundreds of kilometres from their cultural

connections to land, people, networks and circles of healing) and transitions for

Aboriginal people back into the community setting are difficult. Services are primarily

located in Metropolitan regions and are somewhat limited in rural and remote areas.

There is also a need for increased Aboriginal human resources within the workforce.

19. This could be improved with more education and training in relation to managing and

responding to someone who is affected by ATS.

Referrals and interventions

20. When a consumer is brought to ED for an ATS-related issue during business hours the

community mental health Intake team are contacted. The Intake worker will then

complete a mental health assessment on the consumer. Consultation and further

mental health assessment is then completed by a psychiatrist.

21. After business hours, the Mental Health Emergency Crisis (MHEC) Team is contacted

via teleconference or videoconference (preferably videoconference). The MHEC Team

conducts a mental health assessment and completes a consultation with the on-call

psychiatrist. A decisions is then made to admit or discharge the consumer.

22. People who are seeking supports in regards to ceasing ATS can self-refer or be referred

by their general practitioner or by any other service to mental health and drug and

alcohol services.

23. We have access to drug and alcohol consultation liaison services in the form of clinical

consultations which are either face to face with staff or via

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teleconference/videoconference. Consultation liaison services also provide clinical

supervision, education and training.

24. There are very limited drug and alcohol specific services within Broken Hill. There is a

high demand for the Far West Local Health District to manage such presentations as

they are high risk.

25. If there were more drug and alcohol services within the Far West I would definitely

utilise them, especially for the rural and remote regions, and for working with

Aboriginal and Torres Strait Islander people.

Families

26. In my experience as a health professional working with families who are affected by

ATS use, families want supports for the affected person/s, but limited supports and

services are available. There are difficulties in gaining access to services such as

rehabilitation.

27. There is little the Health system can do about the affected person that is using unless

the person is willing to voluntarily seek help. The Mental Health Drug and Alcohol

Services have no grounds to address the ATS use of any person without consent unless

the person is sectioned and bought in involuntarily.

28. ATS use can lead to family dysfunction. In some cases, intoxication and chaotic families

from ATS use can lead to children being forcibly removed.

29. The impact of ATS use can lead to children being at risk of long term health problems.

Also, mothers using ATS during pregnancy can result in lower birth weight in children.

30. Drug and alcohol assessments are completed for all new referrals to the Mental Health

Drug and Alcohol Services. During assessment, consumers report their current and

past history of use of drugs and alcohol. There is a lot of mistrust of government

systems amongst Aboriginal people and their families due to the history of colonisation.

31. Obtaining treatment is time consuming due to systematic processes or procedures. If

processes and/or procedures were more effective, availability would improve over

time. Having an accessible drug rehabilitation centre for Aboriginal People and support

from Aboriginal People to provide culturally appropriate supports and transitions into

community would be more effective.

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32. I am able to make appropriate referrals, however, face to face support is limited. To

connect with Aboriginal people and their families it is preferable to do so face to face,

rather than via videoconference or teleconference.

33. Referrals are 100kms away from country, land, kinship and culture, making transitions

back into the community more difficult as Aboriginal people are at risk of relapsing

without the appropriate supports in place or available.

Custodial

34. The Far West Local Health District has correctional centres in Broken Hill and in

Ivanhoe.

35. ATS users leaving custody face barriers to successful reintegration into the community.

The processes for people to receive treatment include going through referral pathways,

being accepted by the service, and waiting for a Specialised Psychiatric Assessment.

This is all time consuming.

36. Homelessness and housing, with limited or no after hours/weekend support, are major

issues for this cohort.

Workplace issues

37. Addressing the needs of Aboriginal people that I know personally presents a clear

challenge within itself. I have overcome these challenges by advocating for Aboriginal

people and their Families, and in providing recommendations or advice on what is the

right treatment pathway or plan for Aboriginal people and their Families.

38. There is a need for more training in management of ATS users and culturally

appropriate treatment plans, how to respond to ATS users and how to meet any legal

obligations regarding ATS users.

39. A drug specific rehabilitation centre within the Far West of New South Wales would be

beneficial. Indigenous cultural considerations such as ensuring the care being received

is culturally safe, having strong connections to the consumer's country, people and

their families, spiritual connections and healing need to be part of the treatment.

40. It is important to ensure a smooth transition back into the rural and/or remote

community for Aboriginal and Torres Strait Islander people and their Families. This

includes ensuring the services they are linking into are accessible and are available,

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rather than having telehealth or video linkups, as a majority of Aboriginal and Torres

Strait Islander people prefer to connect with specialists face to face.

General

41. The history of colonisation has a huge impact on Aboriginal people and their families.

The mistrust, loss of country, loss of connection to land, the dispossession of culture,

shared knowledge, language and spiritual healing has transgenerationally impacted on

Aboriginal people today and will continue.

42. The cost of rehabilitation for Aboriginal people is financially difficult, including the cost

of travel to a rehabilitation centre S00kms or more from their home town, the cost of

accommodation and the cost of food. The emotional impact on Aboriginal people that

are living away from country, kinship and culture for three months or more has an

impact on their wellbeing and healing journey.

43. The cost for Aboriginal families with larger families to travel to visit their loved ones in

facilities such as rehabilitation is traumatising, especially for the children. There is a

desperate need for a local Drug and Alcohol Rehabilitation Centre in the Far West to

provide culturally safe and appropriate services to Aboriginal People and their Families.

44. There is a need to increase the Aboriginal Mental Health Drug and Alcohol Workforce

in having identified positions as there are limited human Aboriginal resources. There

is a need to form teams specialising in Mental Health and Drug and Alcohol to improve

on the effectiveness of working with Aboriginal people and their families, and to ensure

that the Health Service is providing excellence in healthcare in rural and remote regions

that is culturally appropriate to the needs of Aboriginal people and their families.

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