Speaking of Science: Unlocking the power of Indigenous co-design and intervention: Transformative outcomes through authentic collaboration

Professor Toombs, a self-prescribed storyteller, spoke about how unlocking the power of Indigenous co-design and intervention can ultimately lead to transformative outcomes through authentic collaborations. With a focus on the holistic concept that underpins Indigenous health and well-being, Professor Toombs discussed the vision, process, and outcomes of her research into suicide prevention and primary healthcare access among Aboriginal and Torres Strait Islander communities across Australia.

Listen to Professor Toombs ‘Speak of Science’ and answer questions openly and honestly on how non-Indigenous allies can rebuild trust with mob, how we can get mainstream to relinquish to Aboriginal-led programs and her advice for early-career Indigenous researchers. You don’t want to miss this one!

Recorded on Thursday 30 May 2024 from 11:00 – 12:00 AEST.

Video transcript

Professor Steve Wesselingh  0:03  
But I really want to take this opportunity to recognise the importance of the lands we call home. We do this to show our continued commitment and responsibility to improve our knowledge of local First Nations people. Their cultures and their relationships with groups right across the country. So I really wanted to emphasize that point. And before we formally get started, there will be opportunities to ask questions at the end. And so I'd really like you to put those questions into the Zoom chat function if you if you can. And then we'll make sure we get those questions to be answered right at the end. We've had a number of these webinars, and they've been really successful, and if you want to go back and rewatch any of them, recordings are made available afterwards on the NHMRC website. And as I mentioned, this is our fourth webinar in the Speaking of science series. And we're really hosting some of the best and most respected health and medical professionals to discuss research breakthroughs, insights, innovations, and controversial issues right across the board. And we really had some really good feedback. And if you have any other feedback at the end of the session, or if you have an opportunity to talk to colleagues and friends about the series, please do but also talk to us about how we can improve it. Right now we're in the middle of celebrating National Reconciliation week, which is a time for all Australians to learn about our shared histories, cultures, achievements, and how to explore the national efforts towards achieving national reconciliation. And the theme this year is 'Now more than ever', and, and obviously after the referendum last year, you know, a real focus on this area, a focus on closing the gap. And and a fight for justice and rights of Aboriginal and Torres Strait Islander people has to be ongoing and must continue. And so today's talk is a really important part of that.

So NHMRC actually tries to help this process and has taken some significant steps in in advancing reconciliation. And really, our goal has been to use our research and our research funding to improve Aboriginal and Torres Strait Islander health outcomes right across the board. And, and we've done that, by increasing the amount of funding we that goes to Aboriginal and Torres Strait Islander health research, and it's now up to 8% of the MREA. Our goal was 5%. And we now 8% of all of our funding goes to Aboriginal and Torres Strait Islander health. The other target we have is to increase the number of CIA's who are on NHMRC grants. And at the moment, unfortunately, that's around 1.7%. We'd like to see that doubled up to 3.4%. So that that is a an area that we'd like to improve and build that capability and capacity in the Aboriginal and Torres Strait Islander community.

Which brings me to our guest speaker for our May Speaking of Science webinar, Professor Maree Toombs. And Maree is a distinguished public health researcher, strategic leader in indigenous health with expertise in mental health, suicide, and suicide intervention. She's got over 20 years of experience in teaching and developing indigenous curricula, both in education and health. And Maree has improved the way people culturally work with indigenous Australians in urban, rural and remote areas. And her success is based on co-designed, high impact research, led by the priorities identified by participating communities, really important principle. Maree recently commenced the role of Professor of Aboriginal and Torres Strait Islander Health in University of New South Wales, School of Population Health. And previous to that held the position of Director of Indigenous Health within the Rural Clinical School at the University of Queensland. In 2023, she was the recipient of the prestigious Australian Mental Health prize, and was invited to join the 2023 Australian mission delegation to the United Nations in New York. She is also presented with the Monash University Churchill Fellowship in 2011. And she's worked very hard with NHMRC on a whole lot of areas. But most importantly, she's a member of the NHMRC Principal Committee Indigenous Caucus and I've worked closely with her on that and and she's been absolutely terrific. In addition, she was included in the NHMRC 10 of the Best, 14th edition, for her significant work in I-ASSIST, the first indigenous led and designed suicide intervention program in Australia. And if you haven't read the short story, I encourage you to read the whole of the 10 of the best, but certainly the story about Maree. [Audio cut out}

Professor Maree Toombs  5:44  
Okay, should I start my presentation? Steve, you went on mute for that last bit. So am I good to go?

Professor Steve Wesselingh  5:55  
Wait, sorry, how long was on mute for?

Professor Maree Toombs 5:58  
Oh, maybe just 20 seconds. But I think everybody's heard enough. I've got a big head, I can tell you.

Professor Steve Wesselingh  6:07  
Maybe I'll just just say, I really enjoyed working with Maree and really looking forward to this talk. So yeah, let's go Maree.

Professor Maree Toombs  6:15  
Aww thanks, Steve. Alrighty, so, oh, now I've lost my little space here. [Acknowledgment to country.] My name is Maree Toombs, and I am a proud Euralayie/Kooma woman from north-western New South Wales. And I love to tell people that I come from the most boring town in Australia, it has been voted that, it's official. And you can get a tea towel that says that. So that little place is called Goodooga. And there's some amazing Aboriginal activists that come out of that that community. I'd like to pay respect to the Bidjigal peoples of the lands that I'm on today up here in Sydney, in the eastern suburbs, so a very beautiful place and acknowledge country, wherever you may be today, And also to acknowledge any Aboriginal and or Torres Strait Islander peoples that are on this webinar today. And a big thank you to Steve who is a genuine authentic leader and a great advocate for the work that we do in indigenous health. So thank you for your kind words Steve.

Professor Maree Toombs  7:41  
Okay, we've done acknowledgment. But I did just want to point out here that we do have 250 countries here. And so when you think about research in this country, and you think of Europe, Europe has about 46 countries, we have 250 that we have to try and navigate in terms of the research that we do in indigenous health. So that translational piece, working with all of those different countries with their own languages and own nuances around the way that culture is done is it's something just to keep in the back of your mind through this presentation.

It's a critical time to reflect on the state of indigenous research in this country. And despite the best efforts and good intentions of many, the reality is that indigenous peoples continue to experience drastically poorer health outcomes compared to those of non-Indigenous Australians. This is something that's an ongoing, ongoing legacy of colonisation, dispossession, and discrimination. And I think the sad part about this is that Australians don't know the history of this country and with a stronger understanding of the impacts that the policies have had on the oldest surviving civilization in this world. And I would say, our first scientists ever, as being the oldest surviving civilization in the world, it's important to understand why we have these disparities. And some of you may know some of these policies. Some of you may not have been exposed to these at all. But essentially, they have been purposely designed to break down our culture. And so the work that I do is really focused on trying to wake up spirit, which is how we see ourselves as Aboriginal and Torres Strait Islander peoples, when our spirit is well, we are well. When our spirit is sick, our spirit, we are on well, and so I just thought I would pop this up here because we've had some good times we've had some bad times and we've had a referendum on October 14th last year that has left a lot of injury for many Aboriginal and Torres Strait Islander peoples as well. But be that as it may, I'm going to be sharing some really positive research outcomes with you today. And there's a couple of case studies and I'm a storyteller, and I don't really consider myself a researcher. I see myself as a facilitator, and I'm very much community based and community led.

So let's get started. So to set the scene, I was finishing up my PhD in 2012, when a very interesting looking cowboy type of a figuire darkened my doorway at the Rural Clinical School up in Toowoomba, and he was an endocrinologist, flew an aeroplane, wild looking lad, and he announced himself as the new head of the Rural Clinical School. Referred to me as Toombsy, and said 'Toombsy we're going to do some research together. And I'm thinking to myself, who-are-you? So I was a little bit unsure of this man, but his enthusiasm was a little bit contagious. And so I said to him, 'Well, what are you thinking about?' And he said, 'I don't know'. He said, 'this is your gig. I've got this great track record'. So he, he was a pretty confident sort of a fellow. And he said to me, 'why don't you go and yarn with mob? And you come back and tell me what people are saying out there'. And I thought, this is great. So I got the keys to a lovely car for two weeks, and I went out and spent time across the communities that I know really well in southeast and in southwestern Queensland. So where my family and connections from living in Toowoomba for 25 years resonated. So during this consultation time, I really just wanted to hear from mob about what their understanding of research is, where they saw the need, and if it was something that I could help with through funding. And the the initial piece that really struck me was this almost shock of people looking at me saying what you actually want to hear our voices, and you actually want to hear what we need? And I was like, yes. So there was kind of this little bit of a disbelief around it, which actually made me feel really sad, but also didn't surprise me in the same token, because of you know, a lot of paternalistic models that have been placed over us. But overwhelmingly, there were three themes. The first one was to understand what mental illness looks like for Aboriginal peoples, and I say, Aboriginal and not Torres Strait Islander here because it was in this western Queensland piece.

Professor Maree Toombs  13:02  
And prevalence, people actually wanted to know, what did it actually look like in communities. The second one was, this really deep cut that suicide was creating in these communities, where young people were taking their lives at alarming rates. And the communities were just saying, we need to do something. And then the third piece was around chronic disease, and basically, community saying, unless our spirit is well, we can't actually look after other parts of our physical health. So with that, went back to the Rural Clinical School reported back to my then boss, and we applied for our first National Health and Medical Research Council grant, back in 2013. And got it. So it was a Project Grant. And I was in shock, because I never in a million years thought that I would be a lead investigator on a grant like that. But the grant was to actually have a look at pure prevalence of common mental disorders in Aboriginal peoples across South-eastern South-western Queensland. And I kept saying to mob, are you want to do this because it means you have to sit down with a diagnostic interview. And you know, we're going to blind a couple of psychiatrists to the results to see if it you know, that the concordance marries up. And so I explained all of this to everybody. And they're like, we need to do it.

Professor Maree Toombs  13:02  
So it ended up becoming the most successful prevalence study with Aboriginal peoples in the country. And just imagine this okay, so imagine me coming up to you in a medical service or out in the community and saying, 'Hey, we're doing this mental health study, to help mob understand you know common mental disorders? Would you like to do an interview with us to see if you have a mental health issue, so that we can get a better understanding on how to support you?' So that was basically the remit. 544 people said yes to that. And, I mean, that just blew my mind. Because I think if someone had come up to me, and asked me that, without that consultation, I would have said, no. But communities asked for this. And so that's what they got. And what we did find is, we use the DSM for research models. So it was this structured clinical interview. And we validated that with a population of 50 initially, to understand if it was appropriate. What I will say about the results of this research were that they were focused on English speaking, Aboriginal peoples, and so we didn't take this into remote communities. And, and you'll see there in front of some of the outcomes. One of the things we did find with this study was we could not get it published in Australia so. Because the rates of common mental disorders, particularly major depressive disorder, and anxiety and self medicating with alcohol and other drugs was so much higher than what the Australian standards for saying we won't believe. So there was a whole lot of cross checking and [audio cut out]

theology is great, but can you throw in some good news? It's like, we can't it's a prevalence study. So anyway, they ended up ended up being published in the British Medical Journal of Psychiatry, which actually has a high impact. And this woman here, Miss Margie Duncan, was our recruitment person. So she's a community girl. She comes out of a mission called Toomelah. And she, on one day alone, recruited over 90 people out of a place called Boggabilla. And so there was a whole lot of mob their playing bingo, or I think it might be called housie here in New South Wales. And she gets on the microphone and just said, 'right-o you mob, you said you wanted this study. So you need to get down to the clinic now, the team are in town, and they're ready to go'. And anyway, half of or maybe even three quarters of the bingo hall got up, marched down the road to the clinic where we were recruiting, yeah, and an hour later, we had 90 people signed up. So it was very exciting. And the power of the people and this woman here is Ruth, she was one of three of our clinical, clinical psychologists that worked on this, on this grant. And you can see a breakdown there of, of the disorders that we found. I couldn't, I couldn't leave this project as a standalone because it was one thing to identify what was going on. But it was another thing to do something more about that. And so off the back of this project we scaffolded into another project, which I'll just briefly discuss. And it's working with traditional healers and clinical psychologists in a a model of care that community are co designing. And that project has been going along really well until unfortunately, COVID hit and now we're just trying to get ethics back again and get it going. But it's been a little bit troublesome. But hopefully we can continue the work in that space. This project here was the second piece that I spoke about in terms of mob being really worried about the rates of suicide in community. And you know, the thing about suicide is it's an end point. And there's so many things that can be put in place before a person gets to that point. If the community understand and you know, the wider group understand what what brings it on. And so this was a really hard project to do. It was empowering, but it was difficult because most people that we've worked with over 94 different communities for this project had direct lived experience and I'm not talking just about one direct relative But it was often many. And so it was a really hard project to get through. But in the end, like it's definitely paid off. And so this was a Targeted Call, NHMRC Targeted Call for suicide intervention. And get so it was very precise, precise. And we got this grant back in 2014, I think it was. And once again, back out to community, lots of consultation. And this took a really long time to come to fruition. But it won an award last year, which Steve mentioned around the the Australian mental health prize, but likewise, its biggest gift is it's actually saving lives. So this was an $840,000 grant. And we know just in the first three months of rolling this out that there were 140 lives, I think it was on top of that, because we go further, and 140 lives saved in three months. And dollar figure that's come out of the federal government is one suicide costs the Australian people's 4 million $4 million. And so that's based on the loss of income of that person who's passed, about 100 people around that individual are directly impacted on that. And so that little $840,000 has made a massive difference to the lives of many Indigenous Australians. So here are the preliminary outcomes. Before I actually jump into this, once again, we went back out to those original communities that were involved in that prevalence study that I showed you. And we just sat down and really yarned around like, what this was. And there was real shame around this because people were losing and still are losing their loved ones at a rate that is completely unacceptable. In this country, we have some of the highest rates in the world. And there was a shame because community couldn't make a connection between culture and suicide. And the reason for that is we started to keep like circling back into these communities was two things. One, this isn't an Aboriginal and or Torres Strait Islander disease, this culturally is is something that didn't exist in our communities until the 1980s. There is no word for suicide that we can find in any language, the closest we can find is there's a Yolngu word so up in eastern Arnhem Land that speaks to giving up, so that's as close as we can get. So that was kind of the ammunition that we were able to use to actually start to engage our communities with how to talk about suicide. One, culturally, it didn't exist for us. Two, it's the direct result of colonisation. And because of that people were able to kind of distance themselves from, from suicide as being culturally and be more about colonisation, which started these conversations. And now we've got this national program. So these were the preliminary outcomes. And as I mentioned, we had 140 interventions in the first three months of rolling this out. 77% had a personal experience for suicide. I would actually argue that that's more now just given that we've been doing this for a few years. 69% had supported a young Indigenous person, then the rest of the things are there, this one at the bottom cited in the NICE international guidelines. Apparently that's a really big deal. I didn't know it was but anyway, so but over in the United Kingdom, so go us Okay, and with the development of I-ASSIST, we did work with over 90 communities, we have had big interests from Canada, New Zealand and the US as well to tailor this program into something that can work in those communities as well. This is an old slide, but we're up to over 8000 people that we've trained. And this is just the pilot stuff here. But we're, we've been collecting data obviously as where we're moving along, and we're finding that almost everybody that does the I-ASSIST training will do at least one intervention within the first two weeks of the training. And for me, learning about what suicide intervention was, I went and did a program by Living Works, who we partner with, around the non Indigenous version of this. And it was through that process that I knew that my own brother was at risk of suicide. And that was, yeah, really quite pivotal for me in terms of making sure that this works. But he had been circling around me for about a year with all of these things that he was saying, and he was literally screaming out for help. And the best that I could say to him was, 'I hope you're not thinking about doing something stupid', because I had no idea how to tackle this issue. And on the first night of the training for the Living Works program, I sent my brother an email because I tried to call him and he didn't pick up the phone. So I sent him a message. And I just said, you know, something along the lines that you're going to probably think I'm a bit of an idiot, but I'm doing this training around suicide intervention. And I'm gonna ask you a question dot dot dot, are you thinking about killing yourself? That's actually what I said, and because intervention is actually asking the question, and I sent it to him, and I'm looking at this, and I can't believe I just did this. Three seconds later, he wrote back, how did you know, and I'm like, pick up the phone, and I used this

model with him. And he did exactly what the model said he would do. And so with that, I thought, oh, my gosh, this actually works. And so we've tailored this program around the Living Works, non Indigenous model, and I'll share you the protocol that we came up with. So this is the I-ASSIST overview, input from these 94 different communities that I spoke about. And we've really had to spend a lot of time at the front end of our training, because just to roll into a community and go, Hey, everybody, we're in town, and we're going to do some work around suicide intervention, people are going to go home and lock their doors and not come out because this stuff is fairly heavy. And so we spent two to three months setting the scene and engaging with people around what would be the best way to come in to do this. What resources do you need? And and how can we facilitate this in the most culturally safe way that we can. And so some communities would say, well, we're going to have a psychologist in the room or we want a  traditional healer, we want to a smoking ceremony. Some community see suicide as being like black magic. So we had to facilitate what that would look like. So we could manage that as well. But it was different for different communities. But by engaging in that front end piece, which is actually how we do all research with indigenous peoples, and I would argue anybody to be honest, through doing that, the success was we filled the room. So we would have up to 30 people in the room at any given time for the project, when it was in research outcome mode. So the community connection piece. So we had a two and a half day training. And this is still how it rolls today. The first sort of session, which was  the evening or the day before we came in to do the training was really to let community know what this was about. So talking about suicide for two days, is hard work. Doesn't matter who you are. It's very draining. It's taxing on us as the facilitators as well. And so having that community connection where we have food, we share stories, sometimes it was around a campfire, sometimes yarning circles, but it was generally always outside. And that was about people sharing their own personal stories about suicide and the trauma that sits around that. And the power of that peer support that came from those connections have been ongoing. So people continue to support people in this space as participants who have gone through the training, it was also an opportunity for people to opt out. So you know, this could be not just something that people are not ready for. During the actual research and yeah, evaluation on this project we only ever had one person opt out so which I think is pretty amazing. And the actual skills and training component there was this day one and day two, which was essentially the Living Works ASSIST model, but very much adapted and nuanced to the way that we do business as Aboriginal and Torres Strait Islander peoples overlaid with the social and emotional well being framework. So and then finally, the ongoing support. So setting up a peer network, and having continual online training and connections with with mob, who are the ones doing the, the intervention, so their role is to support those that are at risk of suicide. But this is really set up to support those people that are providing the support. Because, you know, if we don't look after ourselves first in this space, then it's hard to help others. And finally, with this project, we have an indigenous governance group, a program manager, training networks, social enterprise model and community connections. And this social enterprise piece is the piece that I'm really excited about, because what we really want to do here is focus on building indigenous trainers who can chase their own funding and make an income from this. So how do we set people up in their own business, teach them about how to open up, you know, bank accounts, and ABNs and how to manage accounts, and all those sorts of things, is a piece of work that were trying to get funding for. But it's interesting, nobody's really interested in this piece. And I'm not quite sure why. Because to me, this is the translation at its best, but it is I will keep plugging away at that one. And finally, just an overview of the specific requirements. So we've had some pushback from non Indigenous trainers who want to lead training and I-ASSIST. And it's not, it's not for non Indigenous people to lead, this has actually been specifically designed to empower indigenous leaders, who are the the main trainer. If an ally is required, because we can't get to indigenous trainers, that's fine. But that's at the choice of the lead training. And I keep saying finally, but it's not because the slides keep coming along. So I just want to really quickly tell you. How am I going to time. Okay, really quickly tell you about this fellow here. So Daniel came in and did the I-ASSIST training out in a little place called Oakey in western Queensland, and this is his beautiful daughter. And on the end of day one of the training, we asked people to go home, and do some self care. So self care for me is going shopping, or make myself a nice big chocolate milkshake or something. So that's my self care. What Daniels self care was after starting the workshop with us, was to show up the next day with this painting here. And so this is the model. So he was able to interpret what we do, literally painted this overnight, and came back and presented this to the group as his homework. And so the model is this. So in here, this is where the knowledge sits. So these are the trainer trainers, those trainers impart the training out to other trainers so that they can then take the knowledge and wisdom back into communities. So when we go north, south, east and west, we cover all of Australia and share the I-ASSIST training, which in turn creates a whole lot of helping hands. So when we saturate communities with I-ASSIST, we have seen some remarkable results. And an example was Cherbourg in south western Queensland. It's actually where my family were removed to. And Cherbourg during COVID was having a suicide a month. So we're up to 11 suicides in 11 months, we went in saturated that community and we went 18 months without a suicide. And what that group also did is they made stickers and put the stickers on to houses like Suicide Safe houses so that anybody could knock on those doors at any time of the day or night and there would be someone behind there that would listen and hear story and support them. This is actually a net, you can't see it. It's not a very good image. But this is to create a safety net and a suicide safer Australia for indigenous peoples and over here is to remember those who have past to suicide and have gone to the dream time. So this painting and I can't show because I've got this screensaver up here, but this painting is actually hanging behind me. Here's some of our participants. Maria's the trickiest lady I think I've ever met in my life, because she had so much trauma around family and loss. And after we finished with her look at her sitting up there at the front with her certificate saying that she she did the training. So she's been a wonderful advocate. Alrighty, how are we going for time? All right. Okay, should we have a quick vote? Should I keep going? Or should we have some questions? Because we've got about 15 minutes left. Someone call it out and make an executive decision.

Professor Steve Wesselingh  36:07  
I think keep going for a little bit longer.

Professor Maree Toombs  36:09  
All right, okay. All right. So this one here, when I die, if I have this mob van, and I'll show you an image of it in a minute, somewhere on my gravestone, I'll be very happy. So this was some funding that we got through the old health workforce Australia, back in 2012. And it was a $300,000 grant to purchase a van, or some type of a primary health care vehicle that could deliver primary health care to the Darling Downs area in Queenland, an under serviced indigenous space and place. And so we landed on of all places, Warwick. Which is about 55 minutes south of Toowoomba. And Warwick is a place where lots of indigenous peoples come into town, but they were essentially invisible. And so yarning with mob out there, they only presented at the emergency department when they were acute, they weren't accessing primary health care. And they really wanted to see this van down there. So the van was funded for medical students, allied health students and a doctor. And so we filled the van with medical students, allied health, a Aboriginal health worker and a doctor and we set it up in the park in Warwick. And the reason why it was set up in the park is because, we approached the Darling Downs health service to see if we could have the van put on to hospital grounds at Warwick. And they said no, because, you know, we hardly have any Aboriginal people in this community. And I said, well, I beg to differ. And they argued with me. But just as a side, I'm now on the board of the Darling Downs health service. So Warwick duck and weave, everytime they see me. But they said no. Council said, 'Well, you could put it in the middle of a park in the middle of Warwick. But if it's vandalized, it's on you'. So the community said, we will look after it, it will be fine. And so we took it, and we parked it in the middle of town. And on the first day, one elder walked past, had a little walking stick, he looked over at us, gave us a little wink and kept going. The next day, a couple of kids at around nine o'clock in the morning, kicked, Indigenous kids kick the footy over at the van, so that they could come over and get their ball and have a look at it. And then later that afternoon, the community started flowing in. So within three months, we had 900 people accessing this van. And there were kids there that had never been immunized. So they've missed out on their four year old, you know, health checks and a whole range of things. And it was game on. So after, I think we got to 12 months, the state government said to us, we'll fund a fixed clinic for you for three years. And if it's successful, then you know there'll be ongoing funding. And so once again, went back to the council. And they offered us a very rundown of Queensland Health building, which didn't have ramp access. And we were told that our that our participants or clients were not allowed to use the toilet in that building because there was another group of people in there and would be disruptive but they could cross the road. And I know exactly what was sitting behind that, and it was called racism. And so I, yeah, I said no, thank you very much and went and found the flashiest building I could find in Warwick. And we opened it up for business and I'm talking flush, it had a chandelier in a glass lift that took our mob up to the first floor where we set up the first clinic. And yeah, it was hilarious, you'd see sort of people walking down the street, and then they'd see the big medical service, which was called Carbul, and then they have to get into this lift and you could just imagine, anyway. But long story short, we proved Warwick wrong. We, after 12 months, we had 1600 people on the books. To this day, I think there's about I think we're up to about 2600 people that access that clinic. And we partnered with Carbul medical services, who are also sitting over in Toowoomba. And this fixed clinic now services, not just Indigenous people, but a lot of non Indigenous people use it as well, because it's the best in town, we have the best GP's, we have the best staff, and it's amazing. So I'm gonna leave it there, because I know that we're running out of time and have some questions. But I might just leave this here. Because the impact of the referendum has had a devastating effect on the mental health and wellbeing of Aboriginal and Torres Strait Islander peoples. And I consider myself to be extremely resilient. And I actually suffered depression for the first time in my life as a result of this, because I've just felt like a stranger in my own land. And so most, I like to celebrate the people that did support us. But yeah, I thought I might just leave this here, just as a reminder of how far we still have to go into space. So questions.

Professor Steve Wesselingh  42:09  
So thank you so much, what an amazing story. Incredible, and, and your presentation as stories is so so effective. So thank you. The I-ASSIST program, you know, looks tremendous. And I think I was muted. I don't know how I did that. But I managed to mute myself. But I did say while I was muted that the I-ASSIST program was in the latest edition of NHMRCs is 10 of the best. And so it's a great story there for everyone to read, if you want to read our 10 of the best and I-ASSIST is there. So I guess I may, and the fact that it's in the NICE guidelines as well is just really terrific. So maybe I'll ask the first question, but also get people to put questions up on the chat so that we can put those to Maree as well. And that I guess implementation is always the issue, isn't it? It's you, you do this wonderful and fantastic work, but how do you then spread that across the countries? I'm just interested about I-ASSIST and the implementation and the moving of that right across the communities across Australia? Did you want to just comment on that?

Professor Maree Toombs  43:18  
Of course. It's, yeah, it's so difficult. And I did see some data that says it takes about 16 years for a project to get like serious funding, which is really depressing. So a couple of things have happened with the implementation. So it was going really, really well. Unfortunately, the company that we were working with have decided that they don't want to .... training. And so that has been devastating. So where we're at at the moment, is rallying all of the indigenous suicide networks of which there are quite a few like Gayaa Dhuwi, and then also Suicide Prevention Australia, around how we can move this forward, because it's the only intervention program in the country and people know it works. So I'll go down swinging with it, and we will get there and people know it, so you know, the suicide intervention research is a very small community of people. And so it has its benefits because it means that we can collectively come up with solutions to you know, hairy, audacious problems like this one, but it is still being rolled out. I don't know. I feel like the other concerning issue too, is that you know, when we're looking at translation, there's always these hot topics. So suicide was a hot potato for a while, and there was a lot of funding coming into it, but that seems to be declining as the focus is moving towards other equally important issues like domestic violence and a whole range of places and spaces. So I think it's a little bit concerning when it's not a flavor anymore. So that's, that's the other piece that we've got a work around.

Professor Steve Wesselingh  45:24  
Thanks for that. Just looking at the chat. There's so many positive comments about what you're about your stories in your presentation all really positive. One person asked, how much support do you get from the state health department's to implement your work?

Professor Maree Toombs  45:40  
None. Well, actually, no, that that's not true. We have got a small piece of a larger Ministry of health funding. So I think they they funded $13 million 2 years ago to roll out Living Works. So the company that I worked with, other programs that predominantly across schools in response to COVID, as part of that, I think there's eight to 10 workshops that we have to deliver. And we have. And we're just waiting on ethics to get back to evaluate those. But I'm presenting to the Ministry of Health next week, so they know that I've got my eyeballs on them.

Professor Steve Wesselingh  46:27  
Another one, thank you for your wonderful talk, how's your brother doing?

Professor Maree Toombs  46:30  
Oh, thank you, whoever asked that. He's amazing. So yeah, we had that, that intervention and lots of tears. And, and yeah, and he shared the reasons why. And so post that, trip to the GP, on some anxiety and depression medication, counseling, and I can say now that he is in an amazing job. So he is a irrigation manager for the largest winery in the southern hemisphere, and he's their, their head person. He earns way more money than what I do. He's in a great relationship. And he's really happy.

Professor Steve Wesselingh  47:22  
So good to hear, fantastic. Another person, Maree, this shows the value of community led research and care delivery, what support do you offer your Aboriginal workers doing this challenging work?

Professor Maree Toombs  47:34  
That's a great question. We we really lean in on each other? And, yeah, there's, there's a lot of connection and support that we just give by virtue of the fact that we become our own little family. So I'm like the big mother duck in all of this. And so. But also, there are opportunities that people need to debrief with a psychologist or with healers. And yeah, we've we've pretty much, I treat my staff, the way that we will treat the participants, so everybody is cared for.

Professor Steve Wesselingh  48:15  
Another comment. This is amazing. And so inspiring, incredible examples of indigenous led initiatives. As a non Indigenous ally, I feel desperate to help. But I think the level of trust that mob have is very low. How can we start to rebuild trust?

Professor Maree Toombs  48:35  
That's a, that's a great question, that just gave me goosebumps. I think, were hurting. And the trust, I think what's happening underneath all of this is there's this movement that's starting to occur with mob going, okay, we need our allies. But we also need to actually come together and unify, and really think about what it is that we need to be safe in this country. So it's a roundabout way of saying we're getting there with coming back to the table. Like this is the first big presentation that I've given post referendum. And I have not been able to do this up until this point. And it's only because I love Steve and NHMRC so much, but we're getting there. And we know we know that there's many of you out there who are amazing and are our allies. I just think we just need a little bit of time to heal because it was a really big slap.

Professor Steve Wesselingh  49:43  
And from Fiona, how do we get how do we get mainstream? How do we get mainstream to relinquish to Aboriginal programs birthing on Aboriginal led programs? Birthing on country is another example.

Professor Maree Toombs  49:56  
Yeah, that that's the million dollar question. And you know, just thinking about the Voice. So just going back to that referendum again, the Voice was about relinquishing that power over to Aboriginal and Torres Strait Islander peoples to make decisions on behalf of, of who we are in this country. And I honestly believe that that relinquishing is one of the biggest issues that we have. And you know, if you take the example of a big pie, so let's say, nonprofit, not for profit, organization, A, B, C, and D, are all applying for that $1.5 billion pile of money to go and provide mental health services into, you know, Cherbourg mission, for example. And I'll use that place because the amount of dollars that go in there is eye boggling. It will eyewater. But you don't see the results. So the organisation gets the money. Straightaway, they cut out 25% of the pie, and go, that's for administration, then the rest of the pie apart from about 5% is to employ their own people to fly in fly out of these communities. And so Aboriginal Health is big business, there's a lot of money out there for it. It's not landing on the ground where it needs to, and I'm [audio cut out]

me and my colleagues into coming into these communities to do work. So it's, it's a really big issue. I don't know what the answer is, because it's capitalism. And yeah, I don't know. But I'm, whoever asked that question, it's a really important one that needs to be answered.

Professor Steve Wesselingh  51:47  
Thanks. And Judith says thank you for a beautiful presentation and stories. How have you found working with ethics and the iterative nature of this type of work?

Professor Maree Toombs  51:58  
Oh, oh, yeah, really difficult. So I mentioned earlier about that traditional healing project. I've had an ethics committee blocking me for 18 months, because they don't understand culture. And they're saying to me that traditional healing is unsafe, because we don't know what it is. And I'm like, but it's a research project. And that's why, you know, we're doing this so that we can demonstrate. But by the way, we have been doing this for 65,000 years, I'm not sure what yet what we have to prove its efficacy. That's the type of things that I personally am experiencing right now, along with these gatekeepers, who will literally say to me, we will not support you unless you give us money. And so that's the other one. So there's some really naughty people with a lot of power out there that make it really difficult. And I'm finding more difficult than ever to get ethics. So I've got an Investigator Grant at the moment. And we've been in the process of ethics now for 18 months. So another big one. And I'm hoping we're going to get it over the line in the next couple of weeks. But yeah, really, it takes a lot of time. And because it's considered high risk, just by virtue of being indigenous, it makes it even harder.

Professor Steve Wesselingh  53:35  
Thanks for that. I'm hopeful there's some early career indigenous researchers watching this and so what would be your advice to the next generation of indigenous researchers?

Professor Maree Toombs  53:47  
Oh, look, back yourself. Like, and I know that sounds very Pollyanna, but I have been made to feel like an imposter in this space for a really long time. And comments like, you only got that research because you're Aboriginal. Well okay, yeah, I probably did. But we need more Aboriginal researchers to do this work. So you know, that's not a bad accusation to make off me. So back yourself, don't be afraid to have a go at a grant even if you think you don't have the right level of expertise, like go and find allies and people that will support you. But don't be CI X on the grant, like with your aboriginality and your knowledge of what it is to navigate the complexities of this world as a First Nations person, DNA to this place, you have the right to be sitting up there as Chief Investigator A having a go at those grants and, and building the capacity. And my thing is paid-it-forward, so working in this space is a real privilege. You know, I've, I've had a life that I would never ever, ever have imagined for myself, I started out as a grape picker. So choose to set the scene of where I've come from, and I was a cleaner. And now I'm a professor at a university. So, you know, the sky's the limit, just back yourself, be authentic. And, yeah, avoid having that imposter syndrome, because you're not an imposter. You belong to this country.

Professor Steve Wesselingh  55:27  
Fantastic. Thank you. There's another question here. Is there information resources or links available on your traditional healing project? sounds incredible. I really hope we loosen the threads, so you can bring this forward.

Professor Maree Toombs  55:42  
Beautiful question. And we are getting there. So with the traditional healing component, we haven't finished it yet. Because of COVID. This, yeah, this Ethics Committee, which is doing my head in, I might add that that particular area, where we're having issues, voted no more than anywhere else in Australia. So with the referendum, so I think there's some stuff going on there as well. We've just made the decision to pull that ethics out of there and plug it into another ethics process that we're going through to get this done. But it is coming. And and it's very, very exciting. So when it's ready and available, hopefully I can come back and do another one of these webinars and present on it.

Professor Steve Wesselingh  56:32  
Fantastic. And perhaps the last question, what's what's been the biggest highlight for you across your career?

Professor Maree Toombs  56:42  
See, I hate questions like that, because it made me get all emotional. So I think it's, I think it's being in my authentic self, working in these communities, with people who have the answers to the solutions, and seeing the power of that, like I literally, I feel like these communities make me feel good, which in turn makes me want to give back so much more.

Professor Steve Wesselingh  57:14  
Fantastic. No that. So I think we'll, we'll end on that note, and conclude the May Speaking of Science webinar, I really want to thank you, Maree, for a fabulous, fabulous talk. And you can see by the comments, everyone's been moved and had goosebumps, and I really been moved by your story. It's just just incredible. Want to tell everyone that this was recorded, and so people can go back and watch it. There'll be another Speaking of Science webinar, and we'll be announcing what that is in the next few weeks. And, and again, thank you, Maree. And thank you, everyone who's who's come online at a really terrific turnout. And I hope everyone enjoys the rest of the day. Thank you.

Professor Maree Toombs  58:08  
Thanks, everyone. Thanks for having me. Thanks.

End of transcript.