Why Mental Health Practitioners Have a Responsibility to Actively Challenge Oppression

I acknowledge that as a White Australian I walk on this land because of a history of dispossession, genocide, and colonisation, contributing to the collective and intergenerational trauma experienced by Aboriginal and Torres Strait Islander communities then and today. I recognise that all the land referred to as Australia was stolen; that Aboriginal people never ceded their sovereignty, and that this always was and always will be Aboriginal land. I stand in solidarity with and fight alongside Aboriginal people in their struggle for liberation from systemic and structural oppression. 

Notes:

1. I use ‘Aboriginal’ to respectfully refer to Aboriginal and Torres Strait Islander peoples collectively. This is not to diminish the unique experiences of Torres Strait Islander people, but is done with the intention of improving the readability of the text. All terms are used to acknowledge and honour the original people of what is now known as Australia.

2. I have focused on racism rather than other forms of oppression because racism has been foundational for the establishment and continuation of Australia as a nation state. This is not to discount other forms of oppression, and it is important to note that oppression based on class, gender, sexuality, age, and ability are also built into Australian society. 

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As mental health professionals, we are required to position ourselves in spaces where different ideas are put forward and contested [1]. In practice, this means that we align ourselves with therapeutic approaches that make sense of people’s lived experiences in different ways. Where some approaches may locate the problem within the individual (e.g., the biomedical model), others consider the cultural, economic, and political contexts in which people live. 

Anti-oppressive practice (AOP) is an approach that acknowledges that we do not work within politically neutral contexts. AOP invites us to reflect on what it means to be a mental health practitioner within a society that is dependent on oppression and marginalisation along lines of class, race, gender, sexuality, age, ability, and all other forms of intersectional violence [2]. Importantly, AOP encourages us to move beyond reflection, and ask ourselves whether we can accept that oppression is real and then not engage with changing the systems and structures that uphold and perpetuate it [3]. 

So, I ask you: can you, as a mental health practitioner, accept that we live in a society where oppression exists and then not advocate to change the systems and structures that uphold and perpetuate it?  

I, personally, cannot. I believe that therapeutic work is inherently political, because we cannot separate people's lived experiences of distress from the material conditions of their lives. As mental health practitioners, consciously or unconsciously, we choose to take an active or passive stance in the face of oppression. I choose to take an active stance. In this blog post, I explore the historical and political context of oppression in Australia, the relationship between oppression and trauma, and what we can do about it.  

Colonisation and ongoing oppression of Aboriginal people

Australia was established through colonisation, a process that involved the systematic dispossession of Aboriginal people from their land and culture, through mass removal, acts of genocide and ethnocide, and the spread of introduced disease [4] [5] [6]. The ‘Stolen Generations’ refers to a period of government-led oppression whereby thousands of children were removed from their families, placed into mission schools and homes, and forcibly assimilated into White colonial roles [4] [6]. The Bringing Them Home report found that while such child removal policies were enacted under a guise of concern for protecting and ‘preserving’ individual children, a principal aim of these policies was to “eliminate Indigenous cultures as distinct entities” [7] (p. 237). In 1997, Former High Court Judge and co-Chair of the Inquiry, Sir Ronald Wilson, stated:

“Children were removed because the Aboriginal race was seen as an embarrassment to White Australia. The aim was to strip the children of their Aboriginality and accustom them to live in a White Australia. The tragedy was compounded when the children as they grew up, encountered the racism which shaped the policy and found themselves rejected by the very society for which they were being prepared.” [8] (p. 10)

White Australia has a Black history. Image source: Social Science Insights.

Aboriginal people continue to experience systemic and structural oppression today. Almost 30 years on from the release of the Bringing Them Home report, Aboriginal children are still removed from their families at increasingly higher rates than non-Aboriginal children. In South Australia, Aboriginal children represent 5.5% of the population aged under 18 years, but comprise 37.4% of all children in out-of-home care [9]. Aboriginal people also experience disproportionately high levels of incarceration, representing 33% of the prison population despite comprising only 2% of the national population [10]. 

Australia’s treatment of migrants, refugees, and asylum seekers

Australia, similarly, has a history of marginalising and oppressing migrants, refugees, and asylum seekers. In fact, racism and exclusion have been central to Australia’s immigration policy and its development as a nation [11]. The Immigration Restriction Act 1901, which formed the basis of the White Australia Policy, aimed to limit non-white immigration to Australia with the purpose of keeping Australia ‘British’ [12]. The policy garnered support from media outlets, with a Sydney Morning Herald editorial published in March 1901 arguing that “if we are to have ‘a White Australia’” the Federal Parliament must attend to the “danger of unrestricted coloured immigration” [13]. The Immigration Restriction Act officially ended in 1958, although other parts of the White Australia policy continued into the 1970s, including the registration of non-British migrants as ‘aliens’ [12]. 

Australia’s treatment of refugees and asylum seekers is widely criticised by the international community for being punitive and unsympathetic. At times, it has also been labelled as a breach of international human rights law [11]. In 2001, for example, then Prime Minister John Howard introduced and developed a number of contentious policies, including offshore processing, mandatory detention, and temporary protection visas that made it harder for individuals to seek asylum in Australia [11]. Successive Labor and Liberal governments have continued these policies, in addition to introducing new policies that aim to further discourage people from claiming asylum in Australia [11]. For instance, in July 2013, the Rudd Labor government introduced the denial of visas to ‘unauthorised’ boat arrivals. Since then, asylum seekers arriving by boat have been detained (usually offshore) while their asylum claims are processed, yet with little to no prospect of being granted permanent residence in Australia [14]. Building on this, in 2013 the Coalition established the military-led Operation Sovereign Borders with the aim of intercepting ‘unauthorised’ boats, and turning them back to their point of departure, returning them to their home country, or transferring them to a third country for offshore processing [15]. These policies are still in place today. 

Figure 2. Advertising material created to discourage people from claiming asylum in Australia. Image source: Australian Government Department of Home Affairs. 

As of the 31st of August 2024, there are 985 men, women, and children in closed detention facilities, and 226 in community detention [16]. These include asylum seekers who arrived by boat, as well as those who previously applied for, or held, protection or humanitarian visas. The average number of days spent in closed detention is 525 [16], although this number is likely to have reduced dramatically since November 2023 when the High Court ruled that indefinitely detaining refugees and asylum seekers was illegal [17]. The longest period a person has been detained in immigration detention in Australia was 5,766 days - nearly 16 years [17].  

Link between oppression and trauma 

There is growing awareness that experiences of oppression are associated with symptoms of traumatic stress [18] [19] [20] and can be implicated in poor mental health outcomes [21] [22]. For Aboriginal people, the intergenerational impacts of colonisation and contemporary experiences of racism can be understood as experiences of oppression-based trauma [23] [24] [6]. Menzies [4] suggests that “the forcible separation of Aboriginal and Torres Strait Islander children [during the Stolen Generations] is, arguably, the practice that has left the most traumatic legacy, which continues to have a profound impact on Aboriginal people today”. This is reflected in disparities in mental health outcomes between Aboriginal and non-Aboriginal people. Compared with non-Aboriginal Australians, Aboriginal people die by suicide at almost twice the rate, are hospitalised for intentional self-harm at 3 times the rate, and are 2.4 times as likely to experience high/very high levels of psychological distress [25]. 

Refugees and asylum seekers experience cumulative trauma across their migration journey [26], long before they even arrive in Australia. They leave their home countries to escape war, civil unrest, political violence, persecution, and other hardships. Often, they are displaced and living with uncertainty, in ‘temporary’ situations, for periods that may span many years, or generations within a family. Being a refugee, forcibly displaced, or an asylum seeker is associated with an increased risk of developing post-traumatic stress disorder (PTSD), psychosis, and symptoms of traumatic stress [27]. Australia’s harsh responses, through prolonged mandatory detention and denial of permanent protection visas, only add to refugees’ and asylum seekers’ already extensive experiences of trauma [28]. 

The story Afghan asylum seeker Khodayar Amini speaks to the profound detrimental impact of Australia’s immigration policies and practices. In August 2015, Amini died by suicide following self-immolation, the act of setting oneself on fire. He had been granted a bridging visa and released from detention, but feared that he would be detained again or sent back to Afghanistan, where most of his family had already been killed by the Taliban [29]. He left behind a suicide note, that read: 

“[this is a] statement [written] with my blood for those who call themselves human beings, I ask you to stand up for the rights of refugees and stop people being killed just because they have become refugees. Humanity is not a slogan; every human being has the right to live. Living shouldn’t be a crime anymore.” [30]

Ben Quilty’s oil painting dedicated to Khodayar Amini. Image source: Art Gallery of South Australia.

Let us be guided by Amini’s words within our practice: humanity is not a slogan.    

Taking action to challenge oppression

Without an awareness of the historical and sociopolitical contexts that are central to the lived experiences of those we work with, we risk reproducing and reinforcing the oppressive systems and structures that contribute to their experiences of trauma (see Jack Castine-Price's infographic on microaggressions). While it is important to consider how we might replicate systems of oppression within the therapeutic space, there is an imperative for us to actively participate in movements to change the systems and structures that uphold and perpetuate oppression in our communities and society more broadly. Since oppression and marginalisation is directly associated with the experience of trauma, as mental health practitioners seeking to alleviate distress, we have a responsibility to the people we work with to work towards dismantling the structures and systems that do them harm [31] [3]. 

This is where anti-oppressive practice comes in. Where person-centred, affirming, and non-pathologising approaches may centre and validate the lived experiences of oppressed and marginalised peoples, anti-oppressive practice (AOP) requires practitioners to reflect on how we tolerate and reinforce oppression and marginalisation within our therapeutic spaces and communities. AOP invites practitioners to consider advocacy and activism as a professional responsibility [2] [3] [31], with the aim of specifically addressing problems of power, by identifying, challenging, and changing the values, structures, and behaviours that uphold systemic and structural oppression [32]. You can learn about how to do this within the therapeutic space from Jack Castine-Price's infographic here; however I invite you to consider extending your anti-oppressive practice into your workplace and the broader community.

Here are some ideas for how you might do this: 

• Call out your peers or colleagues when they are perpetuating oppressive ideas. 

• Join protests and rallies fighting oppression-based injustice (e.g., Invasion Day, Reclaim The Night, Pride).

• Become an active member of your local activist organisation (e.g., Anti-Poverty Network SA).

• Attend NAIDOC celebrations and connect with local mob. 

• Stay up-to-date on world events that may impact migrants, refugees, and asylum seekers you work with. 

• Advocate for the people you work with and support them to navigate oppressive institutions (e.g., immigration, correctional services, mental health, social services, NDIS). 

• Become an active member of your professional association (PACFA and ACA), union (e.g., the Australian Services Union), or political party. 

• Use your power to advocate for procedural change within your workplace and to lobby governments for policy reform. 

So, as a mental health practitioner, will you take an active stance in the face of oppression? 

I leave you with a quote from political activist and former member of the Black Panther Party, Angela Davis:

‘I’m no longer accepting the things I cannot change. I’m changing the things I cannot accept.’ - Angela Davis. Image source: Anthony Rella, MA, LMHC. 

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[1] Conyer, M. (2020). Reckoning: Reshaping clinical practice by grappling with privilege and colonisation. Beyond the psychology industry: How else might we heal?, 95-111.

[2] Brown, J. (2019). Anti-oppressive practice. Anti-oppressive counselling and psychotherapy, 46-60. Routlege.

[3] Pollock, K. (2019, September). Activism and anti-oppressive practice. https://counsellinginnorthumberland.com/2019/09/01/activism-and-anti-oppressive-practice/ 

[4] Menzies, K. (2019). Understanding the Australian Aboriginal experience of collective, historical and intergenerational trauma. International Social Work, 62(6), 1522-1534. https://doi.org/10.1177/0020872819870585

[5] Rhodes, L. (2019). The colonising effect of Western mental health discourses. Social Work & Policy Studies: Social Justice, Practice and Theory, 2(2).

[6] Smallwood, R., Woods, C., Power, T., & Usher, K. (2021). Understanding the impact of historical trauma due to colonization on the health and well-being of indigenous young peoples: a systematic scoping review. Journal of Transcultural Nursing, 32(1), 59-68. https://doi.org/10.1177/1043659620935955

[7] Human Rights and Equal Opportunity Commission. (1997). Bringing Them Home. https://humanrights.gov.au/sites/default/files/content/pdf/social_justice/bringing_them_home_report.pdf

[8] O’Brien, P. (2002). Are We Helping Them Home? Surveys of progress in the implementation of the Bringing Them Home recommendations. The National Sorry Day Committee. https://www.aph.gov.au/~/media/wopapub/senate/committee/indigenousaffairs_ctte/submissions/sub72_attach_a_pdf.ashx

[9] Commissioner for Aboriginal Children and Young People. (2024). Holding onto Our Future. https://cacyp.com.au/wp-content/uploads/2024/06/CACYP-Inquiry_Final-Report_14052024.pdf

[10] Australian Bureau of Statistics. (2024, January). Prisoners in Australia. https://www.abs.gov.au/statistics/people/crime-and-justice/prisoners-australia/latest-release

[11] Nipperess, S., & Clark, S. (2016). Doing critical social work: Transformative practices for social justice. Anti-oppressive practice with people seeking asylum in Australia: Reflections from the field, 195-210. Routledge.

[12] National Archives of Australia. (2023). The Immigration Restriction Act 1901. https://www.naa.gov.au/explore-collection/immigration-and-citizenship/immigration-restriction-act-1901 

[13] Atkinson, D. (2015). The White Australia Policy, the British Empire, and the world. Britain and the World, 8(2), 204-224. http://dx.doi.org/10.3366/brw.2015.0191 

[14] Crowley, T. (2024, 19 February). How does Australia’s boat turnbacks policy work, and has it changed? ABC News. https://www.abc.net.au/news/2024-02-19/how-does-australias-boat-turnbacks-policy-work/103486164 

[15] Australian Government. (2024). Operation Sovereign Borders. https://osb.homeaffairs.gov.au/zero-chance

[16] Refugee Council of Australia. (2024, August). Statistics on people in detention in Australia. https://www.refugeecouncil.org.au/detention-australia-statistics/ 

[17] MC, A. (2023, 14 November). Detainees walk free after Australian High Court’s ‘life-changing decision’. Aljazeera. https://www.aljazeera.com/news/2023/11/14/detainees-walk-free-after-australian-high-courts-life-changing-decision 

[18] Holmes, S. C., Facemire, V. C., & DaFonseca, A. M. (2016). Expanding criterion a for posttraumatic stress disorder: Considering the deleterious impact of oppression. Traumatology, 22(4), 314–321. https://doi.org/10.1037/trm0000104

[19] Holmes, S. C., Zalewa, D., Wetterneck, C. T., Haeny, A. M., & Williams, M. T. (2023). Development of the oppression-based traumatic stress inventory: a novel and intersectional approach to measuring traumatic stress. Frontiers in Psychology, 14, 1232561. https://doi.org/10.3389/fpsyg.2023.1232561

[20] Williams, M., Osman, M., & Hyon, C. (2023). Understanding the psychological impact of oppression using the Trauma Symptoms of Discrimination Scale. Chronic Stress, 7, 24705470221149511. https://doi.org/10.1177/24705470221149511 

[21] Vaid, E., & Lansing, A. H. (2020). Discrimination, prejudice, and oppression and the development of psychopathology. Prejudice, stigma, privilege, and oppression: A behavioral health handbook, 235-248. Springer. 

[22] Vines, A. I., Ward, J. B., Cordoba, E., & Black, K. Z. (2017). Perceived racial/ethnic discrimination and mental health: A review and future directions for social epidemiology. Current Epidemiology Reports, 4, 156-165. https://doi.org/10.1007/s40471-017-0106-z

[23] Dudgeon, P., Watson, M., & Holland, C. (2017). Trauma in the Aboriginal and Torres Strait Islander population. Australian Clinical Psychologist, 3(1), 1741.

[24] Milroy, H. (2018). A call on practitioners to play a stronger role on intergenerational trauma https://croakey.org/a-call-on-practitioners-to-play-a-stronger-role-on-intergenerational-trauma/ 

[25] Australian Institute of Health and Welfare. (2024). Aboriginal and Torres Strait Islander Health Performance Framework Summary report. https://www.indigenoushpf.gov.au/getattachment/79e5f9c5-f5b9-4a1f-8df6-187f267f6817/hpf_summary-report-aug-2024.pdf

[26] Saadi, A., Al-Rousan, T., & AlHeresh, R. (2021). Refugee mental health—An urgent call for research and action. JAMA Network Open, 4(3), e212543-e212543. https://doi.org/10.1001/jamanetworkopen.2021.2543 

[27] Bäärnhielm, S., Laban, K., Schouler-Ocak, M., Rousseau, C., & Kirmayer, L. J. (2017). Mental health for refugees, asylum seekers and displaced persons: A call for a humanitarian agenda. Transcultural Psychiatry, 54(5-6), 565-574. https://doi.org/10.1177/1363461517747095

[28] Silove, D., & Mares, S. (2018). The mental health of asylum seekers in Australia and the role of psychiatrists. BJPsych International, 15(3), 65-68. https://doi.org/10.1192/bji.2018.11

[29] Davey, M. (2015, 19 October). Afghan asylum seeker feared dead after self-immolation during video call. Guardian Australia. https://www.theguardian.com/australia-news/2015/oct/19/afghan-asylum-seeker-feared-dead-after-self-immolation-during-video-call

[30] Procter, N. G., Kenny, M. A., Eaton, H., & Grech, C. (2018). Lethal hopelessness: Understanding and responding to asylum seeker distress and mental deterioration. International journal of mental health nursing, 27(1), 448–454. https://doi.org/10.1111/inm.12325

[31] Ansara, Y. G. (2020). Building an anti-oppressive community of practice: Moving from lip service to liberation through belonging. Psychotherapy and Counselling Journal of Australia, 8(2).

[32] Corneau, S., & Stergiopoulos, V. (2012). More than being against it: Anti-racism and anti-oppression in mental health services. Transcultural Psychiatry, 49(2), 261-282. https://doi.org/10.1177/1363461512441594