The silence that is not named: Being Indigenous and identifying as LGBTIQ+

Indigenous/LGBTIQ+ people experience discrimination in many ways, including racial discrimination and homophobia, which can result in the construction of double identity crises around culture and sexuality. This research set out to provide a safe space and voice around the issue of being both Indigenous and part of the LGBTIQ+ community. It was one of the first research projects to focus on the unique and complex experiences of those living at the intersection of being both Indigenous and part of the LGBTIQ+ community.

"We’ve just inferred [that] LGBTIQ+ communities have big health challenges, [and that] Aboriginal people do. [If] you layer [the health challenges] on top of each other, it must be a real concern…but this is the first time we’ve actually been able to have the data so we can demonstrate the problem properly, as opposed to just guessing what the issues may be." Professor Braden Hill

Breaking the Silence explored Indigenous/LGBTIQ+ people’s experience and use of a range of health and social services. It identified barriers and enablers in accessing appropriate and timely support, and measured the extent to which the health, social and emotional wellbeing and other support needs of Indigenous/LGBTIQ+ people are met. The research generated insights and recommendations regarding the provision of genuinely inclusive service responses for Indigenous people identifying as LGBTIQ+ to directly inform policy and practice.

Approach

This study used an Appreciative Inquiry (AI) strengths-based approach that avoids the deficit thinking that has defined  past research with Indigenous people (6). The mixed-methods study was conducted in two phases.

In the first phase, data was collected from Indigenous and LGBTQI+ health and community organisations. To ensure representation from across organisations, staff working in WA health, community, family and social service and support organisations were engaged, including front office, clinical, support, administrative and executive level staff. Workshops were held with these staff to explore their experiences, strengths, and areas for improvement in working with Indigenous/LGBTQIA+ people. The workshops were followed up by a sector-wide survey. The aim of this phase was to identify how the findings can inform the design and development of professional development training, service delivery models and policies that can be embedded within the partner organisations and more widely in other organisations in Western Australia.

The Breaking the Silence research partners were:

• Sexual Health Quarters
• Yorgum Aboriginal Counselling Service
• Mootditj Koort (health and family services)
• Wungening Aboriginal Corporation (drug and alcohol service).

The second phase surveyed Indigenous/LGBTQI+ people living in WA about their experiences at the intersection of Indigeneity and LGBTQI+ identities.

Impacts and outcomes

The Breaking the Silence study established an evidence base to inform policy and practice. It generated unique knowledge and insights that can be used to better understand how Indigenous people navigate the intersection of being both Indigenous and LGBTIQ+ and to guide the provision of genuinely inclusive service responses. Knowledge generated includes:

• Health and wellbeing needs and concerns of Indigenous/LGBTIQ+ communities.
• How Indigenous/LGBTIQ+ people experience and use a range of mental health, sexual health, education, family and community support organisations.
• Factors including individual, family, cultural, organisational and systemic factors that enable or prevent Indigenous/LGBTIQ people from accessing services (e.g. service characteristics and activities).
• The role families play in supporting Indigenous/LGBTIQ+ people to come to terms with sexual and cultural identities, and access a range of health and support services.
• Current practices, confidence, knowledge, and training needs among Western Australian health and community service workers working with Indigenous/LGBTIQ+ clients.
• How all levels of a range of organisations respond to the needs of Indigenous/LGBTIQ+ people and the establishment of a baseline for how services are currently delivered to this group, including identification of gaps in services and areas of unmet need.
• Identification of responsive, inclusive, and Indigenous/LGBTIQ+ culturally appropriate and safe service delivery models, processes, referral pathways, professional development training and policy responses and practices that can be embedded in WA health, education, and social services to more effectively meet the needs of Aboriginal and Torres Strait Islander who identify as LGBTIQ+.

The research influenced practices within partner organisations, including:

• Highly visible signs and symbols (Aboriginal and Pride flags, posters and artwork) displayed throughout the organisations, particularly in main reception areas.
• Service intake processes updated to identify and capture data on Indigenous LGBTIQ+ clients.
• Comprehensive staff development and upskilling about inclusive language and terminology, and strategies, processes and policy responses that can respond effectively to the needs of Indigenous/LGBTIQ people.
• Development of respectful protocols and strategies for engaging with Elders and senior Aboriginal Board Members in the development of service models that meet the needs of Indigenous/LGBTIQ+ clients.

"One of the big things was…when we asked them about how do you know when your clients are LTGBTIQ+…these were drug and alcohol services, psych counselling services, general medical services, sexual health clinics…basically most of the Aboriginal organisations said we don’t ask. We don’t ask the question. So a lot of them changed quite immediately their demographics intake to make sure that LGTBIQ+ was considered as part of that process, training around appropriate terminology, and that actually for the first time allowed them to track queer clients coming into their service, whereas before that we used to say, we don’t know if anyone actually comes here. Giving them that guidance was really important." Professor Braden Hill

The research delivered immediate community benefits for Indigenous/LGBTIQ+ people with the promise of additional benefits in the future, including:

• Affording a safe space for the voices for Indigenous/LGBTIQ+ individuals, who have for the first time been able to ‘break the silence’ and safely describe their experience of living in the WA community as both Aboriginal and LGBTIQ+ and how a range of services and online resources can be improved to better support them.
• Providing confirmation of support for Indigenous/LGBTIQ+ people from Elders and Senior Aboriginal Leaders from the Noongar Community. This provides an opening for conversations between CEOs and Board Members of Aboriginal led organisations.

Research findings were communicated and disseminated widely, with information published in journal articles and made available in public reports that were launched at a community event and distributed to all Indigenous led organisations in Western Australia. See additional information below for links to reports and journal publications associated with this research.

The Exploratory Research Grant contributed to research capacity within WA by:

• Building capacity of the Indigenous research workforce who led the study.
• Increasing understanding on the intersection of Indigeneity and gender/sexual diversity.
• Generating additional research revenue.

This initial exploratory research grant has led to further funding and research, including:

• A grant from the Department of Health WA to explore workforce training needs, develop an organisational training package, and operationalise the recommendations for Indigenous/LGBTIQ+ inclusivity with WA organisations.
• National Health and Medical Research Council grant to scale up the work nationally and expand focus to include youth demographic (14-25 years). See Walkern Katatdjin Rainbow Knowledge.

What worked

Extensive community consultation and engagement of Aboriginal elders was critical to the project’s success and included Elders Yarning Groups. The research was informed by ongoing community consultation, including consultation with Indigenous elders and senior people who identify as part of the LGBTIQ+ community, and Indigenous professionals and workers currently providing services in this area. Significant consultation occurred with Aboriginal and Torres Strait Islander organisations and other organisations providing health, community, counselling, educational, sexual health and wellbeing services to Aboriginal and Torres Strait Islander people in WA.

Importantly, the research was led by Aboriginal and Torres Strait Islander researchers including Indigenous/LGBTIQ+ researchers. Indigenous and LGBTIQ perspectives were also prominent in the Advisory Group that provided oversight and guidance to the research team, with more than seventy per-cent of Advisory Group members Indigenous and/or identifying as LGBTIQ+.

Key challenges

A challenge for this project was the involvement of non-Indigenous ethics committees in determining what was safe and appropriate ways of conducting research. Due to committee views, the ‘community first’ design of the project had to be re-considered to the frustration of the Indigenous researchers who have first-hand knowledge of their community’s needs. The assumption of Indigenous/LGBTQIA+ vulnerability is problematic, and needs a re-think when research is conducted by those with lived experience and connection to the community they are working with and for.

Another challenge for this project was reach, particularly into regional and remote areas. Restricted travel meant visits to regional areas was not achievable. While the use of paid social media for the survey in community was helpful, it did not reach a diverse profile in terms of ages. Much of the sample was skewed towards people under the age of 40.

REFERENCES

1. AIHW. Deaths by suicide amongst Indigenous Australians: Australian Institute of Health and Welfare; 2022 [Available from: https://www.aihw.gov.au/suicide-self-harm-monitoring/data/populations-age-groups/suicide-indigenous-australians.
   
   
2. Australian Government. Status and determinants of Aboriginal and Torres Strait Islander health: Department of Health and Aged Care; 2021 [Available from: https://www.health.gov.au/topics/aboriginal-and-torres-strait-islander-health/status-and-determinants.
   
   
3. Ferdinand A, Paradies Y, Kelaher M. Mental Health Impacts of Racial Discrimination in Victorian Aboriginal Communities: The Localities Embracing and Accepting Diversity (LEAD) Experiences of Racism Survey. Melbourne: The Lowitja Institute; 2012.
   
   
4. Paradies Y, Ben J, Denson N, Elias A, Priest N, Pieterse A, et al. Racism as a Determinant of Health: A Systematic Review and Meta-Analysis. PloS one. 2015;10(9):e0138511.
   
   
5. LGBTIQ+ Health Australia. Snapshot of Mental Health and Suicide Prevention Statistics for LGBTIQ+ People. 2021.
   
   
6. Bellinger A, Elliott T. What Are You Looking At? The Potential of Appreciative Inquiry as a Research Approach for Social Work. British Journal of Social Work. 2011;41:708-25.
   
   
7. Haswell MR, Kavanagh D, Tsey K, Reilly L, Cadet-James Y, Laliberte A, et al. Psychometric validation of the Growth and Empowerment Measure (GEM) applied with Indigenous Australians. The Australian and New Zealand journal of psychiatry. 2010;44(9):791-9.