Patrick McGorry: Now tonight, I'm not going to just talk about youth mental health tonight. I'm going to talk about the whole situation of mental health care in Victoria, which I've been really concerned about probably for about ten years.
And I'm going to show you some pretty disturbing figures. And I'm going to also try and convey an air of optimism as well, because I think we're about to really turn the corner. And I'll explain that a bit more later as well.
So now, I'll just start off with a couple of stories. This should be playing automatically.
Jon Faine: The other day I accepted an invitation from a listener to sit down, have a cup of tea, and a bite, and talk about what's happened in his family. He wants to be known by the name of Tony. And he told me a tale across the table that left me very distressed and feeling somewhat, well, inadequate and useless, I might say.
Tony wants his story to be heard by a wider audience, and I'm more than happy to provide the microphone for it.
And good morning to you, Tony.
Tony: Good morning. Thanks, Jon, for having me.
Jon: Let's start at the beginning. Tell us, what happened?
Tony: I guess the best place to start would be, nearly on three years ago now, my wife and I received two distressing calls from two of our older sons.
Jon: You have how many children?
Tony: Altogether. We've lived in our community for over 30 years. Like all parents, we've always wanted to do the right things, and we're very connected in that community, a loving family, grandparents who adored the grandchildren in that respect.
But on this particular day, we received two distressing calls separately – one to me, one to my wife. And it was basically screaming coming over the phone, and there was the mention of, ‘he's going to shoot me’.
I grabbed my wife, we jumped in the car, and we went to this place, which happened to be my parents' house about ten minutes away. We got there, and as we were rounding the corner, there was over 30 police cars. There were helicopters. It was like a scene out of some sort of movie, and there were the tapes that they put across the road. Well, I disregarded the tapes and I drove through them. And I could see my younger of the two older boys lying on the ground.
Jon: He's how old?
Tony: At the time he was approximately 25. As with anything like that, of course, what you're hoping for is to see some kind of movement, because he was just lying there. And so we had no idea whether he was dead, or alive, or whatever.
Jon: Were there police nearby?
Tony: There was over two dozen police–
Jon: No, no, nearby, specifically, him on the ground?
Tony: Yeah, there were police literally covering the whole street. It was literally like a scene out of some sort of movie. I saw a movement in him, which sounds stupid, but it was kind of a relief. At least he was alive. But we still had no indication of what condition he was in.
Jon: Were the police attending to him at the time?
Tony: The police were standing around. At that point, there was no ambulance. At that point, I jumped out of the car. The police tried to stop me from going to him, but I decided that I would do so anyway. My wife was really distressed, of course, that kind of thing.
Jon: Your other son?
Tony: My other son, there was no sign of him, but the police that were in the area were standing outside the gate of this particular home, and they had their guns drawn. And so, of course, we were fearing the worst. I guess I summed up the situation by recognising that he had fired the gun and–
Jon: So one of your sons had shot one of your other sons?
Jon: And all of this is because …?
Tony: They'd had an altercation. Both of them had been, for some time, using ice. And we had tried virtually everything. We had – plenty of times we'd had the CAT team around, we'd had police officers around, we'd had smashed up rooms, smashed up house. We had tried everything in our power. We'd been in rehabilitation places, all sorts of things that had gone on, none of which really addressed the issue with regard to it. And there's plenty that I can say about that particular thing.
Jon: So a prosperous family, thoroughly Melbourne middle-class, find their world turned upside down because of this particular substance and the grip it's got on your two eldest children.
Tony: That's right. And these young men had not had any bad upbringing or anything else like that. I don't think we're terribly bad parents. I think we’re average parents. We had always given them the opportunity to speak freely with us and communicate with us.
Jon: Good educations and all the rest of it.
Jon: So, Tony, let's avoid some of the issues here, but not avoid others. One of your sons is now in jail. The other one is not.
Jon: One of them, the one in jail, is no longer using. The one who's out is–
Tony: Possibly, possibly still.
Jon: May still be using.
Jon: And your frustration, the issues to do with ice use and take-up in our community have been discussed now for years.
Jon: But your specific frustration is directed at what part of what's going on?
Tony: I think it's important to say too, Jon, that I'm not saying that what the authorities are doing is wrong. I'm not saying they're being bad, or wrong, or otherwise. What I'm saying is that the current way that we deal with this doesn't work. It just doesn't work.
Patrick: So that's one story. And I just want to say that I've met that father on many occasions since then. I've seen his son in jail, and the son is absolutely 100 per cent recovered now. An incredibly good young man, actually.
But that story – and there's more in the interview where the father – by the way, the father's given me his permission to play this story tonight, because it's so graphic. When I heard that on the radio, I just stopped the car and just listened to it. And it made me feel very emotional, actually, because I've heard those stories so many times.
And he had to stand in between police and his son on several occasions to protect the son's life. So his son could easily have died. And we hear this story, I wouldn't say every day, but very, very commonly, increasingly commonly, in this state in the last five or ten years.
Another story is of a young colleague of ours, whose brother has schizophrenia. I saw him, actually, when he was first diagnosed, and he's now been treated for about ten years in a very, I would say threadbare way, by a mental health service in the eastern part of Melbourne. Long delays in getting treatment in the first place, languishing for years with severe symptoms just with the GP, and if he gets a little bit more sick then he ends up in hospital for a few days and then back out again – revolving door. And that was bad enough.
But this young colleague of ours told me last year about his sister who was diagnosed with lymphoma. She was in her 20s as well, diagnosed with lymphoma, a form of blood cancer. Treated in exactly the same hospital system, and you would not find better treatment anywhere in the world than that girl received for her physical illness, her life-threatening physical illness, just like schizophrenia is a life-threatening mental illness.
And the family were just completely gobsmacked with the contrast in care. It's like a form of apartheid, actually, the difference in access and quality that you see in the treatment of mental illness, in the same mainstream hospital system. I'm going to come back to mainstream in a minute.
And I could go on and on about stories of people let go from emergency departments who have died within days. Probably at least over 100 people in that situation in Victoria each year. I'll come back to the figures later. So the stories are just piling up.
So what is a mental breakdown? Well, a mental breakdown is an acute time-limited mental disorder that manifests primarily as a severe stress-induced depression, anxiety, or dissociation in a previously functional individual, to the extent that they're no longer able to function on a day-to-day basis until the disorder is resolved. They don't happen overnight. Human beings are intrinsically resilient, and it usually takes multiple forces operating over a sustained period to overwhelm us with emotional pain and compromise our ability to function.
There are nearly always warning signs. They don't happen overnight, and these are usually ignored, or often ignored.
So can a state system, can a mental health system have a breakdown? Well, we often hear claims about the system being broken, don't we? Or that there's no system.
And I think we've been warning now – not just me, but many other people in the mental health field in Victoria – have been warning for over a decade that we've been drifting and accelerating towards a breakdown. We've written quite a number of opinion pieces in the paper, interviewed on Jon Faine, and many other sort of outlets trying to get the governments to listen.
Both sides of politics are responsible here. And I'm not talking about this to blame anyone, actually. I think you'll see why this has happened. There's no individual person or even political party is actually to blame here.
And I think I'm optimistic, because I think the present Victorian government has late last year acknowledged this disastrous sort of situation, this crisis. And it's reached a point of breakdown. And I really believe they're shaping to do something serious to fix it. How serious? That's actually the big question for the next 12 months.
So this picture here is the pessimism that was kind of ingrained in mental health care when I first started working as a trainee psychiatrist. It's a picture from the 19th century, actually, which is where all our thinking about mental illness was sitting until about maybe 20 years ago, really. In 19th-century thinking about incurability: out of sight, out of mind, all that kind of stuff.
And this is the mental hospital I trained in Newcastle – Newcastle Psychiatric Centre. And this is The Royal Park Hospital, which is now closed. When I first came to Victoria 30 years ago, it's where I worked, and that's our inpatient unit there.
And that's our special inpatient unit, where all of our youth mental health work originated from, actually, from that inpatient unit with young people with their first episode of psychotic illness like schizophrenia. So that's the sort of setting that we were starting off from, a very low base – pessimism, no hope, very, very demoralising.
Around the time I came to Victoria, actually the year before, in 1983, this paper was published in the Australian New Zealand Journal of Psychiatry, by George Lipton, who was then the state director of mental health. And he was talking about the politics of mental health. And does it just go around in circles or could we actually spiral out of this and get to a better place?
And he talked – it's actually an incredibly wise paper, analysing all the issues that we're still grappling with, but in a very pessimistic way. And he would have been pessimistic to see, actually, what has happened since. But just a couple of quotes from there.
He says, ‘The politician is severely constrained by the attitudes of his constituency and he leads or lags at his peril.’ Well, I think we've still got that problem with politicians, not just on mental health.
‘He has two major tools which enable him to pursue philosophies that are at variance with public demand. The first is convince the public that some policy or other will rebound to their personal advantage. This often has severe cost implications.’ And that's definitely true of mental health care. That is absolutely true. The cost implications are very significant for the state government.
‘The second is the vehicle of public fear or guilt. This leads to law and order issues …’, as you just heard from that story, ‘… to increasing regulation and occasionally to improvement of services to the disadvantaged when this has become a public scandal.’ And we've had many other examples of untreated mental illness leading to public tragedies, even in the last 12 months in Victoria.
So another quote, ‘How can a politician effectively give priorities to an area whose problematic status is denied by his own constituency?’ Now, certainly in the 1980s that was definitely the case. The public did not want to hear about mental illness, not at all.
You might think they do want to hear a bit more about it now, and I'll come back to that. But I guess you're all here because things have improved a bit, but still. ‘Can he afford to confront them with their denial?’
We might be really great at talking about mindfulness, and having the conversation about mental illness and being aware of depression, but are we willing to talk about more serious forms of mental illness?
‘Can he dare to overly expose the community's guilt and the resentment that this inevitably brings?’
So this is why it's much more challenging than cancer or heart disease, what we're talking about here. It's more complex. There's more – every person has got issues with it.
Mentally ill people are difficult to be with quite often, and it's a challenge. And I think that's one of the things we always underestimate.
So those institutions, as you probably know, were swept away in the 1990s. And there's a paper by Valerie Gerrand describing that process. That happened during the Kennett government. Notice that Jeff Kennett actually opened this theaterette, and I think – well, we can analyse his legacy a bit later on.
But you do get the sense, even now, that mental health, mental illness, it's an awakening giant. This is a cartoon from the age a couple of years ago.
And it's incredibly important to our society, and it is starting to wake up, you can see.
And as we've had Beyondblue, lots of awareness. We've had R U OK? Day. And in 2010, it was probably the top, or third top, Australian issue. You had the economy, you had climate change, and then you had mental health in terms of what the Australian public thought was important.
And the ABC helped us to raise money for mental health research two years in a row. That was fantastic. The whole Mental Health Week, they had programs on mental health.
But they still talked about ‘having the conversation’. And the problem is that none of these changes in atmosphere have led to improvement in investment in mental health care. Which we all assume that if you had better knowledge, better public education, that would be the stepping stone to then people supporting governments or encouraging governments to invest, but that absolutely has not happened.
And that's led Helen Razer, who gave me and the ABC a pretty hard time about Mental As, because she said, that's a complete waste of space. What are you doing? Awareness is just a distraction, actually. It's actually taking the pressure off. It's making the politicians think that something is being done just because people are talking about it.
So I hadn't thought about that before. And at first I was a bit defensive. But then I actually talked to her, and I could see what she was actually saying.
And we're not knocking Beyondblue. They do a lot of great work. But it's this idea that somehow ‘having the conversation’ is enough. And again, not knocking R U OK? Day, because it is the first step. But what if there's nothing beyond that? And in America, there is nothing beyond that.
This is a book by Fuller Torrey, who's been one of the complete leaders of schizophrenia research and serious mental illness research in the US, with the Stanley Foundation. And he's written a book describing what happened in America from the early 1960s through to now.
And basically the federal government decided to invest in community mental health centres, but the intention wasn't to look after people, really, with mental illness. It was to do something preventive, psychoanalytically-based, vague, non-evidenced-based; over-promising that they could actually prevent mental illness through this program.
So what happened was, they closed all the services, all the old hospitals, and they excluded those patients with mental illness from these centres. And gradually, the state governments, they just completely stepped aside from providing care to the mentally ill. And the federal government really didn't do anything effective in its place.
They spend quite a lot of money, in many ways, on mental health care, but the vast majority of people can't access it and it's incredibly limited. So he describes all the consequences of that in the book. You can see the subtitle: ‘How the federal government destroyed the mental illness treatment system’.
And if you have ever been to America, you have to step over homeless people along the pavement wherever you go in the big cities. The jails, the prisons, are full of mentally ill people. And there are homicides and suicides directly attributable to untreated mental illness every single day in large numbers. So it's an absolute war zone, you could say, in terms of what they've created.
They should be thoroughly ashamed of themselves. They hold themselves out to be the leaders of the international psychiatry, with their DSMs, and all these other sort of things. And their country is a joke when it comes to the treatment of the mentally ill. And we are catching that disease. We are catching that problem, and I'll show you the figures in a minute.
Here's another book along the same lines.
That the consequences of the – moving into the shallow end of the pool without hanging onto the deep end. And I'm not saying that our Headspace reform is totally about having a soft entry for anyone who's even got a mild problem. That's absolutely their right with primary care. But we've got to actually make sure the whole spectrum is looked after.
And these countries – the US has not done that. So here are some of the pictures. Some of them are American, some of them are Australian, actually, these pictures. And it's probably getting worse – well, it is getting worse here too.
And in Australia too, there are many more mentally ill people in beds in prisons than there are in hospitals, and it's increasing. And Tony's son, the father in that interview, is one of them.
And it actually took him being admitted to – being incarcerated in prison to get effective treatment for his mental illness and drug and alcohol problems, of which he had both. It wasn't just an ice thing. It was a combination of ice use in a self-medication way with poorly treated mental illness.
And this was in the Herald Sun earlier this year. It's a story. We don't like to talk about this in mental health. But while the vast majority of people with mental illness are safer than the general population, and much less likely to be involved in violent or criminal activity, there is a subset, if they are not treated – like Tony's son – who will end up in conflict with the law. And will be dangerous in that situation, as you just saw, where someone got shot. And if he'd been treated, there's no way that would have happened.
We know that 60 per cent of murders that are committed by psychotic patients – and they're by far the tiny minority of murders, by the way, the vast majority of murders are committed by people without mental illness – but of the ones that are, the small number, 60 per cent of them, are committed by people who have never been treated. So it takes a violent incident to actually bring the person to attention, and these are preventable deaths.
So, obviously, it's not great to have the Herald Sun with these sort of headlines, but community safety is an issue here.
In Orygen, we never saw any murders committed by young people in our region for probably 20 years. I can't remember a single one. But as we've been overwhelmed by population growth and custody services several years ago, we've now seen probably five or six people who have been untreated or poorly treated, and have actually killed people. So this is something we've really got to be honest about as well, while not stigmatising the vast majority of people who wouldn't even ever be anywhere near that.
So this is still part of the whinge part of the lecture. So this is another quote from a paper in the mid '70s. And obviously, what happened in the '90s was we got mainstreamed into acute health care. So all the beds got moved into general hospitals, and we got managed by places like The Royal Melbourne – by the way, also founded by Sir Redmond Barry.
And so that mainstreaming seemed like a good idea, but it really hasn't worked that well. We've been done over, really, by having been mainstreamed into the powerful teaching and acute hospitals. And that's why I think that phrase ‘the battered child of medicine’ is very apt, having worked in that system for the last 20 years or so.
As we look back, we view the battering that psychiatry has taken as the price of painful acceptance of the young child in the family of medicine. But we also see that even in its youth, psychiatry has brought about a revolution of thinking, feeling, and behaviour of the family of medicine as a whole. And in doing so, has profoundly affected the collective consciousness of society regarding its mentally ill.
Well, that's the upside. You might think that that is the case, and that is true to an extent. But we have really suffered through this mainstreaming, and I'll show you why in a minute.
So this is just an example of just one of the many op eds that we've written over the years about this problem. It's a national problem. It's not just a Victorian problem.
The problem with Victoria is that it was the actual jewel in the crown, nationally, of mental health care. I'll show you some figures on that. But we've slipped badly. But all the other states are equally problematic.
That's the MJA editorial, and this is WA. So it's just to show that Victoria isn't the only one. The AMA magazine in Western Australia is actually showing the broken state, and it's all about the mental health services in Western Australia too.
So it's a national pattern. It's the same pattern that happened in the US, but not as bad. But it's heading in the same direction from the state government point of view.
So this is the experience that we feel. This is a Scandinavian slide, actually. But this is us, the mental health workers down here on the right. And we're coming on the scene late. And people have been badly hurt by the time we come in contact with them, like Tony's son.
And there's not much of a safety net. This is part of our argument for early intervention for youth mental health, to build up the system at the front, which I'll come back to, too.
So now, the cavalry arrived last year. I think that the Andrews government, to be fair, when they took office, they recognised there was an issue. And it had been a long time coming, probably at least 15 years. So again, both sides of politics are responsible.
But Stephen Duckett was doing an inquiry into the obstetric deaths out in Bacchus Marsh. And fortunately, and I think he deserves the credit for this, he argued that we should have a look at mental health in terms of safety, in terms of the health system. Because anecdotally people were very aware about all these preventable deaths from suicide. That's probably much more numerically important.
I've got friends that work in the EDs around the city and they're traumatised. Every couple of days there'll be someone that they've seen in the ED, and sent home, and that person will be dead. And that was becoming a thing.
And so I think Stephen Duckett then thought, let's have a look at it. He did. And the department, I think, supported him in this. I think the Department of Health now has some really great leadership and is really looking seriously at these issues.
‘The department has also failed to act on red flags, signalling more systemic problems in care. No way has this been more apparent than in mental health care. Significant degradation in funding, relative to needs and quality and safety, has occurred over the past decade and has not been acted upon,’ he says by the department, but it's really the ministers and the government at the time that were responsible for this. I think we can't blame the people in the Health Department.
‘Our strength and focus on improving care in mental health will be insufficient. However, when the overwhelming threat to safety and quality of care in mental health is the significant rising pressure on services, this will need to be addressed through funding.’
So we've had 500,000 people come into Victoria in the last six years. So this massive population growth, especially where we work in the northwest of Melbourne and the southeast of Melbourne – growth corridors – and we're just getting overwhelmed in these front line services.
So I think here's some figures of what's actually happened in Victoria. If you look at the spending it looks like it's gone up, but that's not in real terms, and it's certainly not in proportion to population increase.
In real terms, there has been a serious cut or failure to keep pace. If we put up the figures for general health care – now, you might think general health care in the hospital system is under pressure too, and it probably is. But it has increased much more rapidly than what we're seeing here, so much so that nationally we're down to about five per cent of the total health budget in Australia is spent on mental health. It's 14 per cent of the burden of disease. So a huge mismatch here.
But the interesting thing is that Victoria has gone from being the highest per capita spender over 20 years to the lowest. I'm going to show you in more – so this shows it more accurately.
The national average – two per cent of the population are covered by state-funded mental health services nationally. Now, we know that the convention is that three per cent of the public suffer, at any given time, from a serious mental illness. So two per cent you could say is not too bad. It's still only two-thirds of people being covered at all.
But in Victoria, we've slipped down nearly to one per cent. So it's about half the level of the national average. And you can see, some states and territories are doing extremely well, like ACT and Northern Territory, surprisingly.
But Victoria used to be, as I say, the jewel in the crown. We used to have hundreds of visitors coming from all around the world, all year, to visit the state-of-the-art community mental health system that was built in the late '90s, and used to come to visit our early-intervention services for psychosis. And they still come to visit our youth mental health reform services. But they're not coming any more to look at our community mental health, because it doesn't exist. It's been dismantled.
If you look at the beds in blue, the number of beds in Victoria are well below New South Wales, and probably on a par with Queensland. So we don't have enough beds, but that's not the main problem, actually. The main problem is the community.
Now, this is emergency department presentations. As the assertive community treatment and the systems have been shrinking in real terms, we've seen this rise. I think it's 42 per cent over the last six years in emergency department presentations.
So that's why everyone's ending up in the ED, because there's no other option. And the CAT teams, such as they remain, are overwhelmed and don't do what they once did.
And it's particularly an issue for young people and people in the prime years of life. It's their main problem, it's their main health problem. Mental health is the main problem of people in the prime years of life. You can see in older people and in little kids, mental health problems are not the main problem that's driving them into the emergency department.
So our emergency departments are incredibly poorly equipped to deal with it. Their mindset, their whole battle plan is about responding to car accidents and heart attacks, and that kind of stuff. They're not calm, relaxed, therapeutic type people. They can't really do it. It's not their fault.
And even when you put mental health people in there, it doesn't really work either that well, despite the best efforts of the people that are doing it. I'm not criticising the staff. It's just a bad model. It should be reserved for absolutely extreme situations, not the first protocol.
And the police shouldn't be the first protocol either, as you can see from that story. Neither should the ambulance service. It should be mental health people. There should be a really strong proactive mental health system with experts in that front line.
So now here is probably the key slide, which is our community context, the amount of community activity that's happening. And it's the worst. It's a disgrace. We were the best and now we're the worst, in terms of the support and funding.
Also, the waiting times for people with mental illness have gone up. The severity of the presentations has increased. All of this is in the Australian Institute of Health and Welfare data. And the amount of time that people spend with these people when they present is shorter as well.
So everything is under massive stress. So it's no wonder that there are so many preventable deaths.
And this is where we need to go. We need to catch up with these other jurisdictions. And we've got to do it fast.
I think the Health Department's modelling might be thinking, well, it took ten years, 20 years, to get like this, so it's going to take ten or 20 years to really fix it up. Well, no! We have to work much more rapidly, and we have to invest very, very heavily to fix this.
And that's going to involve, obviously, creating new workforces as quickly as we can as well and scaling it up. We can't do it overnight, but we’re not going to take ten years. We've got a ten-year mental health plan – that's a joke. A ten-year mental health plan won't even have the same government in ten years. So we should be planning for reasonable time frames, like three to four years, with these sort of things.
So we call this ‘the missing middle’. So what we have, and Frank Quinlan from Mental Health Australia presented this to Greg Hunt last Thursday when we had a big roundtable. And he showed figures.
There's quite a lot of activity at primary care level in general practice, and then there's all this activity at the bottom of the cliff in the emergency department, and the police and everything. But in the middle – experts, specialists, specialists in multidisciplinary care – is in incredibly short supply. It's like a tiny little piece on the graph. Everything else is much bigger.
So we call it ‘the missing middle’. And in Headspace, we can get lots more young people into the bottom step on the ladder, through Headspace, which is fantastic there. And then we can treat a lot of problems in Headspace, but there's about a third of those young people that need more complex care and there's nowhere for them to go. I'll show you in a minute, we're turning three out of four of these young people away from Orygen, which is designed to look after those more complex patients.
So these are the missing steps. The National Mental Health Commission in 2015 said we have to bring in step care for mental health care across all age groups. But the trouble is there's a bottom rung, there's a bottom step, and there's a top step, but there's nothing much in the middle.
And anyone, whatever age you are, if you've tried to seek mental health care in the community, to see an expert or see an expert team, you almost have to invent your own team. And it's very, very hard to find the people, even a city as big as Melbourne with lots of psychiatrists, it's very badly designed, badly organised, and financial barriers exist as well. So those steps are just not in place.
Now, luckily apart from some new leadership in the Health Department and the state government that's at least acknowledged the problem and shaping to do something about it, we do have some other friends and allies who are going to help us, and that's the economists. And this is the reason.
In the hard world of economics, if you are going to invest in non-communicable disease on a logical cost-effectiveness basis, you wouldn't be putting all the money into cancer. We're putting a fortune into cancer in this country, and we're getting a few more months of life expectancy at the end for huge investments.
I'm not saying we shouldn't do it, because that's a value judgement the community will always make. And if I get cancer I really hope that there's really great treatment available. So I'm not knocking it.
But look at what's happening with mental illness. It's incredibly underfunded and yet it has a massive effect on the economy. So if you start treating people in the prime of life, young people and people going through those productive decades of life much more effectively – because only a minority of them get any kind of evidence-based treatment at the moment, even in rich countries – if you did that, it would pay for itself many times over because the economic benefits would flow from it.
We know that. We've done that with psychosis and we've done the cost-effectiveness studies. If we extend that to the other range of mental illness, we will see it there too.
So it's just like a form of self-harm by the country not to actually do this. And it doesn't have to be at the expense of cancer or heart disease. We just have to catch up and do the same things that they do: prevention, early intervention, sustained treatment, and looking after people who've got more long-term conditions properly. That's what they do in those areas. They do that mostly.
And this is some other data from my colleague, Eóin Killackey, showing that the biggest growth in the disability support pension is people with mental illness. That's one of the drivers of these costs.
And once you get on to that DSP there's only two ways out of it. One is dying, and the other is the old age pension. You're not going to go anywhere once you get on that DSP. So it's like a death sentence for our young people if they don't actually recover and they end up in that. Not to say they shouldn't be supported financially but we do everything we can to get them back to work, back to education, back to school.
And if you look at the amount of money in the national economy that's being spent on mental illness, a big chunk of it is on the costs of failure, the cost of failure to treat effectively – welfare costs, prison costs, a whole range of costs increasingly. So we're spending money that – we're actually wasting money by not actually spending it in the right places.
And this is where this term ‘mental wealth’ comes from, from this paper. You've probably heard Malcolm Turnbull using this term ‘mental wealth’, because Ian Hickie inserted it into his brain and he says it quite often now. But basically it means the build-up of social capital across the life span.
So if you have a small child, have a baby, and you bring that child up, you know how much it costs financially and emotionally to bring that young person to the threshold of adult life. And if they break down, if they have mental health problems, which may risk putting them on welfare or possibly dying, even, from suicide, or – obviously that's the most tragic and terrible outcome.
But even if they under-achieve, even if they don't fulfil their potential, then there's a loss of social capital which extends across decades. And that led to the World Bank to value the life of a 22-year-old most highly across the whole lifespan, which is what this diagram actually shows too, that it's the worst thing to happen if you've done all that and the person doesn't actually become productive in society, become self-sufficient, and leads a fulfilling life.
So mental illness is quite different from physical illness in many ways, but especially – we kind of shoehorn it, we've tried to shoehorn it into our clunky, acute system of both general practice and acute hospitals.
But the one thing we didn't do when we were doing that in the '90s was look at the pattern of onset of these illnesses. So it's the mirror image of what you see in physical illness.
In physical illness it's in younger children and it's in the over-50s, pretty much. In the middle years of life, adolescence and middle years, we've never been physically healthier than we are now. We don't need big hospitals for that stage of life. We don't need all those things.
But we've actually forced mental health into the same age ranges, and we've under-invested – particularly in that surge in adolescence and emerging adults, peaking in the early 20s, the system's weakest where it should be strongest. And we've tried to do something about that with some support from government in recent years. And that means building a system of care for emerging adults, basically, teenagers and young adults, which is where all the action is. You can see that surge of morbidity there in that age group.
So Australia has actually done a great thing going by innovating around that in terms of reform for youth mental health. But it's still base camp. We're still nowhere near where we need to be.
And part of the argument is about how young people develop. It's not a ‘one size fits all’, they don't suddenly become adults at 18. It's a transition, and it's particularly a transition that's affected by having mental health problems, and slows things down, makes it much more challenging to make that developmental transition to being an adult.
So early-intervention, Headspace, models like Headspace were backed up by models like Orygen: more specialised, complex care are what we need. It's a process, this sort of reform process.
So starting at the top, it's the former Governor General visiting us a few years ago. We've got a collection of prime ministers – we have to keep updating this collection – but they've all been out to visit us, out in Sunshine in the western suburbs of Melbourne.
And Greg Hunt, we had a meeting with him last week, as I said. See where his hand is? He actually does care about mental illness. His mother had bipolar disorder. He is the first Health Minister that we've ever met who actually really gets what it's really like living with a serious mental illness.
And the Victorian Government, as I say, has commissioned a report, which has been leaked about 100 times by now. And so we know what they think and we know the facts. What we don't know yet is what they're really going to do about it.
But the signs are good. They've got some really serious experts in the health department that have been recruited in to work on it, and hopefully we'll be able to influence it too.
So, what are the things we have to do, what are the pillars of investment? The first one at absolutely top of the list is rebuilding this under-investment in community mental health. I didn't put any numbers on this, because I didn't want to frighten any government people that might be in the audience. But we have to go, broadly speaking, from an annual budget of about $1.1 billion a year, which is spent currently on mental illness in Victoria, to a budget of about $2 billion. And we need to do it in the next five years or so. We've got to build it up in a step-wise way.
So we're talking about hundreds of millions of dollars extra to fix this problem, and that will bring us up to a level where we're covering closer to the full number of people with serious mental illness that need expert care. It still won't get us there. And there will be many savings arising from doing that, actually. So it's not going to, in the end, going to cost the community that much. But if we can find billions of dollars for children's hospitals, and cancer centres, and new freeways, this is our investment in the fabric of Victoria, the human fabric. And we have to do it.
The next pillar is the youth mental health system, and that has to be an absolute centrepiece as well. We have building blocks here in Victoria, but look how weak they are. We cover a million people in the west of Melbourne, and we get 4,000 complex referrals into our front end at Orygen, which links to the four Headspaces that we run.
These are people who seriously need expert, multidisciplinary care. We're turning three out of four of them away, and they're dying in bigger numbers. This is something that makes me absolutely furious when I hear of a death every few weeks. A person that should have been – they don't have terminal illnesses, in a few weeks they'd be better and they'd be alive, and they die unnecessarily. This is happening.
So it's worse than turning away two out of three. We're turning away three out of four.
And the final thing – actually, I should say what we need to do there. First of all, the State Government has, in an incredibly positive move for us, and we're very grateful for this, they're rebuilding our facility, our research/clinical facility at Parkville. So there's an opportunity for a state-wide reform built around that new facility.
And we would like to see much stronger mental health services across not just the north-west, but also the eastern area and the south-eastern area, especially in these growth corridors. And that can be done, and that should be between 12 and 25, strengthening the system, so right in that peak zone. And that will take the pressure off the rest of the adult system too.
So that is something that we've been working on for ten years, and it just hasn't really been nailed. It hasn't really been properly funded. So we really want to see that.
And the final thing is mental health research. Mental health research is incredibly poorly funded in this country. The minister today, Greg Hunt, announced some improvements to that, which are very welcome. But if you look at what the State Government is putting into research apart from this new facility, it's really much less than what you see in the rest of medical research. So a fair deal there too.
And this is the situation nationally, where even though it's the major cause of burden of disease in the prime of life, it's funded much less than cancer and cardiovascular research. Same pattern as within the service system.
And in the UK, and it's probably the same here, if you look at the corporate and philanthropic sectors, for every pound spent by the government on mental health research, the general public donates only zero point three of a pence whereas for cancer, they donate two-pounds-75.
So the situation's worse in the corporate philanthropic public domain than it is for the government. We're getting a raw deal from the government. We're getting a very raw deal from the community in terms of support for mental health research.
And where are the new treatments going to come from? Where are the improvements? Where is the new knowledge? Where is the prevention going to come from if the research is not supported? So that's another thing.
So I do want to acknowledge what the state government has done for us, and I also want to acknowledge Lynne Kosky and Jim Williamson, who's in the audience tonight, for the tremendous effort they put in to help us get to that point when the government was coming in. And they've honoured that pledge. The building is being built.
So this is a huge opportunity for us to really revive ourselves, and move forward, and really deliver, especially in the youth mental health area. But we want to see it happen across the lifespan, because we care about all of the Victorians with mental illness.
So that's what the new facility is going to look like. As well as the functionality, it's like a statement. It's like saying mental health, mental illness, is as important as cancer and heart disease if you have a state-of-the-art facility like this. It's incredibly important for the patients, for their families, and for us as people in mental health.
We suffer from what's called structural stigma. Not just the patients are stigmatised, and the families, but we are for working with them, and within medical research, all these areas. We're underfunded because of the structural stigma. That's an antidote to stigma when you do something like that. So we're very grateful to the Premier.
The other side of the coin, we talked about the prime ministers, and the health ministers, and all of that. They're dependent, like George Lipton pointed out, on the public. The public has been too passive, way too passive on this.
We've managed to mobilise 800 people, going back 13 years, which really was the kind of groundswell that got Headspace funded, that kind of activism that was happening then. And in other countries, they're starting to do that. This is in Ireland. There's a mental health reform movement there.
Grassroots activism is what we need, probably at this level, I think. This is in Poland, actually. They managed to get rid of the Iron Curtain, so surely we can do that for mental health.
And so we have been working, a group of people, including me, who are affected, who've got lived experience of mental illness in their families or personally. And this is a small group. And Lisa Sweeney, I'll mention her, she's here tonight too. She's been a great force getting this off the ground.
We set up something called Australians for Mental Health. We want to raise a lot of money to support this campaign. It's going to be a standing campaign. It's going to move from one state to the other – a campaign for a fair deal for people with mental illness, and it's going to campaign in federal elections as well using the GetUp! sort of model, but we've focused on this issue with a bipartisan target.
So that's the missing ingredient, that we haven't done that yet, and we need to do it. It will help the politicians, it'll help the genuine politicians that do want to do something positive. And I think Martin Foley, the current minister, I think he genuinely wants to address this. But he needs us to create the environment where enough money will be freed up to do it.
So I'm going to stop. I thought I had picture, one slide which – I had a ‘thank you’ slide, actually. I just wanted to thank everyone affected by mental illness who's shared their stories and helped us to get this issue on the agenda.
I want to thank all my colleagues. I want to thank the State Library. I want to thank the politicians that do support us and both sides of politics.
And I mentioned Jim. I want to thank Jim. He gave me lots of really good advice for the lecture, including one thing I forgot, which was we spend about $23 million at Orygen on the western suburbs of Melbourne for a million people, and 50,000 young people with mental illness live there, and we treat about 1000 a year. A high school – I think he showed me the budget for Glen Waverley High School in the eastern suburbs – is about $23 million as well. One high school. And that's all we've got for the whole mental health problem in the whole western suburbs. We need to triple that if we're serious. That's the sort of scale we're looking at. And I thin – thank you, Jim, for that very good comparison. We're looking for that.
We spend $22 billion a year now on the NDIS for 400,000 Australians. We spend $8.5 billion a year for the four million Australians with mental illness. So you can see the mismatch, and those are the sort of figures we've got to turn around and we will be hoping that our government, and with an election year, we are looking for a bit of a bidding war between the two parties in terms of who's going to fix it.
So I'll stop there. Thanks very much. Sorry it went on too long.
Thank you very much. And I'd also like to acknowledge the Wurundjeri and Bunurong people and the land itself.
Getting away with murder. The Deputy Prime Minister of this country in the year 2017 said Aboriginal children should not be taught their own culture and language, because it would retard them. Her fellow ministers and advisors weighed in with the opinion that Aboriginal culture was flawed, because we hadn't invented the wheel, or done anything useful with the land. Some went so far as to say child abuse was one of our cultural traits.
There is nothing post-colonial about Australia. It still has a Raj mentality and a vindictive adherence to colonial myth. Our country has never really investigated the colonial legacy. Preferring to express horror at the inadequacy of the Indigenous population and the need to control the destiny and band-aid the wounds, and if a crisis in health and education is perceived, it is better to send in the army than teachers and doctors. Taking the land from people as the spoils of religious wars, made more efficient and lethal by the creation of great ships, allowed the Europeans to extend their influence to all continents. That the Chinese visited many of those continents before the Europeans but chose to socialise and trade with the inhabitants rather than murder them and steal from them, is another story and another psychology.
The European brain was so intrigued by its own superiority that it rendered every civilisation they encountered as savages. It didn't matter that the First Nation people of Vancouver built two-storey houses. Didn't matter that the First Nation people of the Pueblo had advanced cities. That the Aztec and Mayan were as wealthy as any other nation on earth. That the Australians invented bread and society. Yes, society. For the world's oldest town, and oldest by many thousands of years, is found in western New South Wales.
Of course, Australians refuse to visit the fount of civilisation, because it questions every myth we make about ourselves. For Christians to remain Christian and worthy of their religion, the people they kill must be asking for it, and the land they steal must be handed to them like a windfall apple.
But the Pope had a way of helping the Christian conscience sleep at night in dreams of civilised excellence. In 1493, Pope Alexander VI decreed a papal bull, called The Doctrine of Discovery. In response to the voyages of Columbus, the Pope decided the Church must explain and ratify the attacks on indigenous peoples and the theft of their lands.
The rationale goes like this: if a people do not recognise the name of Jesus Christ – and you'll be surprised how many people on different continents did not – then it was the duty of the Christian to take their land and bring them into the light. Most of those brought into the light had that light extinguished immediately, by Christian swords. Many Christians still yearn for the same solution, and so do many Muslims.
Christians had many bland formulae for explaining away the imperial deeds. The English artist Edward Hicks painted countless versions of the Kingdom of the Branch, where quaint scenes of lambs and lions lying down with each other – a trick incidentally, which has been very difficult to repeat – and then being led from the wilderness contain a small cameo in a dark corner of the painting.
There's the dark corner. I was familiar with the stupid kid lying down with the spotless leopard, and just accepted it as part of the smarmy kitsch of Christianity, until I peered into that dark corner and saw the fine print of the Christian promise.
In the version of that trope prepared for the Americans, the Puritan William Penn of Pennsylvania fame is talking to a group of First Nation Americans after the end of the Indian Wars. The Indians have lost everything but a bunch of feathers and are forced to treat with Penn from a position of hopeless disadvantage. They decide that if Penn walks from sunrise to sundown in a straight line, then that line should form the side of a square of land that Penn could call his own. Of course, the Penn family trained sprinters to race across the land, in relay, and thus ten-fold the area claimed. Ah, the Christian spirit. The Puritan genius.
The poverty of the European spirit and the devilry of its intelligence created a massively unequal world. And that inequality is blamed on indigenous peoples instead of the nature of the European mind. In Australia, that meant crushing the oldest civilisation on earth, and the creators of bread, language and democracy.
Almost no Australians know anything about the Aboriginal civilisation, because our educators – emboldened by historians, politicians and the clergy – have refused to mention it for 230 years.
Think for a moment about the extent of that fraud. Imagine the excellence of the advertising required to get our most intelligent people in 2017 to believe it. Imagine the organisation required in the publishing industry to fail to mention Aboriginal agriculture, science and diplomacy. Don't blame Pauline Hanson. Don't blame Geoff Blainey and Keith Windschuttle. Blame Manning Clark, Gough Whitlam and every editor of Meanjin and Overland, for they too were guilty of that omission.
What omission? Well, let's look at what the explorers reported of the Aboriginal agricultural economy, and see if you can remember any priest, parent or professor alluding to it.
Lieutenant Grey in his 1839 exploration of parts of Western Australia – so far unseen by Europeans – saw yam gardens over five kilometres wide and extending a distance past the horizon, further than he could see, simply because they had been so deeply tilled he could not walk across them. So Thomas Mitchell, in the country that is now the Queensland–New South Wales border area, rode through nine miles of stooked grain that his fellows describe as being like an English field of harvest. Isn't that word, stook, an interesting word when applied to what we thought we knew about Aboriginal history?
Isaac Beatty saw the hillsides of Melbourne with terraced in the process of yam production, and that the tilth of the soil was so light, you can run your fingers through it. Mitchell saw these yam fields stretching as far as he could see near Gariwerd in the Grampians. He extolled the beauty of these planes, assuming that God had made them so that he could discover them, not once thinking how peculiar it was for the best soil in the country to have almost no trees. This was a managed field of harvest. George Augustus Robinson saw women stretched across the same fields of horticulture in the process of harvesting the tubers.
Charles Sturt had his life saved in Central Australia when he came upon people who were harvesting a river valley and supplied him with water from their well, roast duck and cake. Both Mitchell and Sturt described the baked goods as the lightest and sweetest they had ever tasted. How many historians have read those comments? And yet not one has considered that it would be in the nation's commercial and culinary interests to find out the particular grasses from which those flours were made. How many thought that it would be interesting for our children to learn at school?
Ian Kerr noticed that. As he brought the first vehicle into the plains south of the Echuca, his cartwheels turned up bushels of tubers. Once again, some of Australia's best soils were almost bereft of trees. The plains having been horticulturally altered to provide permanent harvests of tubers. Unlike Mitchell's self-indulgent congratulations, Kerr was aware who had produced this productivity and later recognised that it was his sheep that destroyed it.
James Kirby is one of the first two Europeans in the country of the Wadi Wadi, near Swan Hill. They pass gigantic mounds of bullrushes, cumbungi, stacked up and steaming, and wonder about the vast enterprise but never think about the productivity of that plant. Aboriginal people were harvesting the base of the stem as a delicious salad vegetable and making mounds of the leaves to process starch. Just one more source of baking flour. Kirby notices a man fishing on a weir his fellows had built across the river. Well, Kirby assumes, with great reluctance, that blacks had built it, but only because he knows he's the first white man to see them.
The construction of the dam included small apertures at the bottom so that water and fish movements could be controlled. Kirby describes the operation: 'A black would sit near the opening, and just behind him, a rough stick about ten feet long was stuck in the ground with the thick end down. To the thin end of this rod was attached a line with a noose at the other end, a wooden peg was fixed under the water at the opening to the fence, to which this noose was caught. And when the fish made a dart to go through the opening, he was caught by the gills. His force undid the loop from the peg, and the spring of the stick threw the fish over the head of the black, who will then, in a most lazy manner, reach back his hand, undo the fish and set the loop again around the peg.'
The man refuses to look at Kirby even though he knows Kirby is watching. Already, the Wadi Wadi have decided correspondence with Europeans is not to their advantage. But this man can't hide his pride in the technique. You could say his manner was insouciant.
But how does Kirby explain the operation? He writes, 'I have often heard of the indolence of the blacks and soon came to the conclusion, after watching a black fellow fish in such a lazy way, that what I had heard was perfectly true.' So weirs and constructions, machinery and productivity, all rendered by Kirby as laziness. Wasn't he describing an operation, which would fit neatly into any description of European inventiveness and industry?
Now for reasons, which are almost impossible to explain, I have found myself at the meetings of two different universities in the last month, where staff were asked to beam with excitement because their university had been rated 23rd and 17th in the world, for a particular area of scholastic endeavour. The first ten horses at the Melbourne Cup win something. I think the 10th horse gets a biscuit of hay, and the jockey, a wallop that Uncle Alec knocked back last Christmas. And I've seen under-age soccer teams where every child got a trophy, but 23rd and 17th? Isn't that a bit like every toddler gets a Kinder Surprise?
We seem desperate for the world to acknowledge our excellence but unable to investigate our own history. We have had 230 years of scholarship in Australia from over 25 universities but not one of them has wondered about the Aboriginal domestication of plants and the vast fields of agriculture witnessed by the explorers, the so-called unchallengeable founts of knowledge of Australian history. We stab out our eyes rather than regard Aboriginal achievement in this country. Our best citizens go to extraordinary, noble and understandable lengths to protect the innocent refugees from war. But we still allow First Australians to have their money quarantined for crimes they have yet to commit.
The reason for the national antipathy to racial politics in this country stems, I believe, from the national ignorance of Aboriginal culture and economy. And that ignorance has to be laid, in part, at the feet of our learning institutions. A legion of professors and doctors at our universities decided it would be unnecessary for our golden youth to know what the explorers witnessed of Aboriginal excellence.
Today, we wring our hands because the Darling River stops flowing in January. We seemed bemused when the over-ploughed soils of the Wimmera blew about our heads in Melbourne in the '60s, '70s and '80s. We wonder why we cannot get a second yield of hardwood blue gum from the forests of Tasmania, Western Australia and Victoria. So in apparent wrath at the vagaries of nature, we poison that weedling second crop. We have ruined the soil, but we'll blame Greenies for crop failure and unemployment, rather than blame the poor science on the massive and soil-destroying machinery.
But like the baker's blinkered horse, we cannot look behind. We cannot admit that First Nation land management – and when I say First Nation I'm not talking about Pauline –First Nation land management, finely tuned over 100,000 years, might have the ability to clear the fog from our brain. Even today, our agricultural scientists seem to be surprised when the Aboriginal domesticates thrive in the soils and climate to which they were born.
Oh, we love to talk about bush tomato, lemon myrtle and wattleseed, because they fit our venal understanding of hunting and gathering. But when asked to consider the virtues of agricultural products grown on fields so wide the explorers could see neither their beginning nor their end, we become flummoxed and querulous. These crops are perennial. They were staples of Aboriginal diet and economy. The word staple suggests permanence and utility, and both the latter two words were the sole basis for the application of terra nullius.
I don't mean to berate, but the hour is late. Aboriginal health and education continues to fall far below the national average, and the incarceration rate of Aboriginal Australians should be the shame of the nation, instead of a prickly nuisance. Australia seems to wash its hands of this state of affairs, never seeming to wonder how dispossession and the failure of the nation to believe our pre-colonial and post-colonial histories works on the psyche of both Aboriginal and non-Aboriginal people.
If we are to make a nation rather than a mere economy, we have to absorb the history. We don't need to worry about how Aboriginal people got here, because archaeology seems to be proving Aboriginal opinion. That we've always been here. We have to worry about how the rest of us got here and who to thank.
Australia is a drying continent. World and national inaction on the human contribution to climate change is leading to a situation where we will soon be growing mangoes in Canberra. Aboriginal domesticates do not require any more moisture than the Australian climate provides. No more fertiliser than our soils already contain, and as they are adapted to Australian pests, they need no pesticide. These plants are an environmental boon to the nation. Apart from the fact that, as they're all perennial, with the large root masses of plants adapted to dry conditions, they sequester carbon. If we only dedicated 5% of our current agricultural lands to these plants, we would go a long way to meeting our carbon emission reduction targets. And you have to believe me in my maths there, because I failed Form 3 Arithmetic at Fawkner High School. My father thought that was a good qualification for me to study accountancy.
These are achievements and opportunities. And the biggest opportunity is the chance to begin a conversation with Aboriginal Australia about the real politic of our history. Forget the gnashing of teeth and the gushes of tears for this state of affairs. Let's get down to tin tacks.
We can and will provide employment for remote Aboriginal communities. We can and will provide health and education professionals. We can and will enjoy the improvement in national well-being, and we will do it as a public, because the political system is failing us. We know politicians will refuse to consider anything which challenges their control. Parliamentary vision is dead. When any prime minister wrings his hands and sheds tears of remorse, you know at the first drop of moisture that he intends to do nothing.
Aboriginal and Torres Strait Islander people meet at Uluru. And despite the diversity of opinion, the frustration, the old enmities, they thrash out a statement so modest, so considerate of reality, that many Indigenous people are appalled that something so vague and general can be the product of such long consideration. And yet, the prime minister dismisses it out of hand, as being too ambitious.
Australians will have to make the hard yards themselves. A parliament of barristers and lawyers can draft legislation, they just can't imagine what has to be drafted. We might allow the politicians to think our plan is their own idea. Sometimes it's the only way to get them to concentrate. But we have to formulate that idea, and it has to be done after long consultation with Aboriginal Australia. Real talk. Equal talk. Not reconciliation, or recognise, or close the gap formulated on the assumption of our inadequacy. But a true conversation about what was lost, and what was gained, and how that has forged the national schizophrenic psychology.
We have to read Sturt, Mitchell, Warburton, Giles and Gregory. And we have to try to quell the triumphal urge while we read. We have to try and read beyond the daring and hardship of the explorers and the vast riches they discovered. We have to read for the cultural economy of Aboriginal Australia, which they've witnessed and described and which is housed in this building. We also have to restore the sections in Lieutenant Grey's journal where he speaks about Aboriginal housing, irrigation, agriculture and road making. Because when the journal was edited and published, those were the only items left out.
Maybe that's a job for a university that doesn't want to be satisfied with a Kinder Surprise for being 27th best in the world at something. Maybe there's a university that wants to investigate the root of the oldest civilisation on earth. The civilisation that invented bread, society, language and the ability to leave us 350 neighbouring nations without land war. Not without rancour, for that is the human condition. But without a lust for land and power. Without religious war, without slaves, without poverty, but with a profound responsibility for the health of Mother Earth for over 120,000 years. This is not a noble savage sentiment. It is the iron-clad rigour from reading the true history of the country. I think Australia is capable of this rigour. I think we must absorb the pain and weariness such rigour will demand of us. Temper democratic, bias, Australian.
This man is Mannalargenna. Eighty per cent of Tasmanian Aboriginal people today are related to that man. Simply because he was virtually the last man. His hairstyle has been created by using pelletised clay in the locks of his hair. After George Augustus Robinson, the missionary who was paid to collect Aboriginal people and send them to the islands of Bass Strait, Mannalargenna felt that he had betrayed his people, or at least let down his people. So as the bough of that ship with George Augustus Robinson at the helm ground into the sand of the beach of Green Island, Mannalargenna cut every lock of his hair and threw it into the sea. A more profound statement of disillusionment, of devastation and disappointment has hardly been made in the world's history.
This stone was found by a young Aboriginal Wiradjuri man in the Australian Museum. There wasn't just one of them, there were thousands of them. Thousands of those stones. The stone is that big [indicates size with open arms]. It's too heavy to use above your waist. It was attached to a right-angled handle. The leading edge had only ever been used in the soil. Only one of the stones in the museum was labelled. This one is called a bogan pick. It is a plough. it is a land-turning tool used by Aboriginal people. There are thousands of them that have never been described in any academic text other than what the explorers described.
Here's an opportunity. We can't look at this and be devastated by its absence in our scholarship, because here is the opportunity for young scholars and old to examine these things. To dispel the myth that we've allowed to cloud our eyes.
After Jonathan Jones, who found that first stone, told me about it – sent me that photograph – that photograph, which should change the mind of Australia about its own history and change our relationship with Aboriginal people, forever. I was in Daylesford talking to some permaculture people and I happened to be able to get to the museum, and I found a glass cabinet with eight or nine of these stones in it. And they were called 'unusual stone'.
Once again, the leading edge has never been used on stone or wood, only ever in soil. And they truly are unusual stones, because they are Aboriginal earth-turning tools. None of your children, or grandchildren, or yourselves have ever heard of these things. And we pride ourselves on coming 27th in the world for something, and now is our opportunity to become first in the world at discovering our history and being honest about it. It's not going to be easy. It's going to be unpleasant. There's a lot of grievance to be held and expressed, but we have to be up for it. We have to be patient. We have to be brave, and we have to see it through. Because otherwise, our history is deluding us. We are deluding ourselves about how come we live in this wonderful land. This beautiful land we call Australia, and look what we've done.
Norman Tindale was laughed out of the country for describing Aboriginal grain areas. And yet, when we look at this map that was produced recently of his findings where Aboriginal people had been harvesting grain over thousands of hectares, and the dotted line, which also encapsulates the grey areas, is the Aboriginal field of harvest. It goes right through the centre of the country. The current Australian wheat belt is the grey area. Aboriginal people were harvesting most of Australia. We now know that that line should extend right through here. [Indicates] So roughly half of Australia was under crop to Aboriginal people.
We did a harvest last summer at Mallacoota, at the airport because it's one of the last surviving pure crops of kangaroo grass that we could access. I've got to thank the East Gippsland Shire for allowing us to do that. I can't thank them for the boat ramp that has been built in a bay where it should never have been built. But they did let me harvest the land. We ground the grain into flour, and this [Shows slide] was taken at Lake Mungo. And this coming weekend, Mungo Man will be returned there.
I could talk for hours about how come Lady Mungo and Mungo Man were taken out of the sand where they were buried, traditionally, ritually. The first ritual burials in the world. And why one of Australia's academics put Mungo Lady in a suitcase and brought her to Melbourne. And how the people had to wait 40 years to get her back. To rebury their great-great-grandmother.
But we did get back. And those old girls, those people who work so stoically, so bravely to get their relations back, also wanted to get their food back. So they made the students go and harvest the grain, Panicum decompositum. And that Panicum decompositum grows in the sand of Lake Mungo. It only needs one watering from one rainfall, and it will produce grain that you can turn into flour and bake bread. [Shows slide] There's the bread. There's the loaves as they came out of that oven. You could smell them from 300 metres away.
I really hope that the cooks of Australia, the households of Australia, will want to bake this bread in the future, because your kitchen will smell beautiful for three days afterwards. It is a beautiful product, and we're only now starting to think about it.
Proud of that photo. That's my son and daughter at that harvest. My son said about my daughter, you only turn up for the photograph. We've been working for three days out here – ignoring the fact that my daughter's got three kids and has no time to herself at all.
I talk about Aboriginal culture and history. This is a whale. That's a stone whale, or a real whale. It doesn't matter which. And it's a story of how Aboriginal people survived the rising of the seas and how the whale told them how to move away from the ocean as it rose, but also warn the people that they would then enter the areas of their cousins and that they would have to negotiate the new occupation of that land with their cousins. And they would have to do it with peace. Probably the only time, in the world's history, that a people have moved onto other people's lands and not fought for it. This is our country. This is our history, and this is what we have to know about ourselves.
That's the kangaroo grass. And this very ugly photograph is of a grinding dish, which is 35,000 years old. This was used to grind grain into flour for the first time on earth, so I thought. And that's 17,000 years before the Egyptians thought of the same thing. They were too busy building pyramids at the time to think about bread. But I thought that was the correct date until in Arnhem Land last year, or the start of this year, a stone was found 65,000 years old. At Warrnambool, the midden site has now been aged at 80,000 years. Lake George in Canberra is showing signs of 125,000 years of Aboriginal occupation, which is 50,000 years before the Out of Africa Theory. There's a fair bit to do in the scholarship of Australia before we understand our real history of this continent.
This woman was working at the museum. She comes from Cuddie Springs, where the stone was found. She's Kamilaroi. She has her left hand beside a stone, which could easily have been used by her great-grandmother's people. Because even though that stone was so old, there were other stones with it, which are of more recent age. She is standing beside a piece of palpable Australian history, which is only now being investigated.
There were more stones in that village. Bill Gammage, who wrote that great book, The Biggest Estate on Earth, sent me this photo of a painting, because it shows murnong. The painting is actually called The Coming of Cattle to Cambatong Country, five years after Batman and Fawkner came to this town. So what those cattle have done, is they've eaten their way through the Aboriginal crop.
This is murnong. It comes out of the garden at Mallacoota where I've been growing murnong now for five years. A bush rat ate that murrnong and it had to walk past strawberries to do so. That is an indication of how beautiful this plant is and how Australian gardeners will love growing them.
Now someone in here knows Beth Gott. That's her on the left. And Beth Gott wrote the only paper about murrnong, and without it we would know nothing about the plant. Nothing. Beth Gott, 96 years old, still walks to work every day. And that woman virtually had to work alone. Had to challenge every male academic in her faculty over the years. And she did so for the sake of her country.
That's my son's plantation of murnong. This is microgera scapagera, a slightly different version. Still beautiful. When that field was produced, it was probably the biggest in Australia. So I'm doubly proud of that boy.
Those are the Brewarrina fish traps, arguably the oldest human construction on earth. Of course, no one ever goes there. No Australian. Million and a half Chinese people go and visit Lake Tyrrell in Victoria. No Australian goes there. The Chinese are interested in Aboriginal knowledge of the night sky. We almost seem to refuse to have anything to do with Aboriginal people in this country. And I can say we, because a fair portion of my blood is Cornish. Every time I speak about these things, I have to recognise the fact that my own family is conflicted. All of our families are conflicted. But there is something we can do about it. Because we have brains and we have hearts.
This is a fishing machine from Cape York peninsula. It's a photograph, so it's recent. Donald Thompson from Melbourne University took that photograph. A great Australian. It should be in every textbook in Australia, because that river had to be dammed to produce that system, because every fish in the river that wants to come downstream has to go through one of those two apertures. The whole thing is built on stumps. It's a piece of architecture. It's a piece of engineering. It's a piece of industry. And it's a perpetual fishing machine. And it can be closed off so that the fish just go on their merry way, and it can be opened again to operate it. It's a piece of wizardry. And no Australian student has ever seen that photograph in a textbook.
These are Aboriginal houses. Cape York. These houses could hold 25, 30 people. The ones in western Victoria, some of them could hold 52. And we know that as a fact, because one of the settlers who was negotiating to take the land from those people went into one of those houses for that negotiation, and there were 52 Aboriginal men already in there. There would have been 52 Aboriginal women, except they didn't want to meet him.
This is a fascinating photograph. These are widows caps. They're made out of gypsum. The same man I talked about before, Jonathan Jones, has found Aboriginal pottery in the South Australian museum at Adelaide. Pottery. Never been exhibited. Aboriginal pottery.
What are we doing with our time in this country? All this knowledge yet to be found, and we leave one of the great indicators of civilisation, according to European people. Europeans decide on what they think is civilisation and then describe the lack of it in other people, and one of those lacks for Aboriginal people was pottery. And these are examples of Aboriginal pottery. And I thought they were the only examples. Adelaide Museum is full of them, and we know nothing about it.
More examples of the beauty and serenity that Charles Sturt and Mitchell described of Aboriginal cemeteries.
Aboriginal houses in the Western District of Victoria. More houses appropriate to their location and the climate. More houses.
This one's interesting. Look at the scale. Big house, open at one end. Have a look at that opening. How is that supported? That is supported by a beam. It's a piece of architecture and has never been commented on. As far as I know, by Australian academics.
That's the bread that we made last summer from kangaroo grass. That's a chook. And that's a book.
So, thank you. Sorry to be so miserable, but that's our story. That's the Australian story. Thank you.
Let me pay respect to the Wurundjeri First Nation: I bring greetings from Cape York Peninsula. Thank you friend John Wiley and the State Library of Victoria for the honour of presenting this year’s Oration in memory of Sir Keith Murdoch, whose family we acknowledge tonight.
Being in a library, a glorious library, I'm reminded of my own glorious library in my father's room, my late and too long gone father, who one day when I was a child built a small bookshelf, the only bookshelf in the house, into which he placed all of the discarded books given by the missionary, which he and I scoured night after night – me searching for something interesting other than the latest treatise on the Book of Deuteronomy. My father left me with one invocation, taken from some obscure parenting book, a quotation from Francis Bacon to the effect that reading makes a full man. It is an invocation that has never left me and was my father's greatest gift to me: that reading makes a full man.
My subject tonight is the legacy of the great American public intellectual and politician, Daniel Patrick Moynihan, the author of one of the most famous briefings in the history of public policy. As an aide in President Lyndon Johnson’s Labor Department, Moynihan’s 1965 paper The Negro family: The case for national action argued the US Government was underestimating the damage done to black families by what he called 'three centuries of sometimes unimaginable treatment' and the 'racist virus in the American bloodstream' would continue to plague blacks into the future. He wrote: 'That the Negro American has survived at all is extraordinary – a lesser people might simply have died out, as indeed others have… But it may not be supposed that the Negro American community has not paid a fearful price for the incredible mistreatment to which it has been subjected over the past three centuries. The Negro family, battered and harassed by discrimination, injustice and uprooting, is in the deepest trouble. While many young Negroes are moving ahead to unprecedented levels of achievement, many more are falling further and further behind.'
Fifty years later, we live in the wake of Moynihan’s electrifying thesis on African-American prospects in the wake of civil rights. The discourse reverberated here in Australia. Moynihan’s was an attempt to identify the radical centre in thinking about the legacy of slavery and racism, and its effects on African-Americans, and what it would mean for the hopes and dreams they held after the catharsis of civil rights. These 50 years saw a tumultuous dialectic play out: between those captured by Moynihan’s striking call to arms, and those alarmed by its analysis. This discourse began immediately with a vehement campaign by liberal social reformers and leftist activists to oppose the adoption of Moynihan’s thinking by the US Federal Government.
The first riposte to The Negro family came from Harvard academic William Ryan, taking aim at Moynihan’s identification of the black family as the ground zero of black poverty and social crisis, later published in book form in 1971, Blaming the victim.
I re-read Moynihan and Ryan in preparation for my remarks tonight, as well as a bracing retrospective by Ta-Nehisi Coates in Between the world and me. Coates is the leading black intellectual of the Black Lives Matter movement and his book is a searing analysis of the ongoing American dilemma.
Consider this: up to 10% of black males in America's major black cities are in jail, comprising a tragic proportion of America's five million citizens in prison.
Last year, on its 50th anniversary, the Atlantic republished The Negro family and Coates’ article, 'The black family in the age of mass incarceration'. It is astounding to reflect that the argument that any attempt to attribute responsibility or personal agency to individuals in respect of social problems has its genesis in Ryan’s accusation that one may be ‘blaming the victim’. It became the most powerful nostrum of leftist objection to social analyses on personal behavioural terms and any policy responses predicated upon such analyses. In my reading of Ryan, however, I cannot gainsay much of its insight and perception. Unlike the leftist discourse that he spawned in subsequent decades, Ryan’s original critique cuts to the quick and warrants serious reflection.
I won’t rehearse the terms of that original disputation, except to say Ryan objected to the so-called ‘tangled pathology’ within African-American families as a misattribution of their predicament. Whilst Moynihan’s denunciation of the ongoing horrific effects of racism against black Americans was unequivocal, Ryan cogently argues slavery was not the immediate cause of the problems manifesting in black families: poverty and racial discrimination were their cause. Similar problems were manifesting with other peoples around the world in like circumstances.
I find Ryan’s critique sobering in long retrospect, because he reminds us of the danger of conveniently pathologising specific aspects of black life, particularly family life in the ghettos, without turning our eyes to the economic and structural circumstances in which these families live and the deprivations they not only suffered in the distant past, but continued to endure. Social policy responses in the modern era have been confined to addressing segments of egregious disparity without looking at the broader circumstances that gave rise to those problems and which, more importantly, drive these problems into the future.
The chief accusation against Moynihan is the Negro family’s causal role in poverty. This is, I think, unfair. The better way to understand Moynihan’s argument is that the Negro family was the victim and became the transmitter of poverty. Once entrenched, with all its effects on black family life, the family then becomes the means by which poverty is transmitted to children.
When I reflect on the history of this discourse over half a century, I wonder how much better it would have been if the insights of these two great intellectuals had somehow been reconciled. Each correcting and balancing the other, rather than repudiating each other. Instead, they became polar opposites in an unresolved discourse that organised a liberal progressive tribe on the one side, and a conservative tribe on the other.
Charles Murray’s 1984 book Losing ground, which laid out the modern articulation of welfare reform, is the legatee of Moynihan’s Negro family. However, the very alarm harboured by Ryan that the political and intellectual right would pathologise and blame African-Americans for their own predicament was realised when Murray and Richard Herrnstein subsequently published The bell curve, spuriously arguing that black Americans were intellectually inferior to whites. The problem of poverty and social inequality had their source in the innate character and genetics of black people, and the old assumptions about black racial inferiority found its new sociological cloak in The bell curve.
Attempts to build policy in the radical centre found their apotheosis in President Bill Clinton’s enactment of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) in 1996, aiming, in Clinton’s invocation of Moynihan’s original words, ‘to end welfare as we know it’. It sought to reconcile the behavioural dimension of welfare dependency and the structural opportunity of employment. These reforms were supported by the now New York Senator Moynihan, to the dismay of the welfare rights lobby. There is great debate about the success of the PRWORA reforms, but it is clear this reconciliation was dependent upon the availability of work. The deal worked during the Clinton administration when jobs were available, but could not be sustained in the economic downturn. You can mandate personal responsibility but not employment opportunity.
My interest is in the radical centre. This is the place where those in search of a better society might best hunt. It is the sweet spot representing the right combination of conservative, social and liberal ideas and insights. Rather than the weak, ‘lowest common denominator’ compromise between left and right, the radical centre is the highest, noblest compromise. It brings together high ideals with hard realism. It is high-minded pragmatism informed by intense dialogue and negotiation.
Bill Clinton, Tony Blair and other social democratic leaders around the world were the chief proponents of radical centre politics. However, its invention began in Australia with the Hawke–Keating Government in 1983. Keating was its greatest exponent. My own view is the difference between Keating as the champion of the radical centre – seeking to produce social good underpinned by economic reform – and John Howard, is that Howard was the great manager of the centre, whereas the exceptional character of Keating’s leadership was to drive the radical centre: to pursue reform and not just manage.
The politics of the radical centre have declined in the past decade and a half and we have retreated to that old tepid partisanship, plying for the promiscuous affections of swinging voters. The terms of public political debates are largely between the 15% of the far right against the 15% of the far left, with the middle just sagging. There was a brief emergence of third way political philosophies in the nineties, and the political strategy of triangulation, employed by Clinton and other so-called Third Way proponents, but this turned the radical centre into mere tactics, rather than a means of creating better policy and politics.
My thinking about welfare dependency and reform for my people and Australians generally evolved in the shadow of these developments. Daniel Moynihan, William Ryan, Charles Murray, Bill Clinton, Tony Blair and Paul Keating’s Working Nation were critical contributors to my emerging thought.
As perspicacious as William Ryan is in Blaming the victim, in retrospect his thesis informed a half century’s worth of leftists encouraging the poor to see themselves as victims. This was not his intention, but it was his effect. His riposte to Moynihan was a nostrum that became an ideology that became a mindset, and legions of leftist social workers and academics compounded the idea that the victimised were indeed victims and entitled to a sense of victimhood. I have long argued against the horrific results of this legacy. Inculcating a sense of victimhood in the victimised is for me to remove power from the victims. In a sense, the right’s relative heartlessness was preferable: better to object to the right’s hypocrisy than to succumb to the left sanctifying victimhood. The frog falling in the fire can at least jump, whereas the frog in the freezer hibernates peacefully unto death.
In 1999 I published my thesis: Our right to take responsibility. My conviction was in the difference between poverty and passivity. Poverty in the Third World, as I had witnessed in Vietnam, was of a different character entirely to the passivity in my home community. Like Ryan, however, from my reading of Theodore Dalrymple’s accounts of the social pathologies of welfare dependent white people in England, I saw clearly the problems caused by welfare are not racially or culturally unique. They apply to any peoples placed in similar circumstances. Dalrymple’s accounts could well have been written about the communities I know in Cape York.
My thesis was based on the idea we needed to assume responsibility as a power. As a power to take control over our lives and to have the kind of self-determination that successful citizens, communities and peoples need, expect and are entitled to in a liberal and social democratic society. Like Moynihan, my thesis aroused objections from the Australian left, Indigenous and non-Indigenous. A similar discourse that engulfed the Moynihan report played out in a provincial echo here in Australia.
I want to go through the main contentions in this discourse that have eluded common ground. Firstly, in relation to social disadvantage and poverty, the issue of explaining the ultimate origin of these problems going back to the colonial past, to the legacy of racism and exclusion, versus more proximate explanations such as Indigenous communities leaving the cattle industry and joining the welfare rolls, and the rise of substance abuse epidemics, is the subject of great convulsion. My argument has been that, though historical wrongs have ongoing impacts, many problems now manifest in our communities are of recent origin. They concern the rise of substance abuse epidemics and welfare dependency in recent decades.
Another debate centres on causation. What drives poverty – is it the structural circumstance of disadvantaged peoples, or the behaviour of the people themselves that explain the cause of their problems?
Yet another dimension is the effect of racism. Aboriginal and Torres Strait Islander peoples have experienced and continue to experience appalling racism in Australian society. But in responding to that racism, should we inculcate a sense of victimhood in the victimised, or should we resist racism whilst ensuring it does not become our burden? I mean not in any way to diminish its soul-crushing effects on individuals and communities – I only mean to say that we should never nurture a sense of victimhood, otherwise we let the racists win.
And finally, the whole question about agency. Should we focus on personal agency or structural reform? The left say structural reform and the right say personal agency. Like Clinton and Obama, I say both/and. The crucial question is, however: what should the relative emphasis be? My own view in relation to analysis: at least 51% is structure and 49% is agency. However, when it comes to action and what we should do and must do, then my argument is it is at least 51% agency and 49% structure. Because at the end of the day, it is personal agency that will drive any structural reform. We can’t just sit back and hope structural reform will somehow happen, and absolve us of the necessity of agency. This is the passive leftist daydreaming of social justice. Social justice in truth is secured when, two by two, clutching our children to our breasts, we climb the stairs of social progress in pursuit of better lives for our families, animated by the engine of our own liberal self-interest, whilst supported by the social underpinnings of that staircase built by the distribution of opportunity.
We need strong, healthy, educated children to emerge in distressed communities, whilst at the same time working for structural change. The stronger our children are, the better they will be able to fight for future reform.
In 2015, eight regional communities across Indigenous Australia provided the Federal Government an agenda for Empowered communities, which grapples with the structural dimensions of Indigenous empowerment. This blueprint sought to answer the call for empowerment made in the 1990 Royal Commission into Aboriginal Deaths in Custody. Twenty-five years after the Commission, the number of Indigenous people in prison has doubled. Australia’s Indigenous imprisonment rate is the highest in the world: 27% of our prisoners come from 3% of the population. No statistic speaks more profoundly to the structural nature of our predicament than this one. If there is not a structural, indeed constitutional basis for 3% of any society filling 27% of its jails, then we would have to subscribe to a theory of innate criminality on the part of those peoples. The most notorious figures concerning the Indigenous plight in this country make plain this is not a problem of criminology or socio-economic development – this is a problem of disempowerment derived from that people’s status in the nation.
We proposed a comprehensive policy paradigm for consideration by federal, state and territory governments. Essentially, the challenge of creating a level playing field between the elephants of government and the mice of Indigenous Australia is to find the right fulcrum between the two, to create a relationship of negotiation and mutual responsibility and respect, rather than a top-down relationship of mendicancy and control.
The other structural agenda that is imperative, in my view, is the constitutional recognition of Indigenous Australians. This, too, is about empowerment and responsibility. Australia’s First Nations must be empowered with a voice in relation to the laws and policies that affect our people.
Finally, the country needs to embrace the Indigenous heritage of Australia in a way that celebrates it as the heritage of the entire nation, and which provides assurance to our First Nations that the extraordinary languages and cultures of this land may endure long on this continent. As they have done for more than 50,000 years.
Empowerment, recognition and cultural embrace. These are the structural agendas of Indigenous policy to which we must employ the shoulders of the nation. But achieving them must be the mutual responsibility of Indigenous Australians and non-Indigenous Australians alike. We all recognise the problems and yearn for solutions. The question is: will the nation’s leaders take up this challenge? Are we willing to work together to make the paradigm shifts that are needed? Is anybody willing to lead?
As a nation, we must have the courage to change the way we do business in Indigenous affairs. I put these views forward from the unfortunate conclusion that there is little that is promising in what has been done and is being done under the banner of ‘welfare reform’ in our country. Fiddling around with entitlement design and conditions is not by itself going to reform this scene. They will be components of a comprehensive agenda, but they are not sufficient to make reform.
Indeed, we have probably worsened things with the move to outsourcing human service delivery to the private sector. Whilst this outsourcing may be said to be more efficient, the truth is that we have now created and entrenched industries whose sole rationale is the existence of social problems. Beyond the employment and training services industries, we now have private-sector industries in all manner of social need and misery: the dead end of which is child protection. The profit motive now exists in the space that separates lost children from their mothers’ bosoms. These vampire industries have completely colonised Indigenous Australia, and constitute the Australian welfare state’s main response to poverty and the problems that arose from welfare dependency.
Now that rentals flow in these industries, there is no incentive for players work to resolve the social problems that is their market. Rather, the imperative now is to simply manage and indeed sustain these problems. The purveyors of quasi-markets of outsourced government service delivery now hold the commanding heights, and resist reform.
My belief has always been that we need to pursue reform on both fronts: at the behaviour and structural levels. I do not resile for one minute from mutual responsibility and conditional welfare. By themselves they will not solve our problems but there is no escaping the fact that disadvantage over time becomes dysfunction, that poverty over time becomes passivity.
This is where our hindsight on William Ryan has 50 years more evidence. The struggle for structural reform is not easy. Even where we have developed concrete agendas for empowerment, the country’s political leaders do not know how to respond. If I have learned anything these past 15 years, it is that reforms to secure the radical centre on poverty and disadvantage require national leaders to lead them. You need the equivalent of Paul Keating to lead real social reform, as the flip side of economic reform. The radical centre cannot be secured by activists and provocateurs from the outside, and neither by minor ministers. Only a Lyndon Johnson or Paul Keating can have the dexterity and authority to do what needs to be done.
Finally, let me tell you why I so passionately believe that welfare reform and structural reform is crucial. My friend Danny Gilbert, founder of Gilbert + Tobin, is here tonight, and together with an extraordinary group of corporate leaders including Ann Sherry, former Treasury Secretary Ken Henry, Gab Trainor, they support us in the prosecution of our reform agenda. We are confident of the progress we are making. We are stemming the transmission of disadvantage: I see it with my own eyes every day. From the first university graduate of my own community, today there are hundreds of students graduating from the highest quality boarding schools in Queensland, and these young men and women now find themselves in universities across the nation. They are graduating with degrees in law, nursing, engineering and medicine. Some of them are now starting their own families and I can assure you that the transmission of poverty is now well in reverse with these young men and women. They are transmitting aspiration and hope to their children.
And then there is the ultimate short-circuit – a job. There is no more effective a measure that will stop intergenerational welfare reform and dependency in its tracks than a parent going to work every day.
Let me show this short iPhone video of this beautiful young girl from the Coen campus of my greatest prize, the Cape York Aboriginal Australian Academy. She has received direct instruction as a pre-prep student, and is putting the magical pieces of reading together. She is four years old and on the way to reading by the time she starts primary school. And she is no different from her colleagues.
These are the great pleasures of my work. Nothing excites me more than seeing this kind of magic. I have utmost optimism for this little girl’s future. Her parents send her to school at above 95% attendance rates. Her family puts money aside into a trust account for her education every week. She has hundreds and at times more than a thousand dollars in her trust fund, depending whether uniforms, tuckshop, musical instruments and books have been purchased from her funds. Her mother and father know something is going on for their beautiful child, and they are engaged.
The only thing I worry about is whether her black skin will raise barriers to her future, and whether she will enjoy her Aboriginal language and heritage, along with all of the other great privileges of her Australian citizenship.
While I hope she will develop her own resilience to the slings and arrows that she will surely face, I pray that she will have the future she deserves and has reason to value.
'The burial of Burke' infrared
Examination with an infrared light source can reveal the fascinating back story to how a painting is produced, uncovering preliminary sketches, alterations and hidden details not evident in the finished artwork.