 And so with that, on that theme, I'd like to introduce Professor Louise Newman to deliver a keynote address. Louise Newman is a Professor of Developmental Psychiatry and Director of One Ash University Centre for Developmental Psychiatry and Psychology. Prior to this appointment, she was a Chair of Perinatal and Infant Psychiatry at the University of Newcastle and the previous Director of the New South Wales Institute of Psychiatry. In January 2011, she was appointed as a member in the General Division of the Order of Australia. She is a practicing infant psychiatrist with expertise in the areas of disorders of early parenting and attachment, difficulties in infants. She has undertaken research into the issues confronting parents and histories of early trauma and neglect. Her current research focuses on the evaluation of infant-parent interventions in high-risk populations, the concept of parental reflective functioning in mothers with borderline personality disorder and the neurobiology of parenting disturbance. She has published in the areas of infant mental health, attachment disorders, trauma and prevention of child abuse. She is co-author of the textbooks Clinical Skills in Infant Mental Health and Contemporary Approaches in Child and Adolescent Mental Health. She is a Convener of the Alliance of Health Professions for Asylum Seekers and Vice President of Doctors for Refugees. She has been a Government Advisor on Asylum Seeker and Refugee Mental Health and contributed to the development of policy for mental health screening and response to torture survivors. She has been involved in research in the impact of immigration detention on child asylum seekers. I'd like to welcome Louise for the keynote address. Thank you very much. It's really such a pleasure to see everything at this stage. And I remember very clearly having discussions several years ago now with Kate Jones when she said, look, I've got an idea. And we were sitting down just over a cup of coffee and she had captured something that was so crucial within our work. The need to have a vision about healing and recovery for children who'd experienced such traumatic events. And things went on from there and here we are. So congratulations to everyone who's been involved. And it obviously takes a huge amount of work to get from the vision to the operationalisation of such a concept. But I think what we have here is truly a very innovative approach, a vision that says that we need to do something therapeutic for the most vulnerable children, for those most in need, for those where we know that they've suffered trauma and disruption to the extent that unless we do something it's likely to have very long-term consequences for functioning, but particularly for relations and connectedness to others and social inclusion. So there are many, many reasons. I think the evidence is actually very clear about why we should be doing exactly what Kate and others have been working on. So it's a therapeutic approach that very importantly says trauma and attachment models do have something to offer when we translate them into the sort of practices and services that we hope to have at a centre like this, where there can be a focus on rebuilding children's sense of belief in others, children's sense of trust in others and the capacity to have relationships that are meaningful, that are reciprocal and that are safe. So calling this a place rather than a clinic or an office or a building I think is actually very, very symbolic and very, very important. This needs to be a safe place for children to come to. A place where they can have a sense that this is actually a secure base if we're thinking in the terms of attachment theory. So I think the symbolism, the name, a plant that's well known for its role in healing and recovery are very important. So from my perspective essentially this is an approach based on an understanding of the rights of children. The children have a right to care and protection. Adults, communities, societies and cultures have a role in providing that. Children have a right to safe relationships and if they have been harmed they have a right to therapeutic input and they have a right to recovery. So the rights of children I think is something that underpin all these sorts of activities and the building of a model like this. But, and I think I can't resist the opportunity to say a few words about the real need in the current political climate to maintain a focus on the rights of children, all children. I think during the proceedings today we'll hear about many different groups of children, their needs, their vulnerabilities, whether that's from indigenous populations to multicultural groups and in the work that I'm involved in, children and infants who are seeking asylum and safety in this country but are not provided that at all. So I think bearing that in mind as we go forward in developing approaches to working with children is going to be very important. Okay, can you go on to the next one? Thanks. Sorry, the clicker's not functional. Okay, so we're all familiar with a very broad notions of what actually constitutes child abuse and neglect. Now we tend to think clearly within a particular health framework but we also need to be mindful of the broader aspects where societies and communities overall can fail to protect children or can set up policies and practices that actually damage children in some way. The UN Convention on the Rights of the Children, if we're thinking within a rights framework, clearly underpins this project but many activities. We look at children's rights not only for care and protection but for participation and the voice of children I think is something that's often very difficult or fairly underplayed when we have these discussions so it's very pleasing to see in this project that children will be very much seen as having a role and a voice in the sorts of interventions and approaches that they might be involved in. And I think what's fundamental to the UN Convention is that rights are universal. They don't apply to some children and not to others. They actually apply to all children, wherever they might be, whatever their visa status. Now a lot of my workers with children of this age are very young and of course when we're thinking about the very young, we speak for them. They're essentially in need of someone to think about them, to bear them in mind, to actually talk about their needs and interests on their behalf as best as we can. At the moment in the parent-infant mental health unit that I run at Monash I have an asylum-seeker mother with a small baby who's seven months of age who have come from Christmas Island to Darwin where this mother delivered to find themselves in detention in Melbourne and a mother who finds herself terrified and despairing that her baby will be sent to Nauru or potentially worse to Madison Island. She's one of a group of mothers who are currently in deep states of despair as you may have heard about. In the middle of this really complex debate I think maybe what's being forgotten are the rights of children to care and protection. So this little baby of the mother I care for has what we would call failure to thrive. He's not growing, he finds it difficult to eat. He's very small, for those of you who understand baby's issues he's under six kilos and he's seven months of age. He's a very thin, sad, despairing baby with a despairing mother. When we look at situations like this I think it's very important that someone thinks about child development, the rights of the child, the need to protect children and the vulnerable regardless sometimes of political debates where this can get very much lost which is what we're seeing at the moment. Particularly again for the very young. We're also as people have alluded to talking about longer term consequences that of the implications of early developmental trauma on children's neurological development, their brain development, the development of their emotional capacities and importantly the development of their capacities to relate. So when we think about some of the most vulnerable children I think it's very sobering when we think about not only the current distress and trauma that we might need to respond to but also the implications of this for social functioning, for society as a whole. Particularly in an era when we are concerned about adolescent mental health and we know that many of those adolescents with mental health problems have come from very traumatic backgrounds. So even more concerning when we look at government approaches and policies that literally replicate some of the very traumatic experiences that the rest of us spend our time trying to treat and to prevent. I think very important debates at the moment. The young, particularly the infants in the 0-3 period can suffer a huge variety of traumas with these long term implications but particularly important are going to be the impact on attachment relationships connectedness with others. There's a lot of discussion in this field of course about the importance of attachment. Our attachment to our carers, to our extended family networks to community, to culture, are fundamental to human functioning. They provide a set of meanings, scaffolding for interpersonal interactions and shared values and the capacity we hope to transmit those shared values to the next generation. I think and we'll hear more about this today obviously but the impact on groups such as Indigenous communities with disruption of attachment and hugely significant and we've seen the long term implications of that as we look at the translation of disrupted attachments and caregiving contexts into disrupted social functioning and the real need to actually intervene in that and prevent that rather than cast moral aspersions on particular people. I think the same applies when we look at the asylum seekers. The motivation of these people to offer their child a future, a better life is a worthy motivation and yet what we hear constantly at the moment and very difficult to intervene in this and to actually have a more broader and sophisticated discussion is that these are somehow bad people wanting to exploit others with only self-interest at heart. I think that's very disappointing that we in Australia have sunk to such a level that we can't even have a more sophisticated discussion of some of the core values that motivate anyone to protect their children. I would like to think that all of us, if we found ourselves in situations where we were persecuted, discriminated against or our children had no future, we would all become asylum seekers, I would hope, and take our children. So we have, I think, academically a great interest in the field of so-called developmental traumatology which tries to understand the impact of trauma on development and the way trauma expresses itself at different age groups has been a marvellous academic exercise. We do know a lot more about the long-term implications of trauma and how we maybe can intervene. We have evidence-based models which can help us shape therapeutic approaches. What's very important, though, is that we maintain the momentum and have bases where we can actually do this sort of work, where we can look at the evaluation of tailor-made interventions for different population groups, for different communities that are based on an understanding of the way in which trauma is experienced and expressed and different ways of intervening. So we can't assume that all different, all traumatised groups in the community will respond to the same approach. So the dialogue with communities themselves around what constitutes trauma, what does recovery mean, I think is very important. At my unit, we're doing some of that work with young refugees who have been extremely traumatised, but talking to them in terms of their own cultural set of meanings and understandings about what does recovery mean, what's going to be helpful, what sort of services do we need, what would you actually come to if we had something. And I think what's most noticeable is that many of these groups do not easily go to the mainstream public hospital sector for support or treatment. And as one young Sudanese boy said to me, why would I go to the hospital? The hospital at home in his country is the place you go when you're really going to die, where there is no alternative. He said, why don't you come to me? Why don't you come to where we hang out, his group of young people? And I think that's a simple example, but really very, very important that we need to avoid imposing our particular frameworks and understandings of trauma and recovery on diverse populations, to make much more embedding ourselves within those population groups and thinking about what we can do. The evidence about the impact of early adversity in the broad sense on development and its relationship to mental health outcomes is actually quite clear. I'm making this point, and I know I'm speaking to the converted, but I think it's an important point to highlight in terms of some of the debates that go on currently. A lot of these debates, of course, are about how can we get more resources and funding for our particular part of the service? How can we build up, in my perspective, how can I get more money for infants when infants are not necessarily going to present with mental health problems until later? Someone who works with young people or adolescents might argue, well, I should have more of the funding because that's when the young people present to services. So we get into these very limited and rather polarized discussions. What we do know is that all mental health problems, whether they present in adolescence or young adulthood, have underlying vulnerability and risk factors, and that trauma, abuse and neglect is probably the most significant group of factors that we know about in terms of large-scale epidemiological studies. Those are the factors that contribute to the whole range of mental health problems down the track. Not just one mental health problem, not just something that we might call post-traumatic stress disorder or so-called borderline personality disorder which some people will be familiar with, sometimes not helpful labels, but the entire range of mental health problems. In other words, there's increasing evidence that trauma, abuse and maltreatment early on set up neurovulnerability to the entire range of mental health problems. Now, we don't know enough about why one person develops a particular disorder, another person develops a different one. There are obviously many factors contributing to that, but what's significant is what we do know. Trauma and abuse contribute in a major way to neurovulnerability and to the burden of mental health problems in adolescence and young adulthood. What that says to me, and I'm totally biased obviously, what it says to me is that we should be doing much more about early identification and early intervention of these high-risk families and children who are already exposed at a very young age to trauma and abuse. We know enough about the science of brain development to say that those experiences, in and of themselves, contribute to setting up a vulnerable brain, a brain that's much more likely to develop mental health problems in response to later trauma and stress. What we know from a social and cultural perspective is that trauma and stress is cumulative, and people who are vulnerable, may vulnerable in their early years by adversity, attachment disruption, abuse, neglect and so on, are more likely to have stressful experiences down the lifespan, sensitised to poor relational functioning, to re-exploitation and re-victimisation, very vulnerable in that sense, and then more likely to have very marked responses in terms of stress response. So doing something about early vulnerability really speaks to me about primary prevention as far as we can do that, but certainly we need greater expertise and service responses in how to actually intervene for these children who are at great vulnerability of contributing to our overall community burden of mental health. Some of the examples, I guess, are fairly well known, and the Romanian and Bulgarian orphans such as these children in unbelievably poor institutional care where many, of course, were also abused in a direct sense, as well as being neglected under fed and having little in the way of human interaction. These terrible examples have, of course, allowed us to understand much more about the developmental pathways, the impacts of these sorts of experiences. And Kate Jones, to get back to Kate, and I've had many discussions over the years about some of these children who we see out of home care and under the various programs who continue to have, even though they've been in places of safety for many years, ongoing difficulties with attachment and with believing that they are safe. So some of these young people from these sorts of backgrounds neurologically and functionally remain oriented around survival, makes perfect sense if you've lived in an environment like this. They're operating in a basic and core level around surviving in case something terrible happens again and not being able to re-establish a sense of safety. So for all the children that we're talking about today, re-establishing a sense of safety and a belief and a hope for the future that things might be all right is going to be pretty fundamental, but very difficult for some children with these experiences. We know that this is a CT scan brain of a child in one of these, from this background, a Bulgarian institutional care and a normal three-year-old brain, and essentially the child who's been neglected and deprived in such an extreme way is showing in the way their brain is actually structured. Equivalent degeneration and loss of brain tissue that we might see in someone who has a degenerative dementia in their later years. Fortunately, we do know a lot more about the capacity of the young brain to regenerate and to actually recover to varying degrees from some of these experiences. But this is, I think, a very important point that a lot of us spend time talking about the needs of children in an emotional and psychological way. We're also talking about in the early years the way the child's brain develops and is shaped or in this situation damaged by the social and emotional environment that they find themselves in. The children in detention is probably, I think, an extremely, it's an emotional issue, but an issue which I personally think that none of us who work with children or in child protection settings can be neutral on. I find it very puzzling when people say to me, I don't have a view on children in detention. I'm not prepared to speak out or to have a stated belief about this because it's so political. Child protection, the needs of children, the rights to protect children have always been political. I think it's absolutely naive to assume that there's ever been anything different. We're very clear that we advocate for the rights of children in the mainstream community. We have people working extremely hard in indigenous communities and other groups. We're used to that, and I'm really, I think it's very concerning that this group of children is seen as somehow different as if rights apply to others but not to these children. This is a drawing from a child on Manus Island when children were there. These children experience themselves literally as imprisoned, as trapped. And this girl, you can't read her writing there, but she talks about the dots being, she keeps a calendar of every day that she's in detention. This is an eight-year-old child. The issues for infants, of course, over the years have been raised and have been raised today, as we speak, and as you may be aware, they've been, in the last two days, 10 mothers on Christmas Island have been engaging in self-harm and suicidal behaviours of varying types. What's significant about that is that it is about their babies. Women are of the belief that if they, even if one successfully suicided, then maybe the babies would be given better options. And I think this speaks to tremendous despair and raises very significant questions for all of us involved in children about the necessity of keeping children in places like Christmas Island, the necessity of threatening these young women and their babies with transfer to somewhere like Nauru, where having been there, the circumstances of detention and the capacity to meet the needs of vulnerable children are incredibly limited. So the asylum-seeker children also include, of course, children without families. Children are the unaccompanied minors, many of whom are now, of course, in our community, and are still around 50% of young people arriving unaccompanied. Children within these environments have been exposed to the sorts of traumas that when we speak about trauma in general, we're very concerned about, but these have even greater magnitude. Children are witnessing the behavioural disturbances that have gone on in these environments over the last decade. Children are not able to be protected in terms of what they're exposed to. Children with families witness the mental breakdown of their parents, such as these young children on Christmas Island at the moment. Many of the parents are depressed, despairing, fail to protect children because of their own mental health problems. So we have cumulative risk in these sorts of situations. These are drawings that we collected from the initial round of detention in Baxter and Woomera. Children exposed to riots, to extreme riot responses. And I think we're probably all familiar with these sorts of descriptions of what actually went on in detention. But the question I think we need to ask as a group of people involved in responding to children at need is why on earth we're doing it again? And I think this is one of the most difficult questions when the evidence in terms of the research and unsurprising results that children are damaged in these environments, I think that's fairly clear. The Department and the Minister is unlikely to challenge that directly. But I think what makes the current situation even more morally perilous, if you like, is that the conditions of detention which cause in a major way the problems that we've seen and the developmental and poor psychological outcomes for children are in fact being replicated. Despite the fact that we have, in migration law, statements to the effect that children should only be detained as a matter of last resort for extremely brief periods of time for necessary processing. I don't think that's unreasonable. But at the moment we are detaining children and babies as a matter of first resort and as you're aware, not offering care and protection for unauthorised, so-called unauthorised arrival. So these, in many ways, are the crises that come up when we work with child protection and children in need. And many of us in our different work contexts are experienced in advocacy and in making statements and trying to broaden the discussion and actually trying to have a more comprehensive approach and essentially a more humane approach to the most vulnerable. So I think we can all contribute to this discussion but particularly important that we don't remain neutral. So we've called this the groups that I'm involved with using quite strong language but I'm not going to shy away from the strong language. That the great irony of a marvellous project like this and what we all have to struggle with is the fact that whilst we're doing this and contributing in such a significant way to developing a therapeutic framework for children we have some in our political leadership who are literally supporting the abuse of children and arguing that this is necessary in some way for the greater good. I think that's the argument we need to challenge from a human rights perspective and from a child protection perspective that no state should be abusing children in this way. That states and communities have a responsibility, a key responsibility to protect children that all of us as members of the community have a right and should be opposing state-sanctioned, abusive children or any policy or practice that is damaging children and that we have a view on this. So I would urge you if you feel strongly enough about this issue to actually contribute to that discussion on the basis of the work and support that you already have for child protection. A unit such as this, a place of safety like this project will in fact see some asylum seeker and refugee children no doubt and will have, I hope, an ongoing and significant role in protecting those children in the same ways we protect any others. Thank you very much.