Journal Special Issues
Indigenous Mental Health
Overview
Edited by:
Graham Martin OAM, MD, FRANZCP, DPM
Professor and Director, Child and Adolescent Psychiatry, The University of Queensland
Tracy Westerman
Indigenous Psychological Services Pty Ltd, Curtin University of Technology, Perth
Ernest Hunter
North Queensland Health Equalities Promotion Unit, University of Queensland, Cairns
Tom Brideson
Charles Sturt University, New South Wales
Research studies on Indigenous groups in Australia and internationally continues to illustrate the negative impact of colonialisation on their mental health (Australian Institute of Health and Welfare, 2002, 2003). Despite this, a number of recent articles have argued that Indigenous people do not access mental health services at a level that is commensurate with this need (Dudgeon, Grogan et al., 1993; Garvey, 2000).
Indigenous people who come into contact with mental health services are more likely to receive services which are reactive in nature (Atkinson & Clarke, 1997; Memmott, Stacy, Chambers & Keys, 2000) such as basic counselling, advocacy, support or diversionary activities. In combination, this means a dearth of preventative or therapeutic levels of intervention with Indigenous people, despite the obvious need for this. Contributing to this problem is that there exist few published examples of effective preventative programs or therapeutic interventions with Indigenous people. Whilst examples of good practice exist, this information is not being shared within the profession, therefore not providing an opportunity for empirical and cultural validation or replication across different contexts. This has affected service delivery at the individual clinical level as well as at the broader system levels, the combined effect being the inequity in access to mental health services by Indigenous people.
Problems at the clinical level include that practitioners often have the desire to be 'culturally appropriate', but are frustrated by the lack of empirically grounded conceptual frameworks that have proven their efficacy with Indigenous people with specific mental health issues. Successful outcome is mostly measured subjectively and in the absence of a consistent theoretical framework which can be applied to specific presenting issues. This again makes tracking successful outcome attributable to intervention difficult.
At the system level, services struggle with embedding / incorporating culturally appropriate practice within policy and procedural frameworks. Given that models of service delivery have been characteristically monocultural, significant onus is left to services to determine solutions in the absence of guidance. This is also done in significant absence of outcome driven evaluative processes which convince organisations of the 'fiscal' sense of adopting certain practices.
The solution to increasing access to mental health services by Indigenous people lies in the integration of specific cultural and clinical competencies within the system and practitioner levels. Clinical competence is often defined as the extent to which certain therapeutic techniques are proven to be useful treatments for certain disorders (National Aboriginal and Torres Strait Islander Health Council, 2003). Cultural competence is about the ability of practitioners to identify, intervene and treat mental health complaints in ways that recognise the central role that culture plays in mental illness (Cross, 1995; Dana, 2000).
This collection of research reports and case studies offers a thorough exploration of the unique mental health service challenges facing Indigenous communities, particularly in the area of prevention and mental health promotion.
This powerful and challenging Special Issue of Advances in Mental Health is at times not comfortable to read. It challenges us, and the writing of many of the authors gets through our defensive guard. It is thought-provoking reading for mental health practitioners, researchers, students, lecturers, clinicians, nurses, social workers, carers, mediators, counsellors, consumers, commentators and policy developers involved in Indigenous mental health.
Table of Contents
Editorial: On social justice
Graham Martin
Guest Editorial: Engagement of Indigenous clients in mental health services: What role do cultural differences play?
Tracy Westerman
Guest Editorial: Commonality, difference and confusion: Changing constructions of Indigenous mental health
Ernest Hunter
'That's just the way he is': Some implications of Aboriginal mental health beliefs
David Vicary, Tracy Westerman
Indigenous maps of subjectivity and attacks on linking: Forced separation and its psychiatric sequelae in Australia's Stolen Generation
Leon Petchkovsky, Craig San Roque, Rachel Napaljarri Jurra, Sally Butler
The struggle for systematic 'adulthood' for Aboriginal Mental Health in the mainstream: The Djirruwang Aboriginal and Torres Strait Islander Mental Health Program
Tom Brideson, Len Kanowski
Australian Aboriginal suicide: The need for an Aboriginal suicidology?
Terri Elliott-Farrelly
