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InPsych 2015 | Vol 37

June | Issue 3

Psychology in current issues

Strong recommendations address dire status of Indigenous Australians’ mental health

The recent National Review of Mental Health Programmes and Services, conducted by the National Mental Health Commission (NMHC), had a particular focus on the mental health of Aboriginal and Torres Strait Islander Australians. The Review’s findings provide further evidence of the alarming gulf between the wellbeing and mental health of Indigenous Australians and other Australians. The Review provided strong recommendations that can substantially close the appalling Indigenous mental health gap with proper funding and implementation.

Confronting evidence of Indigenous Australians’ mental health and wellbeing
The Review shone a spotlight on the mental health of the three per cent of Australians who identify as being of Aboriginal or Torres Strait Islander origin, whose outcomes are poor on most high-level indicators and measures of wellbeing. On some measures, outcomes have worsened in recent years:
  • Death from suicide for Indigenous Australians was twice the rate for non-Indigenous Australians for the period 2008–2012, with the rate three times higher for Aboriginal and Torres Strait Islander people aged 25–34 years.
  • The hospitalisation rate for intentional self-harm increased by 48.1 per cent for Indigenous Australians between 2005–2013.
Coupled with these disturbing and worsening findings are the following outcomes for Indigenous Australians:
  • Indigenous adults are 2.7 times more likely to have high/very high distress levels compared with non-Indigenous adults.
  • 39.1 per cent of Indigenous people aged 15 years and over had experienced at least three life stressors (e.g., death of a family member, serious illness).
  • There has been little change in the level of alcohol and substance use and harm among Indigenous Australians.
  • There has been no improvement in the relatively high rates of disability and chronic disease among Indigenous Australians.

The Review’s scrutiny of mental health care provision confirmed that these catastrophic mental health problems are not being addressed by current services, which are considered neither effective nor cost-efficient. There are significant limitations in policy implementation, and the design of services does not work within the broader concept of social and emotional wellbeing that is essential for Aboriginal and Torres Strait Islander people.

  1. Recommendations from the Review
    Fortunately, the Review made recommendations across five areas aimed at transforming the mental health outcomes for Aboriginal and Torres Strait Islander peoples, and creating an effective and efficient system capable of meeting need.
  2. Make Aboriginal and Torres Strait Islander mental health a national priority
    The Review proposes making Aboriginal and Torres Strait Islander mental health a national priority, supported by a specific mental health COAG Closing the Gap target.
  3. Integrated mental health and social and emotional wellbeing teams
    The Review proposes a requirement for mental health and social and emotional wellbeing (SEWB) teams to be established in all Indigenous Primary Health Care Organisations and Aboriginal Community Controlled Health Services. The integrated teams would implement pathways of care for: mental health screening, treatment and support; alcohol and other drug abuse; chronic illness support; and SEWB promotion and community strengthening.
  4. Invigorate culturally responsive and accountable mainstream mental health services
    The Review proposes the provision of incentives and accountability requirements for mainstream services to improve their contribution to better mental health outcomes for Aboriginal and Torres Strait Islander peoples. These would include strategies for policy approaches, cultural competency professional development, and partnership agreements with local Indigenous health services.
  5. Sharpen role of Aboriginal and Torres Strait Islander services
    The Review proposes a refocussed role for dedicated Aboriginal and Torres Strait Islander services to support Indigenous Australians’ journeys across the mental health system. This would ensure all Indigenous people admitted to mainstream mental health services receive referral and discharge linkages with local Indigenous health services, cultural support during admission (including access to traditional healers and healing services), and maintenance of links to family.
  6. Mental health workforce development
    The Review proposes a mental health workforce strategy to support the changes in service delivery and enable services to be more culturally responsive and better able to work with Aboriginal and Torres Strait Islander peoples.

In the wake of the Review, there is now a major opportunity for the Government to correct failed past efforts and implement these recommendations with proper funding and in consultation with mental health experts, Aboriginal and Torres Strait Islander Australians and the rest of the community.

Australia is fortunate that one of the NMHC’s Commissioners is Professor Pat Dudgeon FAPS, whose presence gave Indigenous Australians a strong voice during the Review. The APS will build on Pat’s work and continue to lobby energetically for Indigenous Australians and Indigenous psychology, and support the similar efforts of the Australian Indigenous Psychologists Association.

References

Disclaimer: Published in InPsych on June 2015. The APS aims to ensure that information published in InPsych is current and accurate at the time of publication. Changes after publication may affect the accuracy of this information. Readers are responsible for ascertaining the currency and completeness of information they rely on, which is particularly important for government initiatives, legislation or best-practice principles which are open to amendment. The information provided in InPsych does not replace obtaining appropriate professional and/or legal advice.