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Indigenous Mental Health Service Delivery: Why do we need a Unique Service?


Rates of mental ill health in Australia - depression, anxiety, self-harm, suicidal behaviours ... Is there a different aetiology? ... – PowerPoint PPT presentation

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Title: Indigenous Mental Health Service Delivery: Why do we need a Unique Service?

Indigenous Mental Health Service Delivery Why do
we need a Unique Service?
  • Dr Tracy Westerman
  • Managing Director
  • Indigenous Psychological Services
  • Post Doctoral Research Fellow, Curtin University
    of Technology, WA

Indigenous Psychological Services and RC
SEWB Centre
  • SEWB Centre for the Metropolitan, Great Southern
    and South West
  • Training of workers
  • Support for workers
  • Ongoing workshops
  • 3 new staff
  • Service Manager (1)
  • Project Officers (2)

What do we know about Aboriginal disadvantage?
  • Rates of mental ill health in Australia -
    depression, anxiety, self-harm, suicidal
  • Post-traumatic stress
  • Compounded grief and trauma
  • Intergenerational effects of posttrauma
  • Memmott et al (2000) suggest rates of 80 of
    incarcerated indigenous youth have been abused
  • Death attributable to external causes (Hunter,
  • Data from Kids Helpline - 35 of calls regarding
    current abuse
  • Alcohol and drug useage

  • Misdiagnosis, overdiagnosis and underdiagnosis
  • Cultural differences seen as deficits and
    indicators of mental illness / dysfunction
  • Range of cultural triggers implicated in mental
    ill health (Westerman, 2000 Vicary, 2001)
  • Differential cultural and clinical diagnosis
    (e.g. FAS)
  • Auseinet data base cites lack of Indigenous
    specific intervention programs
  • Systematic Evaluation of prevention programs is
  • Notions of cultural competence in service

  • No focus on identifying specific Aboriginal risk
    factors in research or programs
  • Programs are largely diversionary or reactive in
  • Limited focus on reducing known risk factors in
    mainstream (I.e. racism) concomitant with
    indigenous programs
  • Individual versus community treatments

What has been done to address rates of mental ill
  • The delivery of mainstream programs
  • lack of access by Aboriginal people
  • ad hoc, not evidenced based or empirically
    validated, replicated or evaluated
  • The evidence for early intervention approaches in
    NA communities
  • Friends, Aussie Optimism, RAP, Triple-P
  • The evidence for community development approaches

Problem 2 Inequities in research
  • Quality versus quantity research
  • Methodological problems with existing research
  • use of a range of different measures with no
    established validity or reliability
  • data collection techniques
  • Prevalence of mental disorders range from 1.8,
    to as high as 51.2
  • Compromises funding of intervention programs
  • No evidence base regarding what works

Problem 3 Appropriateness of existing services
  • Access to services
  • Levels of engagement
  • Primary versus secondary / tertiary level
  • No information on the nature of the workforce
  • Lack of clinical skills and cultural appropriate
    services indigenous clients
  • Less than half of all non-indigenous
    practitioners feel competent with Aboriginal
  • Less than half of all indigenous practitioners
    feel clinically competent with Aboriginal clients
  • The dual struggle

Problem 3 Assessment and Diagnosis
  • Adequacy of methods of assessment in use
  • Major epidemiological studies and representation
    of Aboriginal people
  • Is there a different aetiology?
  • Mainstream factors at a higher rate, and/or a set
    of unique risk factors that account for the
    higher rates of mental ill health?
  • Confusion regarding the definition and diagnosis
    of mental ill health

Problem 4 Treatment of mental health
  • Treatment efficacy unknown
  • Medication rates
  • Traditional Treatments - the absence of evidence
  • Comorbidity - identification, diagnosis and
  • Aboriginal people seek cultural reasons and
    cultural solutions prior to any other treatment
  • External attribution belief system and problems

The role of IPS
  • A range of training, clinical and research
  • Primary services in over-supply
  • Motivated by the nothing works argument
  • Strengths / differences approach rather than
    deficits - e.g. Parenting differences, not
    parenting problems
  • Westernised traditional treatments combined

Solution 1 Ongoing quality research
  • Ongoing quality research
  • Determining Treatment Efficacy
  • Traditional and westernised treatments
  • Cultural resilience as a moderator of illness
  • Understanding indigenous specific risk factors in
    mental health
  • Impact of child-rearing practices
  • Population versus individual level risk

Solution 2 Increasing Workforce Skills
  • A. Defining workforce on the basis of cultural
    competence as minimum standards
  • The 7 Levels of Cultural Competence
  • At the practitioner and organizational levels
  • Definable, measurable and ongoing
  • Baseline of skills
  • Some strategies that have been used
  • Engaging in Cultural supervision
  • Taking referrals second and third hand
    (traditional way)

Increasing Access to Services
  • Training of Indigenous and Non-Indigenous people
    in tandem
  • Improving Efficacy of Engagement
  • Empirical models of intervention lacking -
    articulate what is different
  • N 189 youth, 98 engagement rates

Solution 3 Developing Culturally Valid
Assessment Protocols
  • The Westerman Aboriginal Symptom Checklist -
    Youth WASC-Y - for Aboriginal youth aged 13-17.
  • WASC-A

Results of culturally validated mental health
screening tool
  • Range of mental health prevalence data
  • Information on comorbidity
  • Able to identify for early stage of risk
  • Able to evaluate efficacy of counselling and
    intervention services
  • A range of strategies aimed at minimising impact
    of cultural differences between client and
  • Impairment within a cultural context
  • Assessing the predominant belief system of client
  • Assessing for cultural triggers to disorder
  • Assessing for culture-specific disorders

Solution 4 Increasing Treatment Efficacy
  • A. Development of information regarding the
    existence of CB disorders
  • The absence of evidence argument
  • 1. Being Sung by an aggrieved party
  • 2. Sorry time or Self-Harm
  • 3. Psychosis or spiritual visits
  • 4. Depression or longing for, crying or being
    sick for country

Increasing Treatment Efficacy
  • B. Model for the resolution of C-B disorders
  • C. Working within the traditional hierarchy of
    Treatment Intervention
  • treatments are hierarchically organised depending
    on cause, severity, type of practitioner required
    and treatment
  • D. Increasing the cultural relevance of existing
    mainstream therapeutic approaches

Therapeutic interventions
  • The nothing works with Aboriginal people
  • Blame the client
  • Framework is a strengths (understanding and
    incorporating cultural differences) rather than a
    deficit approach - how can we take advantage of
    the strengths that Aboriginal people have?
  • CBT
  • Narrative and external attribution belief systems
  • Basic Counselling Skills

Solution 5 Developing Indigenous Specific
Training Packages
  • Development of Indigenous specific training
  • In last 12 months IPS have trained 1,023 service
    providers and 167 community and youth through
    Australia (75 Aboriginal).
  • Developed from within the Aboriginal culture
  • Incorporates indigenous worldview (e.g. conflict
    resolution and payback hierarchies of power in
    problem resolution)
  • 17 different packages

How Indigenous specific information can be of
  • Statewide Suicide Prevention Forums
  • Features
  • Demand for forums from the community
  • Developed specifically for Aboriginal people
  • Content specific to context
  • Community Development approach - youth, community
    and service providers (N425)
  • Introductory, Follow-Up and Counselling Support
  • High risk regions and potential for risk
  • Outcome driven evaluations

Recruitment and Retention
  • Recruitment culturally appropriate tests and
  • Retention training
  • Managing mood
  • Managing my Family and Community Now that I am a
    Wage Earner
  • Communication Skills
  • Managing Conflict / Assertive Communication
  • Problem Solving
  • Working with Non-Indigenous People
  • Working as a Team / Creating a Team
  • Career Planning
  • Leadership Skills

Models of Best Practice what is stopping us?
  • Empirical validation
  • Cultural validation
  • Replication of models for use with other issues
  • Transferability across different groups
  • Longitudinal data
  • Sustainability
  • Access to service providers to deliver culturally
    and clinically valid programs
  • Studies show success of programs depend on
    community self-management and ownership

How to Contact Us
  • Indigenous Psychological Services
  • Suite 3, 20 Twickenham Street, Burswood, Western
    Australia, Australia
  • 08 9362 2036
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