Two way approaches to Indigenous mental health training: Brief training in brief interventions
This study aimed to train health care professionals in a mental health assessment and care plan package designed for Aboriginal clients and carers and to evaluate the training and the package.
The package has been developed over two years of consultation and encourages a collaborative, culturally appropriate approach to mental health assessment and care planning using motivational counselling techniques and relapse prevention strategies. Seventeen workshops were delivered in a range of settings to 261 service providers between 2006 and 2008. The training used the tools developed through the AIMhi 'Story Telling Project' and included multimedia resources, and activities designed to bridge the cross cultural and literacy gap in remote communities, including role play and skills practice.
The training was well received and pre- and post-workshop evaluations show that participants found the workshops interesting and useful, and significantly improved in their confidence in assessment and communication, and their knowledge of early warning signs and treatment. The findings suggest a need in both the Indigenous and non-Indigenous workforce for further training, in both undergraduate and postgraduate settings, and in specialist and primary care.
Menzies School of Health Research and Flinders University, Adelaide, SA, Australia; Charles Darwin University, Casuarina, NT, Australia; James Cook University, Townsville, QLD, Australia; Top End Mental Health Services, Tiwi, NT, Australia
Menzies School of Health Research, Darwin NT
Menzies School of Health Research, Darwin NT
James Cook University, Townsville QLD
Menzies School of Health Research, Charles Darwin University, Darwin NT
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Indigenous mental health, mental health literacy, primary health care, social and emotional wellbeing, program evaluation
PP: 135 - 141
In 2003-2004, Indigenous males and females were up to twice as likely to be hospitalised for mental and behavioural disorders as other Australians (Australian Bureau of Statistics, 2005) and recent comprehensive health surveys suggest high rates of mental distress in the community. The Western Australian Aboriginal Child Health Survey (Zubrick, Silburn, Lawrence et al, 2005), for example, indicated that 20.5 percent of 12-17 years old Aboriginal young people were at high risk of clinically significant emotional or behavioural difficulties.
Indigenous peoples from remote communities have particular difficulty accessing specialist services given issues of distance, language, and literacy (Bailey, Siciliano, Dane et al, 2002; Brock, Acklin, Newman et al, 1999; Cass, Lowell, Christie et al, 2002; Eades 2005). Furthermore, Indigenous peoples often have a different world view which further challenges accurate and sensitive assessment and treatment. They do not necessarily distinguish between wellbeing and 'physical' health or 'mental' health or 'cultural' or 'spiritual' wellbeing; instead, they have a 'whole of life' view (National Aboriginal and Torres Strait Islander Health Council, 2003).
The health workforce, which is predominantly non-Indigenous, is poorly equipped to meet these challenges: 'The health system, overall, does not provide the same level and quality of care to treat illness for Aboriginal and Torres Strait Islander peoples and is so culturally inappropriate or inadequately resourced that their needs cannot be met' (Australian Health Ministers' Advisory Council's Standing Committee on Aboriginal and Torres Strait Islander Health Working Party, 2004, p.5). In the current context of increasing evidence of high prevalence of mental distress, there is a particular additional need and imperative to resource and train the mental health workforce.
Health professionals working across cultures have a responsibility to understand the dynamic relationship between mind, body and spirit, so as to accurately address the whole of health, and there is a need to blend traditional and modern ways of understanding and treating illness in order to develop services which are appropriate to Indigenous peoples (Kirmayer, Simpson & Cargo, 2003; McLennan & Khavarpour, 2004; Murray, Bell, Elston et al, 2002; Roxbee & Wallace, 2003; Trudgen, 2000).
While an understanding of Indigenous perspectives of mental illness, wellbeing and resilience is fundamental to delivery of effective mental health promotion programs and effective treatments, there has been little available to assist in service provider training. In 2003, a remote service provider survey in the Northern Territory (Nagel, 2006b) revealed that strategies for education of clients and carers were limited, and there were few culturally appropriate information resources available (Nagel, 2005).
The Australian Integrated Mental Health Initiative Northern Territory (AIMhi NT) has been working in a participatory action frame-work to explore mental health promotion strategies and treatments and to translate these to service provider training, and resources (Nagel, 2006a, 2006b; Nagel & Thompson, 2006a, 2007). This paper describes the findings of the evaluation of a series of training workshops delivered between 2006 and 2008 for service providers.
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