Two way approaches to Indigenous mental health training: Brief training in brief interventions

Abstract

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.

Authors

Tricia Nagel
Menzies School of Health Research and Flinders University, Adelaide, SA; Charles Darwin University, Casuarina, NT; James Cook University, Townsville, QLD; Top End Mental Health Services, Tiwi, NT

Carolyn Thompson
Menzies School of Health Research, Darwin NT

Neil Spencer
Menzies School of Health Research, Darwin NT

Jenni Judd
James Cook University, Townsville QLD

Robyn Williams
Menzies School of Health Research, Charles Darwin University, Darwin NT

References

Australian Bureau of Statistics (2005) The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples. Canberra: ABS & AIHW.

Australian Health Ministers' Advisory Council's Standing Committee on Aboriginal and Torres Strait Islander Health Working Party (Comprising the Northern Territory, Queensland and South Australia) (2004) Cultural Respect Framework for Aboriginal and Torres Strait Islander Health 2004-2009. Adelaide: Department of Health.

Bailey R, Siciliano F, Dane G, Bevan L, Paradies Y and Carson B (2002) Atlas of Health Related Infrastructure in Discrete Indigenous Communities. Melbourne: ATSIC.

Brock K, Acklin F, Newman J, Arbon V, Trindal A, Bermingham M and Thompson B (1999) Story Telling: Australian Indigenous Women's Means of Health Promotion. Accessed at http://www.eric.ed.gov/ERICWebPortal/custom/portlets/recordDetails/detailmini.jsp?_nfpb=true&_&ERICExtSearch_SearchValue_0=ED467415&ERICExtSearch_SearchType_0=no&accno=ED467415

Cass A, Lowell A, Christie M, Snelling PL, Flack M, Marrnganyin B and Brown I (2002) Sharing the true stories: Improving communication in indigenous health care. eMJA 176(10), 466-470.

Eades D (2005) Aboriginal English. Aboriginal Literacy Resource Kit. Sydney: NSW Board of Studies.

Kirmayer L, Simpson C and Cargo M (2003) Healing traditions: Culture, community and mental health promotion with Canadian Aboriginal peoples. Australasian Psychiatry 11(Supplement 1), S15-S23.

McLennan V and Khavarpour F (2004) Culturally appropriate health promotion: Its meaning and application in Aboriginal communities. Health Promotion Journal of Australia 15(3), 237-239.

Murray R, Bell K, Elston J, Ring I, Frommer M and Todd A (2002) Guidelines for Development, Implementation and Evaluation of National Public Health Strategies in Relation to ATSI Peoples. Melbourne: National Public Health Partnership.

Nagel T (2005) AIMHI NT 2003 Base Line Measures Discussion Paper One. Darwin: Menzies School of Health Research, Institute of Advanced Studies, Charles Darwin University.

Nagel T (2006a) Auseinet - Recovery On-line Toolkit. http://auseinet.flinders.edu.au/toolkit/rec_exmpl.php. Adelaide: Auseinet.

Nagel T (2006b) The need for relapse prevention strategies in Top End remote indigenous mental health. Australian e-Journal for the Advancement of Mental Health (AeJAMH) 5(1), http://amh.e-contentmanagement.com/archives/vol/5/issue/1/article/3342/the-need-for-relapse-prevention-strategies-in-top

Nagel T and Thompson C (2006a) Aboriginal mental health workers and the improving Indigenous mental health service delivery model in the 'Top End'. Australasian Psychiatry 14(3), 291-294.

Nagel T and Thompson C (2006b) Yarning About Mental Health Manual. Darwin: Australian Integrated Mental Health Initiative.

Nagel T and Thompson C (2007) AIMHI NT 'Mental Health Story Teller Mob': Developing stories in mental health. Australian e-Journal for the Advancement of Mental Health (AeJAMH) 6(2), http://amh.e-contentmanagement.com/archives/vol/6/issue/2/article/3298/aimhi-nt-mental-health-story-teller-mob

National Aboriginal and Torres Strait Islander Health Council (2003) National Strategic Framework for Aboriginal and Torres Strait Islander Health - Framework for Action by Governments. Canberra: Commonwealth of Australia.

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Trudgen R (2000) Why Warriors Lie Down and Die. Darwin: Aboriginal Resource and Development Services Inc.

Zubrick SR, Silburn SR, Lawrence DM, Mitrou FG, Dalby RB, Blair EM, Griffin J, Milroy H, De Maio JA, Cox A and Li J (2005) The Western Australian Aboriginal Child Health Survey: The Social and Emotional Wellbeing of Aboriginal Children and Young People. Perth: Curtin University of Technology and Telethon Institute for Child Health Research.

Keywords

Indigenous mental health, mental health literacy, primary health care, social and emotional wellbeing, program evaluation

Meta

PP: 135 - 141

Introduction

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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