"Best intentions" lives on: untoward health outcomes of some contemporary initiatives in Indigenous affairs.

Abstract

A shortened version of a presentation to the Australian Institute of Aboriginal and Torres Strait Islander Studies, this paper raises questions regarding policy and program directions in Indigenous affairs with consequences for Indigenous health. The author notes the inadequate Indigenous mental health database, and describes contemporary conflicts in the arena of Indigenous mental health, drawing on personal experience in clinical service delivery, policy and programme development. Medicalized responses to the Stolen Generations report and constructions of suicide that accompanied the Royal Commission into Aboriginal Deaths in Custody are presented to demonstrate unforeseen health outcomes. Examples are also given of well-intentioned social interventions that, in the context of contemporary Indigenous society appear to be contributing to, rather than alleviating, harm. Problems of setting priorities that confront mental health service planners are considered in the light of past and continuing social disadvantage that informs the burden of mental disorder in Indigenous communities. The importance of acknowledging untoward outcomes of initiatives, even when motivated by concerns for social justice, is emphasized. The tension within mental health services of responding to the underpinning social issues versus providing equity in access to proven mental health services for Indigenous populations is considered.