Considering culture in the psychiatric assessment of Aboriginal and Torres Strait Islander peoples

Abstract

There is little information about referrals of Aboriginal and Torres Strait Islander peoples to general hospital psychiatry services. Even less is known about how culture is incorporated into their psychiatric assessment and management plans. This is important as culture is a fundamental aspect of the social and emotional health and wellbeing of Indigenous Australians. Consultation-liaison psychiatry services are referred patients admitted to the general hospital or Emergency Department. This study was conducted to evaluate whether and how culture is incorporated into the psychiatric assessment and management of Aboriginal and Torres Strait Islander peoples referred to a consultationliaison psychiatry service. Thematic analysis, with a particular focus on cultural references, was used to retrospectively evaluate forty referrals. Results derived from the data analysis were verified by independent analysis of a subset of files by a former Clinical Nurse Consultant in Aboriginal mental health and consultations with Aboriginal Health Workers. Culture was often only indirectly and infrequently documented in the consultation-liaison clinician’s assessment. The clinician demonstrated that culture was considered through direct references; patterns of communication; diagnostic labels; identification of strengths and resilience; and by the involvement of the Aboriginal Health Worker. Culture should be routinely included in psychiatric assessments of Indigenous Australians. Placing the patient in context using a detailed psychiatric formulation may be more informative and helpful for both the patient and referrer than a diagnosis alone. Aboriginal Health Workers may contribute to care in this setting, including by assisting consultation-liaison clinicians to communicate effectively and to deliver more holistic care. However, more attention must be given to formally defining the role of Aboriginal Health Workers and developing true partnerships with clinicians.