How an urban Aboriginal and Torres Strait Islander primary health care service improved access to mental health care.

Julie Hepworth,Deb Duthie,Deborah Askew,Patricia Shuter,Wendy Foley,Lesley-Ann Clements,Michelle Combo

doi:10.1186/s12939-015-0183-x

Abstract

IntroductionAboriginal and Torres Strait Islander people experience higher levels of psychological distress and mental ill health than their non-Indigenous counterparts, but underuse mental health services. Interventions are required to address the structural and functional access barriers that cause this underuse. In 2012, the Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care employed a psychologist and a social worker to integrate mental health care into its primary health care services. This research study examines the impact of this innovation.MethodsA mixed-method research design was used whereby a series of qualitative open-ended interviews were conducted with 7 psychology clients, 5 social work clients, the practice dietician, and the social worker and psychologist. General practitioners, practice nurses, Aboriginal Health Workers and receptionists participated in 4 focus groups. Key themes were identified, discussed, refined and agreed upon by the research team. Occasions of service by the psychologist and social worker were reviewed and quantitative data presented.ResultsClients and staff were overwhelmingly positive about the inclusion of a psychologist and a social worker as core members of a primary health care team. In one-year, the psychologist and social worker recorded 537 and 447 occasions of service respectively, and referrals to a psychologist, psychiatrist, mental health worker or counsellor increased from 17 % of mental health clients in 2010 to 51 % in 2012. Increased access by Aboriginal and Torres Strait Islander people to mental health care was related to three main themes: (1) Responsiveness to community needs; (2) Trusted relationships; and (3) Shared cultural background and understanding. The holistic nature and cultural safety of the primary health care service, its close proximity to where most people lived and the existing trusted relationships were identified as key factors in decreasing barriers to access.ConclusionsImproving social and emotional well-being is critical to addressing the health inequalities experienced by Aboriginal and Torres Strait Islander peoples. This study demonstrates the benefits for clients and health professionals of integrating culturally safe mental health services into primary health care.

Highlights

Aboriginal and Torres Strait Islander people experience higher levels of psychological distress and mental ill health than their non-Indigenous counterparts, but underuse mental health services
Clients and staff were overwhelmingly positive about the inclusion of a psychologist and a social worker as core members of a primary health care team
Increased access by Aboriginal and Torres Strait Islander people to mental health care was related to three main themes: (1) Responsiveness to community needs; (2) Trusted relationships; and (3) Shared cultural background and understanding

Summary

Introduction

Aboriginal and Torres Strait Islander people experience higher levels of psychological distress and mental ill health than their non-Indigenous counterparts, but underuse mental health services. Mental ill health has been estimated to make the second highest contribution (15 %) to disease burden in the Indigenous population accompanied by a disproportionally high level of unmet needs [2, 4] and further exacerbated by disproportionally low access to mental health services [5, 6] Highlighting this gap, Fielke [7] observed; “Indigenous people do not enter mainstream care expecting to be treated well” (p.S75). Responses to Indigenous mental ill-health are frequently reactive and in response to crises, and at times may involve the police [4, 8] This situation results in a cascade of negative effects precipitated by misunderstanding and miscommunication – a negative experience for both staff and patients [4]. Experiences of stigma and racism and a fear of being incarcerated perpetuate reluctance to access mainstream mental health care services within the community [4, 9]

Methods

Results

Conclusion