Aboriginal Mental Health Workers Research Articles

Factors affecting job satisfaction of Aboriginal mental health workers working in community mental health in rural and remote New South Wales.

Objective The aim of the present study was to identify factors affecting the job satisfaction and subsequent retention of Aboriginal mental health workers (AMHWs). Methods Five AMHWs working in New South Wales (NSW) for NSW Health in rural and remote community mental health (CMH) services participated in in-depth, semi-structured interviews to understand how employment and rural living factors affected workers' decisions to stay or leave their CMH positions. Results Using a constructivist grounded theory analysis, three aspects negatively impacting the job satisfaction of AMHWs were identified: (1) difficulties being accepted into the team and organisation; (2) culturally specific work challenges; and (3) professional differences and inequality. Conclusions Policy and procedural changes to the AMHW training program may address the lower remuneration and limited career opportunities identified with regard to the Bachelor Health Sciences (Mental Health) qualification. Delivering training to increase levels of understanding about the AMHW training program, and cultural awareness generally, to CMH staff and NSW Health management may assist in addressing the negative team, organisational and cultural issues identified. What is known about the topic? The Bachelor Health Sciences (Mental Health) qualification and traineeship pathway undertaken by AMHWs differs significantly from that of other health professionals working in NSW Health's CMH services. The health workforce literature identifies that each health professional group has its own culture and specific values and that forming and maintaining a profession-specific identity is an extremely important aspect of job satisfaction for health workers. What does the paper add? AMHWs working in rural and remote NSW CMH services commonly experience low levels of job satisfaction, especially while undertaking the embedded training program. Of particular concern is the health sciences qualification not translating into NSW Health's 'professionalised' workplace, as well as having negative effects with regard to remuneration and career opportunities within NSW Health. In addition, role challenges involving cultural differences and managing additional professional and personal boundaries negatively affects the job satisfaction of AMHWs. What are the implications for practice? The current structure of the AMHW training program creates workplace conditions that contribute to job dissatisfaction among rural and remote-based AMHWs. Many issues could be rectified by NSW Health making changes to the degree qualification obtained under the training program, as well as raising the level of understanding about the program and Indigenous cultural awareness generally among CMH staff and NSW Health management.

Mental disorders due to substance use and cardiovascular disease risk in Aboriginal adults

TO THE EDITOR: Cardiovascular disease (CVD) and mental disorders are the top two contributors to the total burden of disease in Indigenous Australians and make a substantial contribution to the excess morbidity and mortality in this group. There is increasing evidence that mental disorders are risk factors for, or consequences of, CVD. Awareness and better understanding of the intertwined relationship between mental disorders and CVD in Indigenous populations can provide opportunities for coordinated and seamless management of these conditions in health care systems. We investigated the association between mental disorders due to substance use and CVD in a remote Indigenous community in the Northern Territ ry. A cohort of 897 Aboriginal adults aged 20–74 years (85% of the community’s total adult population) was established throu h a population-based renal disease screening program in the community between 1992 and 1995. We followed up 784 participants, who were free of CVD at baseline, to 31 May 2005, using hospital and death records. The study was approved by the Behavioural and Social Sciences Ethical Review Committee of the University of Queensland. Substance use-related mental disorders were determined from participants’ hospital records, using International Classification of Diseases, ninth revision (ICD-9) codes 192, 291 and 303–305; and 10th revision (ICD10) codes F10–F19. Cases of CVD were identified by the first CVD event recorded in participants’ hospital and death records, using ICD-9 codes 390–459 and ICD-10 codes I00–I99. We used the Kaplan–Meier method to calculate cumulative CVD incidence rates for those with and without substance use-related mental disorders. CVD hazard ratios were estimated using Cox proportional hazards models. During a median follow-up period of 10 years, 177 of the 784 participants (23%) had clinically diagnosed mental disorders due to substance use (mainly alcohol: 140 participants), and 243 (31%) developed CVD. Incidence rates of CVD were 71 (95% CI, 58–87) and 27 (95% CI, 23–32) per 1000 person-years for those with and without substance use-related mental disorders, respectively (Box). Participants with substance use-related mental disorders were 2.6 (95% CI, 2.0–3.3) times more likely to develop CVD than those without. After adjusting for CVD risk factors measured at baseline (age, sex, body mass index, smoking status, alcohol use, blood pressure, serum cholesterol level, diabetes and albuminuria status), the association remained statistically significant, with an adjusted hazard ratio of 2.6 (95% CI, 1.9–3.5). Our findings confirm an association between substance use-related mental disorders and CVD in an Indigenous population, after adjusting for potential confounders. Traditional health care systems tend to separate services and treatment for mental disorders from those for physical health problems such as CVD. This separation is even more evident in remote Indigenous settings, where primary health care practitioners are already overwhelmed in providing general medical care to community members, with mental health services being delivered infrequently by visiting psychiatrists. The observed intertwined relationship between these two common conditions calls for integration of mental health services into routine primary health care, and enhanced collaboration between primary care practitioners, cardiologists and psychiatrists, in an effort to curb the huge burden imposed by these diseases. The emerging Aboriginal mental health worker program in the NT has the potential to be an effective service model to bridge the gap between mental health care and day-today primary health care. Dedicated financial resources and ongoing support for recruitment, training and retention of Aboriginal mental health workers will be required for sustained integration of mental health care with primary care in Indigenous communities.

Approach to treatment of mental illness and substance dependence in remote Indigenous communities: Results of a mixed methods study

To develop and evaluate a culturally adapted brief intervention for Indigenous people with chronic mental illness. A mixed methods design in which an exploratory phase of qualitative research was followed by a nested randomised controlled trial. Psycho-education resources and a brief intervention, motivational care planning (MCP), were developed and tested in collaboration with aboriginal mental health workers in three remote communities in northern Australia. A total of 49 patients with mental illness and 37 carers were recruited to a randomised controlled trial that compared MCP (n = 24) with a clinical control condition (treatment as usual, n = 25). The early treatment group received MCP at baseline and the late treatment group received delayed treatment at six months. The primary outcome was mental health problem severity as measured by the health of the nation outcome scales. Secondary measures of well-being (Kessler 10), life skills, self-management and substance dependence were chosen. Outcome assessments were performed at baseline, six-month, 12-month and 18-month follow up. Random effects regression analyses showed significant advantage for the treatment condition in terms of well-being with changes in health of the nation outcome scales (P < 0.001) and Kessler 10 (P = 0.001), which were sustained over time. There was also significant advantage for treatment for alcohol dependence (P = 0.05), with response also evident in cannabis dependence (P = 0.064) and with changes in substance dependence sustained over time. These results suggest that MCP is an effective treatment for Indigenous people with mental illness and provide insight into the experience of mental illness in remote communities.

Two-way approaches to Indigenous mental health literacy

This study was designed to provide important new information about relapse prevention in Indigenous 1 people with chronic mental illness. It aimed to explore Indigenous mental health promotion with Aboriginal mental health workers (AMHW) in order to develop strategies for effective mental health intervention. The research was conducted in three remote Indigenous communities in the top end of the Northern Territory with AMHW. Assessment, psycho-education, and care-planning resources were developed with local AMHW through exploration of local Indigenous perspectives of mental health promotion. Qualitative research methods and an ethnographic approach were used to elicit information, and data included key informant interviews, participant observation, music, photography and story telling. The study confirms that Indigenous people in remote communities prefer to use story telling and local language, local artwork and local music to convey health information. It also confirms that family and local practitioners are key cultural informants and that indirect, holistic and ‘two-way’ messages are preferred.

Challenges to relapse prevention: Psychiatric care of Indigenous in-patients

Relapse is one of the major contributing factors to the high burden of disability of mental illness. Strategies for relapse prevention are needed. Aboriginal and Torres Strait Islander people continue to be over-represented in mental health care nationwide. Partnerships between Aboriginal Mental Health Workers (AMHWs) and non-Indigenous health professionals can assist in provision of culturally appropriate in-patient care and promotion of self-management and relapse prevention strategies. The Australian Integrated Mental Health Initiative in the Northern Territory (AIMhiNT) aims to improve outcomes for Indigenous people with mental illness. This article reviews the quality of care provided in the Top End in-patient setting, and the involvement of AMHWs in the care of Indigenous people who are hospitalised for mental illness. Findings from a series of clinical file audits (1995, 2001 and 2004) at Royal Darwin Hospital in-patient unit are presented. The files were audited for assessment and care planning activities. The audits reveal that significant improvements in in-patient care between 1995 and 2001 were not sustained in 2004. Recording of social history, and appointment of a case manager, were less likely to occur in 2004 compared with 2001, for both non-Indigenous and Indigenous clients. AMHWs were involved in the care of only 55% of Indigenous clients. Busy in-patient units are at risk of focusing on acute care to the detriment of relapse prevention activities and culturally appropriate care. There is a need to develop models of practice that support relapse prevention for in-patient clients. Key strategies will include improved communication with clients, development of self-management skills, and enhanced partnerships with Indigenous service providers.

An Approach to Treating Depressive and Psychotic Illness in Indigenous Communities

This study is one of the activities of a multi-site research program, the Australian Mental Health Initiative (AIMhi), funded by the National Health and Medical Research Council. AIMhi in the Northern Territory collaborated with Aboriginal mental health workers and Northern Territory remote service providers in developing a range of resources and strategies to promote improved Indigenous mental health outcomes. A brief intervention that combines the principles of motivational interviewing, problem solving therapy and chronic disease self-management is described. The intervention has been integrated into a randomised controlled trial. Early findings suggest that the strategy and its components are well received by clients with chronic mental illness, and their carers, in remote communities.

Aboriginal Child and Adolescent Mental Health: A Rural Worker Training Model

The Third National Mental Health Plan places a strong emphasis on the development of an Aboriginal mental health workforce. This paper documents the establishment, implementation and initial evaluation of the Aboriginal and Torres Strait Islander Child and Adolescent Mental Health Traineeship Program, a partnership initiative involving Hunter New England Area Health Service (HNEAHS), Hunter New England Aboriginal Mental Health (HNEAMH) and the Department of Psychological Medicine at the Children's Hospital at Westmead (CHW), with guidance and input from additional collaborators. The program includes: (i) employment as a child and adolescent mental health worker and professional support and supervision through HNEAHS; (ii) a mentoring program provided through HNEAMH; (iii) formal academic studies in Aboriginal Mental Health; and (iv) a clinical education and supervision program conducted through the Department of Psychological Medicine, CHW. Initial feedback suggests that this is a promising program to train Aboriginal child and adolescent mental health workers. Further evaluation will provide information about its viability and effectiveness in providing an integrated, collaborative child and adolescent mental health service for Aboriginal and Torres Strait Islander children and their families.

The Aboriginal Mental Health Worker Program: The challenge of supporting Aboriginal involvement in mental health care in the remote community context

This paper draws on our experience as evaluators of the Aboriginal Mental Health Worker Program that has been operating in eight remote communities across the Top End of the Northern Territory, Australia, for over four years. The program aimed to fund the placement of Aboriginal Mental Health Workers (AMHWs) in remote community health centres, to work under the clinical leadership of General Practitioners and to contribute to development of a culturally appropriate community based mental health care service for Indigenous people. In this paper, we examine the key features of the AMHW program and the originating partnership, the degree of integration of AMHWs in health centre processes and the provision of support for the development of the AMHW role in community mental health work. While there are many examples in this program of AMHWs providing highly valued services within their communities, the evaluation showed that the program did not achieve clear commitments to develop mental health practice around the AMHWs’ role. In addition there was variability in levels of local managerial support for the AMHWs, vulnerability to staff turnover and other discontinuities, as well as tensions in views about what the role of the AMHWs should be. Should it be culturally informed, clinically-related mental health work or community ‘wellbeing work’, and how should each role be supported? Together these factors undermined the sustainability of positive achievements within the program.

AIMHI NT ‘Mental Health Story Teller Mob’: Developing stories in mental health

The Australian Integrated Mental Health Initiative in the Northern Territory is one of a number of sites funded by the National Health and Medical Research Council. The project has been working with Aboriginal Mental Health Workers (AMHWs), and the Top End Division of General Practice (TEDGP) to adapt mental health information to the Aboriginal and Torres Strait Islander context through development of mental health stories. The stories focus on personal strengths and family support, and use local artwork and images, local language, metaphors and music. The concepts have been incorporated into service provider training and psychoeducation resources in the Northern Territory. Development and evaluation of mental health literacy initiatives is important in the context of high rates of mental illness and burden of disease in the Aboriginal and Torres Strait Islander community.

Grief and courage in a river town: a pilot project in the Aboriginal community of Kempsey, New South Wales

Objective: To describe a pilot project implemented in Kempsey, NSW, whereby a psychiatry registrar worked in a community-controlled Aboriginal medical service, Durri Aboriginal Corporation Medical Service, which provides mental health services for Aboriginal people. Conclusions: The Aboriginal Mental Health Workers and psychiatry registrar jointly managed a significant number of Aboriginal people, often with assistance from the local mental health service at Kempsey. The registrar gained insight into the local Aboriginal community and more culturally appropriate clinical methods, as well as some cultural factors that can influence the presentation and management of mental illnesses. The Aboriginal Mental Health Workers increased their clinical knowledge and confidence through working with the registrar.

Grief and Courage in a River Town: A Pilot Project in the Aboriginal Community of Kempsey, New South Wales

To describe a pilot project implemented in Kempsey, NSW, whereby a psychiatry registrar worked in a community-controlled Aboriginal medical service, Durri Aboriginal Corporation Medical Service, which provides mental health services for Aboriginal people. The Aboriginal Mental Health Workers and psychiatry registrar jointly managed a significant number of Aboriginal people, often with assistance from the local mental health service at Kempsey. The registrar gained insight into the local Aboriginal community and more culturally appropriate clinical methods, as well as some cultural factors that can influence the presentation and management of mental illnesses. The Aboriginal Mental Health Workers increased their clinical knowledge and confidence through working with the registrar.

Aboriginal mental health workers and the improving Indigenous mental health service delivery model in the 'Top End'

This article reviews the changing Aboriginal mental health service delivery model of Top End Mental Health Services, and highlights the importance of Aboriginal mental health workers in improving communication with Aboriginal patients. The Australian Integrated Mental Health Initiative Northern Territory Indigenous stream (AIMHI NT) is introduced.Baseline measures of AIMHI NT in 2003, and findings from two clinical file audits (1996 and 2001) at Royal Darwin Hospital inpatient unit are presented. The files were audited for a range of assessment and treatment interventions.The audits reveal significant improvements in Aboriginal inpatient care between 1995 and 2001.Aboriginal mental health workers provide essential services as cross-cultural brokers in the setting of Aboriginal mental illness. The improvements in care found in this file audit coincide with the commencement of employment of Aboriginal mental health workers in the inpatient unit. The AIMHI consultation reveals broad support for employment of more Aboriginal mental health workers in the Top End.

Aboriginal Mental Health Workers and the Improving Indigenous Mental Health Service Delivery Model in the ‘Top End’

This article reviews the changing Aboriginal mental health service delivery model of Top End Mental Health Services, and highlights the importance of Aboriginal mental health workers in improving communication with Aboriginal patients. The Australian Integrated Mental Health Initiative Northern Territory Indigenous stream (AIMHI NT) is introduced. Baseline measures of AIMHI NT in 2003, and findings from two clinical file audits (1996 and 2001) at Royal Darwin Hospital inpatient unit are presented. The files were audited for a range of assessment and treatment interventions. The audits reveal significant improvements in Aboriginal inpatient care between 1995 and 2001. Aboriginal mental health workers provide essential services as cross-cultural brokers in the setting of Aboriginal mental illness. The improvements in care found in this file audit coincide with the commencement of employment of Aboriginal mental health workers in the inpatient unit. The AIMHI consultation reveals broad support for employment of more Aboriginal mental health workers in the Top End.

The need for relapse prevention strategies in Top End remote indigenous mental health

The Australian Integrated Mental Health Initiative in the Northern Territory (AIMHI NT) is one site of a National Health and Medical Research Council (NHMRC) Strategic Partnership initiative seeking to improve remote indigenous mental health outcomes - in a context of increasing hospital admissions and high readmission rates. Remote indigenous mental health service delivery faces challenges of isolation, staff recruitment and retention, and cultural, language and literacy issues. AIMHI NT explored the challenges of mental health service delivery and relapse prevention in Top End remote Aboriginal communities through semi-structured interviews with General Practitioners, nurses, and Aboriginal Mental Health Workers. AIMHI NT sought views from a range of different practitioners and health centres, representing each of the three Top End regions - Katherine, East Arnhem and Darwin Rural. Remote service providers reported low levels of confidence in indigenous mental health assessment, and little formal training in mental health. They reported high rates of relapse of mental illness and high rates of comorbidity, but few relapse prevention activities and relapse prevention tools. The development of relapse prevention activities in primary care requires support and change at all levels - community, consumers and carers, service providers, health system, and health policy. AIMHI NT is engaged in a range of activities promoting relapse prevention in remote NT health centres, and has developed a care plan and care plan training package for remote service providers.

The Indigenous Mental Health Worker

Objective: To provide background and context for the recent Royal Australian and New Zealand College of Psychiatrists (RANZCP) statement on indigenous mental health workers. Conclusions: There are a number of difficulties facing indigenous mental health workers in Australia today. The RANZCP statement is one step in a move to increase recognition of these workers. National registration of Aboriginal mental health workers or the formation of a national association may further promote their identity.

Testing an Indigenous health resource: the participatory development process with The Grog Book

Issue addressed: We describe a process for improving the accessibility and appropriateness of a book designed to stimulate Indigenous community action on alcohol problems. Methods: Using a prototype version of the resource and a loosely structured research protocol, two researchers worked with 16 Aboriginal health and mental health workers in three locations. Results: Participants' responses were analysed, providing research insights to improve aspects of language, structure and presentation, making them relevant and accessible to the target audience. Conclusions: In contrast with the quantitative use of focus groups for preference testing materials with target audiences, this small-scale qualitative ethnographic methodology provided detailed and personalised commentary leading to practical improvements. So what?: Working with potential users helped to ensure that the final version was appropriate to and accessible by Aboriginal and Torres Strait Islander community and health workers, whatever their literacy levels. (author abstract)

Psychiatric assessment in remote Aboriginal communities.

The objective of this study was to describe the psychiatric assessment of Aboriginal patients from remote Aboriginal communities in Central Australia. The method consisted of a summary of the experiences gained during a dissertation year placement as senior registrar with the Northern Territory Remote Area Mental Health Team. Remote area Aboriginal psychiatry entails learning a whole new set of skills in terms of history taking and the mental state examination, a knowledge of the importance of extended kinship ties and cultural issues, the use of Aboriginal mental health workers as partners in assessing and managing patients via their families and accepting referrals from a wide range of sources. Working on a service providing psychiatric care to remote area Aboriginal communities can be a deeply rewarding personal and professional experience.