Torres Strait Islander Mental Health Research Articles

Walking together in friendship: Learning about cultural safety in mainstream mental health services through Aboriginal Participatory Action Research.

Culturally safe service provision is essential to improving social and emotional wellbeing among Aboriginal and Torres Strait Islander communities, and to eliminating health inequities. Cultural safety is about ensuring that all people have a safe and healing journey through services, regardless of their cultural background. In this project, we aim to (1) understand how Aboriginal and Torres Strait Islander peoples conceptualise cultural safety, and (2) co-design a qualitative interview for the next phase of this project, where we plan to learn about experiences of cultural safety within mental health services. We conducted six focus groups (in one metro and two regional areas, Western Australia). Following an Aboriginal Participatory Action Research methodology, we yarned with Aboriginal and Torres Strait Islander mental health service users, carers, community members, mental health professionals and Cultural Healers about cultural safety. Participants described a culturally safe service as one where Aboriginal cultural knowledges, life experiences, issues and protocols are understood and acknowledged, and reported that mainstream mental health services are not currently culturally safe. Participants emphasised the importance of building trust, rapport, reciprocity and following appropriate relational processes when designing a qualitative interview for the next phase. A lack of cultural safety in mental health services is likely to contribute to the disparity in outcomes between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians. Embedding cultural safety into research design allows for authentic community engagement and facilitates knowledge sharing around ways to improve cultural safety in mental health services.

E-mental health interventions for men: an urgent call for cohesive Australian policy and investment

Abstract Few men who experience a common mental disorder access any mental healthcare from a health professional. E-mental health (eMH; online) interventions may facilitate men’s access to mental healthcare and reduce inequities in access via assistance in a format that aligns with their preferences and needs. Recent reviews show that men who have used these programmes generally find them useful and satisfactory; however, data on their effectiveness and factors impacting effectiveness in men’s use are limited. Few eMH interventions have been designed specifically to suit men’s preferences and circumstances, and little is known about the eMH-related experiences and needs of men from vulnerable and marginalized backgrounds. Despite their potential, Australian men’s health, digital mental health, preventive health, and Aboriginal and Torres Strait Islander mental health and social and emotional well-being policies—and men’s health policies from Malaysia, Ireland, and South Africa—make no specific mention to progressing the use or evaluation of eMH for men. We present a series of policy recommendations, aiming to improve men’s access to effective and acceptable mental health assistance via eMH and increase health professional confidence to recommend and support these programmes. These include (i) the need for specific, connected health policy actions and targeted funding; (ii) policy priorities for intervention development, dissemination and evaluation; and (iii) for the experiences of men, particularly those from marginalized and vulnerable backgrounds, to be centred in policy. eMH for men should be promoted alongside interventions to reduce systems and social-level determinants of men’s mental health inequities.

Lessons Learned during a Rapidly Evolving COVID-19 Pandemic: Aboriginal and Torres Strait Islander-Led Mental Health and Wellbeing Responses Are Key.

As the world journeys towards the endemic phase that follows a pandemic, public health authorities are reviewing the efficacy of COVID-19 pandemic responses. The responses by Aboriginal and Torres Strait Islander communities in Australia have been heralded across the globe as an exemplary demonstration of how self-determination can achieve optimal health outcomes for Indigenous peoples. Despite this success, the impacts of pandemic stressors and public health responses on immediate and long-term mental health and wellbeing require examination. In December 2021, Aboriginal and Torres Strait Islander mental health and wellbeing leaders and allies (N = 50) attended a virtual roundtable to determine the key issues facing Aboriginal and Torres Strait Islander peoples and communities, and the actions required to address these issues. Roundtable attendees critically reviewed how the rapidly evolving pandemic context has impacted Aboriginal and Torres Strait Islander mental health and social and emotional wellbeing (SEWB). This paper presents an overview of this national collaborative consultation process, and a summary of the key issues and actions identified. These results build on evidence from other roundtables held in Australia during 2020, and the emerging consensus across the globe that Indigenous self-determination remains essential to Indigenous SEWB, especially during and following a pandemic.

Effects of an Aboriginal and Torres Strait Islander Mental Health First Aid training programme for non-suicidal self-injury on stigmatising attitudes, confidence in ability to assist, and intended and actual assisting actions: an uncontrolled trial with precourse and postcourse measurement and 6-month follow-up

ObjectivesNon-suicidal self-injury (NSSI) is a complex issue affecting Aboriginal and/or Torres Strait Islander Peoples in Australia. We evaluated the effects of an Aboriginal and Torres Strait Islander Mental Health First...

Evaluation of the Aboriginal and Torres Strait Islander Mental Health First Aid Program

ObjectiveThis study reports findings from an uncontrolled evaluation of a course designed to educate participants in how to recognise and respond to mental health problems until professional help is received. MethodsUtilising a mixed methods design, participants in 21 different courses, delivered across two Australian states, were invited to complete pre‐, post‐, and follow‐up surveys and provide qualitative feedback on their training experiences. ResultsParticipants reported feeling more confident in their capacity to respond appropriately to a person presenting with a mental health need and believed they would be more likely to provide assistance. Satisfaction was attributed to the skills and sensitivities of instructors who had lived experience of mental health concerns in Aboriginal and Torres Strait Islander communities. ConclusionThis course holds promise in improving mental health literacy in relation to Aboriginal and Torres Strait Islander mental health. Implications for public healthFew courses are available that address issues relating to the social and emotional wellbeing of Aboriginal and Torres Strait Islander People. This study illustrates how community engagement with primary health and specialist mental health services might be strengthened.

Talking about suicide: An uncontrolled trial of the effects of an Aboriginal and Torres Strait Islander mental health first aid program on knowledge, attitudes and intended and actual assisting actions.

Suicide is a leading cause of death among Aboriginal and Torres Strait Islander people. Friends, family and frontline workers (for example, teachers, youth workers) are often best positioned to provide initial assistance if someone is at risk of suicide. We developed culturally appropriate expert consensus guidelines on how to provide mental health first aid to Australian Aboriginal and Torres Strait Islander people experiencing suicidal thoughts or behaviour and used this as the basis for a 5-hour suicide gatekeeper training course called Talking About Suicide. This paper describes the outcomes for participants in an uncontrolled trial of this training course. We undertook an uncontrolled trial of the Talking About Suicide course, delivered by Aboriginal and Torres Strait Islander Mental Health First Aid instructors to 192 adult (i.e. 18 years of age or older) Aboriginal and Torres Strait Islander (n = 110) and non-Indigenous (n = 82) participants. Questionnaires capturing self-report outcomes were self-administered immediately before (n = 192) and after attending the training course (n = 188), and at four-months follow-up (n = 98). Outcome measures were beliefs about suicide, stigmatising attitudes, confidence in ability to assist, and intended and actual actions to assist a suicidal person. Despite a high level of suicide literacy among participants at pre-course measurement, improvements at post-course were observed in beliefs about suicide, stigmatising attitudes, confidence in ability to assist and intended assisting actions. While attrition at follow-up decreased statistical power, some improvements in beliefs about suicide, stigmatising attitudes and intended assisting actions remained statistically significant at follow-up. Importantly, actual assisting actions taken showed dramatic improvements between pre-course and follow-up. Participants reported feeling more confident to assist a suicidal person after the course and this was maintained at follow-up. The course was judged to be culturally appropriate by those participants who identified as Aboriginal and/or Torres Strait Islanders. The results of this uncontrolled trial were encouraging, suggesting that the Talking About Suicide course was able to improve participants' knowledge, attitudes, and intended assisting actions as well as actual actions taken.

Developing best practice guidelines for the psychosocial assessment of Aboriginal and Torres Strait Islander people presenting to hospital with self-harm and suicidal thoughts.

Objective:To develop guidelines for the culturally responsive psychosocial assessment of Aboriginal and Torres Strait Islander people presenting to hospital with self-harm and suicidal thoughts.Method:The Delphi method was used to establish expert consensus. A systematic search and review of relevant research literature, existing guidelines and grey literature was undertaken to develop a 286-item questionnaire. The questionnaire contained best practice statements to guide clinicians undertaking psychosocial assessment of Aboriginal and Torres Strait Islander people presenting to hospital with self-harm and suicidal thoughts. An expert panel comprising 28 individuals with clinical, community-based and lived experience in Aboriginal and Torres Strait Islander mental health and/or suicide prevention were recruited and independently rated the items over three rounds. Statements endorsed as essential or important by 90% or more of the expert panel were then synthesised into recommendations for the best practice guideline document.Results:A total of 226 statements across all relevant areas of clinical practice were endorsed. No statements covering the use of structured assessment tools were endorsed. The endorsed statements informed the development of a set of underlying principles of culturally competent practice and recommendations for processes of effective and appropriate engagement; risks, needs and strengths to be assessed; formulation of psychosocial assessment; and recommendations specific to children and young people.Conclusion:The guidelines are based on recommendations endorsed across a range of expertise to address an important gap in the evidence-base for clinically effective and culturally responsive assessment of self-harm and suicidal thoughts by Aboriginal and Torres Strait Islander people in hospital settings. Further work is needed to develop an implementation strategy and evaluate the recommendations in practice.

Aboriginal and Torres Strait Islander Social and Emotional Wellbeing and Mental Health

Closing the Aboriginal and Torres Strait Islander mental health gap is an urgent national priority. This commentary provides both an overview of Aboriginal and Torres Strait Islander social and emotional well being and mental health and some of the promising initiatives for restoring wellbeing. Solutions for addressing Aboriginal and Torres Strait islander mental health issues require a “best of both worlds” approach which acknowledges the impact of social and cultural determinants on Aboriginal and Torres Strait Islander wellbeing.

The Gayaa Dhuwi (Proud Spirit) Declaration – a Call to Action for Aboriginal and Torres Strait Islander leadership in the Australian mental health system

ABSTRACTThe Gayaa Dhuwi (Proud Spirit) Declaration aims to improve the mental health of Aboriginal and Torres Strait Islander peoples by supporting their leadership in those parts of the mental health system that work with Aboriginal and Torres Strait Islander populations. A further aim is to promote an appropriate balance of clinical and culturally-informed mental health system responses, including by providing access to cultural healing, to mental health problems in Aboriginal and Torres Strait persons. Developed by the National Aboriginal and Torres Strait Islander Leadership in Mental Health (NATSILMH) as a companion document to the international Wharerātā Declaration, the Gayaa Dhuwi (Proud Spirit) Declaration also sets out principles for governments, professional bodies and other stakeholders to support Aboriginal and Torres Strait Islander leadership in the Australian mental health system; and principles for working with Aboriginal and Torres Strait Islander mental health leaders as they exercise culturally informed leadership within the Australian mental health system. The Gayaa Dhuwi (Proud Spirit) Declaration is being promoted by NATSILMH as a new paradigm for shaping mental health system responses to Aboriginal and Torres Strait islander mental health problems.

Training in Aboriginal and Torres Strait Islander Mental Health: A Trainee and Trainer's Perspective:

Training in Aboriginal and Torres Strait Islander Mental Health: A Trainee and Trainer's Perspective:

The Aboriginal and Torres Strait Islander Mental Health Training Website

The Aboriginal and Torres Strait Islander Mental Health Training Website

Towards culturally appropriate assessment of Aboriginal and Torres Strait Islander social and emotional well-being.

Identification of need for specialist assessment and the use of relevant cultural information to inform mental health assessment and care are two key factors in improving Aboriginal and Torres Strait Islander access to and experience of mental health care. This paper describes the Here and Now Aboriginal Assessment tool (HANAA) and the Cultural Information Gathering Tool (CIGT), two instruments developed to be used respectively by non-mental health clinicians and Aboriginal and Torres Strait Islander mental health workers. Following widespread consultations and feedback, two independent groups of mental health clinicians based in Western Australia and Queensland were involved in developing the HANAA and CIGT. Both the HANAA and CIGT fill unmet needs in terms of instruments that can be used by non-specialists working with Aboriginal and Torres Strait Islander people. Preliminary use of the HANAA and CIGT suggests that they are well received, easy to deploy and effective instruments that promote cultural security and communication with Aboriginal and Torres Strait Islander people.

Aboriginal and Torres Strait Islander Mental Health Practitioners Propose Alternative Clinical Supervision Models

The purpose of this article is to identify issues affecting the clinical supervision of the Aboriginal and Torres Strait Islander mental healthcare workforce, and propose alternative supervision models. Participatory Action Research (PAR) was the primary methodology used to elicit and analyze the reflections of five Aboriginal counselors. The data highlighted a number of inadequacies with current practices that typically lead to high levels of stress and burnout. We recommend the implementation of alternative supervision models including the use of cultural supervisors, and dual supervisors; and accessibility to consultation, supervision, and communities of practice for remote workers through modern technologies.

New online resources on Aboriginal and Torres Strait Islander mental health

New online resources on Aboriginal and Torres Strait Islander mental health

Aboriginal and Torres Strait Islander mental health: paradise lost?

[Extract] It may well be that Australian Aboriginal culture, before significant European contact, provided conditions for mental health that the rest of the world would envy. Traditional Aboriginal culture has several factors that strongly reinforce good mental health. Sense of self was seen as being intimately connected to all aspects of life, community, spirituality, culture and country. Material needs were provided for through sharing rules, and relationships and kinship defined social roles.

A mental health first aid training program for Australian Aboriginal and Torres Strait Islander peoples: description and initial evaluation.

BackgroundMental Health First Aid (MHFA) training was developed in Australia to teach members of the public how to give initial help to someone developing a mental health problem or in a mental health crisis situation. However, this type of training requires adaptation for specific cultural groups in the community. This paper describes the adaptation of the program to create an Australian Aboriginal and Torres Strait Islander Mental Health First Aid (AMHFA) course and presents an initial evaluation of its uptake and acceptability.MethodsTo evaluate the program, two types of data were collected: (1) quantitative data on uptake of the course (number of Instructors trained and courses subsequently run by these Instructors); (2) qualitative data on strengths, weaknesses and recommendations for the future derived from interviews with program staff and focus groups with Instructors and community participants.Results199 Aboriginal people were trained as Instructors in a five day Instructor Training Course. With sufficient time following training, the majority of these Instructors subsequently ran 14-hour AMHFA courses for Aboriginal people in their community. Instructors were more likely to run courses if they had prior teaching experience and if there was post-course contact with one of the Trainers of Instructors. Analysis of qualitative data indicated that the Instructor Training Course and the AMHFA course are culturally appropriate, empowering for Aboriginal people, and provided information that was seen as highly relevant and important in assisting Aboriginal people with a mental illness. There were a number of recommendations for improvements.ConclusionThe AMHFA program is culturally appropriate and acceptable to Aboriginal people. Further work is needed to refine the course and to evaluate its impact on help provided to Aboriginal people with mental health problems.

The struggle for systematic ‘adulthood’ for Aboriginal Mental Health in the mainstream: The Djirruwang Aboriginal and Torres Strait Islander Mental Health Program

The title of this paper refers to issues of growth, development and maturity in Aboriginal Mental Health as it emerges as a specialised profession in the mainstream mental health system. The paper raises many challenges to the existing mental health structures. It asks a number of key questions regarding the professional status of Aboriginal Mental Health Professionals operating in the mainstream mental health industry. The paper describes the approach the Djirruwang Aboriginal and Torres Strait Islander Mental Health Program is taking to ensure that its students graduate with all the necessary skills, attitudes, knowledge and values to be effective professionals in their own right. It highlights the collaboration required by the mental health industry to ensure that the entire mental health workforce and the services in which they operate create a supportive environment for the development of the Aboriginal and Torres Strait Islander mental health workforce. Finally it seeks the support of the mental health industry and professional organisations to move towards systematic adulthood with respect to 1) the professional recognition of students and graduates of the program, and 2) the need for professional organisations, and service management and staff to take responsibility in their responses to Aboriginal mental health issues. The need to effectively deal with the above workforce issues is based on the evidence that Aboriginal and Torres Strait Islander people suffer from higher levels of emotional distress and possible mental illness than that of the wider community. Suicide and self-harm rates are also considerably higher in comparison to that of the broader population (AIHW, 2001). Surely, if there is a higher level of identified need there must also be a higher level of orchestrated effort required.

Emotional and Social Wellbeing: National Policy Context

Objectives: This paper provides an overview of the national policy in relation to Aboriginal and Torres Strait Islander mental health and emotional and social wellbeing. Conclusions: The limited available evidence suggests that mental health disorders are more prevalent in Aboriginal and Torres Strait Islander communities, a situation related to the unique historical, cultural and social situation of Aboriginal and Torres Strait Islander peoples in Australia. Community-based mental health services are not adequately available, while Aboriginal and Torres Strait Islander people are over-represented in inpatient mental health care. A range of program and policy initiatives have been undertaken to address this situation, including both the development of specific Aboriginal community controlled emotional and social wellbeing services and the reform of specialist mental health services. These initiatives have been supported by a range of policy initiatives at Commonwealth, State and Territory levels. Inadequate coordination between sectors in implementing programs and policies has hampered delivery of services. The current development of a national strategic framework for emotional and social wellbeing aims to increase partnerships between the sectors, and to motivate governments to provide more resources to address the issue. Support from the Royal Australian and New Zealand College of Psychiatrists is valuable in moving this agenda forward.

Torres strait islander mental health: Current issues

Torres strait islander mental health: Current issues

A Health Service and Aboriginal & Torres Strait Islander Partnership to Develop and Plan Mental Health Services

The aim of this study was to examine the effects of an action research partnership between the Tweed Valley Health Service (TVHS) and the Aboriginal & Torres Strait Islander community for the development and delivery of Aboriginal & Torres Strait Islander Mental Health Services. This partnership was based upon Labonte's (1989) view of empowerment where it is suggested that to be empowered means to have increased capacity to define, analyse and act upon one's problems. It was proposed that the establishment of a 'partnership' based upon these principles would assist in operationalising Indigenous community participation in TVHS planning. To achieve this type of 'partnership', the health service had to be willing to enter the partnership and to give the authority to the Aboriginal & Torres Strait Islander Health Outcome Council to seek and trial solutions on Aboriginal & Torres Strait Islander Mental Health matters. Key outcomes were defined as the extent to which the re-organised services proved to be acceptable and utilised by the local Aboriginal & Torres Strait Islander population. Outcomes were operationalised through measures of service utilisation and consumer satisfaction with accessibility, process and outcomes. The study trialed participatory action research as a method for Indigenous participation in Mental Health Service planning and development and concludes that it is a valid model for cross cultural research and health service development in a complex medical setting.