Mental disorders and Indigenous Australians
Question:
Discuss about the Indigenous Mental Health And Role Of Mental Health Nurse.
- Mental health problems are regarded as direct manifestation of disharmony or imbalance.
- High rates of mental health issues are experienced by the Aboriginal and Torres Islanders (Reiss, 2013).
- Most common issues include high mortality rates, behavioral disorders, intentional self-harm, and psychological distress (Sveticic, Milner & De Leo, 2012)
Speaker notes- A mental disorder, or mental illness refers to presence of mental or behavioural patterns, which lead to significant impairment or distress of basic personal functioning. These mental abnormalities are generally relapsing, persistent, and remitting. Moreover, they can also get manifested in the form of single episode. A healthcare professional is responsible for diagnosing range of such disorders presented by an individual or community. Indigenous Australians refer to the Aboriginal and Torres Strait Islander individuals of Australia, who are considered to have descended from several groups that were present in Australia and other islands before British colonisation. Such indigenous Australians are twice as likely to get affected by poor health conditions and are 1.5 times more likely to suffer from disabilities or long-term adverse health conditions (Kelaher, 2014).
- Indigenous communities underwent rapid social changes that led to changes in patterns of mental health problems faced by them.
- Indigenous people suffering from mental problems have high unemployment rates.
- Mental health is therefore not considered separate from spirituality or physical health. Aboriginals and Torres Islanders have also demonstrated specific mental health needs (Rickwood, Telford, Parker, Tanti & McGorry, 2014)
Speaker notes- There exist special strengths in the Aboriginal culture that considers mental health to be an essential part of the continuum, which pertains to the individuals, families or entire communities. These are generally attributed to a combination of discrimination and disadvantage that combined with the devastating trauma and grief. These are direct manifestation or consequence of previous removal of their children, colonization of their land and destruction of their communities. Furthermore, premature death of loved ones or family members and loss from incarceration significantly contributed to poor mental condition
- Evaluating and assessing the health needs of a patient
- Devising or formulating specific treatment plans
- Providing a range of psychotherapy related services
- Delivering patient centered care
- Administering therapeutic interventions
Speaker notes- Mental health nurses are required to work with several individuals belonging to a wide range of age groups and coming from all walks of life. The primary role of these nurses are based on utilizing advanced behavioral therapies that will help in facilitating physical and mental recuperation. These nurses are expected to care for all patients, suffering from a range of mental dysfunctions or disorders, regardless of their cultural and ethnic backgrounds (Happell & Gaskin, 2013). The job of providing appropriate mental care services to all patients is challenging and creates an emotional drain on the professionals. Thus, they are required to assess patients who are mentally ill, help them participate in several activities and assist in adherence to behavior modification programs, in addition to implementing pharmacological interventions.
- Mental illness are commonly associated with high levels of disability
- Regional isolation, financial costs and waiting lists are major barriers to low utilization of mental health services (Jorm, Bourchier, Cvetkovski & Stewart, 2012)
- Inability to identify mental illness and holding opinions and attitudes that do not favor mental health care increase mental illness among indigenous people
Speaker notes- Even when the indigenous people are recently being valued by the wider society, they still feel marginalized due to existence of power imbalance between the non-Aboriginal Australians. Indigenous people have reported significantly lower levels of usage of benefits that pertain to Medicare and other pharmaceuticals (Parker & Milroy, 2014). Levels of expenditure for the indigenous people, as decided by the government are way below that other communities. Low access to primary healthcare facilities often contribute to their increased likelihood of presenting major mental health issues. Late presentation of symptoms and low levels of health literacy result in higher rates of mental disorders among the people living in rural regions. This leads to poorer health outcomes.
- Indigenous culture is complex and multidynamic
- Ethnic groups are often under-represented in mental health services
- Poor mental health literacy contributes to impediments in use of mental service
- Healthcare provider might not know about history of colonization and racism
Cultural influences on mental illness
Speaker notes- Attitudes that the indigenous people hold towards prevalence of mental illness are found to vary considerably among individuals, ethnicities, families, cultures, or countries. Religious and cultural teachings also play a role in influencing the beliefs that the indigenous people hold about the nature and origin of mental disorder (Eggington, 2012). Moreover, culture also shapes the attitudes of the mental health providers towards the mentally ill. In addition, culture makes mentally distressed people experience discrimination, social stigma, and false beliefs about mental disorders. This affects their willingness and readiness to adhere to and seek treatment. Thus, gaining a deeper understanding of cultural beliefs about mental illness is imperative for implementing appropriate approaches to mental health care.
- Lack of provision of the services
- Security gaps that lead to high level of violence among the indigenous people
- Legitimacy gaps related to deficient standards of government (Heffernan, Andersen, Dev & Kinner, 2012)
- Marginalization of the target population compared to non-Aboriginal counterparts
- Reduced access to quality care services
Speaker notes- Long histories related to discrimination and colonization of the Aboriginals and Torres Islanders have led to marginalization of these indigenous peoples, from the dominant sections of their society. Most statistical data that elaborate on poverty, health, and education demonstrate that indigenous peoples are poor, least healthy, and do not have access to formal healthcare service and education. This significantly contributes to higher rates of addiction and substance abuse, thereby worsening mental health (Shepherd, Li, Mitrou & Zubrick, 2012). Indigenous people also face systemic exclusion and discrimination from major economic and political power, thereby leading to their over-representation among the illiterate, poor, and destitute.
- Stolen children
- Widespread grief and loss related to land invasion and cultural loss
- Unresolved trauma
- Racism and discrimination
- Loss of self-identity (Parker, 2012)
- Poor economic opportunities
- Poor physical health
- Substance abuse
- Incarceration
Speaker notes- Racism and discrimination has been found to create significant negative impacts on the mental and physical health of indigenous people, due to fear, stress and other adverse emotions accompanying it. The indigenous people can most often internalize stereotypes and negative comments they are being subjected to (Ferdinand, Paradies & Kelaher, 2013). Eventually, these detrimental effects related to discrimination gets passed down to next generation. Before British settlement, 500 indigenous groups were found to inhabit Australia, which resulted in approximately 750,000 people. Colonization of Australia created devastating impacts on the indigenous people. Stolen generations refer to the children of the indigenous people who were forcefully removed from their families by the federal and state government, under the act of the parliaments (Short, 2012). This also resulted in significant adverse effects on mental health
- Depression- It was reported by nearly 33% indigenous people, aged above years
- Dementia- Indigenous people living in rural regions have a ten times increased likelihood of developing this condition
- Worse mental health reported among 93% Aboriginal prisoners
- Schizophrenia- This abnormal social behavior is reported in equal rates as seen in white Australians
Speaker notes- The National Aboriginal and Torres Strait Islander Social Survey (NATSISS) conducted in 2014-2015 states that 29% indigenous people, aged above 15 years self-reported symptoms of anxiety, depression, emotional or behavioral problems, and drug or alcohol dependence. One-quarter (23%) of these people reported presence of mental health condition, in combination with long-term health conditions. Mental health conditions were found less likely among younger people (22%) than those belonging to older age groups (30%-35%) (Abs.gov.au, 2018).
- Not allow prejudice and stereotyping to influence their thinking or behavior towards the indigenous communities
- Forming a partnership, negotiating and demonstrating willingness to provide care
- Recognizing the rights of indigenous people access to optimal mental health services (Bradshaw & Pedley, 2012)
- Respecting dignity and human rights of the patients
- Recognizing importance of their land, culture and spirituality
- Providing culturally safe and appropriate environment
Mental health nurses and their role in Indigenous communities
Speaker notes- Mental health nurses should promote the emotional and mental wellbeing of all indigenous people and work to increase their understanding of their traditions and cultures. The indige nous people should always be treated with respect and dignity to allow for identification of major difficulties that are faced while dealing with them. The nurses are also required to contribute significantly to improve courtesy and increase the awareness of the indigenous people on the mainstream mental health services that can be utilized by them. Every possible efforts must be taken to ensure elimination of all forms of language barriers while providing care services. They should also take into account all existing cultural differences while evaluating the patients.
Conclusion
- Aboriginal and Torres Strait islanders suffer from high rates of morbidity and mortality due to prevalence of mental health disorders
- Historical legacy related to colonization and economic disadvantage
- Mental health professionals should respond to the clinical and social needs of the indigenous people and adopt a perspective that recognizes their historical and social context.
References
Abs.gov.au. (2018). 4714.0 – National Aboriginal and Torres Strait Islander Social Survey, 2014-15. Retrieved 10 April 2018, from https://www.abs.gov.au/ausstats/[email protected]/Lookup/by%20Subject/4714.0~2014-15~Feature%20Article~Aboriginal%20and%20Torres%20Strait%20Islander%20people%20with%20a%20ment
Bradshaw, T., & Pedley, R. (2012). Evolving role of mental health nurses in the physical health care of people with serious mental health illness. International Journal of Mental Health Nursing” href=”https://#”>Mental Health Nursing, 21(3), 266-273. https://doi.org/10.1111/j.1447-0349.2012.00818.x
Eggington, D. (2012). Aboriginal health equity: the key is culture. Australian and New Zealand journal of public health, 36(6), 516-516. https://doi.org/10.1111/j.1753-6405.2012.00950.x
Ferdinand, A., Paradies, Y., & Kelaher, M. (2013). Mental health impacts of racial discrimination in Victorian Aboriginal communities. Lowitja Institute. https://dro.deakin.edu.au/eserv/DU:30058482/paradies-mentalhealthimpacts-2013.pdf
Happell, B., & Gaskin, C. J. (2013). The attitudes of undergraduate nursing students towards mental health nursing: a systematic review. Journal of clinical nursing, 22(1-2), 148-158. https://doi.org/10.1111/jocn.12022
Heffernan, E. B., Andersen, K. C., Dev, A., & Kinner, S. (2012). Prevalence of mental illness among Aboriginal and Torres Strait Islander people in Queensland prisons. Medical Journal of Australia, 197(1), 37. doi: 10.5694/mja11.11352
Jorm, A. F., Bourchier, S. J., Cvetkovski, S., & Stewart, G. (2012). Mental health of Indigenous Australians: a review of findings from community surveys. Medical Journal of Australia, 196(2), 118. doi: 10.5694/mja11.10041
Kelaher, M. A. (2014). Experiencing racism in health care: the mental health impacts for Victorian Aboriginal communities. Education, 55(56), 8-3. doi: 10.5694/mja13.10503
Parker, R. M. (2012). Aboriginal and Torres Strait Islander mental health: paradise lost?. Medical Journal of Australia, 196, 89-90. doi: 10.5694/mja11.11561
Parker, R., & Milroy, H. (2014). Aboriginal and Torres Strait Islander mental health: an overview. Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice, 2, 25-38. Retrieved from- https://www.researchgate.net/profile/Roz_Walker/publication/259715124_Working_Together_Aboriginal_and_Torres_Strait_Islander_Mental_Health_and_Wellbeing_Principle_and_Practice/links/59c3abb20f7e9b21a82fd663/Working-Together-Aboriginal-and-Torres-Strait-Islander-Mental-Health-and-Wellbeing-Principles-and-Practice.pdf#page=54
Pmc.gov.au. (2018). 3.10 Access to mental health services | Aboriginal and Torres Strait Islander Health Performance Framework 2014 Report. Retrieved 10 April 2018, from https://www.pmc.gov.au/sites/default/files/publications/indigenous/Health-Performance-Framework-2014/tier-3-health-system-performance/310-access-mental-health-services.html
Reiss, F. (2013). Socioeconomic inequalities and mental health problems in children and adolescents: a systematic review. Social science & medicine, 90, 24-31. https://doi.org/10.1016/j.socscimed.2013.04.026
Rickwood, D. J., Telford, N. R., Parker, A. G., Tanti, C. J., & McGorry, P. D. (2014). Headspace—Australia’s innovation in youth mental health: who are the clients and why are they presenting. Med J Aust, 200(2), 108-11. doi: 10.5694/mja13.11235
Shepherd, C. C., Li, J., Mitrou, F., & Zubrick, S. R. (2012). Socioeconomic disparities in the mental health of Indigenous children in Western Australia. BMC public health, 12(1), 756. https://doi.org/10.1186/1471-2458-12-756
Short, D. (2012). When sorry isn’t good enough: Official remembrance and reconciliation in Australia. Memory Studies, 5(3), 293-304. https://doi.org/10.1177/1750698012443886
Sveticic, J., Milner, A., & De Leo, D. (2012). Contacts with mental health services before suicide: a comparison of Indigenous with non-Indigenous Australians. General hospital psychiatry, 34(2), 185-191. https://doi.org/10.1016/j.genhosppsych.2011.10.009
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