Program Plan To Address Mental Health Issues In Aboriginal Young Adults In Victoria

Chosen health issue and priority target population

You are required to use the information and evidence gathered from the previous assessments to develop a program plan to address the issue you have identified in a priority population group.

Mental health is one of the greatest and most significant public health priorities in the Australia, and the aboriginal communities can be considered as the most affected population. There are various different factors associated with the entire scenario and each of the factors have given rise to a variety of determinants. Each of the determinants have a significant impact on the mental health issues of the aboriginals (2). This project program will attempt to explore the impact of the most relevant determinants on the mental health issue of aboriginals, especially the younger people residing in Victoria as the selected target population. The project will attempt to illustrate the health issues chosen, the target population chosen, the rationale behind the choice, the determinants, mental health promotion smart goal, and strategies with respect to the integrated health promotion model.

According to the second step of integrated health promotional model, the very first step is to define the problem and the priority setting, and its choice as a target public health priority. The public health priority can be defined as a health issue that affects a large community or a population subjected to a particular geographical areas. Among the various different health priorities, mental health and proper access to mental health service without and discrimination and bullying has become one of the greatest public health priorities in the present day scenario (1). Especially for the aboriginal people as a minority group, the rapid and alarming deterioration of the mental health issues are facilitated by the discrimination faced by the aboriginals, the lack of access to adequate mental health services, and an acute lack of mental health awareness and literacy. In the post colonization era, the aboriginals have had to live a miserable life fraught with many hardships, both cultural and socioeconomic aspects (3). The magnitude of mental health as a public health issue is magnanimous in case of Australia. Elaborating more, according to the report, one among five Australians belonging to the age group of 16 to 85 have been reported to be struggling with some form of mental health issues such as anxiety, affective or mood disorders, and substance use disorders (13). Along with that, it has to be mentioned that the suicide and tendency of self-harming is also considerably high in the Australian demographics, and mental disorders such as anxiety, depression, paranoia and personality disorders have been reported to be the key issues of the most of suicide rates (6). Hence, undoubtedly, it is one of the greatest public health priorities in the Australian demographics. Moreover, there have been little emphasis on the specific experience of the aboriginals when faced with the mental health issues and the lack of access and help seeking behavior among the aboriginals. Hence, the mental health issue has been selected as the key health issue for the project (5).

Determinants and their impacts

 Now, the target population that has been selected for the project are the aboriginal young adults belonging to Victoria. It has to be mentioned that more than a quarter of total population of aboriginals in Australia have been reported to have some form of mental health issues, which measures up to aboriginals have twice as much mental health concerns when compared to the nonnative Australians. Elaborating on the choice of target population, it has to be mentioned that by the census of 2016, more than 30000 individuals residing in the Victoria have identified themselves as aboriginals (7). Along with that, mental health issues are one of the four key issues in Victoria, for which the aboriginals have been reported to seek out primary health care support. According to the statistical review reports, mental illness contributes to 15% of the total disease burden in aboriginals that are living in the Victoria. However, the prevalence rate of mental health issues among the young adults among the aboriginal population have been reported to have a large number of mental health issues when compared to other age groups (10). Moreover, according to the most of the recent survey reports, the age group of adolescents belonging to the age group of 4-17 have been reported to have contributed 14% of the mental health issues.

Determinants of health can be defined as the socioeconomic, personal and cultural factors that have a profound impact on the health condition and health care access of a community. As described by (9), the determinants of health have a strong link with the health disparities and focusing on the determinants of health in a health promotion strategy can help address and eradicate the heath inequities. In this case, there are a number of significant socio-economic and cultural factors that are contributing to the mental health status deterioration of the aboriginal young adults. According to the report of aboriginal health, mental illness is linked very crucially with experiences of grief, loss and trauma (12). In the post colonization period the aboriginals have been subject to many hardships and miseries such as loss of land, forced removal of children and loss of socio-cultural identity. These socio-cultural and historical factors associated with their life journey has contributed to a feeling of entrapment, lack of independence and control has been reported to be a considerable impact in facilitating mental disorders and suicidal tendencies among these population which has also  been imbibed by the young generations (7).

SMART goals and objectives

The second most important determinant of the mental health issues is the discrimination and bullying faced by the aboriginals by the dominant non-native westernized culture. In most cases, the aboriginals are faced with extreme racial and cultural discrimination with respect to English language proficiency, social backwardness, and traditional beliefs and customs which are characteristically different from the dominant westernized societal cultures. Hence, the discrimination faced in all societal fronts have contributed to the extreme mental health issues for the target population. Along with that, the stigmatization against mental health issues are even more discriminating for the aboriginal individuals experiencing extreme bullying and discrimination which not only deteriorates their mental health status, but also reduces their help seeking behavior (11).

The third most fundamental determinant in this case is the impact of the dominant culture on the mental health service design and implementation. The existing mental health services in Australia are designed and practiced by the dominant cultural community with profound western influence. The lack of cultural awareness and appropriateness among the mental health service providers is a string contributing factor for the aboriginals not opting for the mental health services (13). The adaptation of aboriginal traditional healing concept and the idea of overall spiritual and emotional wellbeing as mental health is very low as well. Lastly, the socially backward minority communities are often not included in the health promotion and awareness campaigning due to language and other related cultural barriers. In this case as well, lack of health education and mental health literacy among the aboriginals is a very important determinants as well. The lack of education has been reported to lead to stigmatization and late recognition of the symptoms or need to seek out mental health support, deteriorating their mental health status further (6).  

The goals and objectives are fundamental aspects of a project and the SMART criteria provides a great opportunity for objectives to be precise targeted and addressing each and every factor associated with the issue which is the focus of the project.

In this case, the goal set for the project is to:

Enhance the mental health awareness among the aboriginals, improve the access to mental health services and enhance the cultural appropriateness and quality of mental health services received by the mentally ill aboriginals living in Victoria within 12 months.

T
he objectives for the project include:

• To reduce the rate of suicide and self-harming tendencies among the selected target population due to mental health issues by 5-10% by the help of screening and literacy campaigning.
• To enhance the cultural awareness of the mental health professionals to an extent to reduce the discrimination and bullying faced by the target populations.
• To enhance the awareness among the target population regarding mental health insurance coverage to an extent that more than 75% of the target population understands their coverage benefits and avail them.
• To enhance the access of mental health services among the target population and enhancing help seeking behavior by the help of consistent and periodic mental health awareness campaigning.

The third step of the integrated health promotion model is to generate the solution. In this section the strategies for achieving the goals are discussed with rationale.

Screening and literacy campaigns will be developed to reduce the suicide rate.  The aim of the campaign is to create awareness of the public about the availability of the mental health care services in the target region. The campaign will help educate people on screening services available for various mental health issues and range of treatments offered. The literacy campaign will comprise of mental health care practioners, general physician, nurses and other professionals. The target population will be made aware of traditional healing services and how to access them. The volunteers and the health care providers will explain about the ways to deal with trauma and grief. Further the campaign will also focus on increasing the target population’s awareness on various insurance benefits and ways to avail them.  The outcome of the campaign may include prevention of suicide by increased access to the healing services through campaign.  The campaign will focus on younger people and emphasize on suicide prevention, violence, incarceration, substance abuse, intergenerational trauma and pathways to healing. The campaign will be delivered in collaboration with the members of the “The Aboriginal and Torres Strait Islander Healing Foundation” that is aimed to prevent suicide (14).  The campaign may have positive impact on migrant people needing insurance benefits. The rationale for campaign is the potential to reach the wider target in small span of time. Campaigns have been always been successful in raising awareness of people and yield positive outcomes. Earlier campaigns for awareness on obesity and other chronic illness like Schizophrenia as well as reduction of cannabis consumption have been successful in Australia and various other countries (15).   

A social media campaign will be linked with the above campaign. It will be launched to help people overcome the issues related to insurance coverage such as high cost, lack of awareness and loss of eligibility for Medicaid. This campaign will help reach people who are in rural areas and depend on social media for communication. The aim of the social media campaign is to increases the public awareness on demanding rights of Medicare insurance. The other aim of the social media campaign is to work with the target population to assist them in accessing the mental health screening services. The rationale for this strategy is the study by (16) that highlighted the positive outcome of the anti-smoking online videos via YouTube.  There were more positive than negative response from the videos. In similar other study by (17) it was found that a13-week social media-based exercise was successful in improving the physical activity in target population The social media campaign was successful in motivating people to enroll in exercise classes. The impact of the social media campaign includes public education on health insurances and premiums and monitors the health screening services for the target people. The social media platform that will be used is Facebook as the follower of this site exceeds over 100 billion people in the world (18).  The followers will be given the share and like options and improve the communication between the target population and the mental health care providers. The videos shared on the social media page include interventions to overcome the depression and deal with suicidal thoughts.   It will also help create awareness on the right to medicare/medicaid, health insurance disparity and promote utilization of mental health services (16,17,18).

Education of professionals is the second strategy as they lack awareness of dealing with the mental health issues of the Aboriginal patients. A training program will be designed to educate the mental health practioners in Victoria. It will be facilitated by NGO and support of the local government as well as Aboriginal Community Controlled Health Services (ACCHS).  The volunteers providing the education would create awareness on range of cultural and linguistic needs of the Aboriginal mental health patients. The program will be focused on cross cultural evaluation of the patients with mental health issues like depression, and others.  The objective to achieve based on this strategy is reduction in discrimination with respect to race, culture, language and ethnic background of the Aboriginal patients. The impact of the program is effective communication between mental health practioners and Aboriginal patients. The training may help the practioners to work without any bias in caring process. The practioners may take into considerations the family kinship, language, and cultural identity. It will help the providers gain holistic view of target population (18,19,20). The rationale for the training programme is the development of the cultural competence using the AIMhi education tool to reduce the traditional inequalities. This tool is used as framework for the education and training program as per the principles of this tool that are “empowerment, communication and self management”.  This tool has been successful in promoting the culturally adapted recovery approaches for mentally ill Aboriginals. This training strategy has positively impacted the knowledge of the health care providers (19,20,21,22).  

According to the fourth step of integrated health promotion model, capacity building is necessary for success. For the above mentioned project the potential partners include local government and Non- Governmental Organizations. They will advocate people on the availability of the various healing services for different mental health issues. They will take part in advocating the young people without insurance coverage about human rights. These authorities will also help with funding of the project.

 The stakeholders of the campaigns and educational programmes are-

• Physician specialized in health education and hospital mangers- help with designing of campaign, its material, social media content and evaluation process
• Insurance workers- help with validation of questionnaire and primary and secondary outcomes
• Managers from diverse counties for supervising the scientific work- will help in insurance of immigrants and other young people without insurance (23)

The mental health promotion project will be implemented within timeframe of 12 months. It may be continued if the outcomes are positive. It may be continued at broad scale targeting people of different age groups.  The plan of implementing the campaigns and education programmes will take roughly one month.

According to integrated health promotion model, planning for evaluations and dissemination is necessary for the project sustainability.  For the above mentioned mental health project, evaluation will be performed using survey of the hospitals

To evaluate the screening and literacy as well as social media campaign the awareness raised will be measured by the increasing number of young people seeking behaviour and accepting the severity of the mental health conditions. It can be measured by the internal statistics of the programs, visitors in hospitals, expert insurance provider data,  followers on Facebook, their feedback and comments related insurance packages (24). The number of clicks on Facebook will be counted through Adobe SiteCatalyst. A report will be generated for automatically delivered metrics   (25).   Further the success of the campaigns will be measured by the attendance in campaign, community feedback through surveys. The questionnaires will comprise of the close ended questions regarding the belief about the healing services and interest in attending mental health rehabilitations in depression (26).

Further survey will be conducted for mental health support centers to know increases of visitors for psychological support programs and increases of awareness. From the mental health hospitals the record of active counseling programs in Victoria.  Greater number of visitors and high number of clicks on Facebook indicates the awareness of the mental health screening services and access of counseling services. Another survey will be conducted for the mental health professions to assess their cultural competency in handling young people from culturally and linguistically diverse Aboriginal people. It will contain close ended questions that needs to be rated in the five point liker scale (27,28).  The survey will be followed by the interview comprising of the open ended questions to assess their knowledge and barriers in addressing the cultural needs of the target population during mental health treatment (26,27,28).

Conclusion:

The project program has incorporated different campaigning and literacy programs which are mostly NGO-funded or social media based. Hence, it can be mentioned that the strategies selected are very cost effective and very easy to implement which can be considered a significant strength of the program. Along with that, the strategies selected have been evidence based and targeted to address the particular needs of the young adult target group; it can be hoped that implementation of the programs will be easy and efficient. Lastly, most of the strategies are social media campaigning based and as the target group are young adults, the platform for awareness chosen is relevant, time saving and cost effective with expectation of high success rates. Hence, it can be concluded that the strategies that have been selected for the program with be easily and successfully implemented in the small scale sample population and the success rate will be a sound future direction for more broad large scale mental health promotion strategies for the aboriginals.  

References: 

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