Social and Emotional Wellbeing Screening for Aboriginal and Torres Strait Islanders within Primary Health Care: A Series of Missed Opportunities?

BACKGROUND

Social and emotional wellbeing (SEWB) is a critical determinant of health outcomes for Indigenous Australians. This study examined the extent to which primary healthcare services (PHSs) undertake SEWB screening and management of Aboriginal and Torres Strait Islander clients, and the variation in SEWB screening and management across Indigenous PHS.

METHODS

Cross-sectional analysis between 2012 and 2014 of 3,407 Indigenous client records from a non-representative sample of 100 PHSs in 4 Australian states/territory was undertaken to examine variation in the documentation of: (1) SEWB screening using identified measurement instruments, (2) concern regarding SEWB, (3) actions in response to concern, and (4) follow up actions. Binary logistic regression was used to determine the factors associated with screening.

RESULTS

The largest variation in SEWB screening occurred at the state/territory level. The mean rate of screening across the sample was 26.6%, ranging from 13.7 to 37.1%. Variation was also related to PHS characteristics. A mean prevalence of identified SEWB concern was 13% across the sample, ranging from 9 to 45.1%. For the clients where SEWB concern was noted, 25.4% had no referral or PHS action recorded. Subsequent internal PHS follow up after 1 month occurred in 54.7% of cases; and six-monthly follow up of referrals to external services occurred in 50.9% of cases.

CONCLUSION

Our findings suggest that the lack of a clear model or set of guidelines on best practice for screening for SEWB in Indigenous health may contribute to the wide variation in SEWB service provision. The results tell a story of missed opportunities: 73.4% of clients were not screened and no further action was taken for 25.4% for whom an SEWB concern was identified. There was no follow up for just under half of those for whom action was taken. There is a need for the development of national best practice guidelines for SEWB screening and management, accompanied by dedicated SEWB funding, and training for health service providers as well as ongoing monitoring of adherence with the guidelines. Further research on barriers to screening and follow up actions is also warranted.

Beasts of burden or organised cooperation: the story of a mental health team in remote, Indigenous Australia

OBJECTIVE

This paper aims to describe the growth of a regionally-based mental health team providing services to remote Indigenous communities in far north Queensland.

CONCLUSIONS

By drawing on their experience, the authors are able to identify factors supporting the development and sustained capacity of integrated mental health teams, working in challenging remote settings.

Creative Recovery: art for mental health's sake

OBJECTIVE

This paper describes the background to, implementation of and evaluation challenges associated with an innovative, arts-based, wellbeing and mental health recovery project in a remote Indigenous setting.

RESULTS

Creative Recovery is a community-based arts initiative for Indigenous people with mental health problems. It has been rolled out as a pilot project in a remote Cape York community and is aimed at promoting wellbeing and recovery. The theoretical basis for the initiative is modelled on ideas of the role that social capital plays in improving mental health. This involves both the beneficial impact community participation and the social cohesion it creates can have, not only on an individual's mental health, but also on the social and emotional wellbeing of the communities they are part of. Such initiatives have already been adopted as an integral part of mental health promotion in countries such as the UK, and in other Australian states such as Victoria and Western Australia. The following paper will locate Creative Recovery in the current field of mental health promotion theory and Indigenous social and emotional wellbeing, and will discuss some of the evidence for and challenges inherent in adopting such initiatives.

Listening, sharing understanding and facilitating consumer, family and community empowerment through a priority driven partnership in Far North Queensland

OBJECTIVES

This paper provides an example of a mental health research partnership underpinned by empowerment principles that seeks to foster strength among community organizations to support better outcomes for consumers, families and communities. It aims to raise awareness among researchers and service providers that empowerment approaches to assist communities to address mental health problems are not too difficult to be practical but require long-term commitment and appropriate support.

METHODS

A collaborative research strategy that has become known as the Priority Driven Research (PDR) Partnership emerged through literature review, consultations, Family Wellbeing Program delivery with community groups and activities in two discrete Indigenous communities. Progress to date on three of the four components of the strategy is described.

RESULTS

The following key needs were identified in a pilot study and are now being addressed in a research-based implementation phase: (i) gaining two-way understanding of perspectives on mental health and promoting universal awareness; (ii) supporting the empowerment of carers, families, consumers and at-risk groups through existing community organizations to gain greater understanding and control of their situation; (iii) developing pathways of care at the primary health centre level to enable support of social and emotional wellbeing as well as more integrated mental health care; (iv) accessing data to enable an ongoing process of analysis/sharing/planning and monitoring to inform future activity.

CONCLUSION

One of the key learnings to emerge in this project so far is that empowerment through partnership becomes possible when there is a concerted effort to strengthen grassroots community organizations. These include social health teams and men's and women's groups that can engage local people in an action orientation.

Indigenous Australians' understandings regarding mental health and disorders

The purpose of the present paper was to determine what is currently documented about Indigenous Australians' understandings of mental health and mental disorders through a meta-synthesis of peer-reviewed qualitative empirical research. The following databases were electronically searched (1995-April 2006): AOA-FT and AIATSIS, Blackwell Synergy, CINAHL and Pre CINHAL, Health source: nursing/academic edition, Medline, Proquest health and medical complete, PsycInfo, Science Direct, Synergy and HealthInfoNet. Eligible studies were those written in English and published in peer-reviewed journals, empirical studies that considered Indigenous people's understandings of mental health and provided details on methodology. Five articles from four qualitative studies met these criteria. Meta-ethnography was used to identify common themes emerging from the original studies. Reciprocal translation was used to synthesize the findings to provide new interpretations extending beyond those presented in the original studies. An overarching theme emerged from the synthesis: the dynamic interconnectedness between the multi-factorial components of life circumstances. Reciprocal translations and synthesis regarding Indigenous understandings of mental health and illness resulted in five themes: (i) culture and spirituality; (ii) family and community kinships; (iii) historical, social and economic factors; (iv) fear and education; and (v) loss. The application of a meta-synthesis to these qualitative studies provided a deeper insight into Indigenous people's understandings of mental health and illness. The importance of understanding Indigenous descriptions and perceptions of mental health issues is crucial to enable two-way understandings between Indigenous people's constructs of wellness and Western biomedical diagnostic labels and treatment pathways for mental disorders and mental health problems.

Challenges of measuring the mental health of Indigenous Australians: honouring ethical expectations and driving greater accuracy

OBJECTIVE

While Indigenous Australians are exposed to more risk factors and experience a greater burden and complexity of mental disorder, there is as yet limited capacity to assess this at individual, community or societal levels. This paper explores factors associated with and consequences of inadequate mental health assessment processes.

METHOD AND FINDINGS

The excess burden of Indigenous mental disorders is now demonstrated but is still clearly an underestimate. This motivated a project based in northern Australia to develop effective mental health assessment tools. The initial stages of this project brought together academics and practitioners with Indigenous workers and researchers from Australia and New Zealand. This provided significant and shared insights in relation to the collection and use of Indigenous mental health data.

CONCLUSIONS

Critical themes to guide researchers, services and practitioners were defined and presented in this paper along with a range of individual, social, service and economic consequences associated with systematic non-recognition and under-rating of mental disorders outlined.