Aborigines, colonizers and newcomers: the landscape of transcultural psychiatry research in Australia

The authors present an analysis of transcultural psychiatry research in relation to three main population groups in Australia: Aboriginal Australians, documented immigrants, and refugees. The pioneering reports produced by Western psychiatrists in Aboriginal communities are examined in this article. Additional quantitative and qualitative studies developed with Aboriginal people in the context of a traumatic acculturation process are also reviewed. Subsequently, the authors examine the challenges faced by immigrants with mental disorders in a health care system still unequipped to treat a new array of clinical presentations unfamiliar to the clinical staff. The authors also highlight the development of policies aimed at providing quality mental health care to a mosaic of cultures in an evolving multicultural society. Lastly, the psychiatric manifestations of refugees and asylum seekers are analysed in the context of a series of vulnerabilities and deprivations they have experienced, including basic human rights.

Australian Aborigines and alcohol: a review

Following a summary of the relevant historical and legislative background, this article reviews the literature on: (i) rates of alcohol usage and problem drinking in Aboriginal populations; (ii) adverse effects of drinking; (iii) suggested causes of problem drinking among Aborigines; and (iv) treatment and preventive initiatives. The need to examine Aboriginal alcohol use in the wider context of socio-economic deprivation and rapid social change is emphasized. Key issues warranting further research attention are identified and, while recognizing the difficulties inherent in doing so, suggestions are made as to how the quality of research in the area might be raised. It is concluded that, without long-term planning and commitment of the necessary resources by government, little progress will be made in reducing the problems associated with Aboriginal use of alcohol.

The epidemiology of suicide and attempted suicide among young Australians

OBJECTIVE

This paper summarises a report to the NHMRC the objectives of which were to review research into the epidemiology of youth suicide in Australia and identify gaps in research.

METHOD

Literature searches were conducted. A limited amount of new data analysis was included to shed light on reliability issues of official Australian suicide data.

RESULTS

The review examined suicide data systems, including issues to do with coroners, the Australian Bureau of Statistics and alternative systems. The epidemiological areas reviewed included: all ages, youth, age and gender, geographical, socioeconomic, marital, indigenous, migrants, suicides in custody and gay and lesbian suicides.

CONCLUSION

While much is known about the epidemiology of youth suicide, much remains to be clarified. Study of indigenous issues is perhaps the most neglected area; study of family issues may be potentially be the most productive.

Drugs, sex and social science: social science research and health policy in Australia

Social science health research in Australia has undergone considerable expansion through government sponsorship of projects that complement or address issues related directly to policy and program concerns. In examining the rationale for supporting social science research, and the difficulties that social scientists often face in return in presenting their work in ways that might optimize funding, the paper first explores the paradigmatic tensions between social and biomedical scientists, that in turn influence funding decisions and potentially the receipt and uptake of social research. It also addresses the incorporation of the language and concepts of social science within policy documents, using 'ethnicity' as an exemplar of this. The paper then documents and analyses federal targeted-funding programs for health research, and the measures taken to encourage policy-relevant research. In particular, the paper discusses the funding programs that operate for drug and alcohol use and HIV/AIDS.

Adolescent suicide clusters: evidence, mechanisms and prevention

Cluster suicides account for an estimated 5% of all teenage suicides in the USA. Not all hypothesised clusters are verified, however, when submitted to statistical analysis. This paper reviews possible mechanisms underlying adolescent cluster suicides using the "infectious disease model", key concepts of which are host susceptibility, modes of transmission, degree of virulence, and dose dependency. Preventive measures against cluster suicides are reviewed, including primary prevention against youth suicide, tempered media reporting of suicide, and "postvention strategies" directed to communities affected by suicide.

An examination of recent suicides in remote Australia: further information from the Kimberley

Aboriginal suicide has emerged as an issue of public concern only within the recent past. Within the last decade there has been a substantial increase from levels that were previously low. Under the shadow of the Royal Commission into Aboriginal Deaths in Custody these increases, involving primarily young adult males, raise serious questions. Two years ago the author examined a series of suicides that had occurred in one area of remote Aboriginal Australia, the Kimberly region of Western Australia. This paper examines suicides that have occurred in the following two years, with comparisons both with the previous suicides, and with a group of age-matched Aborigines from the general Kimberly population drawn from a random sample survey.

Out of sight, out of mind--1. Emergent patterns of self-harm among aborigines of remote Australia

In Australia, the Royal Commission into Aboriginal Deaths in Custody has done more to draw attention to the experience of Aborigines nationwide than any of its many predecessors. In the first paper the author summarises findings of the Commission to date and draws attention to the wider contexts of suicides in custody by providing information on self-harmful behaviours and changing Aboriginal mortality patterns from the remote Kimberley region of Western Australia.

Using a socio-historical frame to analyse aboriginal self-destructive behaviour

The last two decades have seen rapid changes in many facets of Aboriginal society, including morbidity and mortality. The same period has witnessed a dramatic increase in writing about and by Aborigines and this has necessitated a re-examination of the national "history" to include the indigenous people of Australia. Medical workers in Aboriginal Australia should be alert to the historical forces determining patterns of ill-health. Psychiatry in particular must develop this perspective if it is to participate with Aborigines in addressing emergent patterns of behavioural distress including suicide, parasuicide, ludic behaviour and self-mutilation. This paper demonstrates the importance of the socio-historical frame in the examination of these behaviours from one discrete region in isolated Aboriginal Australia: the Kimberley.