What we know
- Indigenous Australians experience persistently poorer health outcomes for their entire lives than non-Indigenous Australians.
- Indigenous people also experience poorer social and emotional wellbeing outcomes than non-Indigenous Australians. For instance, among Indigenous adults high or very high levels of psychological distress are nearly 3 times the rate of non-Indigenous adults. Rates of intentional self harm among young Indigenous people aged 15–24 years are 5.2 times the rate of non-Indigenous young people.
- Ten per cent of the health gap between Indigenous and non-Indigenous Australians in 2003 has been linked to mental health conditions; another 4% of the gap is attributable to suicide.
- Indigenous views of mental health and social and emotional wellbeing are very different to those of non-Indigenous Australians. This affects the way in which policies, programs, early prevention and intervention initiatives need to be framed, formulated, implemented, measured and evaluated.
- The provision of mental health services for Indigenous people is both inadequate and inappropriate, and changes need to be implemented immediately (NMHC 2012).
- Current funding for dedicated Indigenous mental health programs and services is limited. Existing interventions focus on supporting families to prevent child abuse and neglect, harmful alcohol and substance misuse, and suicide.
- There is evidence that programs that are developed or implemented in accordance with the 9 guiding principles underpinning the National Strategic Framework for Aboriginal and Torres Straits Islander Peoples’ Mental Health and Social and Emotional Well Being 2004–2009 (SHRG 2004) are more likely to be effective and have positive outcomes than those that do not.
- Programs that show promising results for Indigenous social and emotional wellbeing are those that encourage self-determination and community governance, reconnection and community life, and restoration and community resilience.
- Important program features include:
- a holistic approach
- a focus on recovery and healing from stress and trauma
- a means of empowering people to regain a sense of control and mastery over their lives
- strategies that are Indigenous-led, family focused, culturally responsive, and context specific
- interdisciplinary approaches that provide outreach services and transport
- partnerships with the Aboriginal Community Controlled Health Services sector and local communities.
- There is evidence that both mainstream and Indigenous-specific programs and services that adhere to the Closing the Gap service-delivery principles of engagement, access, integration and accountability are more effective than those that do not.
- ‘Participatory action research’ approaches provide an effective mechanism for involving Indigenous families and communities in developing, implementing and evaluating programs. Programs that adopt participatory action research tend to be more culturally responsive to local contexts and foster a culturally safe environment for program participants.
- Engaging in cultural activities is an indicator of positive cultural identity that is associated with better mental health among Indigenous Australians.
What doesn’t work
- Programs that fail to take account of Indigenous values, lifestyles, aspirations, family and differing needs and capacities of Indigenous people in diverse, complex economic and social circumstances.
- Programs and services developed with inadequate timeframes, funding and program support that fail to address health in a holistic manner and focus on the individual without regard for the family and community context.
- Provision or adaptation of mainstream programs by mainstream providers for Indigenous people without Indigenous community involvement or consultation.
- Programs that are short-term, inflexible and designed and delivered without consultation, engagement and partnership with the community and the Aboriginal Community Controlled Health Service sector.
- Poor engagement with research evidence by the mainstream sector can lead to systemic racism, lack of cultural understanding and appropriateness, and a reliance on ‘one size fits all’ approaches.
- Performance indicators and reporting requirements, developed in accordance with the values and principles of the mainstream mental health system, that do not always align with Indigenous cultural ways of working and views of social and emotional wellbeing.
What we don’t know
- The effect on mental health outcomes of culturally appropriate, early intervention programs maintained over the long term.
- The additional costs to health and mental health and wellbeing of not implementing programs in culturally responsive, appropriate and respectful ways.
- The long-term cost effectiveness of Indigenous-specific programs—there have been few program evaluations, and where evaluations have taken place, they have usually been conducted before the long-term effects could be assessed.
- The extent to which Access to Allied Psychological Services (ATAPS) Tier 2 is being delivered in accordance with the objectives and principles developed through the Aboriginal and Torres Strait Islander Mental Health Advisory Group.
- The significance of access barriers for young Indigenous people to web-based and telephone helpline services.
- What we know
- What we don’t know
3. Key determinants
4. Policy context
- Indigenous mental health policies
- Current policy challenges
5. Programs and service delivery
6. Access to Allied Psychological Services
- Effective program and service delivery principles
7. Program review
- Summary of program outcomes
- Themes for success
- Funding issues
9. Limitations of this review
Appendix 1: Related Clearinghouse issues papers and resource sheets
Appendix 2: Assessing program appropriateness
Appendix 3: Criteria for assessment of evidence
Appendix 4: Pathways to Recovery
Appendix 5: Framework of program evaluation outcomes
Appendix 6: Summary of assessment of appropriateness and effectiveness of programs
End matter: Acknowledgments; Abbreviations; Glossary; References; Related publications