Indigenous Mental Health in Remote Communities

1. Indigenous Mental Health in Remote Communities Pauline Guerin, PhD School of Nursing & Midwifery Flinders University

2. Projects and Team • Australian Research Council funding, 2008-2010 • Applying a contextual model of community research and intervention • AIATSIS (Australian Institute of Aboriginal and Torres Strait Islander Studies) Funding, 2008-2010 • Community perspectives on the issues, treatment and service delivery • Project Team • Professor Bernard Guerin, UniSA Psychology • Dr. Pauline Guerin, Flinders SONM • Deirdre Tedmanson, UniSA School of Social Work and Social Policy • Yvonne Clark, University of Adelaide Psychology (formerly CAMHS)

3. Aims of Project • to document systematically remote Indigenous communities’ and service providers’ views on: • mental health and well-being, • experiences of the mental health services, • traditional interventions (where appropriate), • to obtain more diverse and complex stories about how factors such as: • loss of land, • family and community changes, • loss of traditions, • and spirituality • contribute to mental ill health and compromised well-being.

4. Aims cont… • to recommend how communities and services might use such information while being mindful that such recommendations need to retain the diversity inherent in the communities, and • to provide guidance for local interventions rather than a generic plan wrongly assumed to work anywhere

5. Conceptions of Mental Health • There have been moves away from individual, biological approaches to mental health towards social approaches • Indigenous-specific approaches • Transcultural approaches • Dealing with specific issues (e.g., petrol sniffing) • The role of racism and discrimination in mental health and well-being

6. Indigenous approaches • Emphasis on roles of family, land, traditions, whole-of-life, spirituality & community involvement • Anderson, 2004; Atkinson, 2002; Dudgeon, Garvey & Pickett, 2000; Hunter, 2004; Trudgen, 2000; Vicary & Bishop, 2005; Vicary & Westerman, 2004

7. Transcultural Mental Health • E.g., refugee mental health, focus on community-based approaches • Burr, 2002; Dossa, 2002; Ferguson & Pittaway, 1999; Giosan, Glovsky & Haslam, 2001; Guerin, Guerin, Diiriye, & Yates, 2004; Guerin, Elmi & Guerin, 2006; Hodes, 2002; Holzinger, Kilian, Lindenback, Petscheleit, & Angermeyer, 2003; Ryan, Elmi, Guerin, & Guerin, 2006; Tew, 2005; Wagner, Duveen, Themel & Verma, 1999

8. Specific problem interventions • E.g., petrol sniffing, alcohol, & violence • Brady, 2002; Capp, Deane & Lambert, 2001; D’Abbs & MacLean, 2000; D’Abbs & Brady, 2004; Day, Howells & Casey, 2003; Gray, Pulver, Saggers & Waldon, 2006; Neilson, 2005; Tedmanson & Maher, 2003

9. Racism & Discrimination • Growing international literature relating to how racism and discrimination can contribute to mental ill health • Clark, Anderson, Clark & Williams, 1999; Jasinskaja-Lahti, Liebkind & Perhoniemi, 2006 • But methods can be overly simplified, relying on self-reports/ perceptions of discrimination/ racism at best

10. Remote Indigenous Mental Health • What has this looked like in the literature? • Some individual pathologising, with adaptations of Western approaches • Family & community breakdown  substance abuse, violence  individual interventions • Patel, 2003; Petchokovsky, San Roque, Napaljarri Jurra & Butler 2004; Pollitt, 1997; Sheldon, 2001

11. Social & Political Pressures • Social and political pressures on community community problems  community interventions • Brady, 1992; Brown, Sellers, Brown, & Jackson, 1999; Campbell & Stojanovski, 2001; D’Abbs & MacLean, 2000; Capp, Deane & Lambert, 2001

12. Traditional Approaches • Traditional approaches, eg., Ngangkari • Cawte, 1996, Ngaanyatjarra Pitjantjatjara Yankunytjatjra Women’s Council Aboriginal Corporation, 2003; Phillips, 2003; Reid, 1983; Ryan, Elmi, Guerin, & Guerin, 2006

13. Questions… • Is mental illness in remote communities a problem? Or are these made more salient with media, etc.? • How are issues viewed or defined in communities? • What does ‘breakdown’ of family and community mean?

14. Questions, cont. • How does ‘loss of land’, ‘breakdown of family and community’, loss of tradition and spirituality actually contribute to mental ill-health? • i.e., what are the causal pathways? • How do successful projects actually work? • i.e., why is it that sometimes what seems a great intervention falls apart when transplanted into another location?

15. What might we achieve? • Portray a more diverse and complex glimpse into how ‘mental health’ and well-being of individuals and communities is viewed • Gain a better idea of the diverse links between the loss of land and control, the changes in families and communities, and the individual behaviors that might be classified as “mental health” issues

16. What might we achieve? cont. • Portray a more diverse and complex glimpse into what can be done by communities about such problems (if they are even seen as problems) • Show how rich contextual data can be obtained and documented and retaining diversity • Show how contextual data can provide policy and intervention guidance

17. Methods: A ‘community down’ approach • Using principles of Community Based Research • Involvement of community in research process • May involve ‘capacity’ building • Partnership, shared responsibility, ownership • ‘Gives back’ • Action oriented- interventions

18. Methods, cont. • Informal interviews/ yarns or focus groups • Gains current issues, but can risk being ‘dumping grounds’ for problems • Oral histories • Can provide deeper, more contextualised accounts • Influence of time & social context on ‘remembering’ • ‘On the spot’ experience reports • Researchers-in-training • Benefits- gets at what is happening right now, without influence of other factors • Participatory experiences • Over the course of the project and our involvement in other projects, provides opportunities to see ourselves what is happening… eg., buying a car in Adelaide

19. Themes • How community members and service providers each see the ‘mental health’ and well-being in remote communities • What issues are seen as mental health issues • How specific “symptoms” or DSM categories of “mental illness” are viewed • Traditional treatments, both historic and currently practiced, in so far as communities are willing to reveal to us

20. Themes cont… • Experiences when dealing with mainstream mental health services as clients or carers • The diverse links between the loss of land and control, the changes in families and communities, discriminatory experiences, and the individual behaviours that might be classified as “mental health” issues • What can be done by communities about such problems (if they are even seen as problems)

21. Project Sites • AIATSIS • APY lands, large community and nearby homelands • ARC • APY lands, north Flinders Ranges, & other rural site TBA • Rationale: selecting only 1 site limits a broader understanding and anonymity, but trying to aim for multiple sites would limit depth of data and ability to ‘contextualise’

22. Status of Project • Currently gaining ethical approval (some minor revisions) • Other projects (e.g., Desert Knowledge, other ARC funding) has maintained involvement with communities

23. Some Challenges • Distance • Challenges the ability to apply CBPR approaches • Ethics • Committees accustomed to Western scientific ethics which are not always ‘ethical’ in ‘community’ contexts, e.g., use of names • Movements of researchers since initial development • Delayed progress

24. Web links of interest • AIATSIS: Australian Institute for Aboriginal and Torres Strait Islander Studies • http://www.aiatsis.gov.au/ • ARC: Australian Research Council • http://www.arc.gov.au/ • MMHA: Multicultural Mental Health Australia • http://www.mmha.org.au/ • AUSEINET Australian Network for Promotion,Prevention and Early Intervention for Mental Health • http://auseinet.com/ • Aboriginal Health Research Unit • http://aboriginalhealth.flinders.edu.au/ • Anangu Lands Paper Tracker • www.papertracker.com.au

25. Indigenous Mental Health in Remote Communities Pauline Guerin pauline.guerin@flinders.edu.au Bernard Guerin Bernard.guerin@unisa.edu.au Deirdre Tedmanson Deirdre.tedmanson@unisa.edu.au Yvonne Clark Yvonne.clark@adelaide.edu.au