Quality of life

Aboriginal and Torres Strait Islander people are Australia's indigenous population and evidence indicates that mental illness is a common and crippling problem among these diverse peoples (NSW Aboriginal Mental Health Policy 1997). They experience a disproportionately high rate of mental health problems including suicide, hospitalisation and substance misuse. Factors such as earlier death rates, child removals, incarceration and infant mortality rates all contribute to higher rates of grief, loss and trauma experienced by Aboriginal and Torres Strait Islander individuals, families and communities (NSW Health 2003).

Mental illness as understood in Aboriginal communities
Indigenous people do not see illness, mental or otherwise, as discrete. Wellbeing is an holistic and collective issue, with specific individual health problems being of little relevance if not considered as part of wider social, spiritual and community health (Burdekin et al. 1993). Mental illness or disturbance may be seen as a 'soreness of the spirit' caused by loss of social and family networks, destruction of kinship and family, dislocation from ancestral lands and the conflict between tradition and the pressures of trying to exist within and alongside European culture (Holden 1997).

The prevalence of schizophrenia among Aboriginal and Torres Strait Islander people has been estimated at between 0.2 to 4.2 per cent (Kyaw 1993), a reflection of the incidence rate in the general population (which ranges from one to three per cent). While there is no equivalent term to 'schizophrenia' or 'psychosis', words such as 'madness' (e.g. Walpanalpa) and 'silly' (e.g. Rama rama) are common throughout all Aboriginal languages and are often used in the context of abnormal or disturbed behaviour.

Within the indigenous population indicators of disturbed behaviour include: wandering around at night; talking incessantly; sleep disturbance; hearing voices; breaking taboos (e.g. mentioning the names of dead people); frequently moving between communities; keeping out of normal social interactions; sleeping anywhere; and appearing angry, restless, frustrated, mistrustful, bored or lonely. Alcohol and other drug misuse was closely interwoven with these problems and perceptions of them.

Within the Aboriginal and Torres Strait Islander communities, disturbed behaviour is usually attributed to some problem in the head, with a variety of causes corresponding to physical, spiritual, psychological, substance misuse, or social factors. In general, Aboriginal people respond to such behaviour with a strong sense of family responsibility with people seeking outside assistance only when there were extreme problems.

The identified issues and problems
Historical events and current disadvantages have eroded the wellbeing of many Aboriginal and Torres Strait Islander people so that they are more vulnerable to stresses. Research has shown that Aboriginal people are more than twice as likely to suffer degrees of stress which impair their ability to cope with day to day living (Swan & Raphael 1995). People with mental illness who are also facing the stresses of being an Indigenous Australian may experience exacerbation of their symptoms. Unfortunately, there is no research examining the combined impact of having a mental illness and being an Indigenous Australian. Thus it is important to look at stressors Aboriginal and Torres Strait Islander people face in general, and why the mental health system is not counteracting these problems.

Historical events
Aboriginal and Torres Strait Islander societies were extremely diverse and linked physically and spiritually to the land on which they lived. European settlement involved the killing of many Indigenous people, and those who survived faced: removal from their homes and land with which they were culturally and spiritually linked; forced movement to settlements; removal from their natural sources of food and ways of life; forced assimilation, by denying the right to cultural expression; removal of children from their parents (stolen generations); and forced dependence.

Australia's indigenous populations have faced enormous loss, confusion and displacement. Many Indigenous Australians, have experienced a childhood history of separation from biological parents, neglect or institutionalisation, all of which increase the likelihood of a person experiencing a mental health problems. These issues continue to impact on the present.

Current disadvantages
Social and economic disadvantage
The NSW Department of Health (2003) highlights the following issues facing the indigenous Australian community:

Lower median weekly income: approximately $76 lower than the median income of non-indigenous Australians;

Higher unemployment rates: 20% compared to 7%;

Lower educational attainment: 17% qualified compared to 40%;

More crowded and inadequate housing;

Children are six times more likely to be removed from their families;

Indigenous people make up 21% of the total prisoner population and 70% of the Northern Territory population (higher by 16 times than non-indigenous Australians).

Health Disadvantage
The NSW Department of Health (2003) highlights the following issues facing the indigenous Australian community:

Aboriginal and Torres Strait Islander people have the poorest health status of all Australians;

Average life expectancy is lower by 20 years; infant mortality is three times that of the non-indigenous population;

High burden of illness in early adult life;

Mortality rate in the peak of adult life is 3-4 times greater.

Mental Health Disadvantage:
The NSW Department of Health (2003) highlights the following issues facing the indigenous Australian community:

Rates of depression, suicide and self-harm are much higher;

Higher rates of mental disorders, correlated with higher rates of substance misuse;

Over twice as many deaths associated with mental and behavioural disorders.

Rate of hospitalisation for the indigenous population due to mental disorders is three times higher;

75% of Aboriginal and Torres Strait Islanders have inadequate access to visiting or resident mental health workers;

Disproportionately low access to general practitioners and psychiatrists;

Only 38% of Commonwealth funded Aboriginal Controlled Health Services have a dedicated mental health or social and emotional well being worker.

Barriers in assessment and service delivery
The concept of mental health
Services often fail from the outset, as they do not acknowledge that indigenous people view mental health differently to the mainstream European view. The traditional western approach, of diagnosing and treating a specific physical or mental problem of an individual, may not be seen as relevant to the needs of many indigenous people who take a more holistic approach to mental health and social, emotional and spiritual well being and who place a high emphasis on family and community input.

Assessment issues
Assessment may be inappropriate for various reasons:

failure to recognise indigenous views of mental health;

the use of non-indigenous cultural standards to evaluate the appropriateness of behaviour;

the use of inappropriate tools and diagnostic criteria; and

lack of understanding of language or specific language variations, including recognition of expressions, slang and colloquialisms.
(O'Shea 1996)

Overcoming Barriers
Indigenous peoples' mental health problems, including the exacerbation of the symptoms of schizophrenia, may be lessened if the identified issues and problems of these people are recognised and addressed. While this is not a simple task, a committed approach to the empowerment and recognition of indigenous people in our society, as expressed in policy, media representations and community attitudes, is a starting point.

Service delivery
Assessment and treatment services can be made more appropriate if they incorporate the following principles:

Take into account the holistic view of mental health and social, emotional and spiritual well being, including a cyclic concept of life-death-life and the importance of community wellbeing.

When treating or supporting an Indigenous Australian with a mental illness, be prepared to acknowledge and address other issues that are important to and impact upon the person, such as trauma and loss. The service provider should be aware of these issues, but ensure that the individual is determining what is important.

Do not make generalisations and assumptions about Indigenous people, as there are many indigenous groups, with varying cultural issues.

Be receptive to requests to incorporate traditional treatments into mental health services, especially when the community perceives the person's unusual behaviour (such as hallucinations) as a normal reaction to spiritual matters (Holden 1997).

Conduct assessment, diagnosis and treatment within the community as far as possible. Relationships and context are important to Indigenous people yet often assessment and treatment is conducted far from home and family.

Support Indigenous peoples' right to self-determination in mental health care processes by:

employing indigenous health workers to liaise between communities and mental health services (accessing indigenous expertise and knowledge);

providing cultural awareness training for non-indigenous mental health workers;

educating and training indigenous health workers in mental health issues. The Charles Sturt University, which offers several degrees in Indigenous health is an example of such an initiative (Singh & Kanowski 1996);

training indigenous workers to educate non-indigenous health workers; and
involving indigenous people with schizophrenia, their families and carers, and other community members in training and education programs.

The importance of all these issues has been emphasised by the development of an Action Plan on Social and Emotional Well Being. This Action Plan is a four-year co-ordinated program for specific indigenous mental health services, recognising the role of the family and the need for an holistic approach, providing training and a focus on programs that are community and culturally based.

References

For a list of references for this quality of life section on Aboriginal and Torres Strait Islander People, click here.

For more information on Aboriginal and Torres Strait Islander people, visit the ATSIC web site.

To ensure the information presented here is in line with current research and best practice, this section will be updated regularly, so make sure you bookmark this page and return often. If you would like to be alerted to updates automatically, join our free mailing list. We also encourage you to email us with your views on the 'quality of life' content, whether you are a consumer, carer or mental health professional. The Guidelines were developed using a collaborative approach and we would like to ensure that any updates to this section are also carried out in a collaborative manner, so your views are very important to us.

This section on 'quality of life' proudly sponsored by:

SFNSW Inc...Locked Bag 5014 Gladesville NSW 1675...ph: 02 9879 2600...fax: 02 9879 2699...Email: admin@sfnsw.org.au







			Aboriginal& Torres Strait Islander People Aboriginal and Torres Strait Islander people are Australia's indigenous population and evidence indicates that mental illness is a common and crippling problem among these diverse peoples (NSW Aboriginal Mental Health Policy 1997). They experience a disproportionately high rate of mental health problems including suicide, hospitalisation and substance misuse. Factors such as earlier death rates, child removals, incarceration and infant mortality rates all contribute to higher rates of grief, loss and trauma experienced by Aboriginal and Torres Strait Islander individuals, families and communities (NSW Health 2003). Mental illness as understood in Aboriginal communities Indigenous people do not see illness, mental or otherwise, as discrete. Wellbeing is an holistic and collective issue, with specific individual health problems being of little relevance if not considered as part of wider social, spiritual and community health (Burdekin et al. 1993). Mental illness or disturbance may be seen as a 'soreness of the spirit' caused by loss of social and family networks, destruction of kinship and family, dislocation from ancestral lands and the conflict between tradition and the pressures of trying to exist within and alongside European culture (Holden 1997). The prevalence of schizophrenia among Aboriginal and Torres Strait Islander people has been estimated at between 0.2 to 4.2 per cent (Kyaw 1993), a reflection of the incidence rate in the general population (which ranges from one to three per cent). While there is no equivalent term to 'schizophrenia' or 'psychosis', words such as 'madness' (e.g. Walpanalpa) and 'silly' (e.g. Rama rama) are common throughout all Aboriginal languages and are often used in the context of abnormal or disturbed behaviour. Within the indigenous population indicators of disturbed behaviour include: wandering around at night; talking incessantly; sleep disturbance; hearing voices; breaking taboos (e.g. mentioning the names of dead people); frequently moving between communities; keeping out of normal social interactions; sleeping anywhere; and appearing angry, restless, frustrated, mistrustful, bored or lonely. Alcohol and other drug misuse was closely interwoven with these problems and perceptions of them. Within the Aboriginal and Torres Strait Islander communities, disturbed behaviour is usually attributed to some problem in the head, with a variety of causes corresponding to physical, spiritual, psychological, substance misuse, or social factors. In general, Aboriginal people respond to such behaviour with a strong sense of family responsibility with people seeking outside assistance only when there were extreme problems. The identified issues and problems Historical events and current disadvantages have eroded the wellbeing of many Aboriginal and Torres Strait Islander people so that they are more vulnerable to stresses. Research has shown that Aboriginal people are more than twice as likely to suffer degrees of stress which impair their ability to cope with day to day living (Swan & Raphael 1995). People with mental illness who are also facing the stresses of being an Indigenous Australian may experience exacerbation of their symptoms. Unfortunately, there is no research examining the combined impact of having a mental illness and being an Indigenous Australian. Thus it is important to look at stressors Aboriginal and Torres Strait Islander people face in general, and why the mental health system is not counteracting these problems. Historical events Aboriginal and Torres Strait Islander societies were extremely diverse and linked physically and spiritually to the land on which they lived. European settlement involved the killing of many Indigenous people, and those who survived faced: removal from their homes and land with which they were culturally and spiritually linked; forced movement to settlements; removal from their natural sources of food and ways of life; forced assimilation, by denying the right to cultural expression; removal of children from their parents (stolen generations); and forced dependence. Australia's indigenous populations have faced enormous loss, confusion and displacement. Many Indigenous Australians, have experienced a childhood history of separation from biological parents, neglect or institutionalisation, all of which increase the likelihood of a person experiencing a mental health problems. These issues continue to impact on the present. Current disadvantages Social and economic disadvantage The NSW Department of Health (2003) highlights the following issues facing the indigenous Australian community: Lower median weekly income: approximately $76 lower than the median income of non-indigenous Australians; Higher unemployment rates: 20% compared to 7%; Lower educational attainment: 17% qualified compared to 40%; More crowded and inadequate housing; Children are six times more likely to be removed from their families; Indigenous people make up 21% of the total prisoner population and 70% of the Northern Territory population (higher by 16 times than non-indigenous Australians). Health Disadvantage The NSW Department of Health (2003) highlights the following issues facing the indigenous Australian community: Aboriginal and Torres Strait Islander people have the poorest health status of all Australians; Average life expectancy is lower by 20 years; infant mortality is three times that of the non-indigenous population; High burden of illness in early adult life; Mortality rate in the peak of adult life is 3-4 times greater. Mental Health Disadvantage: The NSW Department of Health (2003) highlights the following issues facing the indigenous Australian community: Rates of depression, suicide and self-harm are much higher; Higher rates of mental disorders, correlated with higher rates of substance misuse; Over twice as many deaths associated with mental and behavioural disorders. Rate of hospitalisation for the indigenous population due to mental disorders is three times higher; 75% of Aboriginal and Torres Strait Islanders have inadequate access to visiting or resident mental health workers; Disproportionately low access to general practitioners and psychiatrists; Only 38% of Commonwealth funded Aboriginal Controlled Health Services have a dedicated mental health or social and emotional well being worker. Barriers in assessment and service delivery The concept of mental health Services often fail from the outset, as they do not acknowledge that indigenous people view mental health differently to the mainstream European view. The traditional western approach, of diagnosing and treating a specific physical or mental problem of an individual, may not be seen as relevant to the needs of many indigenous people who take a more holistic approach to mental health and social, emotional and spiritual well being and who place a high emphasis on family and community input. Assessment issues Assessment may be inappropriate for various reasons: failure to recognise indigenous views of mental health; the use of non-indigenous cultural standards to evaluate the appropriateness of behaviour; the use of inappropriate tools and diagnostic criteria; and lack of understanding of language or specific language variations, including recognition of expressions, slang and colloquialisms. (O'Shea 1996) Overcoming Barriers Indigenous peoples' mental health problems, including the exacerbation of the symptoms of schizophrenia, may be lessened if the identified issues and problems of these people are recognised and addressed. While this is not a simple task, a committed approach to the empowerment and recognition of indigenous people in our society, as expressed in policy, media representations and community attitudes, is a starting point. Service delivery Assessment and treatment services can be made more appropriate if they incorporate the following principles: Take into account the holistic view of mental health and social, emotional and spiritual well being, including a cyclic concept of life-death-life and the importance of community wellbeing. When treating or supporting an Indigenous Australian with a mental illness, be prepared to acknowledge and address other issues that are important to and impact upon the person, such as trauma and loss. The service provider should be aware of these issues, but ensure that the individual is determining what is important. Do not make generalisations and assumptions about Indigenous people, as there are many indigenous groups, with varying cultural issues. Be receptive to requests to incorporate traditional treatments into mental health services, especially when the community perceives the person's unusual behaviour (such as hallucinations) as a normal reaction to spiritual matters (Holden 1997). Conduct assessment, diagnosis and treatment within the community as far as possible. Relationships and context are important to Indigenous people yet often assessment and treatment is conducted far from home and family. Support Indigenous peoples' right to self-determination in mental health care processes by: employing indigenous health workers to liaise between communities and mental health services (accessing indigenous expertise and knowledge); providing cultural awareness training for non-indigenous mental health workers; educating and training indigenous health workers in mental health issues. The Charles Sturt University, which offers several degrees in Indigenous health is an example of such an initiative (Singh & Kanowski 1996); training indigenous workers to educate non-indigenous health workers; and involving indigenous people with schizophrenia, their families and carers, and other community members in training and education programs. The importance of all these issues has been emphasised by the development of an Action Plan on Social and Emotional Well Being. This Action Plan is a four-year co-ordinated program for specific indigenous mental health services, recognising the role of the family and the need for an holistic approach, providing training and a focus on programs that are community and culturally based. References For a list of references for this quality of life section on Aboriginal and Torres Strait Islander People, click here. For more information on Aboriginal and Torres Strait Islander people, visit the ATSIC web site. To ensure the information presented here is in line with current research and best practice, this section will be updated regularly, so make sure you bookmark this page and return often. If you would like to be alerted to updates automatically, join our free mailing list. We also encourage you to email us with your views on the 'quality of life' content, whether you are a consumer, carer or mental health professional. The Guidelines were developed using a collaborative approach and we would like to ensure that any updates to this section are also carried out in a collaborative manner, so your views are very important to us. This section on 'quality of life' proudly sponsored by: