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Mental health in rural and remote communties: annotated bibliography

Allen, J., Inder, K. J., Lewin, T. J., Attia, J., & Kelly, B. J. (2012). Social support and age influence distress outcomes differentially across urban, regional and remote Australia: an exploratory study. BMC Public Health, 12(1), 928.
The aim of this study was to examine whether increasing remoteness had any effect on psychological distress. 4219 people over 55 years were surveyed across New South Wales about their levels of social support, demographic details, remoteness and levels of psychological distress experienced. The report concluded that remoteness could reduce the levels of psychological distress associated with a lack of social support. This may be due to people living in remote areas having a higher level of self-sufficiency. The study was limited in that it only studied older people.
Blignault, I., Haswell, M., & Pulver, L. J. (2016). The value of partnerships: lessons from a multi‐site evaluation of a national social and emotional wellbeing program for Indigenous youth. Australian and New Zealand Journal of Public Health, 40(S1).
This study provides the results of a three-year evaluation of SAM our way- a program that aimed to improve the social and emotional wellbeing of Aboriginal and Torres Strait Islander living in remote and regional areas of Australia. Five out of the 14 sites were studied, selecting from diverse locations over several states and in depth case studies were performed. The best performing sites were those where strong local partnerships had been formed with the local Indigenous community. Several lessons were learned including the importance of program design and resourcing and ways of working. It was essential to build partnerships with the local community including training and engaging members and working consistently with them, taking things slowly. Evaluation is essential and needs to be built into the programs. Activities need to be engaging and, effective integrating with other programs and services.
Carey, T. A., Wakerman, J., Humphreys, J. S., Buykx, P., & Lindeman, M. (2013). What primary health care services should residents of rural and remote Australia be able to access? A systematic review of “core” primary health care services. BMC Health Services Research, 13(1), 178.
A systematic review was performed to address which primary healthcare services should be accessible to all Australians regardless of geography. It was done in response to the inequality in access to healthcare faced by those in remote and rural communities. It concluded that defining a list of core services was difficult but that they should be an appropriate fit for service and evidence-based. Policy makers, consumers, practitioners and researchers need to work together in developing them to ensure that they are affordable and accessible to all.
Inder, K. J., Handley, T. E., Fitzgerald, M., Lewin, T. J., Coleman, C., Perkins, D., & Kelly, B. J. (2012). Individual and district-level predictors of alcohol use: cross sectional findings from a rural mental health survey in Australia. BMC Public Health, 12(1), 586.
Excessive alcohol use has been cited as a problem in rural and remote Australia and this study aimed to examine the geographical variation in rates and the potential effects of socio-economic disadvantage, population change and remoteness from services in contributing to this disparity. A survey was performed on 1981 people randomly taken from the electoral role using the Australian Rural Mental Health Study. It found that gender, age, marital status and personality status were the biggest contributors to at risk alcohol use. Financial advantage and experiencing multiple recent adverse life events also contributed to increased alcohol use. Relatively few district-level factors were linked to increased alcohol consumption after controlling for other factors.
Inder, K. J., Handley, T. E., Johnston, A., Weaver, N., Coleman, C., Lewin, T. J., & Kelly, B. J. (2014). Determinants of suicidal ideation and suicide attempts: parallel cross-sectional analyses examining geographical location. BMC Psychiatry, 14(1), 208.
Suicide rates are consistently higher in rural than urban settings so this study aimed to examine if there were any differences in determinants of suicidal ideation and attempts between the areas. The main determinants were psychological distress and mental illness. Parallel cross-sectional analyses were performed using data from the 2007 National Survey of Mental Health and Wellbeing (n=8463) and the Australian Rural and Mental Health Study (n=634). The former was under representative of rural and remote participants and the latter was over representative. Geographical location was not found to be associated with suicidal ideation or attempt, but socio-economic factors were significantly associated with higher rates of suicidality. Access to lethal means and isolation, resulting in not being found quickly may also affect the rate of suicidality. It stressed the importance of developing and evaluating targeted evidence-based intervention strategies for at risk groups.
Morandini, J. S., Blaszczynski, A., Dar‐Nimrod, I., & Ross, M. W. (2015). Minority stress and community connectedness among gay, lesbian and bisexual Australians: a comparison of rural and metropolitan localities. Australian and New Zealand Journal of Public Health, 39(3), 260-266.
The aim of this study was to examine the impact of locality on minority stress experienced by lesbian, gay and bisexual (LGB) Australians. Increased stress and lack of community connectedness experienced by LGB individuals has been associated with increased depression, drug and alcohol use and suicidality. Data was collected by survey (n=1306) to assess minority stressors, connection with community and social isolation. The results were than analysed to assess the effect of locality on these stressors independent of gender, age, ethnicity, education and income. Those living in rural and remote areas and unexpectedly outer metropolitan areas experienced higher levels of stressors and high LGB disconnection than those living in inner metropolitan areas. Reluctance to disclose sexuality, including increased concealment of sexuality from friends and internalised homophobia in men were more common in rural and remote communities. This will put them at increased risk of psychiatric morbidity. It recommends health promotion in these communities that is aimed at reducing homophobia and discrimination and support services to assist those struggling with stigma and isolation.

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Annotated bibliography: Closing the gap in Indigenous mental health

Calma, T., Dudgeon, P., & Bray, A. (2017). Aboriginal and Torres Strait Islander social and emotional wellbeing and mental health. Australian Psychologist, 52(4), 255-260.

This report identifies the large gap suffered by the Indigenous community as compared to non-Indigenous Australians. It discusses several reasons for this including the trauma of colonisation, racism, poverty, disconnection from their culture and healthcare practices that are not culturally appropriate. It emphasises that Indigenous mental health should be an approach that improves the social and emotional well-being (SEWB) of Indigenous Australians. This a more holistic and collaborative approach to health than the Western concept and it incorporates the many socio-economic factors that influence Aboriginal health with an emphasis on prevention. Community engagement, involvement and empowerment are essential components of any initiative, along with self-determination and a recognition of cultural differences.

Carey, T. A., Dudgeon, P., Hammond, S. W., Hirvonen, T., Kyrios, M., Roufeil, L., & Smith, P. (2017). The Australian Psychological Society’s apology to Aboriginal and Torres Strait Islander people. Australian Psychologist, 52(4), 261-267.

This report examines the history of The Australian Psychology Society’s (APS) treatment of Aboriginal Australians. It discusses the lack of involvement of Indigenous Australians in policy and advisory roles and admits to a lack of articles in Australian Psychologist about improving Indigenous SEWB. It details the improvements it has made over the years including an Indigenous psychology group, education in culturally appropriate treatment and encouragement to Indigenous people to become psychologists. This progress culminated in an apology to the Indigenous peoples of Australian in 2016 that was well thought out, discussed, and received positive feedback from both Indigenous and professional groups. It acknowledges that it still has a way to go to bridge the gap.

Dudgeon, P., Bray, A., D’Costa, B., & Walker, R. (2017). Decolonising psychology: Validating social and emotional wellbeing. Australian Psychologist, 52(4), 316-325.

This report examines each of the seven domains, which interconnect to maintain the SEWB of Indigenous Australians. These are mind and emotions, family and kinship, community, culture, Country and spirituality. It is important that these are incorporated into any program with the aim of improving the mental health of Aboriginals. It explains how disconnect from any of these domains can be detrimental to the mental health or SEWB of each individual.

Geia, L., Pearson, L., & Sweet, M. (2017). Narratives of Twitter as a platform for professional development, innovation, and advocacy. Australian Psychologist, 52(4), 280-287.

This report examines how Twitter engagement can help to raise health professionals’ awareness of SEWB in Indigenous Australians. It utilises narrative methodology supplied by an Indigenous nurse-midwife, an Indigenous educator and a non-Indigenous journalist. Innovative platforms are developed on Twitter such as @IndigenousX which enable Indigenous people to reflect upon and discuss their SEWB. These accounts can then be followed by health professionals to gain an Indigenous perspective own health and SEWB. Indigenous people in turn benefit by having an arena for discussion and reflection. It identifies a gap in knowledge about whether psychologists are engaging in the sphere and if so are they benefitting from it?

Health, H. E., & Aboriginal. (2012). Closing the gap in a regional health service in NSW: a multistrategic approach to addressing individual and institutional racism. New South Wales Public Health Bulletin, 23(3-4), 63-67.

Hunter New England Health services the largest Aboriginal community in New South Wales. It identified problems with individual and institutional racism and culturally insensitive practices. The report details the steps it took to address these problems and thus reduce the gap in healthcare experienced by Aboriginal people. Partnerships were formed with Aboriginal groups and advice was sought from them. Three strategies were employed: staff and managerial training and education; leadership and consultation; negotiation and partnerships. It stresses the importance of ongoing commitment to address this organisational goal.

Otim, M., Kelaher, M., Anderson, I., & Doran, C. (2014). Priority setting in Indigenous health: assessing priority setting process and criteria that should guide the health system to improve Indigenous Australian health. International Journal for Equity in Health, 13(1), 1-12.

There is a large gap in health outcomes between Indigenous and other Australians, which the Australian Government has pledged to close. The objective of this study was to gauge the perceptions of Indigenous and non-Indigenous decision makers of priority setting in Indigenous healthcare. It identified an economic approach to priority setting was acceptable and useful in Aboriginal Community Controlled Health Services with the potential to utilise evidence in its implementation. This use of evidence will help to maximise health outcomes for Aboriginal people thus reducing the health care gap experienced by them.

Ralph, S., & Ryan, K. (2017). Addressing the mental health gap in working with Indigenous youth: Some considerations for non‐Indigenous psychologists working with Indigenous youth. Australian Psychologist, 52(4), 288-298.

Indigenous youth between the ages of 15-24 are recognised as one of the most disadvantaged and vulnerable groups in Australia. The article reviews the current knowledge about the mental health needs and SEWB of this group. Psychological strategies such as the Access to Allied Psychological Services program are examined as to their relevance and effectiveness. It identifies that whilst Indigenous mental health workers are the ideal, but due to a lack of a skilled and available workforce who are able to deal with the complexity of needs in this client group, non-Indigenous psychologists need to be used. It does however confirm that the psychologist needs to be culturally aware of the needs of the youth in order to engage with them and successfully manage their treatment.

Smith, S., O’Grady, L., Cubillo, C., & Cavanagh, S. (2017). Using culturally appropriate approaches to the development of KidsMatter resources to support the social and emotional wellbeing of Aboriginal children. Australian Psychologist, 52(4), 299-305.

KidsMatter is an Australian initiative aimed at improving the mental health of young children in primary school and early childhood centres. A need for resources aimed at improving the SEWB of Aboriginal children was identified. The report details the development of this project. The project utilised participatory action, narrative therapy and critically reflective practice to define the Aboriginal perspective of SEWB. Aboriginal cultural consultants worked collaboratively with schools, health professionals and members of the Aboriginal community to develop culturally appropriate and effective resources. This resulted in a collection of culturally appropriate and professional learning tools to use in the promotion of SEWB for Aboriginal children.

Togni, S. J. (2017). The Uti Kulintjaku Project: The path to clear thinking. An evaluation of an innovative, Aboriginal‐Led approach to developing bi‐cultural understanding of mental health and wellbeing. Australian Psychologist, 52(4), 268-279.

Uti kulintjaku (UK) means to think and understand clearly and the objective of the project was to strengthen the understanding of mental health between Aboriginal people and non-Aboriginal health professionals. This project examined an innovative approach to bridging the gap between Western health care and traditional Indigenous care. It involved a group of senior Indigenous women working collaboratively with non-Indigenous health care professionals, all of whom had substantial experience in working in Indigenous communities. The aim was bridge any misunderstandings caused by language differences and improve the SEWB of the community. The woman who participated in the project have become empowered as a team and have learnt a lot about themselves, whilst increasing their self-confidence. The use of culture has reinvigorated cultural knowledge and several posters were developed which can be used in the future. Discussion in the community about mental health and finding new ways to tackle it and work with mental health services to enhance SEWB has increased. The tenets of the project of promoting healing and empowerment of individuals and groups were critical to the success of the project. It began as a language project but developed into increased shared understanding and it demonstrated the importance of traditional cultural methods such as story-telling and art in the healing process.

Postscript

These resources are all available to Healthy Options Australia employees, student and volunteers from the library database. Please email the library if you experience any problems in accessing them.

library@hoa.org.au


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2016 Review of illicit drug use among Aboriginal and Torres Strait Islander people

The Australian Indigenous Alcohol and Other Drug Knowledge Centre (the Knowledge Centre) has launched a new eBook based on the 2016 Review of illicit drug use among Aboriginal and Torres Strait Islander people, produced by the Knowledge Centre. The team from the Knowledge Centre hopes that the electronic version will be a good learning tool for those in the AOD sector. Illicit drug use is an issue of concern to Aboriginal and Torres Strait Islander and non-Indigenous Australians, and this eBook provides a comprehensive synthesis of information for those involved in Aboriginal and Torres Strait Islander health.

The eBook has been created for Apple devices such as iPads, iPhones, laptops and desktop computers. It is free to download from iTunes, or the Knowledge Centre website. There is also an accompanying animated infographic which has been developed based on the review. Please find links below:

 

Illicit drug use among Aboriginal and Torres Strait Islander people (animated infographic)

 

2016 Review of illicit drug use among Aboriginal and Torres Strait Islander people (eBook)

 https://itunes.apple.com/au/book/illicit-drug-use/id1226941831?mt=11&ign-mpt=uo%3D4

Links to download are also available from the Knowledge Centre website:

http://www.aodknowledgecentre.net.au/aodkc/about-us/news/5243

 (Australian Indigenous Alcohol and other Drugs Knowledge Centre , 2017)