A+Review+of+Issues+impacting+on+the+Mental+Health+of+Indigenous+Australians


 * Cultural Artefact **

The "Dance of Life" painting is the last in a series of six paintings which depict a multi-dimensional model of health and well-being from an Indigenous perspective. The painting brings together the preceding five pieces of art, which represent the five dimensions of the Indigenous health and well-being model, which are: the biological or physical dimension, the psychological or emotional dimension, the spiritual dimension and the cultural dimension. The model of Indigenous health and well-being was developed by the Aboriginal and Torres Strait Islander Mental Health Committee of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) to assist mental health practitioners better understand the issues and complexities impacting on the mental health of Indigenous Australians.



**Issues impacting on the mental health of Indigenous Australians**

The mental health of Indigenous Australians is a critical public health issue in Australia, evidenced by the over-representation of Indigenous Australians in statistics regarding mental health morbidity, experiences of psychological distress, significant life stressors and rates of mortality including suicide. In addition to establishing the mental health needs of Indigenous Australians as a national public health issue in need of urgent priority, this paper will discuss several key issues impacting on Indigenous mental health highlighted by research. A consideration of these issues, including placing mental health in the context of recent historical events and the theory of self-determination, will assist to explain the broader cultural and social shifts which must occur for the Australian Government to successfully address the inequities that exist between Indigenous and non-Indigenous Australians. These issues are:
 * health and mental health morbidity
 * socio-economic disadvantage
 * the history of policy and legislation governing Indigenous Australians, and
 * the Aboriginal and Torres Strait Islander mental health workforce.

**Literature Review**

**//Health and mental health morbidity//** The life expectancy of an Indigenous person remains 17-20 years less than a non-Indigenous person in Australia (Australian Bureau of Statistics, 2009). Despite the fact that overall the Indigenous population is much younger than the non-Indigenous population, the mortality rates for Indigenous males and females are around three times higher than those of their non-Indigenous counterparts (Australian Bureau of Statistics, 2008). The leading causes of death in 2008 for Indigenous people living in Australia were: cardiovascular disease (including heart disease and strokes); external causes (including transport accidents, and self-harm); and cancer (Australian Bureau of Statistics, 2010). Indigenous Australians also report higher than average levels of psychiatric morbidity with major life stressors, loss, grief and trauma being more common and raising the risk for mental health problems. In 2008 to 2009 Indigenous people were almost twice as likely to be hospitalised for mental and behavioural disorders as were other Australians (Australian Institute of Health and Welfare, 2008). In 2004 to 2005 the National Aboriginal and Torres Strait Islander Health Survey (NATSIHS) conducted by the Australian Bureau of Statistics found that "Indigenous people aged 18 years or older were twice as likely as their non-Indigenous counterparts to feel high or very high levels of psychological distress" (ABS, 2006). The higher overall levels of psychological distress reported by Indigenous people are consistent with the relative frequencies with which the two populations experienced specific stressors in the previous 12 months. According to the 2004-2005 NATSIHS, 77% of Indigenous people experienced one or more significant stressors in the previous 12 months (ABS, 2006). The proportions reporting specific stressors were generally higher for Indigenous people than for the total population, particularly for the 'death of a family member or friend', 'alcohol or drug related problem', 'trouble with police', and 'witness to violence'. Due to the potential for health and mental health problems to be inter-related, mental health practitioners require a good understanding of health profiles to provide holistic treatment.

**//Socio-economic disadvantage//** Several social, education, economic and environmental factors contribute generally to the poor health status of many Indigenous people, including discrimination, education, employment, income and housing. These disadvantages underlie specific health risk factors (such as alcohol and other drug misuse, smoking, nutrition, obesity and physical inactivity), and often contribute to lack of access to good quality health care. Because a higher proportion of the Aboriginal and Torres Strait Islander populations live in some of the most remote areas of Australia, they often have poor access to health, mental health services and resources. The tendency of Aboriginal and Torres Strait Islander patients to present late in the course of illness can also contribute to the severity and co-occurrence of disorders. According to a recent comprehensive review by Thomson, MacRae, Burns, Catto, Debuyst, Krom, Midford, Potter, Ride, Stumpers and Urquhart (2010) Indigenous Australians suffer the most disadvantage of any population group in Australia with regard to all socio-economic indicators, being more likely to have:
 * lower levels of household incomes
 * higher rates of unemployment
 * lower levels of educational achievement, attendance and retention
 * <span style="color: black; font-family: Arial,sans-serif;">higher rates of incarceration, and
 * <span style="color: black; font-family: Arial,sans-serif;">higher rates of children under child protection orders.

<span style="color: black; font-family: 'Arial','sans-serif';">Considering the high levels of health and mental health morbidity of Indigenous Australians, it is clear that prevention, treatment of and recovery from mental health disorders is a complex task, requiring a broad range of cooperative strategies which address the fundamental pre-requisites for equitable health outcomes, including access to education and employment opportunities.

<span style="color: black; font-family: 'Arial','sans-serif';">**Cultural and Social Analysis**

<span style="color: black; font-family: 'Arial','sans-serif';">**//History of policy and legislation governing Indigenous Australians//** <span style="color: black; font-family: 'Arial','sans-serif';">To gain a better understanding of the state of disadvantage that persists for an Indigenous person in today's society in terms of health, mental health and socio-economic disadvantage; it is critical to appreciate the impact of historical events, changes in social eras and political attitudes toward the 'native' Australians. Before the arrival of European settlers in 1788, Aboriginal Australians occupied the continent under a clear system of land ownership with rules for rights of occupancy, use and inheritance (Burgmann, 2003). <span style="font-family: 'Arial','sans-serif';">Traditional Aboriginal culture had a number of strong reinforcing factors on mental health including a sense of self that was seen in a collective sense and intimately connected to all aspects of life, community, spirituality, culture and country. Kinship was of prime importance in defining social roles. Aboriginal people were given a sense of meaning and understanding of life experience through their connection to country and Dreaming. Spiritual beliefs offered guidance and comfort and held a sense of connectivity and belonging despite distress, death and loss ( Milroy, Milroy, Parker,& Phillips, 2003).

<span style="color: black; font-family: 'Arial','sans-serif';">Following colonisation, a series of 'protective' legislative Acts were enacted which effectively governed all aspects of life for Aboriginal and Torres Strait Islander peoples, including where they could live, work and even who they associated with. In the 1930s legislation shifted to reflect the decision that 'assimilation' was the answer; a decision which was to have long lasting negative consequences for the culture and identity of Indigenous Australians. The minutes of the 1937 Conference of Federal and State governments contain the following statement:

<span style="color: black; font-family: 'Arial','sans-serif';">"The Conference believes that the destiny of the natives of Aboriginal origin, but not of the full blood, lies in their ultimate absorption by the people of the Commonwealth, and it therefore recommends that all efforts be directed to that end."

<span style="color: black; font-family: 'Arial','sans-serif';">It is estimated that between 1910 and 1970 up to one in three Indigenous children were forcibly removed from their families and communities to be placed in institutions, church missions, adopted or fostered. During the 1950s and 1960s policy slowly began to focus more on integration, social transformation began to accelerate after a Referendum in 1967 supported the inclusion of Indigenous Australians into the national census. Over the next decade government settlements were integrated into communities with some allowances for self-management. In the 1970s a paradigm shift occurred, with the Aboriginal community approaching the Australian Government requesting the right to administer their own communities. In 1972 the Commonwealth Government proclaimed a policy of 'self-determination' for Aboriginals, whereby they gained the right to make decisions about matters affecting their own lives, including the pace and nature of their future development within the legal, social and economic framework of Australian society.

<span style="color: black; font-family: 'Arial','sans-serif';">In the landmark High Court "Mabo" judgement of 1992, Aboriginal people acquired native-title land rights. Justices Deane and Gaudron stated in their joint decision that, 'the acts and events by which that dispossession ... was carried into practical effect constitute the darkest aspect of the history of this nation'. It was around this time that the Hawke Government announced its plans for Aboriginal ‘self-determination’, replacing the Department of Aboriginal Affairs and the Aboriginal Development Corporation with a statutory authority known as the Aboriginal and Torres Strait Islander Commission (ATSIC). <span style="font-family: Arial,sans-serif;">However, despite these shifts, the concept and ramifications of Indigenous Australians' self-determination has long been under debate, especially since the termination of ATSIC in 2004-2005. Some argued that ATSIC did not constitute self-determination in the first place, given that the Federal Government had always retained and exercised its power over the Aboriginal communities and ATSIC.

<span style="font-family: Arial,sans-serif;">As it applies in politics, self-determination is an international law principle stating that nations ought to have the right to freely choose their sovereignty and status without compulsion or interference. Article 1 of the International Covenant on Civil and Political Rights states that s elf-determination is the right of all peoples to 'freely determine their political status and freely pursue their economic, social and cultural development'. However, there are no consistent definitions to what constitutes a nation or legitimate group or how decisions are to be made (Kirgis, 1994). In Australia there is no agreement as to whether Indigenous groups satisfy the definition of 'peoples' nor whether self-determination give Indigenous peoples the right to break away from an existing nation. Therefore, although enshrined in multiple international agreements and considered 'essential before any other rights can be recognised' the right of self-determination lacks a precise definition and remains one of the most romantic of rights within the human rights agenda (Castellino & Gilbert, 2003).



<span style="color: black; font-family: 'Arial','sans-serif';">In psychology, self-determination theory (SDT) is a macro force concerning human motivation, personality and innate psychological needs. SDT was accepted as a sound empirical theory in the mid 1980s, and is centred on the belief that human nature shows persistent positive features and an inherent tendency toward growth (Deci & Ryan, 2002). According to Deci and Ryan (2002) there are three psychological needs which are essential for psychological health, well-being and self-motivation; these are the needs for competence, relateness and autonomy. 'Competence' refers to being effective in dealing with the environment in which a person finds oneself, 'relatedness' is the desire to interact and be connected to others and 'autonomy' is the ability to be the causal agents of one's own life (Deci & Vansteenkiste, 2004). While humans are inherently proactive in reaching their potential, to actualise this inherent potential they require nurturing from the social environment. That is, SDT emphasises that a person's basic needs must be fulfilled for well-being and growth and without this, they will experience negative consequences (Deci & Vansteenkiste, 2004).

<span style="color: black; font-family: 'Arial','sans-serif';">Pettman (1992) argues that throughout post-settlement history, as Indigenous Australians were dispossessed of their land and traditional rights and became the subjects of policy for their management, they were denied agency. That is, as a race and as individuals, Indigenous Australians were not seen as purposive or creative actors in their own right and therefore, were unable to exercise competence and autonomy in their own affairs. It must be remembered that formal barriers to equality remained in place until as recently as the early 1980s (Burgmann, 2003) and today, there remains many ongoing restrictions and disputes of Indigenous rights, their representation in Government and the tendency for solutions to be 'welfare orientated'. In 2003 Aboriginal spokesperson Robbie Thorpe commented, 'How can we talk about self-determination when we are caught up in welfare... While the Government spends money on welfare for our people, and sets up its governing bodies, it is dictating the terms of our existence'.

<span style="color: black; font-family: 'Arial','sans-serif';">The Australian Human Rights Commission's 'Bringing Them Home' Report (1997) drew on the work of various psychological and health experts to demonstrate the impacts that separation of families and institutionalisation has had on mental health including impaired development, attachment and trauma which continued into adulthood. The report also recognises the long-lasting inter-generational impacts on the descendants of those forcibly removed who, as a result, have been deprived of community ties, culture and language, and links with and entitlements to their traditional land. Specifically in relation to Indigenous health and well-being, the report recognised the need for mental health services to be designed and delivered in partnership with communities, utilising Indigenous workers, recommending that:
 * <span style="color: black; font-family: 'Arial','sans-serif';">all services and programs provided for survivors of forcible removal emphasise local Indigenous healing and well-being perspectives.
 * <span style="color: black; font-family: Arial,sans-serif;">Government funding for Indigenous preventive and primary mental health (well-being) services be directed exclusively to Indigenous community-based services including Aboriginal and Islander health services, child care agencies and substance abuse services, and
 * <span style="color: black; font-family: Arial,sans-serif;">all government-run mental health services work towards delivering specialist services in partnership with Indigenous community-based services and employ Indigenous mental health workers and community members respected for their healing skills.

<span style="color: black; font-family: 'Arial','sans-serif';">In February 2008 the Australian Government apologised to the Indigenous people of Australia for previous Acts of Parliament, as recommended in the Bringing Them Home Report (1997) eleven years prior. Prime Minister Kevin Rudd (2008) stated that:

<span style="color: black; font-family: 'Arial','sans-serif';">“We the Parliament of Australia respectfully request that this apology be received in the spirit in which it is offered as part of the healing of the Nation. For the future we take heart; resolving that this new page in the history of our great continent can now be written.”

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<span style="color: black; font-family: 'Arial','sans-serif';">**//The Aboriginal and Torres Strait Islander mental health workforce//** <span style="color: black; font-family: 'Arial','sans-serif';">The provision of health services in Western cultural contexts is usually reflective of the biases of the mainstream culture (Sue, 2003). However, Australia's National Mental Health Plan (Australian Health Ministers, 2003) specifies that culturally appropriate mental health care must be applied within mainstream mental health care services. This is vital, given the potential for vast differences between the perspectives and potential treatment of mental illness in traditional Aboriginal or Torres Strait Islanders' cultures as compared to mainstream Australian culture. For example, within Aboriginal culture, mental illness may be perceived as being an external factor, due to something that person did that was against traditional laws (Swan & Raphael, 1995). Ranzijin, McConnochie and Nolan (2009) have identified many areas for improvement in cultural awareness amongst health workers in Indigenous communities including but not limited to an awareness of Indigenous contexts and issues, client-centred practice, awareness of the health professional's own values and the capacity to reflect on how these values may impact on Indigenous clients. As highlighted by the 'Bringing them Home Report' (2007), Aboriginal and Torres Strait Islander mental health workers perform a crucial role in forming bridges between cultures, mediating between traditional and western medical systems. With the proper support, career structure and recognition, Aboriginal and Torres Strait Islander mental health workers can apply counselling techniques and therapies based on Indigenous knowledge and experience as well as consult regarding psychiatric treatments and medications (Australian Indigenous Mental Health, 2011). They also play invaluable roles in supporting non-Indigenous mental health professionals by introducing them to an Indigenous community and providing cultural expertise, insight and background information.

<span style="color: black; font-family: 'Arial','sans-serif';">**Analysis of the Artefact and Reflection**

<span style="color: black; font-family: 'Arial','sans-serif';">The “Dance of Life” painting as a cultural artefact represents the need for mental health practitioners to understand and approach the mental health care needs of Indigenous Australians with an appreciation of their history and the dimensions of life most important to Indigenous people. Potential solutions for healing must not only involve access to clinical treatment, but address the vast underlying factors contributing to poor health outcomes of Indigenous Australians, including the impacts of historical events, policy and legislation, social, education economic and environmental factors. By bringing together the five critical dimensions of a person's life, the Dance of Life painting represents the grounding in community and support one’s needs to be enabled to restore all of the dimensions to balance and harmony. <span style="font-family: 'Arial','sans-serif';">Swan and Raphael (1995, 19) comment: <span style="font-family: 'Arial','sans-serif';">[T]he Aboriginal concept of health is holistic, encompassing mental health and physical, cultural and spiritual health. This holistic concept does not just refer to the whole body but is in fact steeped in harmonised inter relations which constitute cultural well-being. These inter relating factors can be categorised largely into spiritual, environmental, ideological, political, social, economic, mental and physical. Crucially, it must be understood that when the harmony of these inter relations is disrupted, Aboriginal ill health will persist.

<span style="color: black; font-family: 'Arial','sans-serif';">Completing this review gave me a greater appreciation of the complex factors which continue to affect the lives of Indigenous Australians today. It is true that an apology alone will not alter the conditions faced by Aboriginal and Torres Strait Islander people, but there is hope that this acknowledgement will assist progress the practical changes required to achieve real equality, the right of self-determination for Indigenous people and continue to shape the social environment required to support better mental health outcomes for all Australians. Meeting the needs of competence, relatedness and autonomy requires recognition of Indigenous persons' distinct cultures, forms of social organisation, governance and decision-making and as far as possible, transferring responsibility and power to Indigenous communities to make decisions that affect them.

<span style="color: black; font-family: 'Arial','sans-serif';">If you have time, please see the video below, it is part of a series made in remote communities identified under the Council of Australian Governments' National Partnership Agreement on Remote Service Delivery. The small community of Wurrimiyanga (Nguiu) on Bathurst Island in the Northern Territory has rallied to address a major mental health care challenge facing the community.

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If you let me play sports, I'll learn what it means to be strong
 * <span style="color: black; font-family: 'Arial','sans-serif';">Reflections **
 * //<span style="color: black; font-family: 'Arial','sans-serif';">1. 'If you let me play sports, I'll learn what it means to be strong' //**

<span style="color: black; font-family: 'Arial','sans-serif';">Hi Laura <span style="color: black; font-family: 'Arial','sans-serif';">Thank you for this essay on why our society ought to encourage young women to participate (and continue to participate in) sports and lead healthy lifestyles. Your cultural artefact was compelling and quite emotive, especially voiced by young girls and women. I thought it was very effective how it is not clear who the girls are asking to let them play, it could be their parents, their peers or the broader society. While it could be argued that there is nothing actually stopping women from playing sports and reaping its benefits, your essay effectively draws out the practical barriers and lack of encouragement for girls to do so. It appears that the same priority is just not placed on sports for girls as it is for their male counterparts. You mention that “one of the common barriers which girls face going from childhood to adolescences are the myth that you can’t be feminine and play sport”. I think this is a very strong cultural problem or negative stereotype for young women for example, where they are labelled as 'tomboys'. Have you considered this issue from the perspective of any feminist theorists? Bartky (1998) has written extensively on the feminine ideals transmitted to women and men in vitually all aspects of life and through societal institutions including the media. While the masculine ideal is one of physical strength, large size, and aggressiveness; the feminine ideal is beautiful, small, thin, and, perhaps most importantly, weak. As women strive to meet the ideal of femininity, they tend to limit their physical potential. Roth and Basow (2004) write, the extent to which a sport is framed as feminine or masculine controls if and how women participate in it. I would highly recommend their article (see in particular pages 252-255) which explores some of the common ways that female athleticism is limited and de-emphasised, such as through its association with female sex appeal.

<span style="color: black; font-family: 'Arial','sans-serif';">The citation is:Roth, A., & Basow, S. (2004). Femininity, Sports, and Feminism : Developing a Theory of Physical Liberation //Journal of Sport and Social Issues, 28,// 245-265. You can access the article here: []

<span style="color: black; font-family: 'Arial','sans-serif';">Kind Regards, Steph Davis

<span style="color: black; font-family: 'Arial','sans-serif';">**//2. 'You are what you buy' - Implications of Gen Y's consumerist behaviour//** <span style="color: black; font-family: 'Arial','sans-serif';">**//'You are what you buy' -Implications of Gen Y's consumerist behaviour//**

<span style="color: black; font-family: 'Arial','sans-serif';">Hi Frances <span style="color: black; font-family: 'Arial','sans-serif';">I found your essay regarding the implications of consumerism and individualistic behaviour on Generation Y both interesting and convincing. It makes perfect sense, as you have referred to in recent research, that when surrounded by the high expectations of wealth and success portrayed through the media and shows such as 'My Super Sweet 16' that the average young person would feel disappointment, failure and inadequacy with their 'ordinary' life. As we place more and more value in material objects to bolster our self esteem and self worth, the issue compounds as we struggle to keep up with the latest fashions, trends and pieces of technology. I agree with your comments that it is not just Generation Y that is susceptible to consumerism and its effects on mental health, however, having been born into an era where advertising through media was already established therefore being exposed for longer and at younger ages. I am particularly concerned by the level of advertising aimed at young children, from toys to fast food and agree with your suggestion that responsible advertising is an area requiring greater regulation. <span style="color: black; font-family: 'Arial','sans-serif';">Kind Regards, Steph Davis

<span style="color: black; font-family: 'Arial','sans-serif';">**References** <span style="color: black; font-family: 'Arial','sans-serif';">Australian Bureau of Statistics (2006) //National Aboriginal and Torres Strait Islander Health Survey: Australia, 2004-05//. Canberra: Australian Bureau of Statistics. <span style="color: black; font-family: 'Arial','sans-serif';">Australian Bureau of Statistics, Australian Institute of Health and Welfare. (2008). //The health and welfare of Australia's Aboriginal and Torres Strait Islander Peoples//. Canberra: Australian Bureau of Statistics and Australian Institute of Health and Welfare. <span style="color: black; font-family: 'Arial','sans-serif';">Australian Bureau of Statistics (2009) //Deaths Australia, 2008//. Canberra: Australian Bureau of Statistics <span style="color: black; font-family: 'Arial','sans-serif';">Australian Bureau of Statistics (2010) //Causes of death Australia, 2008//. Canberra: Australian Bureau of Statistics. <span style="color: black; font-family: 'Arial','sans-serif';">Australian Institute of Health and Welfare. (2010). Australian hospital statistics 2008-09. Canberra: Australian Institute of Health and Welfare. <span style="color: black; font-family: 'Arial','sans-serif';">Burgmann,V. (2003). The Aboriginal movement in power, profit and protest: Australian social movements and globilisation, Allen & Unwin, 44-97. <span style="color: black; font-family: 'Arial','sans-serif';">Castellino, J., & Gilbert., J. (2003). Self-determination, Indigenous peoples and minorities. //Macquarie Law Journal, 8,// 455-463. <span style="color: black; font-family: 'Arial','sans-serif';">Deci, E., & Ryan, R. (Eds.). (2002). Handbook of self-determination research. Rochester, NY: University of Rochester Press. <span style="color: black; font-family: 'Arial','sans-serif';">Deci, E., & Vansteenkiste, M. (2004). Self-determination theory and basic need satisfaction: Understanding human development in positive psychology. //Ricerche di Psichologia//, //27//, 17–34. <span style="color: black; font-family: 'Arial','sans-serif';">The Royal Australian and New Zealand College of Psychiatrists. (n.d). Australian Indigenous Mental Health. Retrieved 23 October 2011from __http://indigenous.ranzcp.org//component/option,com_frontpage/Itemid,1///__ <span style="color: black; font-family: 'Arial','sans-serif';">Human Rights and Equal Opportunity Commission (1997). Report of the National Inquiry into the Separation of Aboriginal and Torres Strait Islander Children from their Families. Commonwealth of Australia. <span style="color: black; font-family: 'Arial','sans-serif';">Lepper, K., Green, D., & Nisbett, R. (1973). Undermining children's intrinsic interest with extrinsic reward: A test of the 'overjustification' hypothesis. //Journal of Personality and Social Psychology, 28//, 129-137. <span style="color: black; font-family: 'Arial','sans-serif';">Milroy, H., Milroy, J,. Parker, R., & Phillips, N. (2003). Aboriginal and Torres Strait Islander Mental Health. Educational Unit, NSW Institute of Psychiatry. <span style="color: black; font-family: 'Arial','sans-serif';">Pettman, J. (1992). Living in the margins: Racism, sexism, and feminism in Australia. Sydney: Allen & Unwin. <span style="color: black; font-family: 'Arial','sans-serif';">Sue, S. (2003). In defense of Cultural Competency in psychotherapy and treatment. //American Psychologist, 58//, 964-970. <span style="color: black; font-family: 'Arial','sans-serif';">Summary of Australian Indigenous Health. Retrieved 22 October 2011 from [|__http://www.healthinfonet.ecu.edu.au/health][|facts/summary__] <span style="color: black; font-family: 'Arial','sans-serif';">Swan, P., & Raphael, B. (1995). Ways Forward: National Aboriginal and Torres Strait Island Mental Health Policy, National Consultancy Report. Canberra <span style="color: black; font-family: 'Arial','sans-serif';">Thomson, N., MacRae, A., Burns, J., Catto, M., Debuyst, O., Krom, I., Midford,R., Potter, C., Ride, K., Stumpers, S., & Urquhart, B. (2010). Summary of selected social indicators. Retrieved 28 October 2011 from <span style="color: blue; font-family: Arial,sans-serif;">[]

Thomson, N., MacRae, A., Burns, J., Catto, M., Debuyst, O., Krom, I., Midford, R., Potte,r C., Ride, K., Stumpers, S., & Urquhart B (2010). //<span style="background-color: #ffffcc; color: #575757; font-family: 'Helvetica Neue',Arial,sans-serif; vertical-align: baseline;">Overview of Australian Indigenous health status, April 2010. // Retrieved 28 October 2011 from http://www.healthinfonet.ecu.edu.au/health-facts/overviews