Academic journal article Advances in Mental Health

Outcome Measurement in Adult Indigenous Mental Health Consumers

Academic journal article Advances in Mental Health

Outcome Measurement in Adult Indigenous Mental Health Consumers

Article excerpt

The disparity in virtually all areas of health between Indigenous and non- Indigenous Australians has been well documented. Indigenous Australians experience much higher levels of illness and premature death than non- Indigenous people (Australian Institute of Health and Welfare/Australian Bureau of Statistics [AIHW/ ABS], 2005); their mortality rates are nearly three times as high as non-Indigenous and their life expectancy is 17 years less, according to recent estimates (Pink & Allbon, 2008). The subjective health status of Indigenous people is also poor: The 2004-2005 National Aboriginal and Torres Strait Islander Health Survey found that 22% of the Indigenous population aged 15 years and over reported their health as fair to poor, twice the rate of non-Indigenous Australians (Australian Bureau of Statistics, 2006). Numerous factors have been identified as contributing to the poorer Indigenous health. These include poverty, smoking, alcohol consumption, illicit substance use, overweight and obesity, poor nutrition, physical inactivity, and exposure to violence (Pink & Allbon, 2008). To this list can be added greater likelihood of incarceration, family separation and institutionalisation, lower education, and fewer employment prospects (AIHW/ABS, 2005; Gracey & King, 2009).

The picture is similar in the area of mental health (McKendrick, 2007; Parker, 2010). The Indigenous Burden of Disease Study, using data from the late 1990s, showed that mental disorders were second only to cardiovascular disease as the leading cause of burden of disease and disability adjusted life years (DALYs; Vos, Barker, Stanley, & Lopez, 2007; Zhao, Guthridge, Magnus, & Vos, 2004) in the Northern Territory Aboriginal population. It has been shown that 27% of Indigenous Australians reported high or very high levels of psychological distress (using a standard self-report measure), and were twice as likely as non-Indigenous Australians to report such high levels (Pink & Allbon, 2008, p. 110). The hospitalisation rate for mental and behavioural disorders in Indigenous people is about double that of other Australians (Australian Institute of Health and Welfare, 2012).

There are special considerations in assessing the mental health status of people whose language and/or culture is different from the majority in a society. This is because the assessment of mental health status is very dependent on the accurate understanding of internal states and on the meaning of behaviours. Numerous authors have pointed out that extra care needs to be taken when assessing consumers whose language and/ or culture is different from that of the assessor. It is widely accepted that cultural differences between non-indigenous mental health clinicians and Indigenous consumers often results in inadequate clinician assessment practices (Sheldon, 2001). Most obviously, clinicians can misinterpret the meaning of behaviours and beliefs, particularly around cultural matters relating to consumers' spiritual practices and deceased persons. Misunderstanding may also arise from differences in vocal and body language and processes of effective engagement, communication and gaining trust. These problems can affect the way mental health problems are identified and treated (Gulash, Saunders, White, & Nolan, 1999; Westerman, 2004).

When it comes to using standardised instruments such as questionnaires and rating scales with Indigenous people, the evidence and opinions are mixed. On the one hand, some have pointed out that the validity of instruments designed for non-Indigenous people may not carry across to Indigenous consumers. Indeed, the thoughtless use of conventional methods can be harmful: Hunter (2002) has warned that 'well-intentioned actions based on simplistic understandings of Indigenous perspectives continue to compound, rather than alleviate, the ongoing suffering and injustices experienced by Australian Aboriginal people' (Haswell-Elkins, Sebasio, Hunter, & Mar, 2007, p. …

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