Improving mental health of Koori men: a study of help seeking and mental health service response

Mental illness is widespread among Indigenous people in Australia and mental disorders are reported to be the leading cause of disease burden after cardiovascular disease. Indigenous males are affected by mental health problems at higher rates than their non-Indigenous counterparts. This is evident from the higher levels of psychological distress, higher hospitalisation rates and higher death rates due to mental and behavioural conditions among Indigenous men. However Indigenous men do not commonly receive treatment from mental health services. The literature highlights two important reasons. One is that they do not access mainstream mental health services in proportion to their need and the second is the suggestion that mental health services may be culturally inappropriate and inaccessible. This study sought to establish the qualitative factors that influence Indigenous male help seeking and aspects of the service setting that impede access. The specific objectives of this study were fourfold. The study sought to first examine the factors that influence Indigenous male help seeking for mental health problems. Second, the study aimed to identify the factors affecting utilisation of mental health services. Third, the study intended to determine the barriers and facilitators to care for Indigenous men with mental disorders and finally, it sought to identify strategies to improve access to and utilisation of mental health services by Indigenous men in Gippsland. The study was informed by the guidelines on values and ethics proposed by the National Health and Medical Research Council, the Decolonising Methodology of Linda Tuhiwai Smith as well as methods suggested by other authors who have worked in the field of Indigenous health. Within a Qualitative Description design,semi-structured interviews were utilised to obtain narratives from Koori men and carers and mental health professionals. A total of seventeen Koori were interviewed including men, carers, social and emotional wellbeing workers and a hospital liaison officer. In addition, 28 staff from the mental health services were interviewed individually or in focus groups. A total of thirteen themes emanated from the data. These have been categorised into three results chapters. The first results chapter relates to obstacles faced by Koori men in seeking help for a mental illness. This chapter covers the four themes of recognising a mental illness, disclosing one‟s mental illness, reluctance to contact a service, and alternate ways of coping. The second results chapter focuses on the mismatch between mainstream mental health services and includes the three themes, barriers to gaining entry into services, barriers to engagement with services and staffing problems in the services. The final results chapter relates to future directions and outlines six themes. The first two themes relate to improving help seeking among Indigenous men. They include improving mental health awareness among the Community and empowering men to talk about problems. The next four themes relate to rendering services more accessible. They include, building men‟s confidence in services, developing relationships with the Koori community, enhancing flexibility of services and strengthening the role of the Koori Mental Health Liaison Officer. The results are then discussed in relation to the literature on help seeking and available services. In this section, the unique experiences of Koori men with regard to help seeking and service utilisation together with implications for future research and interventions are discussed. Other co-incidental learnings from the study include the need to provide for a long time frame for research involving Koori men, the need to adopt a flexible approach to research and the need to engage cultural advisors who represent different sections of the Koori community. The distinctive aspects of this research are multiple. First, it provides the first in-depth exploration of help seeking among Indigenous men with mental health problems. Second, it sheds light on the various barriers to Indigenous men accessing mental health services. Third, it gives voice to Koori people to indicate how they expect mental health services to be culturally appropriate. Fourth, it provides the first report of dual perspectives of Koori men and carers as well as service providers in improving services. The best solutions for a difficult situation are usually those that include perspectives of all stakeholders. Finally, the research was carried out in a culturally appropriate way and in so doing the researcher has not only been able to identify real challenges and solutions but has also taken a step forward in improving the reputation of research among Indigenous men in Gippsland. Future research will have to determine the feasibility and usefulness of the interventions suggested

Improving mental health of Koori men: a study of help seeking and mental health service response

Mental illness is widespread among Indigenous people in Australia and mental disorders are reported to be the leading cause of disease burden after cardiovascular disease. Indigenous males are affected by mental health problems at higher rates than their non-Indigenous counterparts. This is evident from the higher levels of psychological distress, higher hospitalisation rates and higher death rates due to mental and behavioural conditions among Indigenous men. However Indigenous men do not commonly receive treatment from mental health services. The literature highlights two important reasons. One is that they do not access mainstream mental health services in proportion to their need and the second is the suggestion that mental health services may be culturally inappropriate and inaccessible. This study sought to establish the qualitative factors that influence Indigenous male help seeking and aspects of the service setting that impede access. The specific objectives of this study were fourfold. The study sought to first examine the factors that influence Indigenous male help seeking for mental health problems. Second, the study aimed to identify the factors affecting utilisation of mental health services. Third, the study intended to determine the barriers and facilitators to care for Indigenous men with mental disorders and finally, it sought to identify strategies to improve access to and utilisation of mental health services by Indigenous men in Gippsland. The study was informed by the guidelines on values and ethics proposed by the National Health and Medical Research Council, the Decolonising Methodology of Linda Tuhiwai Smith as well as methods suggested by other authors who have worked in the field of Indigenous health. Within a Qualitative Description design,semi-structured interviews were utilised to obtain narratives from Koori men and carers and mental health professionals. A total of seventeen Koori were interviewed including men, carers, social and emotional wellbeing workers and a hospital liaison officer. In addition, 28 staff from the mental health services were interviewed individually or in focus groups. A total of thirteen themes emanated from the data. These have been categorised into three results chapters. The first results chapter relates to obstacles faced by Koori men in seeking help for a mental illness. This chapter covers the four themes of recognising a mental illness, disclosing one‟s mental illness, reluctance to contact a service, and alternate ways of coping. The second results chapter focuses on the mismatch between mainstream mental health services and includes the three themes, barriers to gaining entry into services, barriers to engagement with services and staffing problems in the services. The final results chapter relates to future directions and outlines six themes. The first two themes relate to improving help seeking among Indigenous men. They include improving mental health awareness among the Community and empowering men to talk about problems. The next four themes relate to rendering services more accessible. They include, building men‟s confidence in services, developing relationships with the Koori community, enhancing flexibility of services and strengthening the role of the Koori Mental Health Liaison Officer. The results are then discussed in relation to the literature on help seeking and available services. In this section, the unique experiences of Koori men with regard to help seeking and service utilisation together with implications for future research and interventions are discussed. Other co-incidental learnings from the study include the need to provide for a long time frame for research involving Koori men, the need to adopt a flexible approach to research and the need to engage cultural advisors who represent different sections of the Koori community. The distinctive aspects of this research are multiple. First, it provides the first in-depth exploration of help seeking among Indigenous men with mental health problems. Second, it sheds light on the various barriers to Indigenous men accessing mental health services. Third, it gives voice to Koori people to indicate how they expect mental health services to be culturally appropriate. Fourth, it provides the first report of dual perspectives of Koori men and carers as well as service providers in improving services. The best solutions for a difficult situation are usually those that include perspectives of all stakeholders. Finally, the research was carried out in a culturally appropriate way and in so doing the researcher has not only been able to identify real challenges and solutions but has also taken a step forward in improving the reputation of research among Indigenous men in Gippsland. Future research will have to determine the feasibility and usefulness of the interventions suggested

Cultural desire need not improve with cultural knowledge: A cross-sectional study of student nurses

Cultural desire is considered to be a prerequisite for developing cultural competence. This study explored cultural desire among student nurses towards Aboriginal peoples and its association with participation in a one-semester unit on Aboriginal health through a cross-sectional survey. Our main outcome, cultural desire, was measured using two items level of agreement with Aboriginal health being an integral component of the nursing curriculum and an expressed interest in Aboriginal health. 220 (74.58%) student nurses completed the survey. Completing the Aboriginal Health and wellbeing unit did not influence students’ opinions on inclusion of the unit as part of the nursing curriculum (odds ratio OR 0.73, 95% CI 0.43–1.29) or their overall cultural desire (mean difference = −0.69, 95% CI −1.29 to −0.08, p = 0.026). Students who completed the unit reported a higher understanding of Aboriginal health (OR = 2.35, 95% CI = 1.35–4.08) but lower interest levels in the subject (OR = 0.45, 95% CI: 0.24–0.84). Further research is necessary to explore how and when cultural desire might develop in nurses who are trained in cultural competence particularly in the contexts of post-colonial disparities and political conflict

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)