Understanding Treatment Gaps for Mental Health, Alcohol, and Drug Use in South Dakota: A Qualitative Study of Rural Perspectives.

PURPOSE: More than 25% of US adults experience mental health or substance use conditions annually, yet less than half receive treatment. This study explored how rural participants with behavioral health conditions pursue and receive care, and it examined how these factors differed across American Indian (AI) and geographic subpopulations. METHODS: We undertook a qualitative follow-up study from a statewide survey of unmet mental health and substance use needs in South Dakota. We conducted semistructured phone interviews with a purposive sample of key informants with varying perceptions of need for mental health and substance use treatment. RESULTS: We interviewed 33 participants with mental health (n = 18), substance use (n = 9), and co-occurring disorders (n = 6). Twenty participants (61.0%) lived in rural communities that did not overlap with AI tribal land. Twelve participants (34.3%) were AI, 8 of whom lived on a reservation (24.2%). The discrepancy between actual and perceived treatment need was related to how participants defined mental health, alcohol, and drug use problems. Mental health disorders and excessive alcohol consumption were seen as a normal part of life in rural and reservation communities; seeking mental health care or maintaining sobriety was viewed as the result of an individual\u27s willpower and frequently related to a substantial life event (eg, childbirth). Participants recommended treatment gaps be addressed through multicomponent community-level interventions. DISCUSSION: This study describes how rural populations view mental health, alcohol, and drug use. Enhancing access to care, addressing discordant perceptions, and improving community-based interventions may increase treatment uptake

Design in perspective: reflections on intercultural design practice in Australia

Since the 1970s, a number of Australian architects have been considering how non-Indigenous designers can work with Aboriginal and Torres Strait Islander people to achieve better built environments. A consistent message from this work has been the importance of employing inclusive, respectful, cross-cultural processes that engage the client and end-users, understand the history of the people and place, and share knowledge and expertise in the process

Aboriginal and Torres Strait Islander domestic architecture in Australia

This chapter examines Aboriginal and Torres Strait Islander domestic architecture across the period from the onset of European colonisation to the early twenty-first century. In these two centuries, housing and living conditions reflected and shaped the often abrupt and disruptive change to the culture, health and livelihoods of Aboriginal and Torres Strait Islander peoples. The post-contact history of Indigenous housing has been determined by government policies, informed by politics and settler attitudes to Indigenous Australians. Until the 1970s, state and territory governments, with specific legislation, exercised control over Aboriginal and Torres Strait Islander lives including place of residence and access to housing. For an extended period of this history, housing choice was oppressively limited. Despite entrenched disadvantage, it is a story of cultural persistence and adaptation to an imposed architecture that expected sedentary living patterns rather than the more mobile Indigenous lifestyles. Towards the end of the twentieth century, a combination of research and architectural practice had identified approaches to Indigenous housing that could improve living conditions of Aboriginal and Torres Strait Islander people