Measuring cultural appropriateness of mental health services for Australian Aboriginal peoples in rural and remote Western Australia: a client/clinician\u27s journey

Aboriginal and Torres Strait Islander people in Australia suffer from poorer mental health than non-Aboriginal people, especially in remote and rural settings. Even with the ongoing adoption of the World Health Organisation’s ‘Closing the Gap’ recommendations, the determinants of mental health, including suicide rates, hospitalisation rates and access to healthcare are not noticeably improving. One of the issues for this gap is the poor cultural proficiently of mental health services, creating a cultural security threat to the workers and service users. In my work as a senior Aboriginal Mental Health worker, I have observed incidents of ongoing cultural incompetence across the spectrum of healthcare. This embeds institutionalised racism that in turn fosters poor mental health. I offer examples of operational cultural proficiency and make recommendations to increase the appropriateness of services for Aboriginal people

Psychological distress and community exclusion in Indigenous communities: a convergent parallel (mixed methods) study

Indigenous people make up approximately 3% of the Australian population, but carry a heavy burden of mental ill-health. Almost 75% of Indigenous people have moderate to severe scores on the Kessler 10 measure of psychological distress. Robust research recognises racism as a risk factor for depression and social exclusion. However, there are significant within-community factors that add to the level of psychological distress. Using Bronfenbrenner’s ecological social capital model, Tajfel’s social identity theory and a created model of indigenist research (the Yerin Dilly Bag model) a 52-item questionnaire was created for a mixed method, parallel convergent study to answer the research questions: 1) What are the risks and protective factors that contribute to psychological distress in Indigenous populations?; 2) What is the self-perceived level of community inclusion / exclusion of Indigenous Australians?; 3) Is being manifestly Indigenous a protective factor for the psychological distress of Indigenous Australians?; and 4) What interactions of Indigenous participants with their communities add to the prediction of psychological distress? Using a purposive snowball sampling technique, 172 participants from 3 Indigenous communities completed either a hard or electronic questionnaire that assessed the perceived level of their community inclusion, their skin colour scores, their level of psychological distress and using a modified Measure of Indigenous Racism Experiences (Paradies, 2006), their experience of lateral violence, or community exclusion. Of these participants, 32 were interviewed using eco-map genograms to prompt narrative style questions about their life experiences, ending in 45.5 hours of recorded interviews. Quantitative data was scored using SPSS V23, with descriptive and interpretive results obtained. Qualitative findings were coded using thematic analysis. Both data sets were then triangulated looking for silence, dissonance, and agreements, using Bronfenbrenner’s four systems of ecological social capital model. Results demonstrated that the most reliable predictor of psychological distress in Indigenous people was community exclusion. The risk factors for community exclusion are living off country, having a different skin colour to the majority of the community (either darker or fairer), and not being involved with the Indigenous people in one’s family. Interventions to improve mental well-being are best placed in the mesosystem of Bronfenbrenner’s model, and might include increasing access to family support services, and alternative ways of being formally recognised as ‘Indigenous’. The Yerin Dilly Bag model is a useful method for working in Indigenous communities as it keeps the focus of the research on the best outcomes for Indigenous communities, where the focus should always be. Policy makers need to consider vehicles of community and social inclusion to decrease psychological distress and its concomitent risk of depression in Indigenous people and communities. Indigenous communities are often violent places, and all interventions need to have community inclusion as a core component. Unless this root cause of psychological distress is addressed, Indigenous Australians will continue to live with a high risk of inter and intra generational depression

Whistleblowing Need not Occur if Internal Voices Are Heard: From Deaf Effect to Hearer Courage; Comment on “Cultures of Silence and Cultures of Voice: The Role of Whistleblowing in Healthcare Organisations”

Whistleblowing by health professionals is an infrequent and extraordinary event and need not occur if internal voices are heard. Mannion and Davies’ editorial on “Cultures of Silence and Cultures of Voice: The Role of Whistleblowing in Healthcare Organisations” asks the question whether whistleblowing ameliorates or exacerbates the ‘deaf effect’ prevalent in healthcare organisations. This commentary argues that the focus should remain on internal processes and hearer courage

Cultural proficiency in first nations health research : a mixed-methods, cross-cultural evaluation of a novel resource

Recent efforts have illustrated the efficacy of culturally proficient approaches to research, underpinned by robust partnerships between researchers and First Nations peoples and communities. This article seeks to determine differences in approaches to First Nations research engagement perceptions between First Nations and non-First Nations researchers, as well as whether participation in a cultural proficiency workshop improved the perceived cultural proficiency of non-First Nations health researchers. Also, whether a set of novel cultural proficiency resources, designed in the Sydney region could be applied broadly across First Nations contexts within Australia. The evaluation adopted a mixed-methods, cross-cultural (First Nations and non-First Nations) design to appraise the novel cultural proficiency resources, identifying participant perceptions to First Nations research engagement, as well as views regarding the feasibility of universal application of the resources. A quantitative pre- and post-workshop evaluation was also undertaken to measure differences in self-reported cultural proficiency. Qualitative data underwent thematic analysis and quantitative data were analysed applying t-tests. Both qualitative and quantitative evaluation showed minimal variation between the cultural groups regarding research engagement perceptions, based on viewing of the online resources. A statistically significant increase in self-reported cultural proficiency was found in non-First Nations workshop participants. Cultural proficiency education and training programs that promote an immersive, interactive, and ongoing framework can build the perceived cultural proficiency of non-First Nations health researchers, however First Nations expertise must validate this perceived cultural proficiency to be beneficial in practice. Based on the research findings, applying the underlying ethical principles of First Nations research with a local, context-centred approach allows for the broad application of cultural proficiency research education and training programs within Australia

Whistleblowing Need not Occur if Internal Voices Are Heard: From Deaf Effect to Hearer Courage Comment on “Cultures of Silence and Cultures of Voice: The Role of Whistleblowing in Healthcare Organisations”

Whistleblowing by health professionals is an infrequent and extraordinary event and need not occur if internal voices are heard. Mannion and Davies’ editorial on “Cultures of Silence and Cultures of Voice: The Role of Whistleblowing in Healthcare Organisations” asks the question whether whistleblowing ameliorates or exacerbates the ‘deaf effect’ prevalent in healthcare organisations. This commentary argues that the focus should remain on internal processes and hearer courage

Indigenous peoples' experience and understanding of menstrual and gynecological health in Australia, Canada and New Zealand : a scoping review

There are a variety of cultural and religious beliefs and customs worldwide related to menstruation, and these often frame discussing periods and any gynecological issues as taboo. While there has been previous research on the impact of these beliefs on menstrual health literacy, this has almost entirely been confined to low- and middle-income countries, with very little information on high-income countries. This project used the Joanna Briggs Institute (JBI) scoping review methodology to systematically map the extent and range of evidence of health literacy of menstruation and gynecological disorders in Indigenous people in the colonized, higher-income countries of Australia, Canada, and New Zealand. PubMed, CINHAL, PsycInfo databases, and the grey literature were searched in March 2022. Five studies from Australia and New Zealand met the inclusion criteria. Only one of the five included studies focused exclusively on menstrual health literacy among the Indigenous population. Despite considerable research on menstrual health globally, studies focusing on understanding the menstrual health practices of the Indigenous populations of Australia, New Zealand, and Canada are severely lacking, and there is little to no information on how Indigenous beliefs of colonized people may differ from the broader society in which they live

Indigenist leadership in academia : towards an aspirational model of mindful servant leadership

The tertiary education landscape in Australia has changed over the past decade, in line with developments in other occupational settings and environments across the western world (Bienen, 2012). Australian universities are now more performance-based (Guthrie & Neumann, 2007); have insecure, non-government sources of funding (Moll & Hoque, 2011); place a strong emphasis on globalisation (Stromquist & Monkman, 2014); and have modified the way in which they support Indigenous programs (Gunstone, 2008). These kinds of changes suggest the need for academics, including Indigenous academics, to demonstrate strong leadership and management skills and abilities. For Indigenous academics, these requirements are in addition to the challenges related to ‘being black in white spaces’ (see Asmar, Mercier, & Page, 2009; White, 2009), thereby increasing the pressure not only to lead but also to be seen to lead. There is a need, then, to develop indigenist leadership models that is rigorously based on evidence and best practice

Factors that sustain indigenous youth mentoring programs : a qualitative systematic review

Background Indigenous youth worldwide continue to experience disproportional rates of poorer mental health and well-being compared to non-Indigenous youth. Mentoring has been known to establish favorable outcomes in many areas of health but is still in its early phases of research within Indigenous contexts. This paper explores the barriers and facilitators of Indigenous youth mentoring programs to improve mental health outcomes and provides evidence for governments’ response to the United Nations Declaration on the Rights of Indigenous Peoples. Methods A systematic search for published studies was conducted on PubMed, Embase, Scopus, CINAHL, and grey literature through Trove, OpenGrey, Indigenous HealthInfoNet, and Informit Indigenous Collection. All papers included in the search were peer-reviewed and published from 2007 to 2021. The Joanna Briggs Institute approaches to critical appraisal, data extraction, data synthesis, and confidence of findings were used. Results A total of eight papers describing six mentoring programs were included in this review; six papers were from Canada, and two originated from Australia. Studies included mentor perspectives (n=4) (incorporating views of parents, carers, Aboriginal assistant teachers, Indigenous program facilitators, young adult health leaders, and community Elders), mentee perspectives (n=1), and both mentor and mentee perspectives (n=3). Programs were conducted nationally (n=3) or within specific local Indigenous communities (n=3) with varying mentor styles and program focus. Five synthesized findings were identified from the data extraction process, each consisting of four categories. These synthesized findings were: establishing cultural relevancy, facilitating environments, building relationships, facilitating community engagement, and leadership responsibilities, which were discussed in the context of extant mentoring theoretical frameworks. Conclusion Mentoring is an appropriate strategy for improving general well-being. However, more research is needed to explore program sustainability and maintaining outcomes in the long term

From the bush to the brain : preclinical stages of ethnobotanical anti-inflammatory and neuroprotective drug discovery : an Australian example

The Australian rainforest is a rich source of medicinal plants that have evolved in the face of dramatic environmental challenges over a million years due to its prolonged geographical isolation from other continents. The rainforest consists of an inherent richness of plant secondary metabolites that are the most intense in the rainforest. The search for more potent and more bioavailable compounds from other plant sources is ongoing, and our short review will outline the pathways from the discovery of bioactive plants to the structural identification of active compounds, testing for potency, and then neuroprotection in a triculture system, and finally, the validation in an appropriate neuro-inflammatory mouse model, using some examples from our current research. We will focus on neuroinflammation as a potential treatment target for neurodegenerative diseases including multiple sclerosis (MS), Parkinson’s (PD), and Alzheimer’s disease (AD) for these plant-derived, anti-inflammatory molecules and highlight cytokine suppressive anti-inflammatory drugs (CSAIDs) as a better alternative to conventional nonsteroidal anti-inflammatory drugs (NSAIDs) to treat neuroinflammatory disorders