Mental health issues have been identified as one of the leading causes of the Indigenous health gap (18% - second only to cardiac disease). When combined with intentional and unintentional injuries (13%) the two issues account for almost one third (31%) of the total health gap (Vos et al, 2007). Nearly one third of the Aboriginal and Torres Strait Islander population report high levels of psychological distress - 2.5 times the rate of others.
Yet, the lack of ‘fit’ between Indigenous concepts of social and emotional wellbeing and mainstream concepts of mental health and illness that have informed mental health service provision to date, has been well documented (NATSIHC 1989; RCIADC 1991; National Aboriginal Mental Health Conference 1993; Burdekin 1995; Swan & Raphael 1995; HREOC 1997; Senate Community Affairs Committee 2008; 2010).
Culturally appropriate services for Aboriginal people are virtually non-existent. Mental health services are designed and controlled by the dominant society for the dominant society (NAHS, 1989, p 171).
In Aboriginal and Torres Strait Islander settings, mental health issues are seen less as individual problems, and more as occurring in the context of social and emotional wellbeing, which links individual wellbeing to connection to land and culture and physical, emotional, spiritual and social factors:
“The concept of mental health comes more from an illness or clinical perspective and its focus is more on the individual and their level of functioning in their environment. The social and emotional well-being concept is broader than this and recognizes the importance of connection to land, culture, spirituality, ancestry, family and community, and how these affect the individual” (SHRG, 2004).
Despite repeated calls for delivery of mental health services within the framework provided by Indigenous concepts of social and emotional wellbeing, there has been an absence of system-wide strategies to support the non-Indigenous mental health workforce to develop the cultural competence required to do this.
To support reforms to the mental health system and to contribute to closing the gap in social and emotional wellbeing and mental health outcomes the Australian Indigenous Psychologists Association developed mental health specific cultural competence training in 2010.
The workshop aims to provide participants with the cultural competence they require to deliver mental health services within a social & emotional wellbeing framework and to accommodate the social and historical determinants when working with Aboriginal and Torres Strait Islander peoples.
The workshop is underpinned by the Guiding Principles from the SEWB Framework 2004-2009 that were developed to underpin the delivery of social and emotional wellbeing and mental health services for Aboriginal and Torres Strait Islander people.
Between June 2012 to June 2014, AIPA worked in partnership with the Department of Health and Medicare Locals to deliver 69 Journey Towards Cultural Competence workshops to 931 administrators and service providers of Access To Allied Psychological Services (ATAPS) programs delivered around Australia.
909 participants completed workshop evaluations.
Participants were asked ‘how would you rate the workshop overall?’
The majority (92% or 838) provided an assessment of either ‘excellent’ (585 or 64%) or ‘very good’ (253 or 28%). Only 65 (7%) participants provided a rating of ‘good’ (6%) or ‘average’ (1%).
Participants were asked ‘would you recommend the workshop to others?’
The overwhelming majority (99% or 896) participants who completed workshop evaluations stated they would recommend the workshop to others. Many participants offered additional comments and feedback. For example 123 participants added ‘definitely’ and 66 participants added ‘absolutely’.
Only eight (less than 1%) participants expressed reservations about recommending the workshop to others. Comments offered by these participants were: ‘unsure’ (3 participants), ‘parts of it’ (2 participants), ‘maybe’ (1 participant), ‘possibly’ (1 participant), ‘probably not’ (1 participant).
Participants were asked to rate a series of statements about the workshop, using a scale of 1 to 5, with 5 being the highest score. 929 participants completed this section of the evaluation.
Participant expectations of the workshop: The majority (910 or 98%) of participants provided a rating of 3 or higher for the statement: ‘My expectations of the workshop were met’. Only 15 (1.7%) participants provided a rating of 1 or 2 for this statement.
Difficulty level of workshop: The majority (836 or 94%) of participants provided a rating of 3 or higher for the statement: ‘The difficulty level of the workshop was about right for me’. Only 57 (6%) participants provided a rating of 1 or 2 for this statement.
Information and Ideas presented: The majority (889 or 99%) of participants provided a rating of 3 or higher for the statement: ‘The information and ideas presented were relevant and easy to understand’. Only 4 participants provided a rating of 1 or 2 for this statement.
Ability to apply the information in the workplace: The majority (872 or 98%) of participants provided a rating of 3 or higher for the statement: ‘I will be able to apply the information when I return to my workplace’. Only 18 (2%) participants provided a rating of 1 or 2 for this statement.
Participant Identified Strengths Of The Workshop
Participants most valued the Aboriginal and Torres Strait Islander psychologists who facilitated the workshops (799 or 45%). Participants drew attention to the stories the facilitators told to illustrate concepts (152) their knowledge (69), their openness (52), their honesty (22), and the respect (18) they showed to participants.
The variety of learning strategies (482 or 28%) was also identified as a strength. This included the case studies, small group exercises, audio-visual elements and guest speakers.
The content (418 or 24%) was also valued, with participants identifying its comprehensive nature, evidence-base and the practical strategies provided to support practice. The SEWB Framework in particular was identified as a valuable resource.
Participants also identified the venue (16 or 1%) and the other participants (13 or .7%).
A samples of unsolicited comments are offered below as evidence of the enthusiasm expressed by participants.
All participants have reported gains in their ability to practice within a social and emotional wellbeing framework and to accommodate the historical and social determinants when working with Aboriginal and Torres Strait Islander clients. This includes recognizing and working with risk and protective factors found within Indigenous-specific domains of social and emotional wellbeing.
For more information see: http://www.culturalcompetence.net.au