Aboriginal

Question 1

Background

Answer 1

Queensland is home to a large number of Aboriginal and Torres Strait Islander people who have unique cultural backgrounds.
Unfortunately, these people are over-represented in the mental health system.
It is essential that these backgrounds and needs are taken into account by clinicians and others in providing health services.
A person’s cultural context needs to be appreciated by clinicians if diagnoses are to be accurate and treatment appropriate.
Research indicates that culturally appropriate services are significantly better services, which will produce better outcomes for patients and the community.

Question 2

Cultural Safety

Answer 2

“cultural safety in health service happens when people feel fully able to use a service provided by people from another culture without risk to their own”
Should be applied to health service delivery in an endeavour to minimise anxiety and to maximise access and use of health services.
Is achieved when the health care system reflects something of you – of your culture – your custom, attitudes, beliefs and preferred ways of doing things

Question 3

Cultural Considerations

Answer 3

-	Aboriginal and Torres Strait Islander health is viewed as holistic and encompassing:
o	The whole of family
o	Social
o	Emotional
o	Cultural
o	Spiritual wellbeing
-	Family – kinship
-	Land – environment
-	Spirituality – ceremony and ritual
-	Holistic health – food and medicine
-	Meeting places – sacred sites
-	Totems – identity (life-death-life)
-	Burial sites – keeping places
-	Stolen generation
-	Communication
-	Gender specific business (male/female)

Question 4

More cultural consideration

Answer 4

• Respect and non-verbal communication
• Eye contact in the context of traditional/urban/rural people
• Quietly spoken
• Gender issues
• Given an option of assessor
• Female might be more comfortable with female
• Male may feel embarrassed to speak to female

Question 5

Treatment considerations

Answer 5

• When assessing a client for the first time, it is important to take into consideration the history and the impact this will have on the mental state of the client
• It is also important to consider how this will impact on ongoing treatment and
• What impact the Mental Health Act will have on the client
• Allow time for responses
  o Aboriginal clients may need some time to process the question/s asked
  o Try to avoid direct questioning
  o Rather try engaging in conversations
  o Consider using
  • I was wondering…
  • You appear to be…
  • Can you tell me….
• Understand the implications of the Mental Health Act (give past policies and living under the State and Territory Acts)
• The impacts of colonisation
  o Depression, displacement, loss, grief, trauma
• Communication
• Identity
• Taboos and cultural beliefs
• Importance of silence, or a safe place for the purpose of treatment
• Assessing practitioner should feel comfortable to sit with this
• Trust issues may arise given the police, church and welfare were mostly European
• Given the tragic history of being taken away from family and land

Question 6

Cultural Sensitivity

Answer 6

• Be aware the client may not want input from another indigenous person (could be a shame issue)
• The client may not want another family or community members to know they are being seen by MH
• There may be conflict issues

Question 7

Cultural Issues

Answer 7

• Do not refer to a dead person by name
• Do not refer to certain close relatives by name (A Torres Strait Islander male may not refer to his brother-in-law by name)
• Do not criticise an Elder
• Be aware of confiding certain personal information to a member of the opposite sex: men’s and women’s business are usually kept separate
• Do not criticise members of the extended family
• Anxiety can be generated by interviewing someone in a confined space
• Spiritual experiences are not necessarily hallucinations or delusions

Question 8

Mental state examination

Answer 8

• Activity around trauma, depression, related to unaddressed child problems, or issues
• Grief and loss compounded by past history
• Alcohol and substance misuse, self medicating, trying to cope or forget
• Other health problems, i.e. diabetes, menopause, STDs, heart problems

Question 9

Mental health or cultural reality

Answer 9

• Depression
  o Lost cultural connections
  o Being away from country, either forcibly or circumstantial
• Grief
  o Loss of cultural ties, i.e. stolen generations
  o Past or recent circumstances
  o Spirit of deceased person remaining in the home
  o (Sorcery) taboos, being sung, cursed