Week 2 Lecture 2a - Indigenous Mental Health (DN)

Question 1

What is an issue around DSM-5 that has outraged many health care professionals?

Answer 1

• Grief (crying after 2 weeks) is being classified as depression
  
  • What is appropriate & what is pathological?

5:00

Question 2

What are some issues in history that have impacted on Indigenous Australians

Answer 2

• Land theft
• Massacres 19th Century
• Stolen children
• Missionization
• Forced movement and resettlement
• Restricted movement on reserves

6:00

Question 3

Who does the term Indigenous apply to?

Answer 3

• Not just Australians
• People living on the land, not part of a state who became subjects of Colonisation
  
  • e.g., Native Americans, Native Canadians, Greenlanders (Denmark), Khoisan people in South Africa, Peru, Argentina

Question 4

How have the many years of discrimination shaped (impacted) Indigenous Australians?

Answer 4

• Consistent social pathologies in entire communities
  9: 40
• Many pathologically related behaviours have been almost institutionalised amongst indigenous populations (i.e., almost expected)

Question 5

How does Forced Movement impact on peoples well being

Answer 5

• Control - not allowed to leave
• Concentrating populations
  
  • alienation from land, language, culture - brutality
  • peoples sense of self & worth systematically erased
  • Refugees of 20th Century

QLD: ppl moved all over the place into missions - noone could visit them without police (Sherberg Mission) forced to walk - often for months (40 different language groups) others shipped off to palm island

15:00

Question 6

What is the US equivalent

Answer 6

• March of Tears
• Cherokee of the US forced to march to reserves

Question 7

What happened in 1966 for Aboriginal Australians?

Answer 7

• Included in Census
• Prior to that held less worth than Kangaroo & Koalas :-(
• Sustained discrimination is a legacy of this policy

16:40

Question 8

What is a sad reality of the concentration of Indigenous populations in Australia?

Answer 8

• it was hoped they would eventually die out
• impact of that on personal identity of Indigenous Australians today
• Impact on their capacity to feel worth while

Question 9

Continuing history of alienation & discrimination has contributed to………………

Answer 9

• Drugs, alcohol, petrol sniffing
• Sexual violence and the abuse of children
• Other interpersonal violence
• Homelessness (e.g., parkies)
• Unemployment
• Poverty
• Boredom
• Poor services/ no integration of services

Question 10

What impact does drug, alcohol, petrol sniffing, fly spray have

Answer 10

• affects brain, mood, cognition & social interaction
• physically, mentally, emotionally, socially

23:15

Question 11

What should be considered with homelessness & Indigenous people?

Answer 11

• living as they would in their own habitat
• may not in fact be comfortable indoors

22:20

Question 12

may get rid of this card eventually??

FACTS OF SOCIAL WELLBEING

25:50

Answer 12

• Almost half of Aboriginal men and over a third of women die before they turn 45
• Indigenous people 18 years and older twice as likely to feel high or very high levels of psychological distress
• Twice as likely to be hospitalised for mental and behavioural disorders than other Australians in 2008-09
• Men were 5.8 times more likely and women 3.1 times more likely to die from these disorders in 2001-2005 than other Australians
• 77% of Indigenous people (59% all) experienced 1 or more significant stressors in the previous 12 months:
  
  • ‘death of a family member or friend’, ‘alcohol or drug related problem’, ‘trouble with police’, and ‘witness to violence’
• One in five Indigenous people had member of the family sent to jail in the previous 12 months

Question 13

Indigenous people were twice as likely (than non-indigenous) to be hospitalised (mental/behavioural disorders) in 2008-09:

Consider the impact being Institutionalised may have had upon these people?

Answer 13

• institutions almost operate like jails to contain mentally ill
• impact mood
• issues of trust/security

Question 14

???

Answer 14

• incarceration does not help people to function well in society

Question 15

What is a surprising fact about alcohol & Indigenous Australians

Answer 15

• Indigenous Australians are less likely to drink alcohol at all compared to non-indigenous Australians (exception Indigenous Greenlanders of Denmark) - But those that do - drink to excess (at dangerous levels

Question 16

What is a disturbing fact about alcohol & pregnant Aboriginal mothers?

Answer 16

• 48% of Aboriginal mothers drink while pregnant - High rates of foetal alcohol syndrome 37:45

Question 17

• Almost half of Aboriginal men and over a third of women die before they turn 45…….. - Consider how this impacts Mental health as well as the future outlook for Aboriginal youth?

Answer 17

• children losing parents young - perhaps impacting their own life expectancy - possibly life without much hope for future - in turn impacting what they do or don’t do with their life

Question 18

What are some of the Mental and Physical defects resulting from Alcohol crossing the placental barrier FOETAL ALCOHOL SYNDROME 40:00

Answer 18

• Can stunt foetal growth or weight, create distinctive facial stigmata - Damage to neurons and brain structures - Psychological or behavioural problems - Permanent central nervous system damage - Memory problems, attention deficits, impulsive behaviour, and poor cause-effect reasoning) - Secondary disabilities (e.g., predispositions to mental health problems and drug addiction. - Learning difficulties, including poor memory, inability to understand concepts such as time and money, poor language comprehension, poor problem-solving skills behavioural problems

Question 19

What is the risk of drinking while pregnant?

Answer 19

Foetal Alcohol Syndrome - Alcohol crossing the placental barrier

Question 20

What are some of the physical characteristics of Foetal Alcohol Syndrome?

Answer 20

• flat lips, thin top lips - not fully formed ear lobes - finger deformity

Question 21

Which country has an extremely high incidence of FAS?

Answer 21

South Africa

• One study in the Western Cape (with large Khoi and San populations) identified 65.2-74.2 per 1,000 children in the first grade population
• 33-148 times greater than U.S. estimates and higher than in a previous cohort study in this same community (40.5-46.4 per 1,000).

Question 22

What is the estimated prevalence of Foetal Alcohol Syndrome (FAS) worldwide?

Answer 22

• 1 to 1.5 cases per 1000 live births worldwide

Question 23

How do Aboriginal & Non-Aboriginal FAS rates compare?

Answer 23

• Aboriginal - 2.76/1000
• Non-Aboriginal - 0.02/1000

reported in WA (2002)

Question 24

PREVALENCE

Answer 24

 The most widely used summary prevalence estimate of FAS is 1 to 1.5 cases per 1000 live births worldwide  Between one and two-thirds of all children with special educational needs are children who have been affected by their mothers’ alcohol intake during pregnancy.  South Africa has one of the highest incidences of FAS globally  One study in the Western Cape (with large Khoi and San populations) identified 65.2-74.2 per 1,000 children in the first grade population – 33-148 times greater than U.S. estimates and higher than in a previous cohort study in this same community (40.5-46.4 per 1,000).  Alaska: 0.20 - 0.30/1000, non-native; 3.00 - 5.20 Alaska Native  In WA (2002) WA Birth Defects Registry reported 0.02/1000 for non-Aboriginal children, with 2.76/1000 Aboriginal children  Australian Aboriginal are less likely than non-Aboriginal women to drink alcohol, but those who do are likely to drink at hazardous or harmful levels.

Question 25

49:00 Medium to Long Term Effects

Answer 25

 Social withdrawal, inflexibility, impulsiveness, and anxiety  Poor educational and employment outcomes  Main cause of intellectual disability in US, Canada, ANZ and Europe  Especially high among Indigenous populations not only in Australia 49:00

Question 26

49:35 CHILDHOOD AND YOUTH SUICIDE

Answer 26

 Canadian Aboriginal population  First Nation communities twice total population  Inuit —6 to 11 times > general population.  affliction of the young – 1/3 all deaths of Aboriginal youth  Youth on reserves aged 10 to 29 - 5 to 6 times more likely to die of suicide than peers in general population.  United States: a Native American 62% more likely to commit suicide than the general population.  Australia: 2001-2006, NT suicide rate for those aged 15 to 24 was 3.5 times that in the rest of the nation  Very young ages and rising no of women – 75% of suicides of children 2007- 2011 in NT are Aboriginal  The suicide rate doubled for youth between ages 10 and 17 – up from 18.8% to 30.1% per 100,000 2007-2011 – in contrast to non-Aboriginal youth suicides down from 4.1% to 2.6%.

Question 27

Consider why so many young people suicide on reserves?

Answer 27

Are they dying on reserves because - not integrated into society - self medicating on drugs or alcohol - or both?

Question 28

What else is going on in their lives that makes them so vulnerable to suicide?

Answer 28

• likely to be living with parents who have emotional problems - parents rate their own children as having emotional problems - 7/10 children - exposed to 3 or more major stressors annually - 2/10 children - exposed to 7 or more major stressors annually - impacts on mental health & sense of security 54:30

Question 29

What IMMEDIATE DISTRESS AND INTERGENERATIONAL TRAUMA result from discrimination experienced by indigenous people? 55:50

Answer 29

• separation from families (foster care) - 30 or more homes moved around foster care system (trust, sense of security, safety) - 1/4 people 15 yrs & over = victims of violence

Question 30

How might the experiences of childhood impact over time?

Answer 30

• Intergenerational trauma

Question 31

How do social, economic, cultural and historical factors interact?

Answer 31

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Question 32

What factors might support resilience in individuals?

Answer 32

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Question 33

What lesson does this offer for working with indigenous men and women?

Answer 33

**

Question 34

Consider suicide rates in different populations and what they might tell us about the experiences of those populations…. Native Americans Canadian Aboriginals Young Australians Aboriginal Children in NT Aboriginal in NT (children) Aboriginal 10-17yrs

Answer 34

Native Americans: 62% more likely than gen. pop. Canadian Aboriginal: twice as likely as gen.pop Young Australians: 1/3 are Aboriginal Aboriginal in NT (15-24yrs) = 3.5 x likely the rest of nation (2001-2006) Aboriginal in NT (children) 75% are Aboriginal (2007-2011) Aboriginal 10-17yrs - per 100K rate doubled 18.8% - 30.1% non-Aboriginal - decreased 4.1% - 2.6%

Question 35

What do suicide rates tell us about a population?

Answer 35

Suicide & attempted suicide rates are a very sharp index of the level of distress experienced within a population