Transcript AN INTRODUCTION TO ABORIGINAL MENTAL HEALTH

AN INTRODUCTION TO
ABORIGINAL MENTAL HEALTH
Dr Adriana Lattanzio
28 June 2012
OUTLINE
General introduction
History and Culture
Colonisation
Statistics
Factors influencing engagement with
health services
 Mental health assessments
 Treatment considerations
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 Indigenous Australians is a term that
refers to 2 distinct cultural categories
 Mainland Aboriginal people
 Torres Strait Islander People
INTRODUCTION
 ABS June 2006 – estimated
Indigenous population of Australia
was 517 000 or 2.5% of the
population.
 In SA, estimated population is 26 000
(5%) but proportionally 1.7% of total
SA population.
 NT, estimated population 66 600
(12.9%) but proportionally 31.6%
 31% Of Aboriginal people live in
major cities
 22% Inner Regional
 23% Outer Regional
 24% Remote / Very Remote Areas
History and Culture
 Pre-colonisation, conservative estimates of
Aboriginal people inhabiting Australia
suggest between 300 000 and 750 000
 There were about 500 clan groups, each
having their own distinctive territory,
history, language and culture
 Estimated that Aboriginal people had been
living in Australia for the last 70 000 years
 It is the oldest living culture in the world
Where did it all begin?
 Aboriginal people will tell you that
they have been here since The
Dreaming
The Dreaming
 The various Aboriginal languages have their own word
for The Dreaming. Pitjantjatjara people call it
Tjukurpa.
 The Dreaming is referred to as a time of creation.
Before The Dreaming the land was just a featureless
plain.
 Spirit beings (Ancestor Beings) existed within this
substance and they emerged from the land (or
water), took a variety of forms and identities and
moved across the face of the earth at times entering
the earth or water again or into the sky to form
heavenly bodies.
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Some appeared in human form, while others were identified
as being both human and animal (in essence). (snake-man,
shark-man).
While they travelled the earth they performed the same
activities as are done in traditional Aboriginal life (gathering
food, making weapons, marrying, cheating, performing
ceremonies).
At times they would act as humans and at other times act
as their animal counterpart.
As they travelled and engaged in their various activities
they formed the earth, the rocks, waterholes etc.
Their activities also provided the rules and expectations for
how life is to be lived. These beings were thought to be the
ancestors of the animal and with the group of people
associated with that area of land (country).
 Understanding the dreaming helps to
understand the significance of land to
Aboriginal people and their references to
sacred sites or sites of significance
 Our cathedrals and churches are the
equivalent of sacred sites for the Aboriginal
people.
 Think about impact of mining, land
development, what is our / your concept of
civilisation?
 Why is it inappropriate to take photos of
landmarks without asking first?
Mythology
 There were no books or written material
handed down from generation to
generation, but rather stories, songs and
paintings. These stories derived from The
Dreaming.
 Some stories were told to children but
others were restricted to men only or
women only after they had passed through
various rituals which lead to manhood or
womanhood.
 Consider why we prefer to use Narrative
therapy with Aboriginal patients.
Social Organisation
 Relationships are of vital importance
and allows them to identify their
relationship to every other member of
the society. This also allows them to
determine the obligations which flow
from the relationship
 Roles and responsibilities are also
determined by relationships
Kinship
 There is an intricate system of relationships
within a family structure.
 Basically each person in a language group
can identify their relationship to every other
member in that group. The family is
therefore enlarged to embrace all.
 Example – Paternal uncle = Father
 Maternal aunt = mother, Paternal uncles
children are brothers and sisters (cousin
brother, cousin sister)
Avoidance Relationships
 In societies where members spend a lot of time in
close contact there is always the risk of problems and
conflict developing.
 Aboriginal societies guard against this by imposing
rules on members of that society by having rules that
either limit or forbid interactions between certain
members, example, a man and his mother – in – law
or father – in – law. When they need to communicate
it is either done through sign language or through the
use of a third person.
 As brothers and sisters become adults they are
expected to observe some reserve in their
relationship.
Mens Business / Womens Business
 As children enter adolescence they undergo initiation.
 This involves the handing down of stories specifically
to women or to men.
 Consequently there are topics that are only for men to
discuss, or things that only men are allowed to do and
others that are only for women.
 It is taboo for a woman to speak about mens business
and vice versa.
 Womens business is usually to do with child birth,
mothering, gathering food. Mens business is usually
about hunting, law.
Colonisation
 Aboriginal people have been here for around the last
70 000 years. Colonisation occurred 1788 (223 years
ago).
 Yet this country was colonised on the legal fiction of
“terra nullius”
 With the expansion of colonisation, the Aboriginal
population rapidly declined and was decimated by
massacres and diseases (measles, smallpox,
whooping cough, syphilis, gonorrhoea).
 The physical and psychological effects of displacement
from their land (country) and incarceration of
Aboriginals forcibly removed from their traditional
lands contributed to the decline.
Impact Of Policy
 1905 Aborigines Act, which gave the
Chief Protectors and Police sweeping
powers to control every aspect of
Aboriginal peoples lives
 1936 Native Administration Bill which
ensured familial separation
 1946 Aboriginal returned servicemen
are refused membership to the RSL
 1967 Referendum. In the Australian
Constitution, Section 127 excluded
people of full blood descent from
being counted in the census. Section
51 prohibited the Federal Government
from passing laws relating to the
Aboriginal people living in Australian
states.
 1992 Mabo Case. Determined that
Native Title exists over particular
types of land and that Australia was
never “terra nullius”
 1 / 05 / 1998 – First National Sorry
Day
 13 / 02 / 2008 – Apology by Prime
Minister Kevin Rudd
Health Statistics
 In 2005 – 2006 Aboriginal people were hospitalised at
14 times the rate of non-Aboriginal people for care
involving dialysis, and at 3 times the rate for
endocrine, nutritional and metabolic diseases.
 Australian Aboriginals were hospitalised for potentially
preventable conditions at 5 times the rate of nonAboriginal Australians
 In 2004 – 2005 half of the Indigenous adults were
regular smokers, twice the rate of non – Indigenous
adults.
 1 in 6 Indigenous adults (16%) had consumed alcohol
at long term risky / high risk levels in the past week.
This was similar to the rate for non-Indigenous
adults.
 Life expectancy for Aboriginal adults was 59
years for males and 65 years for females,
compared with 77 years for all males and
82 years for all females. A difference of
around 17 years.
 In Qld, WA, NT and SA combined,
approximately 75% of all Indigenous males
and 65% of all Indigenous females died
before the age of 65 years. Compare this to
the non-Indigenous population where 26%
of males and 16% of females die aged less
than 65 years.
 For the period of 2001 – 2005
Indigenous infant deaths represented
6.4% of total Indigenous male deaths
and 5.7% of total Indigenous female
deaths. Compare this to 0.8% and
0.9% of the total for non-Indigenous
male and female deaths.
 Indigenous males were 6 times more likely
and Indigenous females were 3 times more
likely to die from mental and behavioural
disorders compared to non-Indigenous
males and females.
 In the period 2001 – 2005 the suicide rate
was almost 3 times that of non –
Indigenous males. Age group 0 – 24 was 3
times and for age group 25 – 34 was 4
times.
 Suicide rates for Indigenous females aged 0
– 24 was 5 times the corresponding rate.
WHY?
 In considering the present we need to
consider the past.
 We are products of our historical
experiences, in the same way as we
are biologically and socially products
of our parents and upbringing.
 Australian Aboriginals have endured multiple and
ongoing trauma and oppression over many years and
generations.
 Their culture, their cultural identity, their history has
been devalued and until recently ignored.
 The historical losses and separations experienced by
Aboriginal families are compounded by adverse health
conditions, high rates of early death, substance
abuse, suicide, mental health problems and family
separation through incarceration or welfare
intervention.
Factors Influencing Engagement
With Health Services
 History and mistrust of white man.
 Cultural Reasons
 Beliefs about illnesses ( externalisation)
 Traditional Healers (Ngangkaris)
 Fear of being sent away and dying away from
their land / country
 Mens business / womens business
 Language
 Stigma associated with mental illness / shame
 Poor health literacy
 Inability to access services
 Poor understanding of how services
work
 Lack of services
 Financial reasons
 Racism
Ethnocentrism
 This is the practice of using one’s own
cultural values and standards as the basis
from which to judge all others. It assumes
the superiority of one’s own way of life and
is often accompanied by contempt for the
customs and values of others.
 It also refers to the failure to realise that
one’s point of view is based on
assumptions, values and ways of perceiving
the world that are culturally specific.
Aboriginal Definition of Health
 Health does not just mean the
physical well being of an individual,
but refers to the social, emotional,
spiritual and cultural well being of the
whole community.
Mental Health Assessments
 Referrals
 Community disturbances
 Often quite late, when the patient is
already very sick
 Shame contributes to late referrals
 Somatisation is common with depression
The Interview
 Location
 Gender (entering rooms, accompanying to
appointments)
 Seniority ? Elders (respect)
 Seating
 Family / Confidentiality
 Body Language
 Tone of voice
 Closed questions
 Length of interviews
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Aboriginal Health workers / Vouching
Your introduction
Interpreters
Taboo topics
Don’t use Aboriginal words
Profile
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Marital status and children
Extended family
Living arrangements
Income
History of Presenting Complaint
 Symptoms
 Duration (concept of time)
 Attribution (don’t be dismissive of
cultural attribution systems)
 Functioning (Changes)
 Collateral
 Stressors – what is happening in the
community
Mental State Examination
 Appearance – don’t judge
 Behaviour – eye contact, length of
time taken to answer questions,
attempting to discuss taboo topics
 Conversation – language
 Affect – can be difficult to assess
 Perception – don’t be fooled (example
– dead people talking, Ngangkaris)
 Cognition – MMSE Vs KICA