Indigenous Governance & Cultural Safety

Hunter, E. (2020). Indigenous mental health: The limits of medicalised solutions. Australasian Psychiatry, 28(1), 55-57.

Objective: The excess burden of mental disorders experienced by Indigenous Australians is complexly overdetermined. Social and political factors contributing to the intransigence of vulnerability are reviewed, and the wider arena of neoliberal political change considered. Conclusions: The dynamic relationship between disadvantage and mental health vulnerability requires that practitioners should be attuned to both the ‘big picture’ and ‘modest and practical ways’ to contribute to reducing the developmental embedding of social disadvantage and transgenerational vulnerability.

Moss, M., & Duwun Lee, A. (2019). TeaH (turn ‘em around healing): A therapeutic model for working with traumatised children on Aboriginal communities. Children Australia, 44(2), 55-59.

Aboriginal children in Australia are over-represented in both the child protection and juvenile justice systems. Using Western therapeutic models of practice with Aboriginal people who live in remote communities can be highly problematic. Moreover, the historical legacy of past and present legislation, government interventions and racist service provision needs to be acknowledged and addressed prior to any service implementation. This paper presents a therapeutic model of practice that incorporates Aboriginal concepts of healing and spirit within a creative therapeutic framework. It will demonstrate how the model works through principles of community engagement and capacity building, enabling the provision of a culturally derived therapeutic intervention that involves a synergy of both Aboriginal- and Western-based healing practices. The findings from the implementation of the TeaH model affirm the need to incorporate Aboriginal concepts of healing, spirit and creative therapies into mainstream practice with Aboriginal people.

Murrup-Stewart, C., Searle, A.K., Jobson, L., & Adams, K. (2019). Aboriginal perceptions of social and emotional wellbeing programs: a systematic review of literature assessing social and emotional wellbeing programs for Aboriginal and Torres Strait Islander Australians perspectivesAustralian Psychologist54(3), 171-186.

Australian Aboriginal and Torres Strait Islander communities have been targets of social and emotional wellbeing programs for many years. However, the few health‐care programs and services that are evaluated rarely provide insight into the participants’ perspectives of program success or failure. This systematic review assessed 33 social and emotional wellbeing programs across Australia to better understand what Aboriginal community members think about the programs and how they could be improved. Results highlighted the interesting and valuable insights provided by Aboriginal participants, including what kinds of program activities and approaches are most suitable, what program characteristics are successful or desired, and their experiences of wellbeing change before and after program participation. They likewise voiced opinions about poorly received programs, culturally inappropriate services and negative experiences. This review highlighted how health and wellbeing programs must better engage Aboriginal and Torres Strait Islander clients to ensure that services are culturally safe, holistic, integrate appropriate staffing, include culturally relevant activities and value patient/participant experiences. These findings have significant implications for the health and wellbeing sector; specifically, research, policy, program design and implementation, evaluation methods, and self‐determination.

Nasir, B. F., Hides, L., Kisely, S., Ranmuthugala, G., Nicholson, G. C., Black, E., Gill, N., Kondalsamy-Chennakesavan, S., & Toombs, M. (2016). The need for a culturally-tailored gatekeeper training intervention program in preventing suicide among Indigenous peoples: A systematic reviewBMC Psychiatry16(1), 357-363.

Background:Suicide is a leading cause of death among Indigenous youth worldwide. The aim of this literature review was to determine the cultural appropriateness and identify evidence for the effectiveness of current gatekeeper suicide prevention training programs within the international Indigenous community. Method:Using a systematic strategy, relevant databases and targeted resources were searched using the following terms: ‘suicide’, ‘gatekeeper’, ‘training’, ‘suicide prevention training’, ‘suicide intervention training’ and ‘Indigenous’. Other internationally relevant descriptors for the keyword “Indigenous” (e.g. “Maori”, “First Nations”, “Native American”, “Inuit”, “Metis” and “Aboriginal”) were also used. Results:Six articles, comprising five studies, met criteria for inclusion; two Australian, two from USA and one Canadian. While pre and post follow up studies reported positive outcomes, this was not confirmed in the single randomised controlled trial identified. However, the randomised controlled trial may have been underpowered and contained participants who were at higher risk of suicide pre-training. Conclusion:Uncontrolled evidence suggests that gatekeeper training may be a promising suicide intervention in Indigenous communities but needs to be culturally tailored to the target population. Further RCT evidence is required.

Monchalin, R., & Monchalin, L. (2018). Closing the health service gap: Métis women and solutions for culturally- safe health services. Journal of Indigenous Wellbeing Te Mauri – Pimatisiwin, 3(1), 18-29.

Métis peoples, while comprising over a third of the total Indigenous population in Canada, experience major gaps in health services that are culturally-safe. This is problematic given Métis peoples experience severe disparities in health determinants and outcomes compared to the non-Indigenous Canadian population. At the same time, Métis are unlikely to engage in health services that do not value their cultural identities, often utilising mainstream options. Traditionally, Métis women were central to the health and well-being of their communities. However, due to decades of colonial legislation and land displacement, female narratives have been silenced, and Métis identities have been fractured. This has resulted in having direct implications on Métis peoples current health and access to health services. Solutions to filling the Métis health service gap may lie in the all too often unacknowledged or missing voices of Métis women.  Given these contexts, this commentary aims to generate critical discussion on the culturally-safe health care gap for Métis peoples in Canada. It does this by calling on policymakers, health care workers, and researchers alike to engage with Métis women regarding the health of Métis communities, and finding solutions towards identifying and implementing pathways to culturally-safe healthcare.