Wellbeing & Healing

Balaratnasingam, S., Chapman, M., Chong, D., Hunter, E., Lee, J., Little, C., Mulholland, K., Parker, R., Watson, M., & Janca, A. (2019). Advancing social and emotional well-being in Aboriginal and Torres Strait Islander Australians: clinicians’ reflectionsAustralasian Psychiatry27(4), 348-351.

Objective: An expert reference group met on four occasions to consider ways forward in terms of Indigenous mental health. This paper summarises the discussion and recommendations. Conclusion: While the negative effects of colonisation and trans-generational trauma continue, we propose renewed emphasis on improving access, cultural orientation and trauma-informed care, and a focus on the needs of young Indigenous Australians.

Butler, T.L., Anderson, K., Garvey, G., Cunningham, J., Ratcliffe, J., Tong, A., Whop, L.J., Cass, A., Dickson, M., & Howard, K. (2019). Aboriginal and Torres Strait Islander people’s domains of wellbeing: A comprehensive literature reviewSocial Science and Medicine233, 138-157.

There are significant health and social disparities between the world’s Indigenous and non-Indigenous people on factors likely to influence quality of life (QOL) and wellbeing. However, these disparities in wellbeing are not captured in conventional QOL instruments, as they often do not include dimensions that are likely to be relevant to Indigenous people. The objective of this comprehensive literature review was to identify these wellbeing domains for Aboriginal and Torres Strait Islander people in Australia (hereafter, respectfully referred to collectively as Indigenous Australians). We searched PsycINFO, MEDLINE, Econlit, CINAHL, and Embase (from inception to June 2017, and updated in March 2019), and grey literature sources using keywords relating to adult Indigenous Australians’ QOL and wellbeing. From 278 full-text articles assessed for eligibility, 95 were included in a thematic analysis. This synthesis revealed nine broad interconnected wellbeing dimensions: autonomy, empowerment and recognition; family and community; culture, spirituality and identity; Country; basic needs; work, roles and responsibilities; education; physical health; and mental health. The findings suggest domains of wellbeing relevant to and valued by Indigenous Australians that may not be included in existing QOL and wellbeing instruments, domains that may be shared with Indigenous populations globally. This indicates the need for a tailored wellbeing instrument that includes factors relevant to Indigenous Australians. Developing such an instrument will ensure meaningful, culturally-relevant measurement of Indigenous Australians’ wellbeing.

Cairney, S., Abbott, T., Quinn, S., Yamaguchi, J., Wilson, B., & Wakerman, J. (2017). Interplay wellbeing framework: A collaborative methodology ‘bringing together stories and numbers’ to quantify Aboriginal cultural values in remote Australia. International Journal for Equity in Health 16(68), 1-13.

Background: Wellbeing has been difficult to understand, measure and strengthen for Aboriginal people in remote Australia. Part of the challenge has been genuinely involving community members and incorporating their values and priorities into assessment and policy. Taking a ‘shared space’ collaborative approach between remote Aboriginal communities, governments and scientists, we merged Aboriginal knowledge with western science – by bringing together stories and numbers. This research aims to statistically validate the holistic Interplay Wellbeing Framework and Survey that bring together Aboriginal-identified priorities of culture, empowerment and community with government priorities including education, employment and health. Method: Quantitative survey data were collected from a cohort of 842 Aboriginal people aged 15-34 years, recruited from four different Aboriginal communities in remote Australia. Aboriginal community researchers designed and administered the survey. Results: Structural equation modeling showed good fit statistics (χ/df = 2.69, CFI = 0.95 and RMSEA = 0.045) confirming the holistic nature of the Interplay Wellbeing Framework. The strongest direct impacts on wellbeing were ‘social and emotional wellbeing’ (r = 0.23; p < 0.001), ‘English literacy and numeracy’ (r = 0.15; p < 0.001), ‘Aboriginal literacy’ (r = 0.14; p < 0.001), ‘substances’ (lack thereof; r = 0.13; p = 0.003), ‘work’ (r = 0.12; p = 0.02) and ‘community’ (r = 0.08; p = 0.05). Correlation analyses suggested cultural factors have indirect impacts on wellbeing, such as through Aboriginal literacy. All cultural variables correlated highly with each other, and with empowerment and community. Empowerment also correlated highly with all education and work variables. ‘Substances’ (lack thereof) was linked with positive outcomes across culture, education and work. Specific interrelationships will be explored in detail separately. Conclusion: The Interplay Wellbeing Framework and Survey were statistically validated as a collaborative approach to assessing wellbeing that is inclusive of other cultural worldviews, values and practices. New community-derived social and cultural indicators were established, contributing valuable insight to psychometric assessment across cultures. These analyses confirm that culture, empowerment and community play key roles in the interplay with education, employment and health, as part of a holistic and quantifiable system of wellbeing. This research supports the holistic concept of wellbeing confirming that everything is interrelated and needs to be considered at the ‘whole of system’ level in policy approaches.

Clark, Y., Augoustinos, M., & Malin, M. (2017). Coping and prevention of lateral violence in the Aboriginal community in Adelaide. The Australian Community Psychologist, 28 (2), 105-123.

Lateral violence describes how members of oppressed groups direct their dissatisfaction inward. This inward deflection has been associated with the Aboriginal community in Adelaide, South Australia and has shown to be destructive. Interviews with 30 Aboriginal participants examining their ways of dealing with and strategising to prevent lateral violence in the community have been presented in a thematic analysis. Overall seven major interpretive themes emerged from these interviews: education is central; support provides unity; champions and role models are essential; culture and identity are empowering; avoidance of Aboriginal spaces by Aboriginal people can be protective; lateral violence can be challenged; and positively reinterpreted. Given that many participants drew on a number of coping strategies to deal with lateral violence, it is hoped that such information will benefit individuals, community, governments and funding agencies to support future research, education and services within communities in order for Aboriginal people to heal and prevent lateral violence.

Hill, N., & Murrary, K. (2020). Psychological sense of community and values: Understanding attitudes towards people seeking asylum and Australia’s First Nations people. Australian Psychologist, 1-14.

Objective:Discrimination and prejudice have significant implications for individuals and communities and are prevalent throughout the world towards marginalised groups. This study investigated the role of psychological sense of community (PSOC), values of self‐transcendence and openness‐to‐change, and demographic variables, with attitudes towards two different groups in Australia. Method:A convenience sample of adults living in Australia (N = 396) was randomly assigned to complete one of two online surveys; reporting on their attitudes towards Australia’s First Nations People (N = 198), or towards people seeking asylum (N = 198). The study assessed the extent to which a PSOC (in reference to local, national, and global communities), self‐transcendence, and openness‐to‐change, predicted attitudes towards the two groups. Results:Self‐transcendence and psychological sense of global community consistently predicted attitudes towards both groups, with psychological sense of global community partially mediating the relationship between self‐transcendence and attitudes. Bivariately, those holding a stronger local psychological sense of community reported more positive attitudes towards people seeking asylum, whereas those holding a stronger psychological sense of national community reported more positive attitudes towards Australia’s First Nations People. However, in multivariable regression models with self‐transcendence and demographic characteristics, only a higher psychological sense of national community significantly predicted more negative attitudes towards people seeking asylum. Conclusions:This research suggests that where people have a strong sense they are part of a global community they hold more positive attitudes towards people from various cultures both near and far. The research has implications for social cohesion and social policy.

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.

Jones, R. , Thurber, K.A. , Chapman, J. , D’Este, C. , Dunbar, T. , Wenitong, M., Eades, S.J. , Strelein, L. , Davey, M. , Du, W. , Olsen, A. , Smylie, J.K., Banks, E., & Lovett, R. (2018). Study protocol: Our cultures count, the Mayi Kuwayu study, a national longitudinal study of Aboriginal and Torres Strait Islander wellbeingBMJ Open, 8(6).

Aboriginal and Torres Strait Islander peoples are Australia’s first peoples and have been connected to the land for ≥65 000 years. Their enduring cultures and values are considered critical to health and wellbeing, alongside physical, psychological and social factors. We currently lack large-scale data that adequately represent the experiences of Aboriginal and Torres Strait Islander people; the absence of evidence on cultural practice and expression is particularly striking, given its foundational importance to wellbeing.

Kilcullen, M., Swinbourne, A., & Cadet‐James, Y. (2018). Aboriginal and Torres Strait Islander health and wellbeing: Social emotional wellbeing and strengths‐based psychology. Clinical Psychologist22(1), 16–26.

Objective: Addressing the continued health disparities between Australia’s Indigenous and non-Indigenous peoples requires a multi-sector approach in which the discipline of psychology has a central role. These disparities are partially driven by a lack of culturally appropriate methods of health delivery. This study aimed to explore urban Aboriginal and Torres Strait Islanders’ perceptions of health and wellbeing through social emotional wellbeing and strengths-based frameworks. Methods: A qualitative study was conducted with 19 urban Australian Aboriginal and Torres Strait Islander people. Data was collected via individual semi-structured interviews and focus groups. Thematic analysis was conducted to identify strengths-based themes within the data. Results: Several attributes and values emerged from participants’ understandings of enhancing mental health and wellbeing. These included acceptance, respect, forgiveness and integrity, honesty, courage, empathy, mindfulness, and spirituality. Conclusions: There are similarities between the central tenets of the strengths and values-based frameworks and a model of social emotional wellbeing. It is important to note that these attributes and values are understood at the individual, community, and cultural level. Each of these attributes and values are intricately linked to being mentally healthy and having strong cultural identity. These similarities may provide an avenue for shared cross-cultural understandings and knowledges of mental health and well-being that will support culturally appropriate service delivery.

Macedo, D., Smithers, L., Roberts, R., Haag, D., Paradies, Y., & Jamieson, L. (2019). Does ethnic-racial identity modify the effects of racism on the social and emotional wellbeing of Aboriginal Australian children? PLoS ONE14(8), e0220744.

Objectives: This study investigates the protective role of ethnic-racial identity (ERI) affirmation on the longitudinal association between racism and Aboriginal Australian children’s social and emotional well-being (SEWB). Methods: 408 children from the K-Cohort of the Longitudinal Study of Indigenous Children were included in the analysis. Data were collected through questionnaire-guided interviews at 7–10 and 9–12 years of age. Children’s racism experience, SEWB (Strengths and Difficulties Questionnaire), and confounding were reported by caregivers. ERI was reported by children and dichotomized into high versus low. Generalized linear models with log-Poisson links and robust errors were used to estimate adjusted Risk Ratios (RR) for the effect of racism on SEWB domains. Effect-measure modification analysis was used to verify differences on effect sizes per strata of ERI affirmation. The presence of modification was indicated by the Relative Excess Risk due to Interaction (RERI). Results: Slightly above half (51.4%) of the children presented high ERI affirmation. Children exposed to racism and with low ERI affirmation were at increased risk of hyperactive behavior (RR 2.53, 95% CI 1.17, 5.48), conduct problems (RR 2.35, 95% CI 1.07, 5.15), and total difficulties (RR 1.73, 95% CI 0.84, 3.55). Positive RERIs indicated the joint effects of racism and low ERI affirmation surpassed the sum of their separate effects in these domains. Children with high ERI affirmation were at increased risk of peer problems (RR 1.66, 95% CI 0.78, 3.52). Conclusions: These findings suggest that ERI may mitigate the risk of poor SEWB due to racism. Fostering affirmative ERI can be an important strategy in promoting resilience in Aboriginal Australian children.

Macedo, D., Smithers, L., Roberts, R., Paradies, Y., & Jamieson, L. (2019). Effects of racism on the socio-emotional wellbeing of Aboriginal Australian children. International Journal for Equity in Health18(1), 132.

Background: Racism is a pervasive experience in the life of Aboriginal Australians that begins in childhood. As a psychosocial stressor, racism compromises wellbeing and impacts developmental trajectories. The purpose of the present study was to estimate the effect of racism on indicators of Australian Aboriginal child socio-emotional wellbeing (SEWB) at one to two years after exposure. Age-related differences in the onset of symptoms were explored. Methods: Data from the B- and K-cohorts of the Longitudinal Study of Indigenous Children were used (aged 6 to 12 years). Racism, confounding variables, and the Strengths and Difficulties Questionnaire (a measure of SEWB) were collected by questionnaires and guided interviews with each child’s main caregiver. Adjusted Poisson regression was used to estimate the relative risk (RR) effects of racism on SEWB for both cohorts separately. RR were pooled in a random effects meta-analysis. Results: Exposure to racism was associated with an adjusted point estimate indicating a 41% increased risk for total emotional and behavioural difficulties, although the confidence intervals were wide (pooled RR 1.41, 95% CI 0.75, 2.07). Analyses by cohort showed younger children had higher RR for total difficulties (RR 1.72, 95% CI 1.16, 2.54), whilst older children had higher RR for hyperactive behaviour (RR 1.66, 95% CI 1.01, 2.73). Conclusions: The effects observed contributes to our understanding of the impact of racism on Aboriginal Australian children. Support for emotional and behavioural difficulties, and hyperactive behaviour, for Aboriginal children might help counteract the effects of racism. Future longitudinal research and policies aimed at reducing racism in Australian society are necessary.

Brown, N., & Brown, A. (2019). “Language breathes life”—Barngarla Community perspectives on the wellbeing impacts of reclaiming a dormant Australian Aboriginal languageInternational Journal of Environmental Research and Public Health, 16(20).

Traditional languages are a key element of Indigenous peoples’ identity, cultural expression, autonomy, spiritual and intellectual sovereignty, and wellbeing. While the links between Indigenous language loss and poor mental health have been demonstrated in several settings, little research has sought to identify the potential psychological benefits that may derive from language reclamation. The revival of the Barngarla language on the Eyre Peninsula, South Australia, offers a unique opportunity to examine whether improvements in mental health and social and emotional wellbeing can occur during and following the language reclamation process. This paper presents findings from 16 semi-structured interviews conducted with Barngarla community members describing their own experienced or observed mental health and wellbeing impacts of language reclamation activities. Aligning with a social and emotional wellbeing framework from an Aboriginal and Torres Strait Islander perspective, key themes included connection to spirituality and ancestors; connection to Country; connection to culture; connection to community; connection to family and kinship; connection to mind and emotions; and impacts upon identity and cultural pride at an individual level. These themes will form the foundation of assessment of the impacts of language reclamation in future stages of the project.

Sutherland, S., Adams, M. (2019). Building on the definition of social and emotional wellbeing: An Indigenous (Australian, Canadian, and New Zealand) viewpointab-Original3(1), 48-72.

This article will build on the definition of social and emotional wellbeing (SEWB) used within an Indigenous health framework. We intend to distance it from its current discipline of mental health, the Eurocentric term commonly used in social science literature. This is to emphasize that, within Aboriginal (Rudder and Grant, 2005) and Torres Strait Islander, Maori, and First Nations (Canadian) languages, there is no specific word for “health.” Indigenous peoples from within these countries have a holistic view of health that encompasses the physical, mental, emotional, and environmental spectrum of wellbeing. This article therefore uses “social and emotional wellbeing” rather than the generic Eurocentric terms of “health” or “mental health” to give this a stronger Indigenous voice. The elements of social and emotional wellbeing are discussed from an Indigenous viewpoint and from extracts compiled in work undertaken by Sutherland (2017). The elements explored may offer new perspectives to others. Similarly, this article offers an explanation as to why elements are siloed within the context of mental and physical health. This has led to some parts of SEWB gaining advantages over others within policy and funding models.

Wynne-Jones, M., Hillin, A., Byers, D., Stanley, D., Edwige, V., Brideson, T. (2016). Aboriginal grief and loss: a review of the literatureAustralian Indigenous HealthBulletin, 16(3).

This article is based on a literature review that was conducted in 2013 as part of the NSW Aboriginal Grief and Loss Training Project funded by the NSW Ministry of Health and delivered by the NSW Institute of Psychiatry (see Appendix, 1.). A series of workshops and resources in Aboriginal grief and loss has been developed and delivered for Aboriginal Mental Health and Wellbeing Workers across NSW, to support them with working with grief and loss in their communities. The aim of the review was to examine the existing literature, training and resources on Australian Aboriginal grief and loss, identifying areas for further research, and to confirm the need for the project. Other Indigenous literature on grief and loss was not reviewed, due to limited resources.

Dudgeon, P., Milroy, H., & Walker, R. (2014). Working Together: Aboriginal and Torres Strait Islander Mental Health and Wellbeing Principles and Practice (2nd edition). Canberra: Commonwealth of Australia.

Whiteside, M., Tsey, K., Cadet-James, Y., McCalman, J. (2014). Promoting Aboriginal health: The family wellbeing empowerment approach. New York, NY: Springer Briefs in Public Health.

This book highlights the health gap that exists between Indigenous and other Australians and proposes that one solution is to empower Indigenous Australians to take control of their own health and wellbeing. In particular, the book describes an Aboriginal family wellbeing model of empowerment which has been used successfully in programs across Australia. The book provides evidence for what can happen when communities accept change, and acknowledges the importance of future resourcing for empowerment programs which do make a difference in the lives of Indigenous Australians.

Australian Indigenous HealthInfoNet. (2020). Overview of Aboriginal and Torres Strait Islander health status, 2019.

Australian Primary Health Care Research Institute. (2015). A ‘Wellbeing Framework’ for Aboriginal and Torres Strait Islander peoples living with chronic disease. Kanyini Vascular Collaboration.

This report presents a wellbeing framework designed to assist healthcare services to improve the quality of life and quality of care, as well as the health outcomes, for Aboriginal and Torres Strait Islander peoples living with chronic disease. Guided by a national reference group, the framework incorporates physical and social, emotional, cultural and spiritual aspects of health and wellbeing.

Dudgeon, P., Bray, A., Darlaston-Jones, D., & Walker, R.,(2020) Aboriginal Participatory Action Research: an Indigenous research methodology strengthening decolonisation and social and emotional wellbeing was published by the Lowitja Institute as part of its respected Discussion Papers series.

Dudgeon, P., Bray, A., Smallwood, G., Walker, R., & Dalton, T. (2020). Wellbeing and Healing Through Connection and Culture. Lifeline.

Dudgeon, P., Walker, R., Scrine, C., Shepherd, C., Calma, T., & Ring, I. (2014). Closing the gap clearinghouse: Effective strategies to strengthen the mental health and wellbeing of Aboriginal and Torres Strait Islander people.

Fogarty, W., Lovell, M., Langenberg, J., & Heron, M. (2018). Deficit discourse and strengths-based approaches: Changing the narrative of Aboriginal and Torres Strait Islander health and wellbeing. National Centre for Indigenous Studies, The Australian National University.

McKendrick, J., Brooks, R., Hudson, J., Thorpe, M., Bennett, P. (2013). Aboriginal and Torres Strait Islander healing programs: a literature review. The Healing Foundation.

This review summarises existing research on healing internationally and nationally, highlighting what constitutes an effective Aboriginal and Torres Strait Islander healing process. This evidence enables the identification of what constitutes an effective healing program and the gaps in our knowledge that can inform future evaluation and research priorities. The literature revealed that to be successful, a healing program needs to be created within the local context; respond to needs identified by local community members and be supported by the local community. Sustainability needs to be multi-level and include development and transfer of knowledge and resources. This includes strong evaluation frameworks that are consistent with an Aboriginal and Torres Strait Islander world view.  The literature review has provided an inter-country context for healing that clearly demonstrates what constitutes an effective healing program; the interface between healing and health and the need for quality evaluations that incorporate Aboriginal knowledge systems. The depth of this material enables the Healing Foundation to identify a clear pathway to building and developing the evidence of healing into the future.

Monson-Wilbraham, L. (2015). Watering the garden of family wellbeing: Empowering Aboriginal and Torres Strait Islander people to bloom and grow. The Lowitja Institute.

This report presents the recommendations and outcomes from the national roundtable Empowering Aboriginal and Torres Strait Islander people through the Family Wellbeing Program. The Family Wellbeing Program is an effective social and emotional wellbeing program originally developed and delivered by and for Aboriginal people. The objective of the program is to develop people’s skills and capacity to move from a position of disempowerment to empowerment. It aims to empower Aboriginal and Torres Strait Islander people with a way to control and change their lives.

National Mental Health Commission. (2019). Monitoring mental health and suicide prevention reform: National report 2019. Australian National Mental Health Commission.

The mental health system in Australia is undergoing significant change. Reforms such as the National Disability Insurance Scheme (NDIS), the Fifth National Mental Health and Suicide Prevention Plan (Fifth Plan), Primary Health Networks (PHNs) and activities in suicide prevention are all occurring simultaneously. These reforms are ambitious in their scope. They are also interrelated which adds to the complexity of their implementation, and it will take time before their implementation leads to sustained change for consumers and carers.

The Healing Foundation. (2016). Restoring our spirits – reshaping our futures. The Healing Foundation.

In response to the Royal Commission into Institutional Responses to Child Sexual Abuse this report sets out a culturally based healing framework for understanding and responding to trauma experienced by Aboriginal and Torres Strait Islander people who as children were sexually abused within public or private institutions. The report draws on the views of Aboriginal and Torres Strait Islander survivors and service providers involved in healing work, the work of the Healing Foundation and the broader literature on trauma and healing. It provides a cultural perspective on the incidence of child sexual abuse in this context, the nature and impact of trauma, healing strategies and practices, and healing responses.

Gone, J. P. (2019). “The thing happened as he wished”: Recovering an American Indian cultural psychology. American Journal of Community Psychology, 64(1-2), 172-184.

Theodore, R., Ratima, M., Edwards, W., Sporle, A., Te Morenga, L., Kiro, C., & Ruakere, H. (2019). How a lifecourse approach can promote long-term health and wellbeing outcomes for Māori. Journal of Indigenous Wellbeing Te Mauri – Pimatisiwin, 4(1), 15-25.

Lifecourse studies examine ways to prevent ill-health, by determining how issues develop and when there are good periods in the lifecourse to intervene. For this reason, lifecourse findings and longitudinal data are increasingly being used to inform government policies and practice, regarding for whom, when, and how prevention and intervention programmes are implemented. Māori and Indigenous peoples experience wide and enduring ethnic inequalities across a broad range of outcomes throughout the lifecourse. There has been limited Māori lifecourse research to date. In this paper, we describe current lifecourse approaches being used by Māori researchers and discuss the value of a taking a lifecourse approach for Māori health and wellbeing. We address issues around longitudinal data. In particular, the need for Māori leadership in the collection, analysis, management, and governance of longitudinal data that can be used to inform health and social policy to guide programmes and interventions that support positive Māori outcomes throughout life.

Webber, M., & O’Connor, K. (2019). A fire in the belly of hineāmaru: Using whakapapa as a pedagogical tool in education. Genealogy, 3(3), 41.

The numerous iwi (tribes) and hapū (subtribes) of Te Tai Tokerau (Northland) have a long whakapapa (genealogy) of influential leaders that have made a significant impact on the Māori world and beyond. However, ruinous media narratives that focus without relent on poverty, low employment, inadequate housing, and lagging educational outcomes—particularly among Māori—continue to negatively impact the ways students from this region define their identity. This paper presents a number of strengths-based narratives—focusing on tūpuna (ancestors) from Te Tai Tokerau whakapapa—that act as counter-narratives to this rhetoric. The paper discusses how these narratives can be used as powerful pedagogical tools that enhance Te Tai Tokerau Māori students’ self-efficacy, aspiration, optimism, and cultural pride, presenting them as powerful agents of their own destiny. This paper draws on data produced from a Marsden-funded study—led by Te Tai Tokerau descendents—that has collected and re-presented multifaceted hapū/iwi-based narratives that celebrate Te Tai Tokerau distinctiveness, success, history, and identity. This wider study has examined, contextualised, and celebrated diverse characteristics recurring in Te Tai Tokerau pūrākau (genealogical stories), pepeha (tribal sayings), waiata (songs), karakia (incantations), televisual materials, and written histories.