Diagnosis of psychiatric illness among tribal Aborigines

What is known about pathways to mental health care for Australian Aboriginal young people?: a narrative review

OBJECTIVES

To (1) gain an understanding of current trajectories of Aboriginal young people through the mental health care system in Australia; (2) summarize what mental health care pathways have been developed or evaluated to guide mental health care delivery for Aboriginal young people; and (3) identify barriers and facilitators to the adoption of effective mental health care pathways for Aboriginal young people.

METHODS

Databases, including, AMED, Embase, Global Health, Health and Psychosocial Instruments, Healthstar, MEDLINE, PsychINFO via Ovid, CINAHL via EBSCO, The Cochrane Library, Indigenous Collections, Informit and Health Systems Evidence, were searched to identify evidence concerning mental health service delivery for Aboriginal young people in a primary care setting.

RESULTS

We did not identify any reports or publications explicitly describing the current trajectories of Aboriginal young people through the mental health care system in Australia. Furthermore, we were unable to locate any mental health-related treatment pathways which had been explicitly developed or modified to meet the needs of Aboriginal young people. The use of appropriate assessment tools, engagement of family and community, flexibility, and central coordination have been identified in the literature as potential facilitators of culturally appropriate mental health service delivery for Aboriginal children and adolescents.

CONCLUSIONS

Aboriginal children and adolescents may face additional difficulties navigating the mental health care system in Australia due to complex socio-cultural factors and the dearth of culturally appropriate and effective mental-health related treatment pathways. Additional research regarding (1) practice trends in Aboriginal settings and (2) how Aboriginal child and adolescent mental health can be improved is urgently needed to inform clinical practice and improve mental health service access and outcomes for Aboriginal young people in Australia.

Aborigines, colonizers and newcomers: the landscape of transcultural psychiatry research in Australia

The authors present an analysis of transcultural psychiatry research in relation to three main population groups in Australia: Aboriginal Australians, documented immigrants, and refugees. The pioneering reports produced by Western psychiatrists in Aboriginal communities are examined in this article. Additional quantitative and qualitative studies developed with Aboriginal people in the context of a traumatic acculturation process are also reviewed. Subsequently, the authors examine the challenges faced by immigrants with mental disorders in a health care system still unequipped to treat a new array of clinical presentations unfamiliar to the clinical staff. The authors also highlight the development of policies aimed at providing quality mental health care to a mosaic of cultures in an evolving multicultural society. Lastly, the psychiatric manifestations of refugees and asylum seekers are analysed in the context of a series of vulnerabilities and deprivations they have experienced, including basic human rights.

Australia's aboriginal population and mental health

It appears that mental illness was present in Australian Aboriginal culture prior to European colonization of Australia but was, most likely, a relatively rare occurrence. The much greater prevalence of mental illness and suicide in the current Aboriginal population is a reflection of the significant disruption to Aboriginal society and has a strong context of social and emotional deprivation. Management of the issues of mental illness in Aboriginal people requires a strong emphasis on cultural safety along with the recognition of family, culture and community in any therapeutic process.

The dawn of Aboriginal psychiatry

OBJECTIVE

The aim of this paper was to survey the writings by Western-trained and other psychiatrists and mental health professionals about Aboriginal peoples of Australia.

METHOD

A literature survey of works by psychiatrists and Aboriginal people from 1788 to the mid-1990s was undertaken.

RESULTS

There is a dearth of literature until the 1960s when there is an upsurge which continues to grow.

CONCLUSIONS

There has been an exponential growth of interest in Aboriginal and psychiatric perspectives since the 1960s. Some suggestions are made to explain this.

Suicide by aboriginal people in South Australia: comparison with suicide deaths in the total urban and rural populations

OBJECTIVE

To ascertain the number of recorded deaths by suicide of Aboriginal people and non-Aboriginals in South Australian urban and rural areas over the period 1981-1988.

METHOD

The South Australian Coroner's records were examined by one of the authors and an Aboriginal research officer in consultation with members of the South Australian Aboriginal community (who identified Aboriginal suicides wrongly recorded as non-Aboriginal suicides).

RESULTS

There was a major increase in suicide by Aboriginal people, both urban and rural, over that period, not marked by a similar increase for non-Aboriginal South Australians.

CONCLUSIONS

A comparison can be drawn with reports of suicide by American Indians. It is possible that Aboriginal deaths by suicide can be ascribed to "anomie" (a concept first developed by Durkheim of social disintegration affecting tribal peoples under colonisation). The paper highlights the need for the development of successful intervention programmes in Aboriginal health.

Homicide and suicide in Africa and England

A UK psychiatrist draws on his earlier experience as a police surgeon in Africa to compare homicide and suicide rates among the Xhosa tribe with those of England and Wales. A consideration of depression in primitive communities may, he suggests, provide the explanation for the low suicide rate found.

The article speculates whether the vastly different homicide/suicide rate found can be explained in terms of aggression and civilization.