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Objective: Mental Health Acts (MHAs) are important pieces of legislation which include essential definitions of mental illness and mental disorder and are used to guide decision-making regarding treatment, including involuntary admissions. In Australia, responsibility for reviewing this legislation falls under the jurisdiction of State and Territory Governments, resulting in interstate variations of legislative definitions and care requirements. In this paper, we outline some of the main differences between MHAs, and argue that it is time for Australia to enact nationally consistent Mental Health Legislation. Conclusions: Substantial divergence exists between definitions of mental illness and mental disorder, differing criteria for involuntary treatment and discrepancies between treatment requirements for Indigenous Australians. While variations between MHAs are understandable considering the historical context, in an increasingly integrated society, it is time for Australia to enact nationally consistent mental health legislation. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objective: The aims of this paper are to describe a Māori approach to assessment and intervention planning using the Māori creation narrative Te Ara a Tāne (The Journey of Tāne) and to outline an evaluation one year after the model was implemented.Conclusions: Te Ara Waiora a Tāne is a kaupapa Māori (Māori-centred) mental-health engagement, assessment, goal setting and planning approach designed to enhance the mana (spiritual and personal authority) of whānau (individuals and family/families) at the point they enter a Māori service and during ongoing mental-health work. Preliminary evaluation indicated that staff considered the model user-friendly and helpful for whānau. Further evaluation is needed to assess the impact of this approach on Māori whānau engagement with services. [ABSTRACT FROM AUTHOR]

The article reports on the changes occurred in the field of indigenous mental health over the last 50 years in Australia. It found major advances in psychiatry and in the roles and capacities of the Royal Australian and New Zealand College of Psychiatrists in the last half century. It also found that Aboriginal and Torres Strait Islander Australia has been transformed by social and political forces that have brought benefits and disappointments to Indigenous Australians.

Objective: This paper describes the background to, implementation of and evaluation challenges associated with an innovative, arts-based, wellbeing and mental health recovery project in a remote Indigenous setting. Results: Creative Recovery is a community-based arts initiative for Indigenous people with mental health problems. It has been rolled out as a pilot project in a remote Cape York community and is aimed at promoting wellbeing and recovery. The theoretical basis for the initiative is modelled on ideas of the role that social capital plays in improving mental health. This involves both the beneficial impact community participation and the social cohesion it creates can have, not only on an individual's mental health, but also on the social and emotional wellbeing of the communities they are part of. Such initiatives have already been adopted as an integral part of mental health promotion in countries such as the UK, and in other Australian states such as Victoria and Western Australia. The following paper will locate Creative Recovery in the current field of mental health promotion theory and Indigenous social and emotional wellbeing, and will discuss some of the evidence for and challenges inherent in adopting such initiatives. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper was to identify the accessibility barriers that deaf people from an Indigenous Australian or culturally and linguistically diverse background encounter when attempting to access public mental health services in Queensland. Method: Consultation with key stakeholders was undertaken. Results: Many of the barriers that deter deaf Indigenous Australians from accessing public mental health services in Queensland, in addition to preventing them from having access to the same continuum of care available to hearing English-speaking people were identified. Conclusions: Deaf Indigenous Australians encounter significant barriers when they seek to access public mental health services in Queensland. If these barriers are to be dissolved to ensure access to the same continuum of mental health care available to hearing English-speaking then a series of education and training, research and resource strategies need to be further addressed. [ABSTRACT FROM AUTHOR]

Objective: The use of innovative information technology is now well established in health. However, while the gap in health status between Indigenous and other Australians is both significant and unchanging, there is limited application of these new approaches to addressing this national health priority. This may in part reflect the 'digital divide', which is another facet of Indigenous disadvantage. This paper describes an approach to address both issues in remote Indigenous settings. Results: The Health Interactive Technology Network began as a proof-of-concept study of touchscreen technology in two Indigenous health settings. It has subsequently expanded to a number of remote Indigenous communities and developed new platforms and applications to respond to emerging health issues. In creating narrative, interactive approaches to address choices in relation to health behaviours, the community development and engagement effects of the creative process have been highlighted. These findings suggest that these approaches will be suited to further expansion in the area of mental health. [ABSTRACT FROM AUTHOR]

Objective: Insufficient understanding of the reciprocal interactions between health and human rights, mental health and human rights and the realization of all human rights by Indigenous peoples constitute a triple jeopardy in how these topics are currently being addressed and/or openly antagonized. This paper will attempt to show how a combined health and human rights approach to mental health in Indigenous peoples can transform a triple jeopardy into a triple opportunity. Methods: The vast and growing body of literature on mental health, health as a whole, and human rights as these relate to health and to Indigenous peoples will be used to frame the discussion. Results: Attention to the complex interactions of health and human rights can guide policy formulation and action by offering a method of analysis, a process of participatory decision and a framework for accountability. In addition, mental health can find its rightful place in the health and human rights discourse through efforts to help policymakers and practitioners broaden their vision of mental illness to holistically encompass aspects of physical, social, emotional and cultural wellbeing. Finally, connecting the role that rights realization plays in determining health and wellbeing will add power to the rightful claims by Indigenous peoples to the promotion and protection of all their human rights - civil, political, economic, social and cultural. Broadening the research agenda by applying systematically a health and human rights analytical framework to the understanding of social determinants of health would minimize the risk of assigning health outcome merely to behaviours, practices and lifestyles, uncovering structural determinants of holistic health entrenched in policies and governmental conduct. Conclusions: Building the evidence of the negative impact of human rights violation on health and the negative impact of ill-health on the fulfilment of other human rights can help in designing comprehensive interventions, building on the synergy between the promotion of health and the promotion of rights. A way forward is proposed for which it is essential that work be carried out across ethnic lines and professional boundaries to further advance the claim of Indigenous peoples for better health and greater enjoyment of human rights. [ABSTRACT FROM AUTHOR]

Objective: The concept of collective trauma has predominantly been applied in the context of natural and human disasters. This paper seeks to explore whether collective trauma offers a respectful way in which to explore and respond to mental health and wellbeing issues for Aboriginal families and communities. Method: A review of the international literature was undertaken in order to determine the elements of collective and mass trauma studies which may have relevance for Indigenous communities in Australia. Results: Findings support the proposition that the patterns of human responses to disasters, particularly in protracted traumas such as war-zones, shows strong parallels to the contemporary patterns of experience and responses articulated by Aboriginal people affected by colonization and its sequelae in Australia. Conclusion: Adopting evidence-informed principles of family and community healing developed internationally in disaster situations may provide helpful ways of conceptualizing and responding in a coordinated way to mental health and wellbeing issues for Indigenous people within Australia. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper is to report the experiences of the author during her Advanced Training Fellowship year in Indigenous mental health and consultation-liaison psychiatry through the Royal Australian and New Zealand College of Psychiatry. The description will include a discussion of how such a Fellowship may complement the key learning objectives of advanced training in psychiatry. Conclusions: A Fellowship in Indigenous mental health can offer a variety of experiences for the psychiatry trainee, including clinical work, research and teaching. The planning and collaboration with Aboriginal health organizations, key clinicians and Ethics committees provides a unique opportunity to learn invaluable communication and consultancy skills. [ABSTRACT FROM AUTHOR]

Objective: Despite recognition of the extremely high rates of mental illness among custodial populations and the fact that Indigenous people represent around one-quarter of Australia's custodial population, little is known about the mental health of Aboriginal and Torres Strait Islander people in custody. Mental health is an important component of social and emotional wellbeing for Indigenous people and this paper considers current evidence regarding the mental health status of Indigenous Australians in custody. Method: A systematic review was undertaken of the quantitative literature relating to the mental health problems of Indigenous people in custody in Australia. Results: Despite high incarceration rates for Indigenous people and evidence that both mental health problems and rates of mental illness are extremely high in this group, studies in this area are few and limited in scope. Conclusion: The first step toward addressing the marked social and mental health problems for Indigenous people in custody is to systematically identify the nature and extent of these problems. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this paper was to investigate the importance and challenges involved in conducting serial cognitive assessments among healthy Indigenous adolescents. Method: Cognitive assessments were conducted at fortnightly intervals for 2 months and again at 6 and 12 months among a group of Indigenous students from a boarding school in the Northern Territory. These students were to be the healthy control group in a long-term study of substance abuse. Recruitment and attrition rates were reviewed and related challenges for assessing participants were identified. Results: From the recruited sample (n=49), 18% reported heavy or frequent use of alcohol, cannabis or petrol. Males were more likely to have used these substances compared to females. Attrition increased as the follow-up interval increased with 49 recruits reducing to 32 in the first 2 months and only 15 and 13 of the initial group remaining for the 6 and 12 month follow-ups respectively. Conclusions: Main challenges included (i) appropriateness of tests and assessment processes, (ii) high rates of substance abuse and other illness in the control group and (iii) high attrition rates. The importance of assessing cognition appropriately is highlighted by a lack of information regarding mental health issues in Indigenous populations. [ABSTRACT FROM AUTHOR]

This project focuses upon the use of jam2jam, a generative computer system, to increase access to improvization experiences for children and to facilitate new kinds of relationships with artists. The network jamming system uses visual and audio cultural materials to enable communities to be expressive with artistic materials that they value as a community. As the system is part of a network, performances can be shared between communities at great distances and recordings of performances can be uploaded to a digital social network () and shared both locally and with the wider community. This paper examines a preliminary project where artwork made by Indigenous mental health clients in Far North Queensland was digitized and given to a group of 8–12-year-old urban Indigenous children to ‘improvize’ with and make music/video clips using the jam2jam instrument. It seeks to generate a discussion and identify applications within creative arts-led community health settings to facilitate new kinds of relationships with self, peers, local community, culture and artists through collaborative improvization. [ABSTRACT FROM AUTHOR]

Objectives: This paper provides an example of a mental health research partnership underpinned by empowerment principles that seeks to foster strength among community organizations to support better outcomes for consumers, families and communities. It aims to raise awareness among researchers and service providers that empowerment approaches to assist communities to address mental health problems are not too difficult to be practical but require long-term commitment and appropriate support. Methods: A collaborative research strategy that has become known as the Priority Driven Research (PDR) Partnership emerged through literature review, consultations, Family Wellbeing Program delivery with community groups and activities in two discrete Indigenous communities. Progress to date on three of the four components of the strategy is described. Results: The following key needs were identified in a pilot study and are now being addressed in a research-based implementation phase: (i) gaining two-way understanding of perspectives on mental health and promoting universal awareness; (ii) supporting the empowerment of carers, families, consumers and at-risk groups through existing community organizations to gain greater understanding and control of their situation; (iii) developing pathways of care at the primary health centre level to enable support of social and emotional wellbeing as well as more integrated mental health care; (iv) accessing data to enable an ongoing process of analysis/sharing/planning and monitoring to inform future activity. Conclusion: One of the key learnings to emerge in this project so far is that empowerment through partnership becomes possible when there is a concerted effort to strengthen grassroots community organizations. These include social health teams and men's and women's groups that can engage local people in an action orientation. [ABSTRACT FROM AUTHOR]

Objective: This study determined the cultural appropriateness of the Structured Clinical Interview for the DSM-IV Axis I Disorders (SCID-I) as an acceptable tool for diagnosing mental illness among Indigenous people.Methods: De-identified qualitative feedback from participants and psychologists regarding the cultural appropriateness of the SCID-I for Indigenous people using open-ended anonymous questionnaires was gathered. Aboriginal Medial Service staff and Indigenous Support Workers participated in a focus group.Results: A total of 95.6% of participants felt comfortable during the 498 questionnaires completed. Psychologists also provided qualitative feedback for 502 (92.3%) interviews, of whom 40.4% established a good rapport with participants. Of the participants, 77.7% understood the SCID-I questions well, while 72.5% did not require any cultural allowances to reach a clinical diagnosis.Conclusion: When administered by a culturally safe trained psychologist, SCID-I is well tolerated in this group. [ABSTRACT FROM AUTHOR]

Objectives: To further progress Kaupapa Māori (Māori focused) approaches within mental health services this study explored the experiences of Māori clinicians from a dedicated Māori mental health service in New Zealand, with a focus on a specific Kaupapa Māori therapeutic approach, Mahi-a-Atua.Methods: A qualitative approach was used to ascertain factors that facilitate and obstruct the utilization of Mahi-a-Atua. In a focus group hui (Māori meeting process), eight Māori clinicians discussed their experiences.Results: Facilitation of Mahi-a-Atua by Māori clinicians occurred through interconnectedness of a number of factors including cultural identity, relationships, wairuatanga (spirituality), kaitiakitanga (guardianship), validation of the model and the ability to co-work and engage in meaningful wānanga (learning) around the intervention. The extent to which clinicians used the model depended on their own perceived knowledge and confidence and how best able to integrate both cultural and clinical knowledge. Other constraining factors pertained to inadequate prior training, limited workforce development training and lack of adequate resourcing for specialized services.Conclusions: This research highlights the need for Māori focused specialized training that utilizes co-working within sessions and ongoing wānanga. [ABSTRACT FROM AUTHOR]

Objective: To describe an Indigenous Samoan psychosocial intervention developed to address the mental health needs of affected communities in Samoa following a tsunami.Method: A partnership was established between Samoan therapists, Samoan Catholic pastoral workers and non-Samoan mental health clinicians, informed by Samoan concepts of self and wellbeing. The format developed for visits to significantly affected households was based on a Samoan cultural practice known as asiasiga and was carried out by pastoral workers, with daily group supervision and access to mental health professionals.Results: Household visits were offered to affected families in villages throughout southern and eastern Upolu and the island of Manono. There was a high degree of acceptance of the programme by Pulenu'u (village governance leaders) and family leaders and members.Conclusions: Mental health responses to the needs of Indigenous Pacific communities following a disaster need to be embedded in the values of those communities. The Samoan practice of asiasiga contributed to the high degree of acceptability of this programme. Partnerships with churches, schools and other local organisations are likely to enhance acceptability and participation. More research is required on Indigenous Pacific post-disaster mental health programmes. [ABSTRACT FROM AUTHOR]

Objective: The aim of this article is to give an overview of Māori concepts informing a collaboration between a Māori healer (NiaNia) and psychiatrist (Bush).Conclusions: Wairua (spiritual) problems can resemble psychiatric disorders or symptoms. Knowledge of relevant Māori concepts such as mauri, tapu, mana, matekite and manaakitanga may assist psychiatrists in collaborating with Māori healers and kaumātua (elders) to enable more appropriate cultural and clinical assessment, as well as helping to build rapport and clinical interactions with Māori whānau (individuals and families). [ABSTRACT FROM AUTHOR]

The article discusses the process outcomes and potential of the Koorie Men's Health Day (KMHD). Professionals from local mental health service and 4 key individuals from the Aboriginal community were invited to form a steering group for KMHD. KMHD is a day program in central Gippsland where Koorie men aged 18 years above underwent a general health check and screening for mental health problems. It cites the KMHD model as a useful way for Aboriginal men to seek help for mental health problems.

Objective: Firstly, to demonstrate the involvement of Aboriginal people in caring-for-country as a case study of how appropriately targeted non-medical primary preventative health strategies can be a cost-effective approach to addressing chronic disease among Indigenous people. Secondly, to demonstrate the use of an analogous approach in addressing the global chronic disease pandemic.Method: A review of prior biomedical and economic research based on the involvement of Aboriginal people in caring-for-country is used to: (a) exemplifying the cost effectiveness of a non-medical preventative health intervention; and (b) the process by which such an approach might be applied across a broader context.Results: The presented results demonstrate one non-medical primary preventative health approach to addressing the health burden affecting Indigenous peoples.Conclusions: The suggested steps in optimising the cost effectiveness of such an approach demonstrate how it could be applied in addressing the global chronic disease pandemic. [ABSTRACT FROM AUTHOR]

Objective: The aims were to review progress in Indigenous mental health over the past 25 years and to identify possible directions for the next 25 years. Method: Māāori involvement in health and health care was used to illustrate key Indigenous developments since 1984. Challenges in the decades ahead were discussed in the context of demographic transitions, life course epidemiology, global trends, technological innovations and health leadership. Results: Progress was measured by a range of indicators including Māāori-referenced life expectancy, Māāori agendas for health, strengthened cultural identity, the dissemination of health knowledge, and Māāori participation in the health sector. In contrast to being ready to respond to change (future takers), active planning for the future (future makers) was seen as a better way of achieving Indigenous aspirations. One option for health advancement currently being developed in New Zealand involved an integrated approach premised on intersectoral delivery and a focus on families. Conclusions: Indigenous health will be advanced by dedicated approaches to family wellbeing that avoid fragmentation, focus on positive strengths, and lead to positive outcomes for family members and the family as a whole. [ABSTRACT FROM AUTHOR]