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Cross-cultural considerations and difficulties recruiting and retaining skilled workers in rural and remote regions may contribute to poorer service use for Aboriginal and Torres Strait Islander people. However, electronic resources may provide the opportunity for remote workforces to deliver structured, evidence-based, culturally appropriate treatments with limited training burden. The aim was to develop and determine the acceptability, feasibility, and appropriateness of a new e-mental health resource (the Australian Integrated Mental Health Initiative [ AIMhi] Stay Strong App) for service providers working with Aboriginal and Torres Strait Islander people in the Northern Territory. Eleven semi-structured interviews were conducted with 15 service providers and managers from a range of rural and remote primary health care service settings in the Northern Territory. All participants were given the resource to trial for at least 1 month before being interviewed about perceived barriers and enablers, acceptability, and feasibility. Thematic analysis revealed support for the acceptability, feasibility, and appropriateness of the resource among service providers. Major themes identified included acceptability, building relationships, broad applicability, training recommendations, integration with existing systems, and constraints to implementation. This is one of the first studies to explore the acceptability of e-mental health approaches for Aboriginal people among the remote health workforce. It is likely that e-mental health interventions, such as the AIMhi Stay Strong App will assist services to deliver evidence-based, structured interventions to improve well-being for Aboriginal and Torres Strait Islander clients. [ABSTRACT FROM AUTHOR]

Indigenous people are over-represented in inpatient mental health care in Australia. Evidence suggests client-orientated care planning increase client engagement, reduce substance dependence and improve self-management among Indigenous people. The successful uptake and implementation of interventions, however, which promote access and cultural security in primary care practice, remains challenging. The Aboriginal and Islander Mental Health initiative introduced a multi-faceted approach to client-oriented care planning, as part of routine care to the Royal Darwin Hospital inpatient psychiatric unit, to determine whether there was change in the quality of care to Indigenous clients over time. The study used a mixed methods design. It was underpinned by an action-oriented research approach and incorporated stakeholder engagement, interactive training in strengths based recovery approach and psycho-education and a quantitative audit of inpatient files. The results suggest some improvements in quality of care for clients in the inpatient unit with increased attention to social and family history, involvement of translators, and allocation of case managers. Cross-cultural training and tools promoted change in some aspects of clinical practice. Some changes, however, were often not sustained and it did not necessarily promote engagement of AMHWs in routine care. Greater emphases on follow up training and provision of clinician feedback, in conjunction with high-level system change and commitment to introduction of culturally adapted recovery principles, is required for more sustained changes to clinician care and implementation success. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to examine the extent to which antenatal emotional wellbeing (EW) assessments are undertaken in primary health care (PHC) centres and factors associated with completion of EW screening. Methods: Medical records of 797 pregnant women from 36 PHC centres in five states (NSW, QLD, SA, WA and NT) were audited. Results: Overall, 85% of the women were Aboriginal. The proportion of women with documented screening for EW varied from 5 to 38% between states (mean 17%). Aboriginal women were four times more likely (adjusted Odds Ratio (OR = 4.13, 95% CI = 2.46-6.92) to not be screened for antenatal EW than non-Aboriginal women. Aboriginality, <4 antenatal visits, absence of an antenatal and birth care plan, and lack of counselling on financial support were independently linked with no screening of EW. Conclusion: Provision of training for health service providers and further research on appropriate screening tools for Aboriginal women are needed to help redress this gap. [ABSTRACT FROM AUTHOR]

Little is known about the performance of outcome instruments with consumers of different cultural backgrounds. We report a study of using routine outcome measures with Indigenous adult mental health consumers, whereby mental health clinicians used two leading Australian measures with consumers who self-identified as Indigenous. Mean scores on most items were different from the predominantly non-Indigenous national averages; some, particularly those assessing accommodation and occupation, were worse while others (those assessing depression) were better. Scores were consistently worse when more informants were involved in the assessment. A set of good practice principles for the use of standardized measures with Indigenous consumers was developed. They recommend using informants whenever possible, ratings should objectively reflect underlying disadvantage and behaviours that are not sanctioned or accepted within the local culture, but not phenomena that are socially or culturally accepted. Despite the advice and training, most assessments did not involve additional informants. The (mainly non-Indigenous) clinicians mostly indicated no additional difficulty in using the outcome measures with the Indigenous consumers, although clinicians reported greater difficulty in completing them when additional informants were present. In 52% of assessments, clinicians felt that the scales reflected the consumer's problems reasonably, and in 22%, well. Perceived validity was positively associated with consumer engagement. The study provides qualified support for the practice of using the HoNOS and LSP for routine outcome assessment with Indigenous consumers. The main provisos are that clinicians need to maximize the engagement of consumers and try to ensure involvement of additional informants to reduce the chances of invalid assessments. [ABSTRACT FROM AUTHOR]

Mental health practitioners struggle to translate recovery paradigms into practice. Changing from a focus on remediation of symptoms to a focus on reclaiming life in the community and enhancing protective factors requires a new approach. One new approach that particularly challenges health providers is the equalising of traditional patient-service provider relationships. Given the additional issues of disempowerment and social disadvantage of Indigenous peoples in Australia, equalising relationships and embedding recovery values for Indigenous mental health clients especially require urgent attention. There is also a need to learn more about the meaning of recovery in the Indigenous context and the ways in which it differs from non Indigenous interpretations. The Aboriginal and Islander Mental health initiative (previously the Australian Integrated Mental health initiative) has developed resources and training which seek to address this gap. The resources support a culturally adapted strengths-based approach to assessment and early intervention and are increasing popular in mental health, alcohol and other drug and chronic disease settings. Indigenous people with mental illness are subject to additional complex and toxic combination of social disconnecting factors. Culturally adapted recovery approaches to Indigenous mental illness are thus an important component of closing the gap in Indigenous health. [ABSTRACT FROM AUTHOR]

The role of the community management order (CMO) in the management of mental illness has been associated with controversy. There is uncertainty as to the effectiveness of such involuntary treatment. Review of outcomes of involuntary community treatment has shown varied results, and in the remote areas of Australia the issue becomes more complex, and outcomes more difficult to measure. The Northern Territory's Mental Health Act 2000 has broadened criteria for detention. The decision to impose follow-up and case management on an individual (who may reside in a community several hundred kilometres from an in-patient facility) requires careful consideration of its ethical, professional and psychosocial implications. The trend toward increasing use of mental health legislation in the Northern Territory — particularly for Indigenous people — deserves close scrutiny in order that culturally appropriate and sensitive treatment plans are developed. [ABSTRACT FROM PUBLISHER]