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There are significant disparities in mental health care between First Nations and non-Indigenous people in settler-colonial nations. This paper, authored by a crosscultural and interdisciplinary team, argues that settler-colonial legislation, the tools and technologies of architecture, and the clinical practice of psychiatry are all implicated. Taking inspiration from Tanganekald, Meintangk-Bunganditj legal scholar Irene Watson, who yearns for freedom to roam across Country and connect with the land of her ancestors, we propose tactics for 'roaming' from the conventions of architecture and psychiatry to decolonize our practices. These include yarning, walking Country, and representing these itinerant practices through wandering lines. The outcomes are processes for developing new therapeutic places and practices for mental health care. [ABSTRACT FROM AUTHOR]

Indigenous young people around the world suffer poorer mental health outcomes than their non-Indigenous peers. Currently, how culture matters for health, what cultural practices are used in community to support health and well-being, and how culture is passed on in Aboriginal contemporary life in southeast Australia--the region most affected by settler-colonisation--is not well understood. This paper presents findings from yarns with a representative sample of 44 Indigenous participants working in the field of health and well-being that explored how culture interleaves with health and well-being. It uses grounded theory as the overarching methodology with community participation in all aspects of the project. Participants were nominated through snowball sampling and screened by a governing board of Elders. They included men and women of varied ages with half residing in urban areas and half in rural Victoria, Australia. They had declared affiliations to 31 traditional tribal groups. The yarns were held over Zoom videoconferencing between an Indigenous research assistant who was part of the community, and each participant. Each yarn was recorded, transcribed, coded and analysed by a multi-perspectival team. Culture was viewed as central to individual and communal life and passed on through relationships with people and Country itself. Community members used a wide variety of cultural practices to aid and maintain health and wellbeing in profound ways. Myriad extant obstacles to health and well-being were also described, from experiences of disconnection through to barriers for accessing services. These findings have the potential to shape future holistic care and policy. [ABSTRACT FROM AUTHOR]

Over the past two decades researchers have been exploring new hybrid methodologies to decolonise Indigenous mental health research. Grounded Theory with Community Participatory Action Research (CPAR), often using Indigenist methods, is the most common. Grounded Theory's claim to rigour is its transparent, organised process of sifting and theme finding, while CPAR respects Indigenous self-determination and Indigenous ways of knowing doing and being, involving Indigenous research participants in all stages of the research from data collection to analysis. On the surface it would seem to be the ideal methodological approach to navigate the cultural divide. However, this article will argue that Grounded Theory's inherent weakness is in the process of thematic analysis, which uses consensus during the analysis phase to find dominant themes. Drawing on the social systems theory of Niklas Luhmann and the political theory of Chantal Mouffe, this article will argue for a group process of "agonistic pluralism" instead. Searching for shared truths has a tendency to smooth out differences. The article proposes an approach for configuring a research team and conducting team analysis that struggles with, and accounts for, dissonances, disagreements and differences. Furthermore, it argues these differences should be recorded as important findings along with agreed themes. The approach has been developed to explore community perspectives on the relationship between culture and health, and in turn, to develop culturally appropriate mental health therapies for First Nations young people within a Western paediatric hospital. [ABSTRACT FROM AUTHOR]

Objective: Indigenous young people are known to have adverse demographic and psychosocial factors affecting worse mental health outcomes and some household factors aiding resilience. In Australia, there has been no exploration of these factors in clinically referred Indigenous young people assessed in a culturally appropriate way. Methods: A total of 113 Indigenous children and adolescents, 217 non-Indigenous young people, age, gender, mental disorder symptom severity, symptom-linked distress and impairment matched, and 112 typically developing participants, age- and gender-matched were recruited. Cultural validity and reliability of the impairing symptoms in Indigenous young people were determined. Key demographic and psychosocial factors were compared across the three groups. Results: The Indigenous clinical group differed significantly from the other two groups that did not differ on three possibly protective measures examined. Key demographic and psychosocial risk factors in the Indigenous group differed significantly from the non-Indigenous clinical group which in turn differed from the typically developing participants. The three groups exhibited a progressively increased magnitude of difference. Conclusions: It remains imperative to nurture features that provide protection and enhance resilience for Indigenous young people and their communities. Indigenous status is linked to significant demographic and psychosocial disadvantage over and above that conferred by clinical impairment and its management. It is crucial that these features are managed and/or advocated for with those demographic and psychosocial factors of the greatest magnitude dealt with first. Future systematic investigations of the contribution of these key factors to mental health referral pathways, assessment and management are needed. [ABSTRACT FROM AUTHOR]

Over the past two decades researchers have been exploring new hybrid methodologies to decolonise Indigenous mental health research. Grounded Theory with Community Participatory Action Research (CPAR), often using Indigenist methods, is the most common. Grounded Theory's claim to rigour is its transparent, organised process of sifting and theme finding, while CPAR respects Indigenous self-determination and Indigenous ways of knowing doing and being, involving Indigenous research participants in all stages of the research from data collection to analysis. On the surface it would seem to be the ideal methodological approach to navigate the cultural divide. However, this article will argue that Grounded Theory's inherent weakness is in the process of thematic analysis, which uses consensus during the analysis phase to find dominant themes. Drawing on the social systems theory of Niklas Luhmann and the political theory of Chantal Mouffe, this article will argue for a group process of "agonistic pluralism" instead. Searching for shared truths has a tendency to smooth out differences. The article proposes an approach for configuring a research team and conducting team analysis that struggles with, and accounts for, dissonances, disagreements and differences. Furthermore, it argues these differences should be recorded as important findings along with agreed themes. The approach has been developed to explore community perspectives on the relationship between culture and health, and in turn, to develop culturally appropriate mental health therapies for First Nations young people within a Western paediatric hospital. [ABSTRACT FROM AUTHOR]

Indigenous people in Australia suffer from significant disparities in health compared to their non-Indigenous peers. Policies to address it have had little success. Using Michel Foucault's concept of 'enunciative modalities' and Wiradjuri historian Lawrence Bamblett's theory of deficit discourses and 'straightline stories,' which builds on Foucauldian theory, this essay explores the reasons for the failures, the complicity of architecture, and responses by the discipline. This article (coauthored with an Aboriginal doctor and academic, and an Elder in the community) argues hospitals, in particular, are alienating environments. It proposes a new Indigenous-led typology to mediate hospital care that is spatio-temporally and materially different. [ABSTRACT FROM AUTHOR]

The relationship between Indigeneity, social adversity status and externalizing symptoms is complex and unclear. This study investigates how Indigeneity, social adversity status and externalizing symptoms are related in young people.A total of 132 Indigenous and 247 non-Indigenous young people aged 6–16 years were recruited from a hospital mental health outpatient service. Normality plots with statistics for social adversity status and parent-reported externalizing symptoms were completed for the two groups, matched for age, gender, mental disorder symptom severity, symptom-linked distress and impairment. Standard multiple regression was used to examine how Indigeneity moderates the relationship between social adversity status and parent-reported externalizing symptoms. A scatterplot investigated the association between Indigeneity and social adversity status in young people with parent-reported externalizing symptoms.The distributions of the two groups and (1) social adversity status and (2) parent -reported externalizing symptoms were non-normal but acceptable for a moderator analysis. Indigeneity and social adversity status made independent significant positive contributions to externalizing symptoms. In contrast the interaction between Indigeneity and social adversity status made a nonsignificant negative trend to externalizing symptoms. A scatterplot revealed Indigeneity moderated the link between social adversity status and externalizing symptoms.High social adversity status is linked to externalizing symptoms in non-Indigenous young people but despite higher social adversity, Indigenous young people don’t necessarily externalize. Potential protective resilience factors for externalizing symptoms in the Indigenous young people need to be ascertained and nurtured. Future systematic investigations of the contribution of these protective factors to Indigenous referral pathways and management are needed. It is also crucial that increased social adversity status is addressed and managed in all young people, regardless of Indigeneity. [ABSTRACT FROM AUTHOR]

A 10-year review of the 2008 Council of Australian Governments’ (COAG) Close the Gap Strategy identified the lack of involvement of Indigenous people in developing policies as a key reason health disparities persist. It also posits that disconnection from Country and culture have been crucial factors. Physical and mental health cannot be separated from spiritual health and well-being amongst Indigenous Australians. This article describes the co-development of a cultural enrichment research study with Indigenous Elders, health service leaders, and community members that places culture at the centre of care to augment traditional Western mental health management. The study has been overseen and nurtured from its inception by a governance board of Traditional Custodian Elders and an Advisory Group of Indigenous health workers. Qualitative data were collected through community ‘zoom-yarns’ between an Indigenous research assistant and 44 community members during COVID-19 lockdowns. These yarns were analysed through an innovative, constructivist, multi-perspectival discursive grounded theory method. Findings have led to an Elder-governed adjuvant cultural therapy which is currently being trialled and will be evaluated using the same multi-perspectival discursive grounded theory research methodology. One third of all Indigenous Australians now live in capital cities, so developing models to bring culture and Country into urban health facilities are becoming increasingly important. The Indigenous-led research approach outlined in this paper suggests a model for engaging Indigenous communities that mainly distrust Western research and have been failed by Western mental health care. It has the potential to shape future policy. [ABSTRACT FROM AUTHOR]

Objective: Recently, Indigenous academics have evolved an Indigenist discourse that centralises Indigenous 'ways of knowing, being and doing'. Through this dialogue, Indigenous 'ways of knowing and being' augment Western biopsychosocial treatments.Methods: This paper outlines the authors' clinical encounters with young people from the Koori community and ongoing consultation with Koori community Elders in Victoria that led to engaging young people and their families in an Indigenist dialogue.Results: The Indigenist dialogue facilitates deeper engagement in the therapeutic process, opportunities to mirror and reflect on young people's experiences, and drawing parallels between Western health interventions and Aboriginal cultural ways of doing health and being healthy.Conclusions: The young people and their families evince greater faith in the management process and a deeper focus, centred awareness and knowledge of their Cultural rights and responsibilities. Future developments should include a systematic database with qualitative and quantitative data to support its evaluation and iterative development and improved community engagement to ensure holistic health gains are maintained. [ABSTRACT FROM AUTHOR]

The Indigenous community in Australia is beset by extraordinary disadvantage, with health outcomes that are substantially worse than those of non-Indigenous citizens. This issue has consequently been the subject of voluminous health research that has given rise to a range of affirmative action policies progressively implemented over the past decade. Statistics, however, remain dire. This paper argues that new models of research practice and policy are required that are inclusive of Indigenous ways of knowing, doing, and being. It proposes a new framework to promote wellness in urban hospitals for Aboriginal young people and their families modelled on equal, 2-way dialogue between Western and Indigenous ways of doing health. Cultural safety is an essential starting point, but a range of other practices is proposed including oversight by a board of Elders, inclusion of traditional healers in treatment teams, and "space, place, and base" within the hospital building and its grounds so that it can be used as a site for culturally engaged Indigenous outpatient care. Practice approaches that embed culture into assessment, formulation, and treatment are being trialled by the authors of this paper, three of whom have Aboriginal heritage. Together the authors are working toward building an Aboriginal Knowledge Place within the major teaching hospital where they work. [ABSTRACT FROM AUTHOR]

Whose values matter when considering which environment is healthier for a child whose guardianship is contested? The biological mother from a remote Australian Aboriginal community, who voluntarily relinquished her but has now requested her return? The foster mother who has cared for her in a metropolitan centre in another State of Australia, thousands of kilometres away? The welfare professionals who also live in that city? Or the child herself, who left her birth home and community five years earlier at the age of two? Drawing on a case study of a seven-year old Aboriginal girl, the authors argue that non-Indigenous values trumped Indigenous values without the realisation of key players who were empowered to make such determinations. The article uses Manuel DeLanda's neo-assemblage theory to consider the range of processes that exert themselves to shape place-values and social identity in colonised nations. It will also draw on Erik Erikson's and Lev Vygotsky's theories of psychosocial development to consider competing sets of values that raised feelings of dissonance within the child. Beliefs about what makes a place health-giving are revealed to be complex in colonised nations. Despite policy and legislative changes to better support Aboriginal people and their right to difference, non-Indigenous professionals can continue to be driven by an unrecognised systemic racism. While place-values are not, of course, the only (or perhaps even the most significant) consideration in guardianship determinations, this article will argue they can play a significant and covert role. [ABSTRACT FROM AUTHOR]

Objective: Increased point prevalence rates of oppositional defiant disorder and conduct disorder have been reported in American Indian and Canadian First Nations children and adolescents. To date, in Australia, there has been no published examination of standardized Diagnostic and Statistical Manual mental disorder diagnoses in First Nations children and adolescents, determined after addressing key cultural methodological issues. Methods: In all, 113 First Nations children and adolescents and 217 non-First Nations young people, aged 6–16 years, age, gender, mental disorder symptom severity, symptom-linked distress and impairment matched were recruited in a case control study. Also, 112 typically developing non-First Nations participants, age and gender matched to the other two clinical groups as a second comparison group were recruited. Diagnostic and Statistical Manual mental disorder diagnoses via semi-structured clinical interview, social adversity status and full scale IQ were determined in all participants with cultural validity and reliability of the impairing patterns of symptoms in First Nations young people determined by First Nations mental health staff and Aboriginal Health Liaison Officers. Full scale IQ and social adversity status were appropriately controlled in the Logistic Regression analyses of Diagnostic and Statistical Manual mental disorder diagnoses between the two clinical groups. Results: Oppositional defiant disorder was the only diagnostic and statistical manual mental disorder diagnosis that differed between the First Nations and non-First Nations clinical groups, adjusting for confounding by social adversity status and full scale IQ in the multivariable model. The point prevalence of oppositional defiant disorder was 2.94 times higher (95% confidence interval: 1.14–7.69) among the First Nations compared to the non-First Nations clinical group. Conclusion: Key known risk factors for oppositional defiant disorder can be identified early and holistically managed in First Nations young people. This will prevent oppositional defiant disorder decreasing their access to mental health services and increasing their involvement in the criminal justice system. In addition, the resilience building aspects of oppositional defiant disorder that may enhance self-respect need to be nurtured. [ABSTRACT FROM AUTHOR]

The article discusses the theory of Gilles Deleuze and Felix Guattari on the different ways groups of bodies in cities and groups of neurons in brains function. It states that developments in cognitive neuroscience and deconstructions of understanding the city from philosophy reveal that relationships within and between groups of neurons, brains and bodies and city are fluid and mutually defining.

“Urban Threads” was an architectural installation that explored the ways in which those without land, money, and power shape the urban fabric, in particular the private territories that are staked out in the public realm and the spatial practices that connect them. All creative works in the installation were produced by women who were homeless in the context of a support group, TimeOut @ The Place, run by a collaboration of welfare agencies in Melbourne. Nine sites, located in minor lanes and alcoves in Melbourne’s Central Activities District, each housed “bedrooms” and “WAR(d)robes,” a “dining room,” and a “Living Room.” The “Path of Most Resistance (and Least Distance)” was marked out between them. The installation was conceived of and curated by the author as part of a PhD by Creative Works. The question “to what extent can architecture be ‘tactical’ (de Certeau’s definition)” is at the basis of the project. [ABSTRACT FROM AUTHOR]