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Journal article

Addressing inequities in Indigenous mental health and wellbeing through transformative and decolonising research and practice

Cultural competency Indigenous mental health Suicide Health services accessibility Indigenous health Social determinants of health Australia

Aboriginal and Torres Strait Islander (hereon respectfully referred to as Indigenous) peoples experience a disproportionate burden of health and mental health issues and suicide. Indigenous rates of death by suicide were double the rate of the non-Indigenous population in 2018.

This paper reviews key mental health and social and wellbeing policy documents and frameworks, and examines relevant literature documenting current decolonising strategies to improve programs, services and practice. It also draws on the key findings of the Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention (CBPATSISP) and Transforming Indigenous Mental Health and Wellbeing research projects. This work builds on the substantial work of the national Aboriginal and Torres Strait Islander Suicide Prevention Evaluation Project (ATSISPEP) which outlines a range of solutions to reduce the causes, prevalence, and impact of Indigenous suicide by identifying, translating, and promoting the adoption of evidenced based best practice in Indigenous specific suicide prevention activities.

An analysis of the literature findings confirmed there are a number of gaps and uncertainties that clearly contribute to the current inequities in Indigenous mental health and wellbeing. These include: health services gaps, barriers to access; lack of understanding of the exact nature and extent of unmet need; the costs and benefits of adopting Indigenous-led and targeted and upstream prevention initiatives; as well as significant data limitations to address them. Several studies support the need for urgent and rigorous research to inform the development, implementation, and evaluation of culturally appropriate mental health care pathways that take account of the specific needs of different Indigenous sub-populations. The Aboriginal and Torres Strait Islander Health Performance Framework Report, identifies a number of barriers to access to mental health-care services including hospitals, community mental health-care and specialised mental health-care services, GPs and private psychiatrists.

Substantial progress has occurred in the past decade within the Indigenous mental health and suicide prevention field. However, given the different experiential and cultural contexts around Indigenous social and emotional wellbeing (SEWB) and mental health, significantly more culturally appropriate and dedicated research is urgently needed and cannot be mainstreamed. Recent studies reveal an over-representation of Indigenous people experiencing psychological distress, depression and trauma, which mainstream mental health service models, and clinical paradigms have been unable to address adequately.

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