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Page 4 of 7 Working with individuals When working with Aboriginal and Torres Strait Islander clients in a mental health setting, a number of issues need further consideration in order for an appropriate assessment to be completed and management plan to be formulated. In general, consulting with Aboriginal and Torres Strait Islander mental health workers can be invaluable when learning interviewing skills. Although there are no set rules for conducting the interview, the following points may be helpful to consider.
Introductions When Aboriginal or Torres Strait Islander peoples meet there is often a brief exchange of information about background and family which serves to locate each person in a network of communities and relationships. Aboriginal and Torres Strait Islander people tend to be highly mobile and it is important to ask about where a person comes from and their experience and heritage rather than assume that the person is a local. You may also find that you will also be asked where you come from and perhaps some questions about your background. Although conventionally you may not answers such questions in your practice, it is polite to say something brief about your background without providing too much detail or personal information.
Accepting that there are differences among cultural groups and acknowledging that this is part of the communication process is important, introductions in general are often less formal and may require an explanation of what your role is rather than name and title. Use of names is a complicated process and some names should not be used e.g. following a death. It is advisable to ask all clients their preferred name or one they use in the community. In some cases, knowing the clients family relationships may be the only way of locating them in the community, for example, Aunty Joan's youngest son. It may also be necessary to ask permission to use certain titles such as 'Aunty' or 'Uncle' when speaking to family members.
The Interview
The timeframe and sequence of the interview may be different e.g. it may be more appropriate to ask about general matters first and illness-related issues later. For example a more social introduction can be helpful, finding out about family, and community as well as knowing where you fit in the system. If more time is taken in the beginning to establish rapport you will be more likely to get the information you require to make an assessment. Questions should be kept short and straightforward, keeping away from double negatives. Allow enough time for questions to be considered, as long silences may be appropriate. Sometimes the true nature of the appointment will not present itself until the end of the consultation.
In many instances there will be a preference for family members, elder, health worker or traditional healer or other people to be present or consulted during the appointment and this should be negotiated at the outset. Address the person nominated as the spokesperson as it may be much later in the consultation when the client will be responsive.
Confidentiality
Issues of confidentiality require careful consideration, especially if transgressions of traditional law are involved, but should not automatically override the request for others to be present. This will also provide you with a source of collateral information. Do not however assume all issues can be readily discussed with family.
Setting
Consider the setting in which you are conducting the interview and whether alternative sites can be used. The setting itself can present quite a barrier and lead to an escalation of symptoms. An Aboriginal or Torres Strait Islander person surrounded by doctors and nurses is likely to feel extremely vulnerable, especially if brought in by the police. Although an interview room may be acceptable, consider using an outdoor area or less formal environment.
Approach
In general you should approach the interview with you having something to offer, as does the patient, family and/or community e.g. a two-way learning experience. That is you are there to share your knowledge as a doctor and the client is there to share their knowledge of family, culture and history, hence both parties have equal status within the interview. Maintaining an openness and non-judgemental and inquiring style is important. Honesty is also important and if unsure about what to do in a situation, be open, ask and wait, instead of trying to bluff your way through. This is more likely to result in better communication. Sitting alongside or in a circle may be more comfortable and preferable to direct confrontation for some groups.
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Guidelines
