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Page 6 of 7
Working with individuals
Understanding and assessing symptoms
The meaning of symptoms and understanding of illness varies widely from more traditional to contemporary explanations. Working within the cultural belief system is essential. If for example the patient identifies a spiritual cause for their illness, they may still accept treatment from you, if also given treatment by a traditional healer. Without this, they may not accept treatment at all. Aboriginal and Torres Strait Islander clients may also experience distress differently, for example, pain in the shoulder or epigastrium may represent grief or low spirit. It is important to explore what the client thinks is the problem as well as their understanding of cause and acceptability of treatment.
Culturally acceptable beliefs and experiences as well as cultural influences on illness can present in a variety of ways and include auditory and visual experiences, different concepts of time, communication, spiritual experiences and gifts, premonitions, dream experiences and healing. Cultural responses to grief and loss for example can include talking and seeing ancestors. Depression, Anxiety and Post-traumatic Stress Disorders can be easily missed if the mode of presentation has auditory and visual phenomena, as mood, and other symptoms can be difficult to assess properly. Be careful not to over-interpret cultural phenomena nor overlook or misinterpret underlying illness. If in any doubt, phenomena can only be made sense of by the original group to which a person belongs. This is the case for traditional healers as well, although there is considerable overlap between groups. Observing and eliciting phenomena in Aboriginal and Torres Strait Islander clients is difficult and can be easily mislabelled. For instance, failure to develop rapport is not necessarily the client's problem when communication and cultural meaning are poorly understood. Shame responses during consultation may involve avoidance, giggling or withdrawal and need to be understood as such and not judged too quickly. Persistence of response or phenomena over time may be better indicators of underlying disorder. Speech, language, behaviour, personal hygiene and levels of activity must be assessed in the context of community norms. Poverty of content and restricted affect may represent extreme shyness and reluctance to engage. These phenomena are easily checked by how the individual interacts with their family, community members or Aboriginal or Torres Strait Islander mental health workers.
Validity
At present there are very few mental health or cognitive assessment tools or tests that have been validated for Aboriginal or Torres Strait Islander clients. Attention, concentration, executive function and memory can be tested in a variety of ways. Low literacy rates still exist in many Aboriginal and Torres Strait Islander communities in Australia and this can have a significant impact on standard testing. It is more important to ask if the person can relate information relevant to them, their community and frame of reference. It is important to keep in mind throughout your interview/session whether the process has been valid. If not them you cannot arrive at an appropriate diagnosis and management plan and may need to start again. If the person agrees with everything you say or says no to every question, it is unlikely that the information is valid and may mean that they are being polite or are uncomfortable with the process. Just remember if you are becoming frustrated with the process, then the client is most likely to be frustrated as well. Try to determine what is wrong with the interview and be open to trying a different approach.
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Guidelines
