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Indigenous health and mental health morbidity There are a number of health reviews and reports available that can assist in understanding the high levels of health morbidity in the Aboriginal and Torres Strait Islander population. As there is the potential for health and mental health conditions to be inter-related and the need for caution in regard to medication interactions and side effects, a good understanding of health profiles is required for good mental health care.
The health of the Aboriginal and Torres Strait Islander population is far below the standard for other Australians. General health levels and life expectancy are poor and there are higher than average levels of psychiatric morbidity. Major life stress events are far more common and communities suffer significantly from repeated loss and grief as well as significant trauma such as domestic violence, adding risk for mental health problems. As major health problems can occur in children and young people, screening for general health morbidity is essential across all age groups and in many cases physical illness may underlie or contribute to psychiatric conditions. As chronic stress can also impact on physical health, identifying and treating psychiatric conditions appropriately is important for improving health outcomes.
There are higher rates of psychiatric morbidity, especially in the areas of depression, post-traumatic disorders and comorbidity (with either substance abuse or a physical condition). Rates of schizophrenia and bipolar disorder are similar to the non-Indigenous population. Suicide rates on average are three times higher but vary considerably across communities.
Life expectancy remains 17-20 years less for Indigenous people in Australia. Indigenous people are more than twice as likely to die, in any age group, than non-Aboriginal people. In the 25 to 44 year age bracket, mortality is five times higher. Aboriginal mothers are ten times more likely to die in childbirth than non-Aboriginal mothers. Health outcomes for infants are also poorer and infants are more likely to have lower birth weight and experience obstetric complications. Problems in childhood often go unaddressed, and many children have chronic infections, poor nutrition, anaemia, and other developmental problems such as language delay adding risk for later problems.
Rates of diabetes, heart disease and renal failure are much higher and are occurring in younger age groups, adding risk for psychiatric morbidity, especially depression. As well sexually transmitted disease, anaemia, chronic infection, respiratory disease, injury, ear and eye problems are more common adding significant health burden for families.
In addition to the higher rates of psychiatric disorders, health outcomes are also worse due to difficulties with providing mental health services. Because a higher proportion of the Aboriginal and Torres Strait Islander populations live in some of the most remote areas, they have poorer access to health services and resources. Services may not be delivered in an appropriate way and there may be difficulties with clinical partnerships. The tendency of Aboriginal and Torres Strait Islander patients to present late in the course of illness can also contribute to the problem.
It is important for clinicians to be aware of the need for comprehensive health and mental health assessment and consider the impact of health and stress burden for families and children.
Essential reading
Indigenous Health Infonet On the basis of existing data: - There are higher rates of: depression, substance abuse and comorbidity, post-traumatic stress disorder.
- Rates of schizophrenia and bipolar disorder are roughly equal.
- There is a high rate of domestic violence in Aboriginal communities, most of it directed toward women. The majority of sexual or physical assaults against Aboriginal women go unreported.
- Trauma and grief in particular are significant concerns in Aboriginal mental wellbeing, both with relation to current conditions (e.g. discrimination, higher mortality rates, abuse) and historical conditions (e.g. stolen generation, destruction of culture).
- Depression is present in 50% of Aboriginal people, based on random samples, and two-thirds of those presenting to a GP.
- The suicide rate is higher than the Australian standard. This is particularly high for young men in custody.
- Mental disorders are frequently co-morbid with general health conditions. Depression associated with diabetes is a particular concern, as the rate of diabetes is very high.
- Psychiatry of Old Age is not well understood in the Aboriginal population, due to the low life expectancy.
- Children's mental health receives inadequate attention, as there is a high tolerance of behavioural problems in children. Children develop behavioural problems on account of chronic middle ear infections, which interfere with their hearing and hence their ability to learn and communicate.
Sources: (Meadows and Singh, 2001); Curtin Indigenous Research Centre
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Key issues
