Australian Indigenous Mental Health - Understanding the Dance of Life

Understanding the Dance of Life

DIMENSIONS	TRADITIONAL	HISTORICAL	CONTEMPORARY	GAPS IN KNOWLEDGE	SOLUTIONS
PHYSICAL	Earth as ‘Mother’, Nature as family Connection to country, source of renewal Traditional medicine Traditional diet and activity, “healthy specimens”	Physical genocide Dispossession, “uprooted” Environmental degradation Rapid change in diet Incarceration, Institutionalisation Forced labour Ill-health, exposure to disease	Population changes Present morbidity, burden of chronic illness Burden of care on children Land-rights and treaty Holistic view Urban, rural and remote differences Exclusion from health	Stress, immunity and chronic disease Grief and mortality Transgenerational trauma and physical health Chronic illness and mental health Complimentary healing practices	Sovereignty and Native Title Equity and access Accountability Traditional diet, medicines and healers Connection to country Holistic medicine Best Start to Life Basic requirements
PSYCHOLOGICAL	Different concepts, beliefs and meaning Sense of self; External attributions; Site of distress Shared learning, cognitive development Identity and role Autonomy and relatedness Life continuum, belonging Birth & bereavement	Psychological Genocide Profound trauma Abuse Loss and grief Extreme powerlessness Misdiagnosis, Mislabelling, Re-traumatisation	Place in society Present trauma, loss, grief Future uncertainty Psychological morbidity, illness Identity issues Psychological strengths Apology International perspective Exclusion from humanity	Appropriate Diagnostic systems Treatment options Culturally valid tools, Appropriate Outcomes Accountability measures Impact of racism and discrimination Cultural and spiritual phenomenology Culture bound syndromes	Truth in history National ‘Sorry Day’ Human rights, Safe development, future assurance Inclusiveness Pride, positive images Professional development Indigenous therapies, grief and trauma Addressing ‘stress’ Identifying and tackling racism
SOCIAL	Community centred Kinship system Attachment and Child rearing Early autonomy Country as home, kin Collective Vs Individual Obligation and reciprocity Two-way sharing	Social genocide Stolen Generations Racism and apartheid Slave labour	Changing role of family especially men Role models Family disruption, isolation Loss of buffering Removal of children, adults Paternity Present disadvantage, impoverishment Reconciliation Exclusion from society	Family therapies Children’s needs Vs Family Community outcomes Systemic barriers	Social Justice Social determinants Generational view, Long term commitment Whole of life concept Tracing family, Restoring Kinship Recording Oral histories Narrative therapies Empowerment Representative body
SPIRITUAL	Origins of life Dreaming Belonging, connectivity Philosophical views Beliefs, Experiences, Healing	Spiritual genocide Impact of mission life Imposition of Christianity	Value of wisdom Intolerance, Understanding difference Exclusion from existence	Spirituality and Health Existential Despair	Central to health of Australia Healing Understanding, tolerance, respect Purpose and future hope
CULTURAL	Lore/Law Language Ceremony Healing Beliefs, Expression, Experiences	Cultural genocide Misinterpretation Tokenism Sacrilege	Cultural clash, two worlds Cultural mix Cultural practices, age, gender Endurance and resilience, strengths Cultural knowledge Cultural grief Exclusion from custom and consciousness	Continuum of cultural identity Diversity of practice and experience Models of care	Acceptance National Identity Compensation Cultural renaissance Self determination (Indigenous rights) Indigenous governance Cultural security Cultural Respect Framework Education, training Shared learning, Collaboration

Overview:
As outlined in the Dance of Life description, there are a number of dimensions each with a number of layers that require consideration when developing a comprehensive approach to understanding Aboriginal and Torres Strait Islander menta health as well as providing assessment and treatment. The following framework lists a number of factors operating at the individual, family, community or broader societal level that could be impacting on mental health and wellbeing. Although many factors lay outside the responsibility of the mental health sector, mental health professionals play a vital role in advocacy and in working collaboratively across sectors to improve outcomes for Aboriginal and Torres Strait Islander families.

Mental health professionals also have a sphere of influence and respect in broader society that can facilitate the process of reconciliation and social justice. Risk and protective factors as well as the concept of resilience needs to be understood within a broader context and through an Aboriginal and Torres Strati Islander lens. This allows for the appropriate development of mental health promotion, prevention and early intervention programmes. Given the magnitude of the historical legacy combined with the contemporary complexities of working within a cross cultural context in mental health, it is essential to be able to understand what influences behaviour, symptom formation and response to treatment.

Clinicians need to be able to tease out the impact of disadvantage and discrimination, be able to recognise illness in the midst of cultural and spiritual complexity and ambiguity, and attempt to address the many factors impacting on wellbeing. Incorporating historical and cultural perspectives as well as flexibility in approach will enhance the clinicians skills and knowledge and provide a platform for meaningful and respectful cross-cultural exchange.