A community‐led design for an Indigenous Model of Mental Health Care for Indigenous people with depressive disorders

Abstract

Objective: To generate outcomes for the development of a culturally appropriate mental health treatment model for Indigenous Australians with depression. Methods: Three focus group sessions and two semi‐structured interviews were undertaken over six months across regional and rural locations in South West Queensland. Data were transcribed verbatim and coded using manual thematic analyses. Transcripts were thematically analysed and substantiated. Findings were presented back to participants for authenticity and verification. Results: Three focus group discussions (n=24), and two interviews with Elders (n=2) were conducted, from which six themes were generated. The most common themes from the focus groups included Indigenous autonomy, wellbeing and identity. The three most common themes from the Elder interviews included culture retention and connection to Country, cultural spiritual beliefs embedded in the mental health system, and autonomy over funding decisions. Conclusions: A treatment model for depression must include concepts of Indigenous autonomy, identity and wellbeing. Further, treatment approaches need to incorporate Indigenous social and emotional wellbeing concepts alongside clinical treatment approaches. Implications for public health: Any systematic approach to address the social and cultural wellbeing of Indigenous peoples must have a community‐led design and delivery.

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“…Focus group participants noted how each role, be it leading or participating in the intervention, led to increased leadership capacity and knowledge of Indigenous culture. Te connection between facilitating culturally inclusive interventions or connecting with others through shared culture and positive self-identity and wellbeing has been documented in other work [31][32][33] and speaks to the strengths of the intervention more broadly. Te focus group results also point to the reach of the intervention, both in terms of how the study drove reengagement at the nonproft service organization and how it helped to reduce stigma more broadly at the organization and within the community of participants.…”

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“…Knowledge-holders offered recommendations for how this well-being could be supported via e-health, noting the importance of connection, trust, and cultural safety, and recognising the impacts of colonisation. Echoing the perspectives of other First Nations youth (Murrup-Stewart et al, 2021), knowledge-holders placed importance on connection to family, Community, Mob, friends, Country, and Spirit in strengthening and maintaining SEWB (Gee et al, 2014), thereby reinforcing the need to reflect these understandings when designing and implementing health services for First Nations youth (Farah Nasir et al, 2021). Understanding and valuing these perspectives of SEWB are key to dismantling western colonial models of health, which often preclude First Nations youth from accessing culturally safe care (Gee et al, 2014).…”

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“…Indigenous Aboriginal and Torres Strait Islander (First Nations) Australians have high rates of health issues, including chronic diseases and reduced life expectancy, compared to migrant and settler populations (Nolan-Isles et al 2021). They also experience high rates of common mental health disorders such as depression (Farah Nasir et al 2021), trauma, and post-traumatic stress disorder (Nasir et al 2021). Despite this, there is still a lack of access to health services in First Nations communities in Australia.…”

“…The uptake of this service by the community was so impactful that additional funding from the New South Wales (NSW) government was secured to establish a fixed clinic. Through this healthcare service, the community voiced a need for a suicide intervention program that acted in real time and without judgement (Farah Nasir et al 2021). Professor Toombs developed the Indigenous-Applied Suicide Intervention Skills Training program (I-ASIST), a suicide intervention model provided in partnership with Livingworks Australia (Farah Nasir et al 2021).…”

“…Through this healthcare service, the community voiced a need for a suicide intervention program that acted in real time and without judgement (Farah Nasir et al 2021). Professor Toombs developed the Indigenous-Applied Suicide Intervention Skills Training program (I-ASIST), a suicide intervention model provided in partnership with Livingworks Australia (Farah Nasir et al 2021). This program has trained over 10 000 people in 90 communities, giving the community a set of critical skills in mental healthcare to support their loved ones when they most need it.…”