The Availability, Appropriateness, and Integration of Services to Promote Indigenous Australian Youth Wellbeing and Mental Health: Indigenous Youth and Service Provider Perspectives

Abstract

Concerns about the complexity, fragmentation and inefficiency of Australia’s current youth mental health service systems have led policy makers to seek improvements through a shift to community-based solutions. However, there is little evidence of how communities can make this shift. This paper examines the efforts of one Aboriginal and Torres Strait Islander (hereafter, respectfully, Indigenous) community—Yarrabah in north Queensland—to develop strategies for mental health and wellbeing service system improvements for school-aged youth (5–18 years). The research was co-designed with Yarrabah’s community-controlled health service and explores the perceptions of Yarrabah youth and service providers. Iterative grounded theory methods were used to collect and analyse data from 32 youth aged 11–24 years and 24 service providers. Youth were reluctant to seek help, and did so only if they felt a sense of safety, trust, relationality and consistency with providers. Young people’s four suggestions for improvement were access to (1) information and awareness about mental health; (2) youth facilities, spaces and activities; (3) safe and available points of contact; and (4) support for recovery from mental illness. Service providers highlighted an appetite for youth-guided community change and recommended five improvement strategies: (1) listening to youth, (2) linking with community members, (3) providing wellbeing promotion programs, (4) intervening early, and (5) advocating to address the determinants of youth mental health. Overall, both groups realised a disjunct between youth need and service provision, but a willingness to work together for systems change. This study demonstrates the importance of community-driven efforts that harness both youth and service providers’ perspectives, and suggests a need for ongoing dialogue as the basis for co-designing and implementing improvements to wellbeing supports and mental health services for Indigenous youth.

Exploring self-determined solutions to service and system challenges to promote social and emotional wellbeing in Aboriginal and Torres Strait Islander people: a qualitative study

“…Our findings are consistent with a recent study of Aboriginal and Torres Strait Islander youth wellbeing services that welcomed both youth and service provider perspectives and identified the need for safe spaces and points of contact for youth, listening to youth, linking to community members, and early intervention service delivery models ( 61 ). The research governance provided by local Aboriginal Elders and service providers was a strength of this study as it promoted trustworthiness through ongoing review and interpretation of emerging findings.…”

“Ngany Kamam, I Speak Truly”: First-Person Accounts of Aboriginal Youth Voices in Mental Health Service Reform

“…By using these first-person accounts in their entirety, the authors acknowledge the need for services -as well as researchers -to work with the "wholeness" of peoples' experiences [41,42]. Dividing and compartmentalising such experiences misses the point in terms of the ways in which services shape their programs to support Aboriginal young people seeking help for mental health concerns [22]. The co-researcher experiences included navigating new and challenging power dynamics, receiving support from the research team and fellow young people, bringing Elders and young people together as a cultural way of working, building confidence and capacity, and realising the bigger picture of systemic change and closing the gap.…”

“…Although the young people were challenged by this group dynamic, they also recognised the importance of working directly with those in positions of power and can make change from top-down, as Shae (S.A.) reveals: "We cannot underestimate the value and richness that Indigenous perspectives, experiences, and ways of working bring to the table". Service provider's recognition of the power imbalance at play and their commitment to slowing down, stepping back, making room, and truly listening to the young people's their voices was essential and demonstrated a new kind of leadership [22]. Hunter (H.C.) supports this when he says that "Collaborating with young people is essential in developing service plans that are orientated towards their needs, while allowing young people to expand their voice and perspective on issues that affect them".…”

“…Although Aboriginal youth mental health is a priority for the government [18], the disproportionately high suicide rates and overall poor mental health outcomes indicate that current government-led solutions are not effective and greater community-led solutions are required [3,4,19]. It is critical that the mental health sector moves towards a way of working that places Aboriginal young people's voices at the centre, where their lived experience is recognised as an invaluable resource to developing culturally safe mental health care and improving mental health and wellbeing outcomes, in terms defined by them [3,4,11,[20][21][22].…”

Evaluating Aboriginal and Torres Strait Islander Social and Emotional Wellbeing services: A collective case study in Far North Queensland

“…This study aims to demonstrate the use of DESDE and a HER approach to describe the pattern of SEWB and mental health service provision for Aboriginal and Torres Strait Islander young people aged 5–18 years living in Cairns and in the discrete Aboriginal community of Yarrabah in Far North Queensland. Young people and service providers in Yarrabah have recently identified several areas of unmet needs, including availability of information about mental health, safe points of contact, access to youth facilities, support for recovery and early intervention ( McCalman et al, 2023 ).…”