Mental Health Services for Remote Aboriginal Communities

The essay highlights the advantages and disadvantages of mental health service delivery approach through face-to-face service delivery model and virtual service delivery model for Aboriginals residing in the remote areas of Australia and suffering from mental health complications. It also discusses the challenges faced by healthcare professionals and suggests professional developmental strategies for improving their skills.

Running head: ASSESSMENT 3
Mental Health Services for Remote Aboriginal Communities
Name of the Student
Name of the University
Author Note

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Introduction
The type of the service delivery holds prominence in the overall outcome of the
service. In mental health service delivery holds significant prominence (McGorry, Bates &
Birchwood, 2013). McGorry, Bates and Birchwood (2013) highlighted that proper service
delivery helps to increase consumer’s participation while decreasing the cost of care and at
the same time helps to improve the overall mental health outcomes. The following essay aims
to highlight the advantages and disadvantages of mental health service delivery approach
through face-to-face service delivery model and virtual service delivery model. The main
target population include the Aboriginals residing in the remote areas of Australia and
suffering from mental health complications. The essay will initiate will rational behind the
chosen target population and positive and negative aspects of face-to-face and virtual service
delivery model. The essay will them aim to critique the limitations and advantages of
delivery counselling and community campaign through face-to-face and virtual service
delivery model. At the end the essay will highlight the personal opinion of the authors and
will propose the required recommendation in order to overcome the challenges of the
healthcare service delivery promote professional development among the mental healthcare
workers.
Population selected: Australian aboriginal
Australian Aboriginal have higher risk of developing unhealthy behaviours like
smoking and drinking and the condition is worse in comparison to the people living in
metropolitan areas (Parker & Milroy, 2014). As per the statistics 34.8% of Aboriginals
resides in cities in comparison to the 70% of non-indigenous population. The statistics also
highlights that 7.7% of the Aboriginal population resides in remote and 13.7% of population
resides in very remote areas (Australian Bureau of Statistics, 2013). These groups of

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Aboriginal population residing in remote or very remote areas mainly suffer from poor
mental health conditions and high rate of occurrence of chronic or other preventable disease
which in turn decreases the overall life-expectancy of the population. This poor health status
increasing with remoteness may be influenced by geographical and environmental factors
like long distance access to services. Another condition underlying the poor physical and
mental health status is guided by poor socio-economic determinants of health (Australian
Institute of Health and Welfare, 2011). Thus remoteness and poor health status are the
underlying causes behind their vulnerability towards poor health-related outcomes. Thus this
selected group of population will be helpful in structuring a critique about mental health
service delivery.
Service Delivery in Mental Health in Aboriginal Population
As per the guidance document published by the Australian Government Department
of Health (2016) in relation to $85 million funding (2016-17 to 2018-19) granted specifically
for Aboriginal and Torres Strait Islander mental health services, the mental health services
must be integrated, safe and culturally competent in order to meet their mental health
requirements. Aboriginals’ mental health services under this funding are specifically directed
towards suicide prevention, substance abuse and effective mental health counselling in order
to overcome depression and anxiety. These services are to link and complement with other
closely connected activities like emotional and social wellbeing. According to Slade et al.
(2014), in order to devise holistic mental health services, two main service delivery
approaches that are required to be undertaken include face-to-face service and virtual service
delivery.

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Face-to-face service delivery
Face-to-face service delivery is a condition where the staffs are required to work live
within the community in order to deliver the service. The main advantage of face-to-face
service delivery in mental health includes working directly with the client and thus helping to
develop-person centred care plan. However, face-to-face service delivery in healthcare is
associated with sudden disadvantages like cost of recruitment or employee retention, poor
knowledge of the staffs about cultural competencies, occupational health risk and problem in
the work life balance of the healthcare service delivery staffs (Mohr et al., 2013).
Virtual service delivery
This service delivery approach is mainly given through phone, or through online
video calls through skype. The main advantage of this approach is, it is cost effective and
helps in easy access and prompt access of patient information through electronic medical
records and thereby helping to implement effective multidisciplinary care approach
(Christensen & Petrie, 2013). According to Christensen and Petrie (2013), Information and
Communication Technology (ICT) at present is regarded as key towards accelerating
advances in mental health. The review conducted by Hollis et al. (2015) revealed virtual
service delivery in mental health through digital technology has potential to transform mental
healthcare service delivery model through connecting patients, services and healthcare data
from different parts of the world. However, the disadvantages of virtual service delivery
through the use of softcopy data include bridging of confidentiality and transparency and
accountability. Moreover, Hollis et al. (2015) also highlighted there exist a gap in the
evidence based underlying these technologies.
Type of Mental Health
Services
Face-to-Face service delivery Virtual service delivery

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Counselling  x
Community Development  x
Education  
Counselling and associated service delivery model
The study conducted by Bennett‐Levy et al. (2014), highlighted that face-to-face
counselling helps in effective promotion of the cognitive behavioural therapy (CBT) which
helps in effective reduction in the adverse mental health consequences. However, CBT might
fit under different cultural and social contexts in order to provide comprehensive care. The
review conducted by Ridani et al. (2015) stated that effective face-to-face counselling is also
helpful in suicide prevention via specifically targeting the risk factors of suicides like social
exclusion, lack of job opportunities, domestic violence, and victims of racism or financial
unrest. Ridani et al. (2015) conducted a study in order to analyse the importance of face-to-
face counselling and revealed that face-to-face counselling is based on effective
communication and development of therapeutic relationship, which helps the service users to
discuss their problems in detail with the mental health nurse of psychologist and at the same
time, helps to take informed decision making. Though face-to-face counselling is helpful in
extracting effective outcome, but proves to be costly in the domain of transportation cost in
the remote areas and the efforts required to encourage the Aboriginals to take part in the
counselling.
Providing effective mental health counselling through virtual service delivery are
increasingly visualised as a potential approach in order to meet the growing demands of the
mental health service (Dowling & Rickwood, 2013). However, Dowling and Rickwood
(2013) highlighted that further research is required to be undertaken in order to support for

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the widespread implementation of online or virtual mental health service delivery through
counselling. Online mental health counselling is effective from the aspect of the service
provide and in reducing the overall cost of care from the service delivery approach. Because,
the mental health nurses or the psychologist procuring the care are not required to commute
to the remote areas and in order to cater Aboriginal communities mental health needs. This
saves the cost of communication (Dowling & Rickwood, 2013). However, providing online
care is not a cost-effective option for the Aboriginal communities residing in remote areas
because the majority of them do not have proper internet access. Though Park (2017) stated
that email and access to internet in the remote areas of Australia has promising future in
mental healthcare delivery, the overall approach is not feasible at this point of time. The
reason behind this is residents of remote Aboriginal communities lack skills for computer
navigation.
Community development and disease education and its service delivery model
The main advantage of community health education and awareness approach in face-
to-face delivery in mental health includes direct communication and active community
participation, which improves overall state of mind of the service users and increases their
mental-health related awareness (North & Pfefferbaum, 2013). According to Zalsman et al.
(2016), mental health service delivery through face-to-face community education and
participation helps to improve mental health outcome likes suicidal approaches arising from
severe depression and anxiety.
However, community development and increasing the mental health awareness
among the Aboriginal communities residing in the remote or very remote areas has certain
share of disadvantages. According to Parliament of Australia (2016), it is difficult to attract
the mental healthcare professionals to work in the remote or very remote areas in order to

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serve the mental health needs of the Aboriginal communities. Poor service user to service
giver ratios hampers the framing of effective community health education approaches for
generating awareness among the Aboriginals with mental health complications in remote
areas of Australia. The service users also experience challenges in face-to-face participation
in the community health awareness and the education program. According to Morawska et al.
(2013), in big city, it is easy to hide if one wants however, it the conditions are different in
remote or very remote areas. Here the population density is very low and thus it is impossible
to visit the local community awareness program or mental health education campaign or
group counselling without the whole town knowing about it. This creates social exclusion
within the community and the service users or the parents of children or young adults feel
lonely due to unavailability of social relationships. Thus, they prefer to stay away from such
interactive programs or awareness campaign.
If such programs are implemented online then the free of social exclusion can be
decreased as online participation through virtual media will ensure privacy and
confidentiality of the participation. Moreover, the healthcare professionals will not be forced
to shift their working based in the remote location thus promoting employee retention and
satisfaction. However, though online education and health promotion will fail to uphold the
concept of active community participation. Moreover, lack of proper internet access in the
rural areas hampers the overall virtual service delivery of mental health awareness program
(Morawska et al., 2013).
My position
If I am asked to describe my position in relation to the ideas raised in the literature
about the service delivery model, I would say that both face-to-face and virtual mode of
service delivery is important in order to provide comprehensive healthcare coverage among

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the Aboriginal communities residing in the remote areas of Australia. I also feel that the
disadvantages of the virtual service delivery model which is highlighted through the analysis
of literature can be overcome because lack of proper internet access of lack of proper
knowledge about the use of internet in mental care model are modifiable risk factors and
proper implementation of teaching and training approach will help to overcome the same. In
face-to-face delivery, I think it is the biased attitude of the healthcare service providers
towards the Aboriginal community which is hampering overall service-delivery approach.
Proper education of culturally competency and generation of cultural awareness will help to
overcome the problem. I feel that proper amalgamation of both face-to-face service delivery
approach and virtual service delivery approach will help to improve the overall mental health
status of the Aboriginal communities residing in remote areas of Australia.
Professional developmental strategies for improving the skills of human service worker
Changing the biased attitude of the mental healthcare professionals
The mental healthcare professionals nurture a biased attitude towards the Aboriginal
community and this is the reason that they lose interest in working for the betterment for the
Aboriginal communities (Morawska et al., 2013). The study undertaken by Christopher et al.
(2014) stated that the mental healthcare professional feel that there are no career progress in
working under remote set-up and fewer charity services to offer support further decrease the
doctors of the psychiatric ratio. These are main challenges experienced by the healthcare
professionals while delivering mental health service in face-to-face counselling. Kohn-Wood
and Hooper (2014) are of the opinion that the proper training of the mental health care
professionals in the domain of cultural competencies and effective communication skills will
help change their biased attitudes towards Aboriginals. Moreover, it is the duty of the
government to come forward and increase the advantages or facilities of the mental

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healthcare professionals so that it encourages them to activity engage in mental health
promotion for the Aboriginal population residing in remote areas in Australia.
Recruitment of the aboriginal healthcare worker
Another challenge that can be highlighted in the face-to-face mental health care
delivery model (in educational campaign or counselling) is lack of adequate recruitment of
the Aboriginal healthcare professionals. Kohn-Wood and Hooper (2014) are of the opinion
that recruitment of the Aboriginal healthcare worker helps to increase the participation of the
Aboriginals from culturally and linguistically diverse community (CLAD) in mental health
promotional campaign. Presence of Aboriginal workforce increases cultural competency of
the workforce and thus helping to increase the participation of the service users in face-to-
face mental health campaign. Moreover Kohn-Wood and Hooper (2014) stated that presence
of Aboriginal healthcare workers also help to decrease the biased attitude of the non-
aboriginal workforce towards the Aboriginal mental health service users.
Training in effective communication
Kourkouta and Papathanasiou (2014) argued that training in the effective
communication skills for the healthcare workers acts as a medium of the professional
development. Good and effective communication between the service users and the mental
healthcare professionals is important for successful outcome of individualized nursing care
for each patients both under face-to-face and under virtual settings. Proper training in the
effective communication skills helps the mental healthcare professionals in understanding the
feelings and the thought-process of the service users and helping to devise proper care plan.
Training in the effective communication skills helps in professional development as it also
help in improving the intrapersonal communication skills. Moreover, proper training in the
effective communication skills help the mental healthcare professionals to understand how to

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deal or interact with CALD and thus helping them to overcome the biased attitude Aboriginal
community members suffering from mental health complications.
Conclusion
Thus from the above discussion, it can be concluded that Thus from the above
discussion, it can be concluded that Australian Aboriginals residing in the remote or very
remote areas are victims of the mental health complications due to lack of proper access of
the healthcare services in the remote areas. Two important approach of mental healthcare
delivery include counselling and community health education approach or mental health
awareness campaign. This two mental health recovery approaches can be delivered either
face-to-face service delivery model or through virtual service delivery model. However, both
face-to-face and virtual service delivery model have sudden share of advantages and
disadvantages. The main advantages in face-to-face healthcare delivery approach include
easy development of person-centred care and one to one service. The challenges in this
approach include cost of recruitment, employee retention, occupational health hazard,
cultural safety and difficulty in understanding language for CLAD communities. One cost-
effective approach in healthcare delivery is virtual service delivery as it does not demand
rigorous staff requitement and employee retention. However, confidentiality and privacy
issues come into consideration in case of online service delivery. Moreover the Aboriginal
community members have poor access of internet or lack of knowledge of internet access and
this creates a barrier in comprehensive usage. Proper training of the mental healthcare
professionals in effective communication and cultural competencies will help in their
professional development and thereby promote comprehensive mental health service
delivery.

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References
ABS (Australian Bureau of Statistics) 2013. Australian Aboriginal and Torres Strait Islander
Health Survey: first results, Australia, 2012–13. ABS cat. no. 4727.0.55.001.
Canberra: ABS. Access date: 13th October 2018. Retrieved from:
http://www.abs.gov.au/ausstats/abs@.nsf/mf/4727.0.55.001
AIHW (Australian Institute of Health and Welfare) (2011). The health and welfare of
Australia’s Aboriginal and Torres Strait Islander people: an overview. Cat. no. IHW
42. Canberra: AIHW. Access date: 13th October 2018. Retrieved from:
https://www.aihw.gov.au/getmedia/677d394f-92e1-4ad5-92b4-
c13951b88968/12222.pdf.aspx?inline=true
Australian Government Department of Health. (2016). Aboriginal and Torres Strait Islander
Mental Health Services. Access date: 13th October 2018. Retrieved from:
http://www.health.gov.au/internet/main/publishing.nsf/content/2126B045A8DA90FD
CA257F6500018260/$File/6PHN%20Guidance%20-%20ATSI%20Mental%20Health
%20Services.pdf
Bennett‐Levy, J., Wilson, S., Nelson, J., Stirling, J., Ryan, K., Rotumah, D., ... & Beale, D.
(2014). Can CBT be effective for Aboriginal Australians? Perspectives of Aboriginal
practitioners trained in CBT. Australian Psychologist, 49(1), 1-7.
Christensen, H., & Petrie, K. (2013). Information technology as the key to accelerating
advances in mental health care. Australian & New Zealand Journal of
Psychiatry, 47(2), 114-116.

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Christopher, J. C., Wendt, D. C., Marecek, J., & Goodman, D. M. (2014). Critical cultural
awareness: Contributions to a globalizing psychology. American Psychologist, 69(7),
645.
Dowling, M., & Rickwood, D. (2013). Online counseling and therapy for mental health
problems: A systematic review of individual synchronous interventions using
chat. Journal of Technology in Human Services, 31(1), 1-21.
Hollis, C., Morriss, R., Martin, J., Amani, S., Cotton, R., Denis, M., & Lewis, S. (2015).
Technological innovations in mental healthcare: harnessing the digital revolution. The
British Journal of Psychiatry, 206(4), 263-265.
Kohn-Wood, L., & Hooper, L. (2014). Cultural competency, culturally tailored care, and the
primary care setting: Possible solutions to reduce racial/ethnic disparities in mental
health care. Journal of Mental Health Counseling, 36(2), 173-188.
Kourkouta, L., & Papathanasiou, I. V. (2014). Communication in nursing practice. Materia
socio-medica, 26(1), 65.
McGorry, P., Bates, T., & Birchwood, M. (2013). Designing youth mental health services for
the 21st century: examples from Australia, Ireland and the UK. The British Journal of
Psychiatry, 202(s54), s30-s35.
Mohr, D. C., Burns, M. N., Schueller, S. M., Clarke, G., & Klinkman, M. (2013). Behavioral
intervention technologies: evidence review and recommendations for future research
in mental health. General hospital psychiatry, 35(4), 332-338.
Morawska, A., Fletcher, R., Pope, S., Heathwood, E., Anderson, E., & McAuliffe, C. (2013).
Evaluation of mental health first aid training in a diverse community
setting. International Journal of Mental Health Nursing, 22(1), 85-92.

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Morawska, A., Fletcher, R., Pope, S., Heathwood, E., Anderson, E., & McAuliffe, C. (2013).
Evaluation of mental health first aid training in a diverse community
setting. International Journal of Mental Health Nursing, 22(1), 85-92.
North, C. S., & Pfefferbaum, B. (2013). Mental health response to community disasters: a
systematic review. Jama, 310(5), 507-518.
Park, S. (2017). Digital inequalities in rural Australia: A double jeopardy of remoteness and
social exclusion. Journal of Rural Studies, 54, 399-407.
Parker, R., & Milroy, H. (2014). Aboriginal and Torres Strait Islander mental health: an
overview. Working together: Aboriginal and Torres Strait Islander mental health and
wellbeing principles and practice. 2nd ed. Canberra: Department of The Prime
Minister and Cabinet, 25-38.
Parliament of Australia. (2016). Services for rural, remote and indigenous Australians.
Access date: 13th October 2018. Retrieved from:
https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Former_Commit
tees/mentalhealth/report/c16
Ridani, R., Shand, F. L., Christensen, H., McKay, K., Tighe, J., Burns, J., & Hunter, E.
(2015). Suicide prevention in Australian Aboriginal communities: a review of past
and present programs. Suicide and Life‐Threatening Behavior, 45(1), 111-140.
Ridani, R., Shand, F. L., Christensen, H., McKay, K., Tighe, J., Burns, J., & Hunter, E.
(2015). Suicide prevention in Australian Aboriginal communities: a review of past
and present programs. Suicide and Life‐Threatening Behavior, 45(1), 111-140.

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Slade, M., Amering, M., Farkas, M., Hamilton, B., O'Hagan, M., Panther, G., ... & Whitley,
R. (2014). Uses and abuses of recovery: implementing recovery‐oriented practices in
mental health systems. World Psychiatry, 13(1), 12-20.
Zalsman, G., Hawton, K., Wasserman, D., van Heeringen, K., Arensman, E., Sarchiapone,
M., ... & Purebl, G. (2016). Suicide prevention strategies revisited: 10-year systematic
review. The Lancet Psychiatry, 3(7), 646-659.