Aboriginal Health and Mental Wellbeing

This assignment delves into the complexities of Aboriginal health, specifically focusing on mental wellbeing within Australian primary healthcare systems. It examines the historical context of colonization and its impact, analyzes current service models, and explores strategies for culturally safe and effective care delivery. The discussion encompasses social determinants, community participation, and the role of Aboriginal Community Controlled Health Organisations (ACCHOs).

Social & Emotional Wellbeing
Aboriginal and Torres- Strait Islander: Social & Emotional Wellbeing
Introduction
Aboriginals and Torres- Strait Islanders population has used this term ‘social &
emotional wellbeing’ (SEWB) to describe about the societal, emotional, cultural as well as
spiritual wellbeing of an individual (Gee, 2014). SEWB emphasize the relation of Aboriginals
with land, family, community as well as spirituality that are important to individuals; which
affects their wellbeing (Langham, 2017). All the health professionals should meticulously
consider SEWB while caring Aboriginals, which is highly sensitive. Australian Medical services
puts greater efforts in improving Indigenous health by adopting WHO’s primary health care
principles (Marles, 2012). This post discusses about the importance of SEWB rather than mental
health activities while implementing Health based programs among Indigenous population..
Difference between SEWB and mental health
SEWB is a complex and multidimensional concept with certain resonance for
Aboriginals & Torres- Strait Islanders (Dudgeon, 2014) whereas mental health is mostly used by
the non-Indigenous population to describe about the thinking, feeling, coping and ability to
participate in daily activities and that mental health involves absence of any mental disorders.
Most of the Aboriginals & Torres- Strait Islanders states that the term ‘mental health’ as well as
‘mental illness’ focuses only on problem aspect and fail to involve those factors that
encompasses and influence a person’s wellbeing (Bowins, 2016, Sherwood, 2013). Moreover,
the holistic view of health in SEWB has pushed the Aboriginals and Islanders to prefer the term
‘social & emotional wellbeing’ rather than mental health.
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Gee (2014) suggested that though the terms SEWB and mental health & illness are used
interchangeably, the later terms should be considered as a part of an individual’s SEWB rather
than equating them with SEWB. Additionally, Aboriginals believe that SEWB is ‘a multifaceted
aspect of health that not only encompasses mental health, but also the varied health and
wellbeing domains such as their link to country, culture, ancestry, spirituality family along with
community (Sherwood, 2013). Considering SEWB and mental health as an aspect of cultural
constructions can definitely enhance the effect of cultural responsiveness and strengths related
approach in-order to manage the emerging issues among individuals.
In-regard to Aboriginal & Torres-Strait Islanders, many past events have imposed a
serious effect on their SEWB. According to Zubrick (2014), colonization has caused a profound
effect on the cultural practices and their implication on SEWB among Aboriginals (Sherwood,
2013). Varied factors have been found to be linked with SEWB as racial discrimination, life
stresses, grief, loss of lands (dispossession), societal exclusion, policies and actions including
child removals (care with protection orders), unresolved life- trauma, incarceration, societal and
economic disadvantages, family violence, unemployment, substance abuse along with physical
health issues (Zubrick, 2014). Gee (2014) has also identified many factors that influences SEWB
as the link of Aboriginals with country, their spiritual beliefs, ancestral origin, kinship, self
determination, cultural continuity as well as governance in community (Parker, 2013). According
to Professor Milroy, three themes were found to have affected Aboriginals and Islanders as the
denial of humanity; existence as well as identity (Gee, 2014).
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Aboriginal Medical Services and its alignment with PHC
Aboriginal community controlled healthcare services (ACCHS) also called as Aboriginal
Medical Services (AMS) has pioneered the current comprehensive primary health care (PHC) in
Australia by following the Alma Ata’s Declaration of World Health Organization (Freeman,
2015). In 1970s, ACCHS was developed in response to the poorer access to health care services
as well as varied discrimination practices in the usual healthcare provided to the Aboriginals. Its
services provided a modified primary health-related care model in-regard to the general health
care practice, which was supported and funded by the Medicare services.
The first ACCHS service that includes the Central- Australian’s Aboriginal Congress
(later termed as Congress) was developed based on the effect of public (local Aboriginal
population) meetings for formulating plans to seek collective advocacy as well as for taking
action to support the Aboriginal’s rights that includes the right to health. Dwyer (2011) has stated
that nearly 150 ACCHS services were found to have served about one- third to half of the
Aboriginals. In present days of Australia, the self determination based policies of 1980s and
1990s were modified by a practice that was featured by a paternalistic- interventionism as well as
a deficit-model related to the Aboriginals health- and wellbeing (NACCHO, 2011). ACCHS
organizations are found to play a greater role in giving the voice for and render control to local
Aboriginal and Islander communities (Sherwood, 2013).
ACCHS strives to provide PHC as enshrined by the WHO in the Alma-Ata declaration-
1978 based on its definition for PHC as ‘essential health-care that are practically applied,
scientifically sound as well as acceptable by society with all the technologies made accessible
universally to individuals, families and communities; by their fullest participation and at an
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affordable cost by the community and Nation’. Many of the principles of ACCHS echoes the
WHO’s definition which also stresses mostly that the community should identify their own
problems and needs for taking an effective action (Freeman, 2016).
The main principle of the National- Aboriginal’s Health Strategy involves ‘not only
maintaining physical wellbeing of Aboriginals is important but also the societal, psychological
and cultural wellbeing of the community is equally important in which the people can achieve
full potential so as to bring the total wellbeing of the Aboriginal community (Freeman, 2015).
The mentioning of ‘community’ is highly essential aspect of the Aboriginals view of their self
and hence strongly connected to health & wellbeing. ACCHS also has a holistic healthcare view
which recognizes the need for a multifaceted Indigenous healthcare and focuses mainly on their
cultural complexities (Freeman, 2016). As Aboriginal communities in Australia has varied
cultural practices and speak distinct languages, local control is must.
The first ACCHS services were implemented in 1971 in the inner cities of Sydney,
Redfern (Marles, 2012). AMS has expanded too many health-care facilities that renders free
medical, psychological, dental, obstetrics and gynecology, pharmacology as well as alcohol
services to a larger Aboriginal group. Greater difficulties were encountered by the Indigenous
people in accessing the health care because of their uncomfortable feeling in seeking medical
care at mainstream hospitals, reluctance, extreme geographical isolation and lack of
transportation. It was overcome by the main-stream services of ACCHS by tackling the cultural
and language disparities. AIHW (2011) showed that there was a greater discrepancy in life
expectancy of Aboriginals and non-Indigenous people with unacceptably higher to be 11.5 yrs in
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Social & Emotional Wellbeing
males and 9.7 in females. Additionally, key health indicators (infant mortality, heart disease,
mental illness) of Aboriginals was found to be worse which shows that a novel approach to
Aboriginals is needed.
Moreover, the services provided by ACCHS are restricted by funding; with majority from
the Common-wealth/ State & Territory Government (NACCHO, 2011). The 2012 Indigenous
Expenditure (Steering) Report shows that for every dollars of money that are spent for non-
Indigenous healthcare, only 0.66 dollars were spent for Aboriginal healthcare. ACCHS strives to
widen its activities to promote accessibility of Aboriginals to essential basic care. Many
Universities have started medical schools to train Indigenous doctors based on the principle
‘stronger focus on the community with equity along with engagement by the medical
personnnels’, thereby enhancing the advocacy and leadership skills in Indigenous people.
As per WHO and World Bank report, integration of people is vital to promote quality of
care (Cotlear, 2011) and hence ACCHS strives to enable comprehensive PHC approach in
Aboriginals to achieve Universal health converge by reducing health inequalities. Community
participation is crucial element in a ‘rights-related approach to healthcare’ that includes the
politics of solidarity and therefore UHC should be framed in human right terms (Grover. 2014,
Freeman, 2016).
ACCHS have adopted greater strategies to tackle the accessibility of services (including
culturally- competent) (Freeman, 2015). It has addressed the following aspects as: Availability-
by providing free transportation to all the service areas; Affordability by providing all services
and medicines; Acceptability by designing the space to provide services in culturally respectful
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welcome and employing local Aboriginals and Engagement- by interactions with local
community (Baum, 2012).
Application of SEWB within ACCHS service
SEWB concerns are found to contribute to higher burden of disease with poorer health
status in Aboriginals, while conversely, chronic diseases increases the risk for getting
psychological problems (Langham, 2017). ACCHS serves a greater number of services within
the social and emotional wellbeing of the Aboriginals so as to improve the overall health of
Aboriginals. One among them is the their participation in disease prevention as well as health
promotional strategies along with the provision of treatment with rehabilitation services,
including medical-related, dental, and mental-health clinics with addiction therapy centers.
These activities of ACCHS include early child-hood with youth-related programs (as ante-
natal care with birthing classes, mother & child immunizations, day-care, pre-school readiness-
program, with youth-based outreach), health check-ups for adult, healthy life-style and exercise
groups, community-based health-care education (sexual health) and mental- health promotions
(in young people with communities) (Baum, 2014).
The AATSIHS (2012-2013) noted that SEWB of Aboriginals are compromised with
higher psychological distress with 2.7 times more as compared to non-Indigenous people (ABS.
2013). Hence, ACCHS adopts the definition of mental health as given by WHO (2016) as a
complete state of societal with emotional wellbeing; with which persons will be able to cope
with the usual life stresses and can realize their own potentials. ACCHS adopts mental-health
strategies among young Aboriginals and communities by teaching psychosocial with behavioral
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skills, inter-personal skills in daily work and counseling so as to promote health-outcomes.
AHMAC (2015) suggested that lower education-status, unemployment and poverty level are
found to increase psychological distress in Aboriginals. Therefore, ACCHS strives to meet
SEWB which is affected by a complex web of biological, emotional, societal, cultural,
environmental as well as economic factors.
Conclusion
It is highly crucial to care the Aboriginal and Islander communities by understanding
their SEWB rather than terming it as mental health. Evidences suggest that ACCHS indulges
itself into the Aboriginal services by adopting all the principles of primary health care as given
by the WHO such as providing essential care by prompting accessibility, availability,
affordability and acceptability; promoting inter-sectoral coordination, coordination with
technologies and promoting community engagement; by considering their SEWB (Freeman,
2015). Most of the ACCHS activities were found to be within their SEWB so as to enable greater
acceptance of services among Indigenous people, thereby enhancing their quality-of-life
(Langham, 2017). Hence, the health professionals should provide holistic care to the Aboriginals
within their SEWB rather than fearing them with term ‘mental health’.
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