Between 2017-18, 9.9 billion dollars was spent in mental health and 4.3 million people received mental health services (Mental Health Services in Australia, Prevalence, Impact and Burden, 2019). The proportion of older Australians is increasing and so is the life expectancy, which means an overall increase in chronic illnesses. The prevalence of dementia in Aboriginal and Torres Islander communities is 2 -5 times higher than that of non-Aboriginal Australians (The Health and Welfare of Australia’s Aboriginal and Torres Strait Islander Peoples, 2015). There several factors that are said to contribute to this disturbing trend. For example, Aboriginal and Torres Strait Islanders, tend to have double the rates of traumatic injury, higher rates of smoking and have a markedly higher incidence of chronic illnesses such as diabetes, cardiovascular and renal diseases. Which are all known contributing factors to the development of dementia. The terms mental disorder can be used to describe a wide range of mental and behavioral disorders. The disorders can vary in duration and severity and can interfere with the individuals cognitive, behavioral and emotional abilities (Mental Health Conditions and Disorders, 2019).
Dementia is a term used to describe a group of similar symptoms characterized by a gradual impairment of brain function. The changes due to this condition may affect memory, speech, cognition, behaviors and thought. In 2017, dementia was the second leading cause of death and is expected to affect up to 550,000 people by 2030 (Dementia Overview, 2017). Finding nonpharmacological ways to manage behavioral issues is essential to improving the overall quality of life for people with dementia (Barton et al., 2016). On top of experiencing neuropsychiatric symptoms which are known to occur universally over the many stages of dementia (Lyketsos, 2015). Indigenous people face an added stress of lack of access to good evidence based culturally sensitive care (Calma et al., 2017). A wide range of behavioral issues have been reported, these include depression, apathy, psychosis, and agitation. Challenging behaviors are common in dementia and they are the main reasons why individuals are placed in care homes (Lyketsos, 2015). This paper will look at some of the barriers that hinder the delivery of mental health services among Aboriginal and Torres Strait Islanders.
Studies now show that Aboriginal and Torres Strait Islander mental health and psychological issues can be attributed to cultural genocide and colonisation. The health and psychological issues seen in the Australian indigenous population can also be observed in other indigenous peoples that went through colonisation (Dudgeon et al., 2017). Colonisation and its disruption of culture, family, and community life through dispossession, often through violent means such as the stolen generation have affected the subsequent generations of Aboriginal and Torres Strait Islanders (Aboriginal and Torres Strait Islander Stolen Generations and Descendants, 2019). Aboriginal and Torres Strait Islanders who were removed from their families as children during the stolen generation, experience significant social and health disadvantages.
According to a survey done by the Australian Bureau of Statistics, 1 in 10 indigenous people bone in 1972, reported being removed from their families. 56% where females and the majority live in non-remote areas (Aboriginal and Torres Strait Islander Stolen Generations and Descendants, 2019). The majority live in New South Wales and in Western Australia. Two thirds are aged 50 and over, while 20% are over the age of 65. There is now substantial literature on the impact, trauma, and more broadly colonialisation has had on indigenous cultures. Common manifestations include, alcohol and substance abuse, interpersonal violence, homelessness and a disruption in meaningful social relations (Children & Young People – Healing, 2020). Suicide has also been linked to the cultural disruption as a result of colonisation. In Australia the descendants of the stolen generation are more likely to be incarcerated in the last five years and 1.8 times as likely to rely on government payments as their main source of income. They are also more likely to experience discrimination when looking for employment. Studies indicate that racism and the broader context of social exclusion has a negative effect on the general mental health and wellbeing of indigenous peoples (Dudgeon et al., 2017).
The reasons for the gap in poor health outcomes between indigenous and non-indigenous people are complicated. For Example, Calma et al., 2017, found that there is a difference in the conception of health between Indigenous people and non-indigenous people. Western medicine by in large, favors the biomedical model of health as opposed to the social model of health. The biomedical model of health focuses on the biological aspects of the disease, while the social model analyses the social aspects of health. The social model of health explores some of the issues that may lead to the health outcome (Lacasse et al., 2019). Aboriginal and Torres strait islanders view the individual as part of the community or the tribe. An individual’s physical, emotional and mental wellbeing is connected and cannot be isolated (LoGiudice, 2016). According to the National Institute of Health and Welfare, social determinants of health are responsible for 31% of the health gap ( Determinants of Health, 2016). For example, the levels of depression tend to be low in individuals with a good social and community structure (Social Isolation and Loneliness, 2019). In most African cultures, in the first months post-delivery of the baby. It is part of the tradition for the youngest sister, cousin or even the grandmother, to live with the mother of the infant, ideally until the baby is big enough to eat solids. There main Job is to help with household duties like cooking and cleaning or look after the other children, the Job of the new mother is then to eat, sleep, and breastfeed.
Social and emotional support structures are also needed for persons with dementia (Barton et al., 2016). A person with dementia can still lead a good quality life, but without input from family members it is difficult for them to achieve purpose and pleasure (Ferreira et al., 2020). There are several ways to plan and provide appropriate activities for people with dementia. Care should compensate for lost abilities, promote self-esteem, maintain residual skills, provide an opportunity for social contact, and care must be culturally sensitive for Indigenous and ethnically diverse groups (Li, 2017). One-way care homes can mitigate for this is, they could provide clinicians that are either Aboriginals or are from ethnic diverse communities. Another way is through access to health care workers with the same gender or if possible, facilities try and not allocate the care staff younger than 30 to help the elderly with activities of daily living like showers. Studies indicate that when there is lack of culturally responsive care, health outcomes are much poorer. Improving cultural responsiveness can, not only remove the barriers to accessing health care services but may also improve the general quality of life for Aboriginal and Torres strait Islanders (Gomersall et al., 2017).
Aboriginal and Torres Strait Islander Stolen Generations and descendants: Numbers, demographic characteristics and selected outcomes, Table of contents. (n.d.). Australian Institute of Health and Welfare. Retrieved June 12, 2020, from https://www.aihw.gov.au/reports/indigenous-australians/stolen-generations-descendants/contents/overview
Australia’s health 2016, Chapter 4 Determinants of health. (n.d.). Australian Institute of Health and Welfare. Retrieved June 21, 2020, from https://www.aihw.gov.au/reports/australias-health/australias-health-2016/contents/chapter-4-determinants-of-health
Barton, C., Ketelle, R., Merrilees, J., & Miller, B. (2016). Non-pharmacological Management of Behavioral Symptoms in Frontotemporal and Other Dementias. Current Neurology and Neuroscience Reports, 16(2), 14. https://doi.org/10.1007/s11910-015-0618-1
Calma, T., Dudgeon, P., & Bray, A. (2017). Aboriginal and Torres Strait Islander Social and Emotional Wellbeing and Mental Health. Australian Psychologist, 52(4), 255–260. https://doi.org/10.1111/ap.12299
Cameron, E. (2015). Is It Art or Knowledge? Deconstructing Australian Aboriginal Creative Making. Arts, 4(2), 68–74. https://doi.org/10.3390/arts4020068
Children & young people—Healing. (n.d.). Australian Indigenous HealthInfoNet. Retrieved June 20, 2020, from https://healthinfonet.ecu.edu.au/learn/health-topics/healing/children-young-people/
Dementia Overview. (n.d.). Australian Institute of Health and Welfare. Retrieved June 20, 2020, from https://www.aihw.gov.au/reports-data/health-conditions-disability-deaths/dementia/overview
Dudgeon, P., Bray, A., D’Costa, B., & Walker, R. (2017). Decolonising Psychology: Validating Social and Emotional Wellbeing. Australian Psychologist, 52(4), 316–325. https://doi.org/10.1111/ap.12294
Ferreira, A. R., Simões, M. R., Moreira, E., Guedes, J., & Fernandes, L. (2020). Modifiable factors associated with neuropsychiatric symptoms in nursing homes: The impact of unmet needs and psychotropic drugs. Archives of Gerontology and Geriatrics, 86, 103919. https://doi.org/10.1016/j.archger.2019.103919
Gomersall, J. S., Gibson, O., Dwyer, J., O’Donnell, K., Stephenson, M., Carter, D., Canuto, K., Munn, Z., Aromataris, E., & Brown, A. (2017). What Indigenous Australian clients value about primary health care: A systematic review of qualitative evidence. Australian & New Zealand Journal of Public Health, 41(4), 417–423. https://doi.org/10.1111/1753-6405.12687
Health. (n.d.). Quality of Care Amendment (Minimising the Use of Restraints) Principles 2019 (au). Attorney-General’s Department. Retrieved April 26, 2020, from https://www.legislation.gov.au/Details/F2019L00511/Html/Text, http://www.legislation.gov.au/Details/F2019L00511
Lacasse, M., Douville, F., Gagnon, C., Simard, C., & Côté, L. (2019). Theories and Models in Health Sciences Education—A Literature Review. Canadian Journal for the Scholarship of Teaching and Learning, 10(3).
Li, J.-L. (2017). Cultural barriers lead to inequitable healthcare access for aboriginal Australians and Torres Strait Islanders. Chinese Nursing Research, 4(4), 207–210. https://doi.org/10.1016/j.cnre.2017.10.009
Lindeman, M., Mackell, P., Lin, X., Farthing, A., Jensen, H., Meredith, M., & Haralambous, B. (2017). Role of art centres for Aboriginal Australians living with dementia in remote communities. Australasian Journal on Ageing, 36(2), 128–133. https://doi.org/10.1111/ajag.12443
LoGiudice, D. (2016). The health of older Aboriginal and Torres Strait Islander peoples. Australasian Journal on Ageing, 35(2), 82–85. https://doi.org/10.1111/ajag.12332 Lyketsos, C. G. (2015). Neuropsychiatric Symptoms in Dementia: Overview and Measurement Challenges. The