Very few stakeholders or interviewees identified Aboriginal and Torres Strait Islander people as a priority population group experiencing higher need or poorer access to services. When directly questioned, most providers indicated that they had not considered the Indigenous community and their ability to access the Better Access initiative related mental health services.
The failure of stakeholders and interviewees to consider the mental health needs of Aboriginal and Torres Strait Islander people should be considered in light of the prevalence of mental illness in these communities, which is approximately twice that of non-Aboriginal and Torres Strait Islander people. The reported rate of high or very high levels of psychological distress was 26.6 per cent for Aboriginal and Torres Strait Islander people (National Aboriginal and Torres Strait Islander Health Survey, 2004-05) compared to 13.1 per cent for non-Aboriginal and Torres Strait Islander people (National Health Survey, 2004-05). Further, with increasing remoteness, Aboriginal and Torres Strait Islander people reported an increasing level of psychological distress. A similar pattern was not observed for non-Indigenous Australians.35
Mental health service usage rates of Aboriginal and Torres Strait Islander people appear to be similar to non-Indigenous persons, at 479 GP encounters per 1,000 population, compared to 468 per 1,000 population.36 Given that the rate of psychological distress in Indigenous communities is much higher than non-Indigenous Australians, these similar encounter rates may indicate that Indigenous Australians are not accessing GPs for mental health issues at a rate comparable to their needs.
Stakeholders discussed a range of difficulties that Aboriginal and Torres Strait Islander communities faced in accessing mental health services. One of the barriers facing Aboriginal and Torres Strait Islander communities is that of appropriateness, with stakeholders noting that working within Aboriginal communities required acceptance into the community and an understanding of the Aboriginal perception of wellness.
When combined with the issues of socioeconomic status and geographic location typical of many Indigenous groups, access to mental health services was recognised as difficult.
One AHP practitioner, with well-established ties and working closely with the local Aboriginal community, reported that the MBS rebate was inadequate to cover the additional costs associated with providing outreach services into the community and time involved in working with the client's family and wider community. The interviewee noted that, although demand was high, he was unable to afford to extend his practice further into the community and was dependent upon non-Indigenous clients to maintain financial viability.
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Several psychologists reported successful interventions based on secondary consultations provided to local Aboriginal health workers. These were arranged through a variety of funding sources, other than the Better Access initiative. The psychologists suggested that the funding of client specific secondary consultation services to local workers in Indigenous communities would provide the skills, support and supervision for local workers (funded through other Commonwealth and State programs) to provide effective mental health care to less complex cases within these communities. Several psychologists and two social workers reported successful instances of providing remote secondary consultation to Aboriginal health workers and the client's family to develop and implement effective interventions around clients experiencing phobias responsive to exposure therapy and implementing cognitive behaviour therapy (CBT) for clients with anxiety and/or depressions.
One group of approved Aboriginal counsellors specialising in Aboriginal mental health reported an extensive statewide telephone based practice, growing rapidly through word of mouth referral and their relationships with Indigenous communities. The program was funded through NGOs, cross subsidisation from training and development opportunities, and volunteer hours. The capacity to expand and train additional AHPs in working with Indigenous communities was constrained by the need for 'face to face' rather than telephone-based services to receive the MBS rebate.
An alternative, and more widely held view, was that services into Indigenous communities may be better funded through alternative programs, such as Better Outcomes or as a component of health funding for Aboriginal and Torres Strait Islander health services.
Footnotes
35 Australian Institute of Health and Welfare, "Aboriginal and Torres Strait Islander Health Performance Framework 2008 report: detailed analyses" (Canberra 2009)
36 AIHW (2008)