Thread by @CroakeyNews

While @coopesdetat is following Tim Flannery's keynote, I am going to jump in and catch up on the Indigenous mental health session from yesterday -@AlisonSBarrett. #RANZCP2022

https://twitter.com/coopesdetat/status/1526427173871300608

Session chair, Dr Emma Adams, provides a heartwarming acknowledgement of country and lovely introduction to the presenters - Prof Helen Milroy, A/Prof Mathew Coleman, Dr Shraddha Kashyap & Dr Jemma Collova #RANZCP2022

Broad overview of Transforming Indigenous Mental Health & Wellbeing Project, aiming to improve Aboriginal & Torres Strait Islander mental health through Aboriginal leadership and authentic partnerships. #RANZCP2022
timhwb.org.au

Three main research streams are under the broad project, led by an Aboriginal expert in their field. Today's discussion is going to focus on the stream led by Prof Milroy #RANZCP2022

But first, Stream 1 is about empowering access to social and emotional wellbeing for Aboriginal and Torres Strait Island people #RANZCP2022

Stream 2 is about empowering workforce, incl Indigenous knowledge is embedded in training #RANZCP2022

Stream 3 is about empowering service systems & embedding cultural safety into mainstream mental health services #RANZCP2022

The focus of this discussion is about some of the research being done under stream 3, primarily 'understanding the key characteristics of a culturally safe mental health service' #RANZCP2022

Traditional Aboriginal and Torres Strait Island cultures and complex kinship systems enabled their wellbeing to flourish - Dr Collova #RANZCP2022

Colonisation, genocide and continuing discriminatory policies cause significant ongoing disadvantage, trauma and high rates of mental health concerns in Aboriginal and Torres Strait Island peoples - Dr Collova #RANZCP2022

Important to develop evidence base around improving service provision for Aboriginal and Torres Strait Island peoples, but also important to acknowledge that colonisation has occurred, and still is occurring in mental health research - Dr Collova #RANZCP2022

Indigenous knowledges and conceptualisations of health and wellbeing have been excluded or devalued, and research has been conducted 'on', rather than 'with' Aboriginal and Torres Strait Island people - Dr Collova #RANZCP2022

Cultural safety steps beyond cultural awareness and understanding of other cultures- a key feature is the notion of power - Dr Collova #RANZCP2022

Cultural safety can only ever be determined by the consumer of the service, ie healthcare, not the provider - Dr Collova #RANZCP2022

In the context of healthcare, the below definition of cultural safety was developed by Curtis 2019.
Third point in particular has some synergies with discussions in Frantz Fanon session yesterday #RANZCP2022

Prof Milroy outlines some differences between cultural safety in mental health and physical health - for example, the way diabetes is treated is mostly the same per individual (biological approach) with some cultural influences over the top of that - #RANZCP2022

In treating mental health, though, culture shapes the very understandings of the nature and cause of distress, decisions to seek help & the degree of discrimination they may face - Prof Milroy #RANZCP2022

Traditional healers had a range of methods and understandings, and with mental health it is important to work within belief systems so that explanations and understandings make sense - Prof Milroy #RANZCP2022

A very Western system of mental health treatment has been imposed on Aboriginal and Torres Strait Island people - Prof Milroy #RANZCP2022

In gaining a better understanding of cultural safety and mental health, we need to learn more about phenomenology (ie hearing ancestors and visual and auditory narratives) & Indigenous peoples' perspectives on stigma in mental health - Prof Milroy #RANZCP2022

How do we engage cultural healers in mental health treatments for Aboriginal and Torres Strait Islander peoples? What makes it safe for us, the community and cultural healers?- Prof Milroy #RANZCP2022

To learn more about cultural safety in mental health services, the research team ran focus groups, yarning sessions to try and gain understanding of community need - Dr Kashyap #RANZCP2022

Cultural safety is also important in research - Dr Kashyap #RANZCP2022

Key principles of the research include - 1) Indigenous leadership is crucial, without the research team being too prescriptive, empower Aboriginal and Torres Strait Islander voices and integrate their knowledge into methodology (such as yarning circles)- Dr Kashyap #RANZCP2022

2) Building and maintaining community partnerships, not just a "one-off" consultation. Decision processes actively involve community and relationship building is one of the research outcomes - Dr Kashyap #RANZCP2022

3) Non-Indigenous researchers need to be self-reflective, acknowledge own cultural identity and relative privilege & have critical awareness of internal biases - Dr Kashyap #RANZCP2022

4) Research needs to be conducted ethically - Dr Kashyap #RANZCP2022

Main aims of the project 👇 with ultimate aim working towards improving cultural safety in mainstream mental health services. - Dr Kashyap #RANZCP2022

Six focus groups/yarning circles were conducted, on Country when possible, non-Indigenous staff participated in cultural awareness programs - Dr Kashyap #RANZCP2022

Authentic co-design allows culturally appropriate and flexible methods of sharing knowledge. For example, data could be collected in forms of art, stories, or songs - Dr Kashyap #RANZCP2022

"By being flexible enough to include that, then we end up learning things that we wouldn't have otherwise learnt and it makes our data that much more rich" - Dr Kashyap #RANZCP2022

Process as an outcome - they learnt that research can't be fast-tracked, but the advantage of taking time building relationships, they know they have access to knowledge they wouldn't have otherwise had - Dr Kashyap #RANZCP2022

The slide shows the definitions of Aboriginal culture found from the research - culture is "innate in all of us" - Dr Kashyap #RANZCP2022

In assessing a person's care needs, cultural identity is "everything" according to results from the research - Dr Kashyap #RANZCP2022

Mainstream mental health services really need to understand cultural identity (e.g. sense of belonging and identity in family and community roles, communication style, connection to clinician etc) - Dr Kashyap #RANZCP2022

The research found that cultural safety from a mainstream mental health service would feel like an "understanding and acknowledgement of Aboriginal cultural knowledge, life experience, issues and protocols" - Dr Kashyap #RANZCP2022

Everyone agreed that cultural safety in mental health services is different to cultural safety in other health services, as there is more stigma, worry about privacy, and important to work with family & community rather than just the individual - Dr Kashyap #RANZCP2022

The research found that mainstream mental health services do not understand Aboriginal peoples and their culture - they don't take into account Aboriginal ways of being- Dr Kashyap #RANZCP2022

They found that some non-Aboriginal mental health workers try to understand, but there is a high turnover of staff, and a burden on Aboriginal mental health workers to keep training staff - Dr Kashyap #RANZCP2022

Suggestions for building cultural safety into mental health services = change environment (ie different waiting rooms), empowering Aboriginal and Torres Strait Island workforce - Dr Kashyap #RANZCP2022

Trust was one of the most important themes identified in the research - Dr Kashyap #RANZCP2022

When mainstream mental healthcare workers engage with Aboriginal and Torres Strait Island people, the starting point is mistrust - it is important to take the time to engage and build trust - Dr Kashyap #RANZCP2022

Respecting cultural protocols and healing practices are also important, as well as treating the person, not the illness - Dr Kashyap #RANZCP2022

The third aim of the research was to co-design a qualitative interview to gain more in-depth about people's experiences of cultural safety in mainstream media - Dr Kashyap #RANZCP2022

The next step in the research project is to work with mainstream services to understand how they can work with cultural healers - Dr Kashyap #RANZCP2022

A/Prof Mathew Coleman is up next to talk about how to embed cultural safety in mainstream mental health - #RANZCP2022

"You truly need to engage by listening and learning" - A/Prof Coleman #RANZCP2022

Our current mainstream mental health services are incredibly reductionist, diagnostic, deficit-based and temporary - A/Prof Coleman #RANZCP2022

When we're providing care that is culturally safe, we need to be around for the long-term, not the short-term, A/Prof Coleman says #RANZCP2022

In trying to understand and identify what cultural safety means, and incorporate that in mainstream services, we need to be open, honest & vulnerable as clinicians. "More often than not, we're going to get it wrong"- A/Prof Coleman #RANZCP2022

Mainstream system culture = Anglo-Australian dominant, health professional led, emphasis "without a doubt" on safety over quality, often at the cost of developing and delivering quality services - A/Prof Coleman #RANZCP2022

Policies often drive practice, metro-centric services transplanted into rural, regional and remote services which mostly don't work, largely custodial and paternalistic - A/Prof Coleman #RANZCP2022

Private mainstream systems are transactional (fee for service) which doesn't really enable the longer-term relationships that are needed - A/Prof Coleman #RANZCP2022

A/Prof Coleman wonders how we can fit the idea of holistic, cultural, social and emotional wellbeing into the rather structured and multi-component mainstream systems ..... #RANZCP2022

And perhaps we need to start to consider improving mainstream services by learning from the ancient wisdom and understanding of Aboriginal cultures, rather than it being the other way around - A/Prof Coleman says. #RANZCP2022