Mental health worsens "dramatically"

A report in 2014 found "dramatic" increases in Aboriginal rates of youth suicide, anxiety and depression, as well as cognitive disability and mental health among offenders, and perinatal mental health. ^[5] More than a quarter of Aboriginal people, and almost a fifth of all Torres Strait Islanders, reported having a mental condition in 2018-19.

A 2020 report found that Aboriginal people experience depression (52%) and anxiety (59%) at much higher levels than non-Aboriginal Australians (32% and 47%). ^[6]

In 2018-19, 31% of Aboriginal people and 23% of Torres Strait Islanders over 18 years reported high or very high levels of psychological distress. 68% had experienced at least one stressful event in the past year, and, alarmingly, so did almost the same proportion of children. ^[4]

Government programs need to take a long-term view rather than employ quick "start and stop" approach or provide too narrowly focused and inadequate mental health services.

Aboriginal mental health and suicide still need to be researched more.

Improving mental health outcomes will have a flow-on effect to other areas, including reducing high incarceration and substance abuse rates.

Risk and protective factors for Aboriginal mental health

The following risk factors are interconnected, and a person with mental illness might show any number of them.

• Widespread grief and loss. This includes grief about the loss of culture, land, connection, and many more areas, often connected to the history of invasion.
• Stolen children. The impact of the past Stolen Generations and ongoing removal of children puts a lot of mental pressure on people, especially when government departments just follow procedures.
• Unresolved trauma. Trauma is a huge factor in Aboriginal health and an agent for many health conditions. If unresolved, trauma can debilitate a person and be passed on to the next generation.
• Loss of identity & culture. When Aboriginal people are separated from their culture and identity, for example when they don't live on their traditional homelands or don't know where they are coming from, they don't feel complete or search for who they are.
• Discrimination and racism. Discrimination based on race or culture, as well as racism, can have a huge impact on any person's mental health.
• Few economic opportunities. Due to other factors, many Aboriginal people are economically and socially disadvantaged. If you have to constantly worry about finance or how you are perceived by others, this worry contributes to mental illness.
• Poor physical health. Physical health problems contribute to the feeling of inadequacy and exclusion, and some people might stop socialising or exercising. 23% of Aboriginal people reported having both a mental health condition and one or more other long-term health conditions. ^[7]
• Incarceration Being imprisoned has a huge effect on people's mental health.
• Culturally inappropriate treatment. Especially the health area is prone to assess Aboriginal people with non-Aboriginal criteria, or expose them to culturally insensitive environments.
• Violence. Domestic violence, as well as violence in prisons, for example, contributes to poor mental health.
• Substance abuse. When Aboriginal people misuse substances to ease their inner pain, it can lead to follow-on issues, such as depression.

Despite the risk factors, there are also some positive, or protective, factors that help Aboriginal people deal with mental illnesses ^[8]:

• Social connectedness and sense of belonging
• Connection to land, culture, spirituality and ancestry
• Living on or near traditional lands
• Self-determination
• Strong Community governance
• Passing on of cultural practices

Traditional Aboriginal healing methods can support mentally ill people to recover, for example South Australia's Ngangkari program.

Depression

The 2014–15 National Aboriginal and Torres Strait Islander Social Survey measured psychological distress (mental or emotional pain), which is often linked with feelings of anxiety or depression.

It found that nearly 33% of Aboriginal people aged over 15 years reported having high to very high levels of psychological distress. This was more than twice the levels reported for other Australians. The figure shoots up to 60% if the person has a mental health condition. ^[7]

68% of Aboriginal people over 15 years experienced at least one personal stressor in last 12 months, such as an illness, accident, overcrowding, death of a loved one or violence. Almost 30% experienced homelessness, and a third felt treated unfairly, e.g. by racial comments or jokes, being called names or ignored while accessing services. ^[9]

Aboriginal women reported these levels of stress more than men. It is often hard to know how common depression is in the Aboriginal population, however, because of the way people understand depression and their cultural understanding of mental illness.

Video: Aboriginal mental health

Learn how culture and spirituality affect the mental health of Aboriginal people in this 9-minute video by Indigenous Health MeDTalk.

Dementia

Aboriginal people living in remote communities are 10 times more likely to develop dementia than people living in countries such as Africa, India and Indonesia; and 5 times more likely than non-Indigenous people ^[2][3]. In the Kimberley region between 13 and 27% of elderly Aboriginal people have dementia., compared to 2.6% amongst non-Aboriginal people aged 45 and over ^[10].

Other statistics show that remote Aboriginal people are 26 times more likely to develop dementia at a relatively young age (between 45 and 59 years) than the rest of Australians ^[10]. Smoking, stroke, head injury and no formal education are the main contributors to the high rate, with the good news that most of these factors can be changed.

Other risk factors are unemployment, underemployment and low status jobs, high rates of drug and alcohol use; brain trauma and increased rates of diabetes, hypertension, renovascular and metabolic disease ^[10]. Mental health is worst among Aboriginal prisoners where up to 93% of Aboriginal detainees have some form of mental illness.

Another factor is less obvious. The colonisation of Australia has caused much trauma among Aboriginal people. Because they couldn't cope with what was happening many developed mental illnesses ^[11].

The dispossession, loss of identity, loss of land, this has all led to a whole lot of lost people.

— Liz Hayden, Aboriginal Health Unit, Graylands Hospital, WA ^[11]

Discriminatory behaviour also contributes to bad mental health, eroding Aboriginal people's self-esteem and value within their community ^[12].

Health professionals found that just treating the psychiatric illness is not enough ^[11], but a holistic approach is required that takes in the historical perspective. Many Aboriginal children who were stolen from their families and grew up on missions came back as "fragmented people" ^[11] with mental health problems.

Video: Discussing Dementia: Losing the Dreaming

Learn about people living with dementia in the Aboriginal community. The short film features Birpai Elder Uncle Bill O'Brien discussing his experience of caring for his mother, who had dementia.

Schizophrenia

Schizophrenia is characterised by abnormal social behaviour and failure to recognise what is real. Sufferers have confused thinking, hallucinations, delusions, are socially withdrawn and lack emotional depth.

In Aboriginal communities, mental disorder is still frequently identified as spiritual disorder, hence it is treated by traditional healers, often alongside Western medical practitioners ^[13].

Schizophrenia is said to be at least as common in Aboriginal people as in white Australians, attributed to the post-colonial epidemic of substance abuse to cope with the trauma. Traumatic stress presents as depressive psychosis in both its unipolar and bipolar forms.

Research has found that Aboriginal people express their distress differently than non-Aboriginal people ^[13].

Other stressors reported most frequently by Aboriginal people were death of a family member or close friend (46%), serious illness or disability (31%), and inability to get a job (27%) ^[13].

Mental health study resource

Working Together: Aboriginal and Torres Strait Islander Mental Health and Wellbeing Principles and Practice outlines the historical, social, cultural, and policy contexts that have shaped Aboriginal mental health and wellbeing, highlights issues that are particularly relevant to Aboriginal people, contains a section that focuses on practice within the field, and presents examples of models and programs for practitioners.

The second edition contains a number of new chapters, providing more information on children and young people; the significant impacts of mental health in the justice system; the cultural determinants of social and emotional wellbeing and intellectual and development disabilities.

Chapters include: History and Contexts, Issues and Influences, Standards, Principles and Practice, Assessment and Management, Working with Children, Families and Communities, and Healing Models and Programs.

The Telethon Kids Institute offers free copies of Working Together (PDF, e-book and hardcopy), but you will need to pay for delivery.

Support services

Proppa Deadly

Proppa Deadly, an initiative of Beyond Blue, is a project encouraging Aboriginal people to take action against depression and anxiety through the telling of their own stories across the First Nations community radio sector.

The project inspires others because those who share their story also talk about the actions they undertook to combat depression and/or anxiety.

Healing Foundation

The Healing Foundation is a national Aboriginal organisation that works with communities to address the ongoing trauma caused by actions like the Stolen Generations. It aims to create a place of safety where Stolen Generations members and their families can speak for themselves, tell their own stories and be in charge of their own healing.

The Healing Foundation is also conducting research in Aboriginal healing, and supporting locally-run projects, training and education, research and commemorations.