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Explorations of Understandings of Mental Health in an Urban Aboriginal and Torres Strait Islander Sample

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Explorations of Understandings of Mental Health in an Urban Aboriginal and Torres Strait Islander Sample ResearchOnline@JCU This file is part of the following reference: Kilcullen, Meegan Lesley (2011) Explorations of understandings of mental health in an urban Aboriginal and Torres Strait Islander sample. PhD thesis, James Cook University. Access to this file is available from: http://eprints.jcu.edu.au/29143/ The author has certified to JCU that they have made a reasonable effort to gain permission and acknowledge the owner of any third party copyright material included in this document. If you believe that this is not the case, please contact [email protected] and quote http://eprints.jcu.edu.au/29143/ Explorations of understandings of mental health in an urban Aboriginal and Torres Strait Islander sample Thesis submitted by Meegan Lesley KILCULLEN BPsych (Hons) In July 2011 for the degree of Doctor of Philosophy in the School of Arts and Social Sciences James Cook University ii Statement of Access I, the undersigned, author of this work, understand that James Cook University will make this thesis available for use within the University Library and, via the Australian Digital Theses network, for use elsewhere. I understand that, as an unpublished work a thesis has significant protection under the Copyright Act and; I do not wish to place any further restriction on access to this work ______________________________________________________________________ Signature Date iii Statement of Sources Declaration I declare that this thesis is my own work and has not been submitted in any form for another degree or diploma at any university or other institution of tertiary education. Information derived from the published or unpublished work of others has been acknowledged in the text and a list of references is given. _____________________________________________________________________ Signature Date iv Acknowledgements I would like to express my sincere gratitude to many who have smoothed my journey along this path. Firstly, I would like to thank my supervisor, Dr Anne Swinbourne for her unwavering support – personal, financial and academic. She has shared my vision of what might be possible and has helped to stay the course in sometimes uncertain times. It is with Anne’s guidance that presenting this thesis was possible. I would like to also sincerely thank my co-supervisor, Professor Yvonne Cadet-James, Chair of the School of Indigenous Australian Studies. Yvonne provided enlightened cultural mentorship, and generously shared knowledge that facilitated the cultural appropriateness of this work. She also opened her home to me when the journey was slow. I was also fortunate to receive an Australian Postgraduate Award throughout this journey, funded by the Department of Education, Employment and Workplace Relations. It is this financial support that minimised worldly distractions and allowed this project to be completed in a timely manner. I would also like to acknowledge the support of staff of the School of Arts, Education and Social Science, both academic and administrative. I thank the School for providing resources and facilities to complete degree. I have also had the pleasure of the sharing this journey with many other wonderful students. Many times we have laughed and cried and supported each other. It has also been my very great fortune to meet the generous and knowledgeable people who kindly agreed to participate in this project. It is to these people that I owe a great debt. Without them, this project would not be possible. v Lastly, I would like to thank my family for enduring these many years of my university journey. Especially, I am grateful for the support of my three wonderful children who have grown into extraordinary people, right before my eyes. The work presented within this thesis was approved by the Ethics Committee of James Cook University. The work within is original and has not been presented for the award of any other degree. Meegan Kilcullen Townsville July 2011 vi Abstract It has been acknowledged that the mental health of Aboriginal and Torres Strait Islander people has been ‘bedevilled’ by the inappropriate application of non- Indigenous models of mental health. Given the poor health outcomes of Indigenous people, another approach to mental health practice is perhaps required. In order to enhance Indigenous health and wellbeing, it is necessary for non-Indigenous practitioners to find a culturally safe way in which to enter the negotiated space of cross-cultural mental health. Such practice can be facilitated through understanding both the points of similarity and divergence in perspectives of mental health across cultures. While the majority of Indigenous people live in urban areas, understandings of Indigenous mental health have primarily been derived from research in rural and remote communities. It is unclear whether findings from rural and remote research are applicable in urban Indigenous communities. The aim of the current research is to address this gap and to explore understandings of mental health in an urban Indigenous sample. This study provided a voice for urban Aboriginal and Torres Strait Islander people to convey their understandings of mental health so that an accurate representation may be available for those who are engaged in health promotion and mental health treatment. Using a positive psychology framework, a strengths-based approach was taken in this study in order to explore understandings of mental health. A qualitative research investigation was conducted with a sample of 19 Australian Aboriginal and Torres Strait Islander participants. Data was collected via individual semi-structured interviews and focus groups. Qualitative analysis was conducted using thematic analysis. A model of Indigenous mental health was developed taking an holistic perspective. Four themes vii emerged as reflecting health and wellbeing and are presented in a model of Indigenous mental health:- Coping Skills: emotional, behavioural and cognitive; Knowledge: regarding physical health and access to mental health care; Social Support: personal resources and help-seeking behaviours; and Connectedness: cultural, social and family and kinship. The theme of connectedness emerged as reflecting a unique contribution to Indigenous health and wellbeing. The role of connectedness to country, family and kinship, knowledge and social networks was highlighted. Further, the theme of connectedness also emerged as central to supporting cultural identity. Not only did connectedness promote and protect mental health and cultural identity, factors that diminished cultural identity also negatively impacted upon mental health. The striking similarity between mental health and cultural identity, as seen in the common theme of connectedness, highlights the necessity of attending to cultural factors to facilitate positive health outcomes. This model of Indigenous mental health begins to fill in the boundaries of the negotiated space that is cross-cultural psychology - the space where both Indigenous and non-Indigenous knowledge offers a path or guidelines to enhance health and wellbeing. It is essential to address those factors that are similar across cultures – coping skills, social support and knowledge, but also to engage at the cultural interface of connectedness to culture, kinship and social networks. This information has implications for cross-cultural clinical practice, through providing a map for non-Indigenous practitioners to engage in culturally safe practice. Further, this information will support the development of culturally safe health and wellbeing programs that sustain and nurture the cultural identity and mental health of viii Indigenous people. In this way, meaningful contributions may be made by health professionals to ‘close the gap’ in health and mental health outcomes for Indigenous people. ix Table of Contents Statement of Access ....................................................................................................... ii Statement of Sources Declaration .................................................................................iii Acknowledgements ....................................................................................................... iv Abstract ......................................................................................................................... vi Table of Contents .......................................................................................................... ix List of Tables ............................................................................................................... xii List of Figures .............................................................................................................xiii Foreword ..................................................................................................................... xiv Chapter 1: Mental Health – Frameworks and Definitions ............................................ 1 Section 1.1 Aims and objectives ................................................................................................................. 1 Section 1.2 Overview of Literature ............................................................................................................ 3 Section 1.3 How is ‘mental health’ defined? ............................................................................................. 4 1.3.1 From a biomedical to biopsychosocial approach ....................................................................... 4 1.3.2 What is mental health?
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