“I Tried to Get Help About My Addiction but He Just Gave Me Tablets:” Male Aboriginal Drug and Alcohol Rehabilitation Clients’ Experiences and Preferences Speaking About Substance Use in Primary Care

Background Primary healthcare (PHC) services are crucial in supporting people with substance use problems. The aims of this study were to explore Aboriginal and Torres Strait Islander (hereafter Aboriginal) males in treatment for substance use problems experiences about speaking about their substance use with PHC staff, and their preferences for accessing PHC about their substance use.MethodsSemi-structured interviews with residential drug and alcohol rehabilitation treatment service clients. Thematic analysis was used to develop themes inductively and deductively. Two interviews were independently double coded by an Aboriginal researcher and the project was supported by an Aboriginal Advisory Group.ResultsTwenty male adults who self-identified as Aboriginal participated (mean age 27 years). Half reported visiting PHC and talking about their substance use before their residential service stay. Two major themes developed: (1) asking for help for substance use or mental health problems linked with substance use, (2) ways to improve access to PHC about substance use. Although some males were offered treatment, some were not, and others had concerns about the treatments offered. ConclusionThis research highlights opportunities to improve access and to better support Aboriginal males with substance use problems in PHC. Focus on culturally appropriate PHC and providing staff with training around substance use and treatment options may improve access. It is important to foster culturally appropriate services, develop PHC staff knowledge around substance use, focus on therapeutic relationships and have a range of treatment options available that can be tailored to individual circumstances.

“I Tried to Get Help About my Addiction but he Just gave me Tablets:” Male Aboriginal Drug and Alcohol Rehabilitation Clients’ Experiences and Preferences Speaking about Substance use in Primary Care

Background Primary healthcare (PHC) services are crucial in supporting people with substance use problems. The aims of this study were to explore Aboriginal and Torres Strait Islander (hereafter Aboriginal) males in treatment for substance use problems experiences about speaking about their substance use with PHC staff, and their preferences for accessing PHC about their substance use.MethodsSemi-structured interviews with residential drug and alcohol rehabilitation treatment service clients. Thematic analysis was used to develop themes inductively and deductively. Two interviews were independently double coded by an Aboriginal researcher and the project was supported by an Aboriginal Advisory Group.ResultsTwenty male adults who self-identified as Aboriginal participated (mean age 27 years). Half reported visiting PHC and talking about their substance use before their residential service stay. Two major themes developed: (1) asking for help for substance use or mental health problems linked with substance use, (2) ways to improve access to PHC about substance use. Although some males were offered treatment, some were not, and others had concerns about the treatments offered. ConclusionThis research highlights opportunities to improve access and to better support Aboriginal males with substance use problems in PHC. Focus on culturally appropriate PHC and providing staff with training around substance use and treatment options may improve access. It is important to foster culturally appropriate services, develop PHC staff knowledge around substance use, focus on therapeutic relationships and have a range of treatment options available that can be tailored to individual circumstances.

What next?

Migration occurs for a number of reasons and there are various stages and types of migration. These experiences are heterogenous and require different approaches. This chapter includes recommendations for service planning, development, and delivery for migrants’ health care. It is important that all health professionals are suitably trained in cultural competence. Explanatory models held by the patients, their carers, and families must be acknowledged and not denigrated. Researchers need to be culturally sensitive, whereas policymakers have legal and ethical obligations to provide adequate resources to deliver accessible and culturally appropriate services. The specific nature of migration and experiences carry with them specific challenges in therapeutic engagement for a number of reasons, which must be understood. Cultural values, nuances, and differences must be recognized and acknowledged. Specific recommendations are made for service planners, clinicians, policymakers, and researchers. Suggestions are made for curriculum development in cultural competence.

UNDERSTANDING PASIFIKA MENTAL HEALTH IN NEW ZEALAND: A review of the literature

Pasifika mental health continues to be a growing concern in New Zealand. This article reviews and presents online available research concerning the mental health of Pasifika in New Zealand. A comprehensive online literature search was conducted. In total, 967 online articles were identified, and 58 met the criteria to be included in the final review. The review identified overarching research themes related to Pacific mental health in New Zealand, specifically regarding mental health prevalence, mental health services, mental health perceptions, mental health prevention or intervention, and suicide. Further, this review explores the role that education, culturally appropriate services, and engaging community activities can play in preventing further mental health disparity among Pasifika in New Zealand.

Intervening in Indigenous Gambling: A Systematic Review of the Literature

Internationally, Indigenous people have higher rates of problem gambling than other population groups, yet the uptake of gambling help services is thought to be low. This may be due to the lack of culturally appropriate services and staff. This study aimed to systematically search and review the literature relating to interventions designed for Indigenous populations that seek to prevent or address gambling harm, to support the design of new programs. Peer-reviewed articles and gray literature that described programs of this nature and/or which reported outcomes for Indigenous participants were included in the review. Included studies were published between January 2000 and May 2019 and available in English. Only four articles were identified for inclusion: two described programs in Australia and two in New Zealand. Only one article provided outcome data, which was inconclusive, and one described three separate interventions. Three of the four described involved community-led approaches informed by cultural and emancipatory principles. There is currently insufficient evidence to guide interventions aiming to prevent and address gambling harm for Indigenous peoples. This review identified an urgent need for new intervention research in this area.

The Sixties Scoop

This paper examines issues concerning First Nations peoples and the child welfare system, and their implications for social work today. It explores the Sixties Scoop to illustrate the devastating impact such policies and practices had on Aboriginal children, families and communities. Cultural genocide is part of this legacy. To deliver more culturally appropriate services, awareness about and acknowledgement of these mistakes can assist social workers to incorporate a social justice perspective into their practice with Aboriginal clients. As well, implications for social work education regarding professional training, curriculum content and course delivery by Aboriginal faculty members are highlighted.

Exploring the experiences of Aboriginal and Torres Strait Islander patients admitted to a metropolitan health service

Objective There continue to be disparate health outcomes for people who are Aboriginal and Torres Strait Islander. The aim of the present study was to measure whether there were any differences in in-patient experiences between Aboriginal and Torres Strait Islander people and those without an Aboriginal or Torres Strait Islander background. Methods Random samples of people were invited to complete a survey following admission at the hospitals at Peninsula Health, Victoria, Australia. This survey was based on the Victorian Patient Satisfaction Monitor. Open-ended questions were also asked to gauge perspectives on how the services could better meet needs of Aboriginal and Torres Strait Islander patients. Results A total of 154 responses was obtained. There were differences between the two groups of participants in the following variables: respect of privacy, representation of culture, assistance with meals and access to a culturally specific worker if needed. This was reflected in thematic analysis, with three main themes identified: (1) interactions with staff; (2) the challenging environment; and (3) not just about me, but my family too. Conclusion There were systemic differences in in-patient experiences. Healthcare services have a responsibility to make systemic changes to improve the health care of all Australians by understanding and reforming how services can be appropriately delivered. What is known about the topic? There is a disparity in health outcomes between Aboriginal and Torres Strait Islander Australians and those who do not identify as Aboriginal and/or Torres Strait Islander. In addition, Aboriginal and Torres Strait Islanders have different interactions within healthcare services. Many rural health services have models that aim to deliver culturally appropriate services, but it is unknown whether the same challenges apply for this group of Australians within metropolitan health services. What does this paper add? This paper identifies the structural supports that are required to help close the gap in health care provision inequality. Many of the key issues identified are not people but system based. Healthcare administrators should consider the factors identified and address these at a whole-of-service level. What are the implications for practitioners? Many practitioners are aware of the challenges of providing culturally appropriate services. This research raises awareness of how traditional healthcare is not a one size fits all and flexibility is required to improve health outcomes.

Understanding Mental Health: What Are the Issues for Black and Ethnic Minority Students at University?

Black and Minority Ethnic (BME) communities continue to experience inequalities within the United Kingdom (UK) mental health system despite major government policy initiatives. Access to higher education for many ethnic minorities remains problematic. Within higher education, BME students consistently face barriers in terms of accessing culturally appropriate services including a lack of cultural understanding, communication issues, and where and how to seek help. This paper attempts to address the problems facing ethnic minorities with regard to accessing mental health services at university. Importantly, this paper highlights that barriers to accessing mental health support for ethnic minorities directly impact upon attainment outcomes and psychological well-being. This study utilizes the narratives of 32 BME university students to examine the impact of negotiating racial inequality and discrimination at university and the impact upon mental health. Aspects examined considered the impact of belonging, isolation, and marginalization on mental health and how this consequently affects university participation for BME students. Utilizing a thematic analysis paradigm, the key findings presented point towards differential healthcare outcomes for ethnic minority university students experiencing mental illness. The empirical findings in this paper suggest that currently ethnic minority service users experience overt discrimination and a lack of access to culturally appropriate services that are cognizant of the racialized plights faced by BME individuals. These findings inform an overarching dialogue, which suggests that mental health service providers need to work more collegially with people from BME communities prior to service design and delivery. Furthermore, the findings suggest that, upon presenting mental health issues, information should be made available in appropriate languages for ethnic minorities to support understanding about their illnesses and how they can seek professional intervention and help. Conclusions and recommendations provided advocate greater diversification of mental health support systems for ethnic minority students within universities. Conclusions drawn will also consider how existing systems can function to dismantle racial inequality within the mental health profession.

The Accommodation Experiences of Older Gypsies and Travellers: Personalisation of Support and Coalition Policy

This article reports on a study exploring the accommodation experiences of older Gypsies and Travellers and how specialist Supporting People services can enhance their wellbeing and social inclusion. The findings suggest that through development of pro-active, culturally appropriate services, flexible, tailored support and joint working, these services have contributed to their users’ wellbeing. Cuts to Supporting People funding pose a serious threat, especially in the context of loss of other services and changes to accommodation policy under the banner of localism. Targeted funding to sustain these specialist services could be important to redress risks of further marginalisation of Gypsy/Traveller communities.