Week 2 Lecture 2a - Indigenous Mental Health (DN) Flashcards Preview

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What is an issue around DSM-5 that has outraged many health care professionals?

  • Grief (crying after 2 weeks) is being classified as depression
    • What is appropriate & what is pathological?




What are some issues in history that have impacted on Indigenous Australians

  • Land theft
  • Massacres  19th Century
  • Stolen children
  • Missionization
  • Forced movement and resettlement
  • Restricted movement on reserves




Who does the term Indigenous apply to?

  • Not just Australians
  • People living on the land, not part of a state who became subjects of Colonisation
    • e.g., Native Americans, Native Canadians, Greenlanders (Denmark), Khoisan people in South Africa, Peru, Argentina


How have the many years of discrimination shaped (impacted) Indigenous Australians?

  • Consistent social pathologies in entire communities


  • Many pathologically related behaviours have been almost institutionalised amongst indigenous populations (i.e., almost expected)


How does Forced Movement impact on peoples well being

  • Control - not allowed to leave
  • Concentrating populations
    • alienation from land, language, culture - brutality
    • peoples sense of self & worth systematically erased
    • Refugees of 20th Century

QLD: ppl moved all over the place into missions - noone could visit them without police (Sherberg Mission) forced to walk - often for months (40 different language groups) others shipped off to palm island



What is the US equivalent

  • March of Tears
  • Cherokee of the US forced to march to reserves


What happened in 1966 for Aboriginal Australians?

  • Included in Census
  • Prior to that held less worth than Kangaroo & Koalas :-(
  • Sustained discrimination is a legacy of this policy




What is a sad reality of the concentration of Indigenous populations in Australia?

  • it was hoped they would eventually die out
  • impact of that on personal identity of Indigenous Australians today
  • Impact on their capacity to feel worth while


Continuing history of alienation & discrimination has contributed to..................

  • Drugs, alcohol, petrol sniffing
  • Sexual violence and the abuse of children
  • Other interpersonal violence
  • Homelessness (e.g., parkies)
  • Unemployment
  • Poverty
  • Boredom
  • Poor services/ no integration of services


What impact does drug, alcohol, petrol sniffing, fly spray have

  • affects brain, mood, cognition & social interaction
  • physically, mentally, emotionally, socially




What should be considered with homelessness & Indigenous people?

  • living as they would in their own habitat
  • may not in fact be comfortable indoors




may get rid of this card eventually??



  • Almost half of Aboriginal men and over a third of women die before they turn 45
  • Indigenous people 18 years and older twice as likely to feel high or very high levels of psychological distress
  • Twice as likely to be hospitalised for mental and behavioural disorders than other Australians in 2008-09
  • Men were 5.8 times more likely and women 3.1 times more likely to die from these disorders in 2001-2005 than other Australians
  • 77% of Indigenous people (59% all) experienced 1 or more significant stressors in the previous 12 months:
    • 'death of a family member or friend', 'alcohol or drug related problem', 'trouble with police', and 'witness to violence'
  • One in five Indigenous people had member of the family sent to jail in the previous 12 months


Indigenous people were twice as likely (than non-indigenous) to be hospitalised (mental/behavioural disorders) in 2008-09:

Consider the impact being Institutionalised may have had upon these people?

  • institutions almost operate like jails to contain mentally ill
  • impact mood
  • issues of trust/security



- incarceration does not help people to function well in society


What is a surprising fact about alcohol & Indigenous Australians

- Indigenous Australians are less likely to drink alcohol at all compared to non-indigenous Australians (exception Indigenous Greenlanders of Denmark) - But those that do - drink to excess (at dangerous levels


What is a disturbing fact about alcohol & pregnant Aboriginal mothers?

- 48% of Aboriginal mothers drink while pregnant - High rates of foetal alcohol syndrome 37:45


- Almost half of Aboriginal men and over a third of women die before they turn 45........ - Consider how this impacts Mental health as well as the future outlook for Aboriginal youth?

- children losing parents young - perhaps impacting their own life expectancy - possibly life without much hope for future - in turn impacting what they do or don't do with their life


What are some of the Mental and Physical defects resulting from Alcohol crossing the placental barrier FOETAL ALCOHOL SYNDROME 40:00

- Can stunt foetal growth or weight, create distinctive facial stigmata - Damage to neurons and brain structures - Psychological or behavioural problems - Permanent central nervous system damage - Memory problems, attention deficits, impulsive behaviour, and poor cause-effect reasoning) - Secondary disabilities (e.g., predispositions to mental health problems and drug addiction. - Learning difficulties, including poor memory, inability to understand concepts such as time and money, poor language comprehension, poor problem-solving skills behavioural problems


What is the risk of drinking while pregnant?

Foetal Alcohol Syndrome - Alcohol crossing the placental barrier


What are some of the physical characteristics of Foetal Alcohol Syndrome?

- flat lips, thin top lips - not fully formed ear lobes - finger deformity


Which country has an extremely high incidence of FAS?

South Africa

  • One study in the Western Cape (with large Khoi and San populations) identified 65.2-74.2 per 1,000 children in the first grade population
  • 33-148 times greater than U.S. estimates and higher than in a previous cohort study in this same community (40.5-46.4 per 1,000).


What is the estimated prevalence of Foetal Alcohol Syndrome (FAS) worldwide?

  • 1 to 1.5 cases per 1000 live births worldwide


How do Aboriginal & Non-Aboriginal FAS rates compare?

  • Aboriginal          - 2.76/1000
  • Non-Aboriginal - 0.02/1000

reported in WA (2002)



 The most widely used summary prevalence estimate of FAS is 1 to 1.5 cases per 1000 live births worldwide  Between one and two-thirds of all children with special educational needs are children who have been affected by their mothers’ alcohol intake during pregnancy.  South Africa has one of the highest incidences of FAS globally  One study in the Western Cape (with large Khoi and San populations) identified 65.2-74.2 per 1,000 children in the first grade population -- 33-148 times greater than U.S. estimates and higher than in a previous cohort study in this same community (40.5-46.4 per 1,000).  Alaska: 0.20 - 0.30/1000, non-native; 3.00 - 5.20 Alaska Native  In WA (2002) WA Birth Defects Registry reported 0.02/1000 for non-Aboriginal children, with 2.76/1000 Aboriginal children  Australian Aboriginal are less likely than non-Aboriginal women to drink alcohol, but those who do are likely to drink at hazardous or harmful levels.


49:00 Medium to Long Term Effects

 Social withdrawal, inflexibility, impulsiveness, and anxiety  Poor educational and employment outcomes  Main cause of intellectual disability in US, Canada, ANZ and Europe  Especially high among Indigenous populations not only in Australia 49:00



 Canadian Aboriginal population  First Nation communities twice total population  Inuit —6 to 11 times > general population.  affliction of the young – 1/3 all deaths of Aboriginal youth  Youth on reserves aged 10 to 29 - 5 to 6 times more likely to die of suicide than peers in general population.  United States: a Native American 62% more likely to commit suicide than the general population.  Australia: 2001-2006, NT suicide rate for those aged 15 to 24 was 3.5 times that in the rest of the nation  Very young ages and rising no of women – 75% of suicides of children 2007- 2011 in NT are Aboriginal  The suicide rate doubled for youth between ages 10 and 17 – up from 18.8% to 30.1% per 100,000 2007-2011 – in contrast to non-Aboriginal youth suicides down from 4.1% to 2.6%.


Consider why so many young people suicide on reserves?

Are they dying on reserves because - not integrated into society - self medicating on drugs or alcohol - or both?


What else is going on in their lives that makes them so vulnerable to suicide?

- likely to be living with parents who have emotional problems - parents rate their own children as having emotional problems - 7/10 children - exposed to 3 or more major stressors annually - 2/10 children - exposed to 7 or more major stressors annually - impacts on mental health & sense of security 54:30


What IMMEDIATE DISTRESS AND INTERGENERATIONAL TRAUMA result from discrimination experienced by indigenous people? 55:50

- separation from families (foster care) - 30 or more homes moved around foster care system (trust, sense of security, safety) - 1/4 people 15 yrs & over = victims of violence


How might the experiences of childhood impact over time?

- Intergenerational trauma


How do social, economic, cultural and historical factors interact?



What factors might support resilience in individuals?



What lesson does this offer for working with indigenous men and women?



Consider suicide rates in different populations and what they might tell us about the experiences of those populations.... Native Americans Canadian Aboriginals Young Australians Aboriginal Children in NT Aboriginal in NT (children) Aboriginal 10-17yrs

Native Americans: 62% more likely than gen. pop. Canadian Aboriginal: twice as likely as gen.pop Young Australians: 1/3 are Aboriginal Aboriginal in NT (15-24yrs) = 3.5 x likely the rest of nation (2001-2006) Aboriginal in NT (children) 75% are Aboriginal (2007-2011) Aboriginal 10-17yrs - per 100K rate doubled 18.8% - 30.1% non-Aboriginal - decreased 4.1% - 2.6%


What do suicide rates tell us about a population?

Suicide & attempted suicide rates are a very sharp index of the level of distress experienced within a population