| Project Objectives / Summary:
The major aim of the project was to hold two-way GP and Aboriginal Mental Health Worker (AMHW) education sessions, where AMHWs assist GPs to fill gaps in training and knowledge of cross-cultural mental health issues, thus:
- Improving the knowledge and skills of GPs dealing with Aboriginal mental health problems
- Improving the knowledge and skills of AMHW dealing with Aboriginal mental health problems
- Sharing knowledge and skills across professions
- Facilitating the collaboration between GPs, AMHWs and other health care providers and the coordination of care of Aboriginal patients with mental health problems.
A further aim was to support the development of a specific curriculum document in Aboriginal mental health training for general practice training.
Project Collaboration:
There was broad formal consultation across a number of stakeholder groups. These included:
- Aboriginal Medical Services Association of the Northern Territory (AMSANT)
- Aboriginal Health Workers Association
- Batchelor Institute of lndigenous Tertiary Education (BITE)
- General Practice Education and Research Unit (GPERU), a collaboration of the Northern Territory Clinical School, Flinders University and the RACGP , incorporating the NT GP training program
- Tiwi Health Board
- Maningrida Health Board
- Central Australian Rural Practitioner's Association (CARPA)
- Ngaanyatjara Pitjanjatjara Yankunytjatjara (NPY) Women's Council Northern Territory Divisions of General Practice
- Frank Spry, consultant to Territory Health Services on Aboriginal mental health policy
- Territory health Services
- Darwin Rural Mental Health Services
- Darwin Urban Mental Health Services
- East Arnhem Mental Health Services
The response from stakeholders was universally positive. Batchelor College of Indigenous Tertiary Education, one of the training institutions for Aboriginal Health Workers in the Top End, enthusiastically supported the concept and committed time and resources to working with GPs on the project.
Project Outcomes:
As a result of the workshops held, progress has been made by GPs, GP Registrars and Aboriginal Mental Health Workers and AMHW students, in understanding the diagnosis treatment, and design of systems of service provision for mental health problems in Aboriginal people.
The workshops have delivered culturally appropriate education curricula in Aboriginal mental health issues in mainstream health education systems -continuing medical education for GPs, and as part of formal education for general practice training.
Non-Aboriginal participants were taught by Aboriginal professionals from their perspective, and were introduced to a cultural formulation. Cultural identity was discussed, with the importance of kinship systems emphasised. Cultural explanations were explored, including blame, sorcery, worry, somatic complaints, and perceived severity in cultural terms. The level of functioning and disability expressed was seen to influence presentations and management. Importantly, the cultural elements of the relationship between the individual, the family, and the GP were emphasised.
The setting of the workshops maximised Aboriginal participation and ownership of the cultural knowledge, and GPs and Aboriginal Mental Health Workers have been encouraged to create partnerships to develop alternative models of mental health maintenance and illness prevention.
Participants viewed Aboriginal Mental Health Workers as central to effective best practice service delivery, and formally supported their employment in Aboriginal communities in the Top End.
Recommendations:
- That there is a need for increased professional recognition, support, and a substantial expansion in the numbers of Aboriginal Mental Health Workers.
- That there is a need to continue developing partnerships in care and sharing of professional skills between the two groups.
- The need for further workshops was particularly identified by Aboriginal participants. They also requested workshops between AMHWs and other professional groups.
- That priority be given to the integration of these two professional groups, both in training and mental health service provision.
Disseminating Project Information:
The project findings have been disseminated to stakeholders and other bodies, including:
- Presentation at NT AMA conference Learning Lessons: Approaching Indigenous
- Health Through Education, by Samut Garling, lecturer in mental health at Batchelor Institute, John Maher and Renee Bauer, Darwin 22-24 November 2000
- Presentation at Primary Mental Health Care Unit of Western Australia conference Partnerships in Care, by Ian Castillon, AMHW at the acute psychiatric unit at Royal Darwin Hospital, and Renee Bauer, Broome 29-30 March 2001.
- Presentation to GP registrars, Darwin, November 2000, by Albert Milleran, AMHWat Maningrida community , and Renee Bauer
- Discussion at Central Australian Rural Practitioners Conference, by Renee Bauer, Alice Springs, November 2000
- Article in Australian Doctor, 18 August 2000
Lessons / Assessment:
This project identified and addressed a specific need with broader policy implications. A significant outcome was funding under the MAHS Program of a proposal to put more AMHWs in communities. The outcomes of this project are capable of transfer to other Divisions for use as a model.
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