Project Title:

Better Medication Management for Aboriginal People with Mental Health Disorders and their Careers

ADAC, in partnership with the Flinders University School of Nursing and Midwifery has recently produced the following report:

"Better Medication Management for Aboriginal People with Mental Health Disorders and their Carers - A Pilot Study in Northern Metropolitan Adelaide", de Crespigny, C., de Bellis, A., Cruse, S., Kowanko, I., Murray, H., Turner, M., Parfoot, W., Roberts, G., Wilson, S., Aboriginal Health Team (now known as Muna Paiendi) (2002),  Adelaide, SA.

We are not able to provide the full text version of the report at this time,  however the following, drawn directly from the report, provides an overview of the published report.

Introduction

Grief and loss, chronic poverty, social dislocation, lack of culturally safe services and long term cultural disruption continue to affect the health and well-being of Aboriginal Australians. The latest statistics indicate that the Aboriginal population is still much sicker, younger and poorer than the non-Indigenous population. Mental Health disorders (problems of emotional and social well-being) are widespread among Aboriginal people, and often complicated by other chronic illness and/or substance use. Quality medication management can be difficult for many Aboriginal clients, their carers or other family members. Anecdotal evidence suggests that unsafe or inappropriate use of medicines is common, with potentially damaging physical, social and economic consequences.  

Aims and Objectives

The aim of this study was to explore the particular needs, experiences and contexts of Aboriginal people diagnosed with a mental health disorder, their carers and other family members, focusing on issues relating to management of medications. The objective was to develop recommendations for quality use of medications for this group.

Participants and Methods

Data was collected from semi-structured interviews and focus groups with Aboriginal people with mental health disorders, carers and health workers. All participants were drawn from the northern metropolitan suburbs of Adelaide. Verbatim transcripts were analysed thematically and recommendations developed collaboratively with health workers.

Results

The data provided a rich insight into the experiences and views of Aboriginal people with mental health disorders, their carers and health workers in relation to medication use. It seems that some people cope with their mental health disorders and manage their medications quite well, and that the Northern Metropolitan Community Aboriginal Health Team provide support and care beyond the call of duty. However it is also evident that medications are not always used safely or optimally, potentially putting some people at risk. Many Aboriginal people with mental health disorders, their carers and other family members are struggling to cope with multiple and complex problems in their lives and are not always receiving adequate and appropriate support. The major issues to emerge from this research centre around:

• poverty
• shame
• understanding of mental illness and medications 
  
• co-ordination of services
  
• adequate and appropriate services
  
• the relationship between alcohol or other drugs and mental illness
  
• burden on carers

Another important outcome is the development of a partnership model for ethical research which provides tangible benefits for participating Aboriginal communities. The research team is applying the model to a larger South Australia wide project currently in progress on the same topic funded by the Commonwealth Department of Health and Aged Care through the Quality Use of Medicines Evaluation Program.

Recommendations

1. That effective and multifaceted programs that address poverty and its root causes among Aboriginal people be implemented and sustained.

2. That health services and health professionals ensure that their practices and policies are culturally appropriate. Suggested strategies include:

• Cultural awareness training and support for non-Indigenous GPs, nurses, pharmacists and other mainstream health workers;
• ensuring mainstream health professionals are educated about Aboriginal understandings and manifestations of health/illness, social and emotional well-being, and traditional approaches to healing;
• dissemination of current referral information for a range of services relevant to Aboriginal social and emotional well-being issues (eg schemes to reunite families);
• employing more Aboriginal workers across all health and social services in the northern metropolitan area of Adelaide
• clarifying, formalizing and promoting systems for recognition and payment of traditional healers (Ngangkari)

3. That culturally appropriate information about mental health issues be made widely available to the Aboriginal community in order to:

• raise awareness and understanding of social and emotional well-being issues;
• destigmatise mental illness;
• increase understanding of the different roles of health professionals (eg psychologists, counsellors, psychiatrists, traditional healers), in relation to mainstream and alternative treatments
• encourage people to seek help
• increase general understanding of medications for mental illness, including purpose, safe use, compliance, interaction with other substances, side effects, storage and disposal.

This information could be provided in multiple forms (eg brochures, posters, videos, stickers) and locations (eg health centres, pharmacies, community centres, sports clubs, schools).

4. That a range of culturally appropriate early intervention strategies for Aboriginal people with social and emotional well being problems be developed and promoted. These might include peer group counselling and community support groups.            

5. That integrated health service delivery systems be developed in the northern metropolitan area. Suggestions relevant to medication management include:

• adopting a regional approach to health service delivery and planning, involving hospitals, emergency departments, GPs, pharmacies and the Northern Metropolitan Community Heath Team (Muna Paiendi)
• Aboriginal and mainstream health services in the northern metropolitan region together developing an equitably resourced system for distributing medications to those who cannot afford them
  
• using additional funds allocated to GPs through the Aboriginal Primary Care Access Program to provide extra consultation time with Aboriginal clients for provision of appropriate explanations and information about mental health and medications;
• developing and implementing effective communication systems between health services, eg a simple interagency computer network. These systems should enable service providers to track individual clients so that over prescribing and conflicting advice is minimised, while preserving confidentiality.
• developing and implementing systems for effective co-ordination of health and other service providers. In particular, better linkages between health services and correctional, educational, employment and social services are required;
• fostering and strengthening collaborative networks of workers across health and social portfolios (eg Aboriginal Workers Forum and the Northern Interagency Group).

6. That all workers providing assistance to Aboriginal people with mental health problems and requiring medications have access to professional training about:

• Social and emotional well-being issues in Aboriginal communities;
• mental health problems;
• alcohol and other drugs; and
• safe management of medications.

These topics could be included in curricula for Aboriginal health worker education programs such as the Certificate in Aboriginal Primary Health Care.

7. That gaps in service provision for Aboriginal people in the Northern Metropolitan area of Adelaide be addressed. In particular there are identified needs for:

• health services for Aboriginal youth;
• gender specific Aboriginal health services;
• health services for older Aboriginal people; and
• drug and alcohol services for Aboriginal clients, eg substance use clinics, harm minimisation schemes, health promotion activities and positive role modelling in schools and community groups.

8. That Aboriginal family members who care for people with mental health problems be supported in their role and recognized for their contribution. In particular, respite schemes, transport assistance and financial support are urgently needed.

9. That support and skills development be made available to Aboriginal clients in budgeting for medications.

10. That pathways be developed for supporting quality use of medications by

• Aboriginal elders on discharge from hospital; and
• Aboriginal prisoners with mental illness on and after release, eg by strengthening and formalising links between correctional services health staff, health workers on the outside and families.
  

Project Contact

Warren Parfoot
Education Manager
Aboriginal Drug and Alcohol Council (SA) Inc.
53 King William Street
Kent Town, SA, 5068
Ph: +61 (08) 8362 0395
Email: warrenpa@adac.org.au

Or: Flinders University School of Nursing and Midwifery