Aboriginal and Torres Strait Islander women and mental health

The disadvantage faced by Aboriginal and Torres Strait Islander people is well documented and has been bought to public and Government attention by initiatives such as the Close the Gap Campaign (Commonwealth of Australia, 2016). It is accepted that there is a 10-year life expectancy and health gap between Aboriginal and Torres Strait Islander people and other Australians as well as a significant mental health gap. This mental health gap has been documented in both research and policy overviews such as by the National Mental Health Commission (2014), the Australian Institute of Health and Welfare (2014) and the Overcoming Indigenous Disadvantage report (Steering Committee for the Review of Government Service Provision [SCRGSP], 2016). The relatively poor condition of Indigenous Australian women’s social and emotional wellbeing is an area of growing concern and is the focus of this article. In this article the term ‘Indigenous’ will be used when referring to Aboriginal and Torres Strait Islander people.

A culturally accepted holistic definition of Indigenous mental health, and one that is central to Indigenous psychology in Australia, is social and emotional wellbeing. This holistic paradigm recognises that wellbeing is influenced by mental, emotional, physical, spiritual, community, family, cultural, and country wellbeing (Dudgeon & Walker, 2015). The mental health gap between Indigenous and non-Indigenous people can be understood to be the result of social determinants that have impaired the Indigenous domains of social and emotional wellbeing.

The mental health gap between Indigenous and non-Indigenous Australians was highlighted in the 2016 Steering Committee Review of Government Service Provision (SCRGSP, 2016) which found:

• Between 2014 and 2015, 33.2 per cent of Indigenous Australians reported high or very high psychological distress, an increase from the 28.1 per cent reported between 2012 and 2013.
• Hospital admission rates for intentional self-harm increased for Indigenous people by 56 per cent during 2014 and 2015 and are around two-and-a-half times higher than for non-Indigenous Australians.
• The suicide rate for Indigenous Australians is twice as high as it is for non-Indigenous people.

The National Aboriginal and Torres Strait Islander leadership in Mental Health (NATSILMH, 2015) Six Steps to Closing the Indigenous Mental Health Gap acknowledged that approaches to Indigenous mental health must recognise the unique historical and social position of Indigenous people and their culturally specific therapeutic needs. Indigenous mental health has been negatively impacted by colonisation which has resulted in widespread trauma and poverty. However, it is also important to recognise that holistic social and emotional wellbeing approaches which nurture healthy connections to family, community, country, body, spirituality, mind, emotions, and culture, are a great source of Indigenous wellbeing and resilience.

Currently there are a number of policy, program and service gaps that limit attempts to overcome the mental health gap between Indigenous and non-Indigenous Australians. The Six Steps to Closing the Indigenous Mental Health Gap position (NATSILMH, 2015) suggests ways in which this could be addressed including:

• a dedicated strategic response to Indigenous mental health
• an emphasis on promotion (that builds resilience to protect against mental health conditions) and prevention in the mental health system as a whole
• more services to meet unmet mental health needs
• more culturally appropriate services
• integrated services across the mental health system.

The mental health of Indigenous Australian women

As the primary carers of their families and extended families, the wellbeing of Indigenous women is central to the wellbeing of the community. Nevertheless, Indigenous women continue to experience high rates of mental health problems and disadvantage with findings demonstrating:

• There has been less improvement in the life expectancy gap for Indigenous females compared to males (Commonwealth of Australia, 2016).
• Indigenous women are hospitalised for violent assaults 35 times more often than non-Indigenous women (Australia’s National Research Organisation for Women’s Safety [ANROWS], 2014) and Indigenous females are hospitalised for intentional self-harm at higher rates than Indigenous males (SCRGSP, 2016).
• For women in the 25 to 34 age group, death by suicide is three times as high for Indigenous women when compared to non-Indigenous women (SCRGSP, 2016).
• Imprisonment rates for Indigenous females are escalating and several studies have found high rates of post-traumatic stress disorder and histories of child abuse in the imprisoned Indigenous female population (Heffernan et al., 2015).
• Between 2014 and 2015 Indigenous females reported experiencing greater levels of stress (38.4 per cent) than Indigenous males (26.7 per cent) (SCRGSP, 2016). At this time Indigenous women reported a significant increase in stressors caused by a range of factors that impact on social and emotional wellbeing such as overcrowding in their homes and unemployment (SCRGSP, 2016).

Culturally appropriate services and programs need to take into account the different needs of men and women. The National Aboriginal and Torres Strait Islander Women’s Health Strategy states:

“Aboriginal and Torres Strait Islander women know that they are collectively sicker, poorer, less educated, more unemployed, less skilled, face greater numbers of their families in jail, die younger, attend a greater number of funerals in any one year, are subject to higher levels of violence and racism and sexism, and are regarded as marginal and a minority than non-Indigenous Australian women”
– Fredericks, Adams, Angus, & the Australian Women's Health Network Talking Circle, 2010, p. 11.

The Strategy, developed through the Australian Women’s Health Network Talking Circle (Fredericks et al., 2010), found that Indigenous women want basic needs met, such as housing, employment and educational opportunities. Leadership and full inclusion in decision making about matters that are relevant to them were key concerns. Programs that promote wellbeing, in particular, cultural wellbeing, were seen as essential, and the necessity of a holistic and whole of community approach to addressing violence within the lives of Indigenous women, and within their communities was stressed. Family support and counselling was seen as critical. This needs to include support for the perpetrators of violence and the people who support them (sisters, brothers, mothers, aunties), not just the victims of violence.

Although men and women’s traditional gender roles were disrupted by the process of colonisation, distinct gender roles are still practised in Indigenous families and communities. Mutually respectful gender roles have been recognised as a protective factor and important for strengthening men and women’s social and emotional wellbeing. Women’s groups have also been recognised as important for nurturing women’s social and emotional wellbeing (Lee, Dawson, & Conigrave, 2013). Culturally appropriate therapeutic practices recognise that sometimes it is appropriate for women to see other women, men other men, and that it is culturally inappropriate for much younger people to counsel older people (Dudgeon et al., 2014).

Cultural healing

In the last few decades traditional Indigenous therapeutic practices (or cultural healing) have undergone a cultural renaissance. Traditional healing practices vary across the country and traditional healers have different names. For example, the Anangu western desert healers are called Ngangkari, in northeast Arnhem Land they are called Marrnggiti, and around Sydney they are called Garraaii (Elkin, 1977; Tench, & Flannery, 1996). In this article, the focus is on Ngangkari healers.

In summary, Aboriginal Torres Strait Islander culture can be said to be gendered. There are specific men and women’s roles and responsibilities which have implications for mental health professionals and the services they offer. For the practitioner, it is prudent to seek advice from local Aboriginal services or mental health professionals to ensure that the services provided are culturally appropriate and take gender issues into account.

The author can be contacted at [email protected]