Evaluation of the Bringing them home and Indigenous mental health programs

9.4 The Mental Health Service Delivery Projects

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The 2001 Evaluation of the Aboriginal and Torres Strait Islander Emotional and Social Well Being Action Plan (1996–2000) found that a number of features of culturally appropriate mental health care had been identified, such as the employment of Aboriginal staff, the use of traditional healers, and the use of Aboriginal approaches to therapy, such as narrative approaches.

Accordingly, the main aim of the 19 Mental Health Service Delivery Projects funded within ACCHSs is to develop and evaluate culturally appropriate approaches to mental health service delivery for Aboriginal peoples. A summary of the projects is provided in chapter 3.

9.4.1 Nature of the client group

9.4.2 Key outcomes and achievements of the projects

9.4.3 Limitations of the Mental Health Service Delivery Projects

9.4.1 Nature of the client group

Some limited information was available on the exact number of clients who were participating in these Mental Health Service Delivery Projects – five projects provided data on this in the survey, although it was not in a form that was readily comparable between the projects. This data does confirm however that the projects worked with quite large numbers of clients over a 12 month period – for example two worked with 156 clients, and one worked with 310 clients. In another instance 80 treatment plans were developed. Yet another project reported that it had 2,565 'connections with clients' and provided 1,235 'episodes of care'.

Staff of many of the Projects consulted reported that the nature of the client group was very diverse in every community. Some services had a high number of young people participating in the projects, while others had larger numbers of older males presenting with a whole gamut of issues (eg substance abuse, child removal, sexual abuse, neglect, family violence and homelessness). Top of page

9.4.2 Key outcomes and achievements of the projects

There are three key achievements of the projects: high levels of client satisfaction and positive outcomes; culturally appropriate service delivery; and conducting activities which contribute to community capacity building.

High levels of client satisfaction and positive outcomes and culturally appropriate service delivery

The projects have provided a very diverse range of strategies to provide culturally appropriate programs to Aboriginal people. Many projects generally focus on narrative therapy approaches, counselling services, health promotion, sexual health, and specialist mental health services. It was reported that the projects had gone to great lengths to provide different strategies to address their clients' needs.

Consultations with clients of some of the projects indicated that there was a high level of client satisfaction with the services provided by the projects.

Culturally appropriate service delivery

It was also reported that the projects have provided services in a culturally appropriate setting with Aboriginal Health Workers and professional and specialist staff who were culturally aware of the needs of Aboriginal clients.

Although the Mental Health Service Delivery Projects do not have a focus on the Stolen Generations, several BTH and Link-Up staff commented that the projects have been a positive step towards meeting the needs of this group in a culturally appropriate way. Some of the projects have actively involved BTH Counsellors as part of their programs and in providing debriefing support. Many of the Aboriginal Health Workers in the projects are participating in modules under the mainstream Mental Health Nursing Program (run through the Gippsland campus of Monash University) so that they can provide more culturally appropriate mental health service to Stolen Generations clients. Top of page

Some workers reported that more mainstream mental health services are recognising the existence of Stolen Generations members since the Mental Health Service Delivery Projects were developed.

Supplementary activities which contribute to community capacity-building

Some of the projects also conduct activities beyond direct service provision which contribute to community capacity-building for other services and community members within their Aboriginal communities. For example some of the Projects have conducted activities such as:

• Facilitating community events (eg National Aboriginal and Torres Strait Islander Children's Day), hosting local forums in relation to child protection and family support, supervising social science and community welfare students, participating in Mental Health Steering Committees which influence service delivery of other agencies and their interaction with the project's client group, and conducting other higher-level advocacy activities within the community.
• Providing the only Aboriginal focused Mental Health First Aid trainer in Australia, to deliver a program to Aboriginal communities in the region where the project is located and elsewhere in the State.

One project who conducts activities of this nature did however observe that there is an ongoing tension between work of this nature and direct service provision, given that there is considerable demand for the service to be conducting both activities. Top of page

9.4.3 Limitations of the Mental Health Service Delivery Projects

There were three key limitations of the projects: long waiting lists, limitations in physical access; and a limited capacity to respond to clients' full range of needs.

Long waiting lists

A key limitation of the projects is that a number have long waiting lists. Some clients and services reported that they were often referred back to the BTH Counsellor, the Stolen Generations Organisation or Link-Up if staff from the project were unable to meet with them at the time they presented to the project. It was also reported that the projects cannot always meet the needs of Stolen Generations members due to the high demand for the services.

The long waiting lists often led to the client needing to access mainstream services which were not culturally appropriate to meet their urgent needs.

I was not able to access the [Mental Health Service Delivery Project] and was referred to a mainstream mental health service. I had to meet someone in a suit in a clinical room who was 20 years younger than me and as soon as they spoke to me it was really insulting so I left and have never gone back. After my bad experience, there was no investigation or follow up as to why I had not come back. I feel like I have slipped through the cracks in the system. I understand that there is a high level of need and I have to compete with other clients to access the services.
(Client, Mental Health Service Delivery Project) Top of page

Limitations in physical access

Most of the Mental Health Service Delivery Projects are located in regional areas. Some workers stated that it was sometimes difficult for their clients to physically access the projects as public transport is often limited and in some cases not available at all.

It was further reported that some clients were not able to afford the costs of public transport which in some instances was very expensive if a client was required to use it several times in the day to access many services.

Some but not all of the projects provide outreach services to see clients or drive them to appointments with other mental health professionals.

Limited capacity to respond to clients' full range of needs

Clients and workers of the projects identified that it is often difficult to address all the clients' issues whilst dealing with their mental health problems. While the programs generally try to adopt a holistic approach towards clients, resources limit the capacity to address all of their issues and needs.

It is really hard to provide appropriate permanent housing for some of our clients with severe mental health problems. On the occasions that we have been able to find appropriate and affordable housing the client is seeking home-based outreach support from our service. When we do provide this outreach support the client is often not at home and it makes it difficult for our program and service to meet the ever changing needs of the clients and community. This also impacts greatly on trying to provide an effective service to our other clients.
(Staff, Mental Health Service Delivery Project)

In one regional area, there are about 60 Stolen Generations members accessing the Mental Health Service Delivery Project. This project has had to extend its geographical coverage due to closure of other services in the area. However this service provision is not sustainable in the long term since the service is spread too thin, which tends to aggravate the overall situation faced by Stolen Generations clients.

In some instances, workers within the Mental Health Service Delivery Projects were unable to meet with clients when they took the initiative to come into the service in the first instance. Many of the clients were turned away due to lack of resources to cope with the high level of demand. Some clients present with severe mental health problems relating to long term use of alcohol and drugs, acquired brain injury symptoms, depression etc. There is also no follow-up provided by the Mental Health Service Delivery Projects. Top of page

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