Evaluation of the Bringing them home and Indigenous mental health programs

4 Literature review

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The literature review aimed to identify current and emerging issues, policies and approaches to meeting the mental health and SEWB needs of Aboriginal peoples affected by forced removal from families and the associated grief and loss, including identifying best practice models and possible alternative service delivery models.

The full literature review is provided in appendix B. The key findings of the review of greatest relevance to this evaluation are summarised here.

• There is very little literature concerning best practice approaches to meeting the SEWB needs of Stolen Generations groups, other than a few evaluations of the programs being evaluated here. The key exception is the Marumali Program, which aims to provide counsellors with the skills to assist Aboriginal people who are suffering from grief and trauma as a result of separation. The program is funded by OATSIH to deliver training to the Aboriginal SEWB workforce on an annual basis. More literature describes good practice approaches to Aboriginal SEWB services generally, rather than specifically in relation to this target group. This makes access to and provision of specific training on this issue for staff of the Link-Up, BTH and SEWB RC Programs more difficult.
  
  
• The Government’s response to the BTH Report has been insufficiently documented, poorly coordinated and insufficiently targeted to meet the needs of the Stolen Generations, as concluded by reports examining this issue. This is consistent with the findings of this evaluation. There has been insufficient prioritisation of the needs of first generation Stolen Generations members.
  
  
• Lessons from overseas experiences highlight that there have been similar removal practices of Indigenous peoples in other countries, with similar very negative SEWB consequences. Government responses to removal practices and their consequences have differed, with a broader range of responses in Canada in particular.Top of page
  
  
• There have been numerous, negative and severe consequences of removal in Australia on Aboriginal people’s SEWB, including loss, trauma, grief, criminal behaviour, adverse life outcomes, substance abuse, higher rates of mental health problems, suicide and violence, parenting problems, and poorer physical health. These effects and consequences are trans-generational ie they impact not only on those directly removed but also on their children, families and communities. This demonstrates the need for the programs being evaluated here, the complexity of their work, and the importance of working with first and subsequent generations of the Stolen Generations.
  
  
• Mainstream mental health responses to Aboriginal people are often inadequate and culturally inappropriate. This demonstrates the importance of programs such as the programs being evaluated here.
  
  
• The Aboriginal SEWB field is a relatively new and under-developed one. For example, there is little published material regarding effective preventative and therapeutic interventions concerning SEWB for Indigenous people. However, the community care stream of the Aboriginal health certificate to be provided under the Health Training Package recently endorses by the National Quality Council should contribute to the future development of this field.
  
  
• The Aboriginal mental health workforce suffers from shortages and under-valuing of workers. These general problems contribute to the workforce difficulties experienced by these programs.
  
  
• Mental health services need to be provided to Aboriginal people in a culturally appropriate manner, through the use of traditional healing approaches and ensuring that mainstream mental health services are delivered appropriately. This highlights the need for services such as those here, and the need to adopt approaches other than, for example, traditional clinical approaches.
  
  
• The prior evaluations of the Link-Up and BTH Programs have consistently identified a range of common issues, including variable skills and qualifications of staff, services not adequately meeting the needs of first generation Stolen Generations members, generally high levels of client satisfaction among those people who do access the services (with some caveats such as concerns about the long delays in receiving records or a reunion through Link-Up), problems with the Foxtrot data collection system for Link-Up, the need for more outreach services, and inadequate attention to evaluation activities. These findings are very consistent with those of the present evaluation.

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