News

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Culture, care and reducing suicide risk

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Mental health is a rising concern for all Australians, but the effects can often be even more acute for Aboriginal and Torres Strait Islander people, manifesting most tragically in a suicide rate that has been described as being at crisis level, particularly among children.
 
When Western Australia’s State Coroner Ros Fogliani delivered the findings from an inquest into a cluster of suicides in the Kimberley region earlier this year, she questioned the adequacy of existing suicide prevention and support services for Aboriginal and Torres Strait Islander people.
 
‘It may be time to consider whether the services themselves need to be co-designed in a completely different way, that recognises at a foundational level the need for a more collective and inclusive approach towards cultural healing for Aboriginal communities,’ she said.
 
Dr Geoffrey Spurling, a GP at Inala Indigenous Health Service and senior lecturer at the University of Queensland, agrees with Ms Fogliani’s assessment. He emphasised the vital importance of getting things right when Aboriginal and Torres Strait Islander people present in distress.
 
‘The stakes are high at this assessment consultation. The consultation needs to be done well, sensitively, and it needs to be effective,’ he told newsGP.
 
‘Decisions regarding the next management steps are crucial to get right, because people’s lives are on the line.’
 
Earlier this year, the Centre for Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention (CBPATSISP) and the Menzies School of Health Research (Menzies) released its Best practice guidelines for psychosocial assessment of Aboriginal and Torres Strait Islander people presenting to hospital with suicidal thoughts and self-harm (the Guidelines).
 
The Guidelines are designed to help boost quality of care for Aboriginal and Torres Strait Islander people presenting to hospitals with severe psychological distress.
 
They contain recommendations designed to:

• develop the cultural competency of hospital staff as a foundation for providing more culturally responsive hospital mental health services
• recommend practices and strategies that encourage patient and cultural safety
• improve the quality of assessments that inform clinical decision-making
• promote a person-centred approach to clinical decision-making that is focused on supporting recovery in the community
• increase patient satisfaction with hospital services
• encourage future help-seeking behaviours.  

While the Guidelines are focused on hospital presentations, Dr Spurling believes they can also be extremely helpful to GPs.

‘Many GPs, especially outside metropolitan areas, would be on the hospital frontline,’ he said.
 
‘Also, given that most Aboriginal and Torres Strait Islander people live in urban areas and many do not want to go to hospital, GPs will often be the first point of call; assessment of suicidal thoughts is a common presentation I encounter as a GP working with Aboriginal and Torres Strait Islander people in an urban context.
 
‘I found these Guidelines useful and relevant to my work, and despite working in this space for 15 years, I found many new learnings; they are an excellent resource for clinicians wanting to do their best in a high-stakes consultation with their Aboriginal and Torres Strait Islander patients.’ 
 
Dr Geoffrey Spurling has found the Guidelines extremely helpful in his practice treating Aboriginal and Torres Strait Islander patients.
 
Professor Pat Dudgeon, a psychologist and Professor from the School of Indigenous Studies at the University of Western Australia, is hopeful the Guidelines will help boost cultural competency among healthcare practitioners and build trust between Aboriginal and Torres Strait Islander people and the health system.
 
‘Little satisfaction is gained when [Aboriginal and Torres Strait Islander] patients front up to hospitals, so they don’t trust them; they only go there when the need is dire,’ she said.
 
‘So it was important work was done to ensure that doctors and people working in hospitals can deal with Aboriginal people and address them in a way that really meets their needs, particularly if they are at risk of suicide or self-harm.’
 
One major issue emphasised in the Guidelines is the additional layer of trauma for Aboriginal and Torres Strait Islander people presented by the legacy of colonisation.
 
‘[Colonisation] impacts all levels of society, from structural barriers to family support networks, and is made up of complex and interrelated factors,’ Professor Dudgeon wrote in the Guidelines’ introduction.
 
‘Any proposed solutions or measurements attempting to address the issues of suicide and self-harm for Aboriginal peoples must consider these historical and contemporary complexities.’
 
Dr Spurling believes clinicians must not only recognise such impacts, but also consider their own attitudes and how they might affect delivery of care.
 
‘Clinicians need to reflect on their own histories, where they have come from, and how that informs their beliefs,’ he said.
 
‘They also need to be aware of how culture is a source of strength for Aboriginal and Torres Strait Islander people.
 
‘Clinicians who are not aware of or do not understand how Australia’s history of colonisation has impacted on the lives of Aboriginal and Torres Strait Islander people will struggle with the assessment of an Aboriginal and/or Torres Strait Islander person with suicidal thoughts.’
 
When asked what she hopes the Guidelines might help to achieve, Professor Dudgeon’s answer is straightforward.
 
‘I’m hoping it’ll save lives,’ she said.
 
‘In the first instance, it’s about ensuring that people get good-quality treatment that addresses the immediate problems, but anything underlying, as well.
 
‘And if we put more resources into hospitals so they can offer a more compassionate, holistic service, that will benefit everyone.’
 
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Aboriginal and Torres Strait Islander health Cultural sensitivity Culturally appropriate healthcare Mental health suicide Suicide prevention

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