‘Her urgent test was the furthest thing from her mind’

It had taken me over a week to track her down, and the investigations I was chasing were urgent. My patient hadn’t had the test I had arranged, nor had she been in for a review.
 
When she eventually answered my call, she immediately broke down. I could hear her crying.
 
A close family member had committed suicide. Not only that – it was the fourth suicide to affect this family in as many months.
 
Her urgent test was the furthest thing from her mind.
 
My patient’s tragedy came back to me in the wake of the RACGP’s recently launched 2019 General practice: Health of the Nation report, which revealed that patients around Australia see their GPs for help with mental health more than any other single health issue.
 
As a GP working with Aboriginal and Torres Strait Islander patients on a daily basis, this finding makes absolute sense to me.
 
Almost all Aboriginal patients – 95% – are affected by suicide in some way. The suicide rate among Aboriginal and Torres Strait Islander people is six times higher than non-Indigenous Australians. And 50% of all youth suicides are Aboriginal people.
 
These are startling statistics, but far from the only ones I could quote.
 
Mental health and suicide rates in this country are reaching crisis point, and our Aboriginal and Torres Strait Islander patients are disproportionately affected.
 
The reasons behind this situation are complex.
 
We know that Aboriginal and Torres Strait Islander people are worse off when it comes to almost all social determinants of health. They experience higher levels of childhood adversity, school dropout, family violence, incarceration rates, poverty, homelessness and overcrowding. The list goes on.
 
But simply identifying these social determinants is a superficial view of a complex issue. It is just one layer of the onion. Peel it back and underneath you will find the aftermath of historical trauma.
 
Terra nullius, the Australian colonisation process where the British claimed the land was uninhabited despite seeing and meeting Aboriginal people, the Stolen Generation, the loss of land, culture and traditional practices.
 
Culture, family and country are linked to the social and emotional wellbeing of Aboriginal and Torres Strait Islander peoples.
 
I sometimes hear friends, other health professionals and acquaintances make comments to the effect of, ‘But that was all in the past’.
 
The trauma continues and has downstream effects between generations. Shame, trauma and grief affect past, current and future generations. Racism, at inter-personal, internalised and institutionalised levels, continues. 
 
The challenges here are not unique – they are mirrored in the experiences of other indigenous cultures after European settlement, such as Native Americans.
 
GPs are at the coalface in tackling this Aboriginal and Torres Strait Islander mental health crisis. It is something many of us see and grapple with every day.
 
At times, the challenge can be daunting. How do you pull out a single issue – say, mental health – when your patient is struggling with insecure housing, family violence and trauma?
 
I don’t have all the answers.
 
But I do know that I will continue to try and do my part. I will continue to bring an open mind. I will continue to open a non-judgemental door to my room.
 
And I will continue to learn from my patients and my colleagues. We all must.

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Aboriginal and Torres Strait Islander health mental health social determinants suicide