Good Practice Guidelines and Examples

Dudgeon et al. (2014) outline nine guiding principles, and they suggest that services that reflect these principles are more likely to be effective than those that do not. The principles were first articulated by Swan and Raphael (1995) and were adopted as the foundation of the National Strategic Framework for Aboriginal and Torres Strait Islander Peoples Mental Health and Social and Emotional Well Being 2004—2009 (Social Health Reference Group 2004). The nine principles are:

  • 1. health as holistic, encompassing mental, physical, cultural, and spiritual health;
  • 2. the right to self-determination;
  • 3. the need for cultural understanding;
  • 4. recognition that the experiences of trauma and loss have intergenerational effects;
  • 5. recognition and respect of human rights;
  • 6. recognition that racism, stigma, environmental adversity, and social disadvantage have negative impacts;
  • 7. recognition of the centrality of family and kinship and the bonds of reciprocal affection, responsibility, and sharing;
  • 8. recognition of individual and community cultural diversity; and
  • 9. recognition of Indigenous strengths (Social Health Reference Group 2004, p. 6).

Services will more effectively engage, and offer scope for more effective outcomes, to the extent that Indigenous Australians are able to recognise these principles within the service.

Dudgeon et al. (2014) conducted a literature review of the academic and ‘grey’ literature to identify effective services. They located 49 studies describing 42 programmes or initiatives that provided information about service effectiveness in addressing a social and emotional well-being outcome for Indigenous Australians. From their review they developed several themes to enhance mental health programme and service delivery success: [1]

  • • Flexibility—having structures and components that cater to local need;
  • • Enhancing existing services and resources to enable programme continuity; and
  • • Taking account of gender, family and kinship systems, language groups, and the involvement of community Elders in programme development and delivery (Dudgeon et al. 2014, p. 24).

Ensuring that mental health services reflect the principles and themes highlighted by Dudgeon et al. (2014) will be an important step for health service planners and service providers to take in order to improve the acceptability and effectiveness of services for Indigenous Australians. It is possible that adopting these themes and principles would also improve services for nonIndigenous Australians.

These principles and themes are complemented by other information, such as that provided by the Australian Indigenous HealthInfoNet (2014), regarding the way in which health services generally can be made more accessible for Indigenous Australians. The Indigenous HealthInfoNet suggests:

  • • Having Indigenous health workers on staff;
  • • Increasing the number of Indigenous people working in the health sector (doctors, dentists, nurses, etc.);
  • • Designing health promotion campaigns especially for Indigenous people;
  • • Having culturally competent non-Indigenous staff;
  • • Making important health services available in rural and remote locations (so Indigenous people living in rural and remote areas do not have to travel to cities, away from the support of their friends and families); and
  • • Funding health services so they are affordable for Indigenous people who might otherwise not be able to afford them (Australian Indigenous HealthInfoNet 2014).

Achieving some of the suggestions offered by HealthInfoNet would help to reduce the unacceptable disparity in health outcomes between Indigenous and non-Indigenous Australians.

  • [1] Indigenous participation in the design and delivery and evaluation ofprogrammes; • Working collaboratively with Indigenous services and the community; • Initiating programmes to commit to being (and to demonstrate that they are)culturally appropriate, competent, and respectful of Indigenous culture; • Having a strong capacity-building focus where knowledge, resources, andskills are shared and developed and Indigenous experience and knowledgeare recognised; • Working together with other (mainstream and Indigenous) services to support the delivery of a holistic and integrated programme or service; • Fostering a culturally safe environment for programme participants;
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