Providing culturally appropriate mental health first aid to an Aboriginal or Torres Strait Islander adolescent: development of expert consensus guidelines

Abstract

BackgroundIt is estimated that the prevalence of mental illness is higher in Aboriginal and Torres Strait Islander adolescents compared to non-Aboriginal adolescents. Despite this, only a small proportion of Aboriginal youth have contact with mental health services, possibly due to factors such as remoteness, language barriers, affordability and cultural sensitivity issues. This research aimed to develop culturally appropriate guidelines for anyone who is providing first aid to an Australian Aboriginal or Torres Strait Islander adolescent who is experiencing a mental health crisis or developing a mental illness.MethodsA panel of Australian Aboriginal people who are experts in Aboriginal youth mental health, participated in a Delphi study investigating how members of the public can be culturally appropriate when helping an Aboriginal or Torres Strait Islander adolescent with mental health problems. The panel varied in size across the three sequential rounds, from 37–41 participants. Panellists were presented with statements about cultural considerations and communication strategies via online questionnaires and were encouraged to suggest additional content. All statements endorsed as either Essential or Important by ≥ 90% of panel members were written into a guideline document. To assess the panel members’ satisfaction with the research method, participants were invited to provide their feedback after the final survey.ResultsFrom a total of 304 statements shown to the panel of experts, 194 statements were endorsed. The methodology was found to be useful and appropriate by the panellists.ConclusionAboriginal and Torres Strait Islander Youth mental health experts were able to reach consensus about what the appropriate communication strategies for providing mental health first aid to an Aboriginal and Torres Strait Islander adolescent. These outcomes will help ensure that the community provides the best possible support to Aboriginal adolescents who are developing mental illnesses or are in a mental health crisis.

Using the Delphi expert consensus method in mental health research

“…Parenting strategies for reducing the risk of adolescent depression and anxiety disorders (Yap et al, 2014) Improve cultural competence Culturally appropriate mental health first aid to an Aboriginal or Torres Strait Islander adolescent (Chalmers et al, 2014) Develop policy How tertiary education institutions can support students with a mental illness (Reavley et al, 2013) Develop a health economic model Cost-effectiveness of 3 antidepressants in major depressive disorder in the UK (LenoxSmith et al, 2009) Define a concept Definition of relapse in schizophrenia (San et al, 2015) Develop a scale Item content for a geriatric depression inventory appropriate to Chinese culture (Xie et al, 2015) Improve classification or diagnosis Clinical subtypes of core premenstrual disorders (Ismail et al, 2013) Determine epidemiology (prevalence, risk factors)…”

Principles of epistemological accountability with methodological implications for measuring, assessing, and profiling human resilience

“…The ethical review and approval for the research involved several different Aboriginal/First Nation review panels, and the Health Canada ethics review board in cases in which two senior scientists from the Public Health Agency of Canada were involved as coinvestigators. This approach is different from that adopted by researchers in Australia, where youth mental health "expert panels" drawn from the Aboriginal communities themselves may be recruited to serve in consensus-forming processes using the Delphi method (see, for instance, Chalmers et al 2014). …”

Inventing Mental Health First Aid: The Problem of Psychocentrism

“…Oblivious to the social significance of socio-political factors, the DSM classification system dismisses non-psychiatric understandings (American Psychiatric Association, 2013). Ironically, although MHFA adopts deficitoriented, essentializing, "us-them" categorization -species talk (Hacking, 2007) -MHFA paradoxically calls on citizens to accept defamatory psychiatric classifications and stop the stigma accompanying psychiatric labeling (Chalmers et al, 2014). The logic of MHFA is essentialist as seen in training seminars, research programs, interventions, and scholarly articles.…”

“…Terms such as "genocide" and "colonization" (Barta, 2008) are absent in the report describing "culturally appropriate" MHFA for Aboriginal or Torres Straight Islander adolescents (Chalmers et al, 2014), and instead the report uses vague, de-politicized words, such as "risk factors" (Chalmers et al, 2014, p. 3), "separations in past generations" (p. 3), and "loss of land" (p.3), and claims that "Young Aboriginal Australians are disproportionately exposed to risk factors, such as grief, trauma, loss" (p. 3). Ambiguous "at-risk" and "trauma" discourses conceal why it is that some groups are more exposed to risk than others, thus diminishing the culpability of authorities and dominant settler groups.…”

“…Ambiguous "at-risk" and "trauma" discourses conceal why it is that some groups are more exposed to risk than others, thus diminishing the culpability of authorities and dominant settler groups. Similarly, reports of Aboriginal youth suicide and self-harm (Chalmers et al, 2014) without specific identification of the injustices killing and harming youth make a denigrating spectacle of Aboriginal anguish while bolstering the heroism of MHFA (Marsh, 2010). MHFA proponents suggest Aboriginal people understand mental health "within a unique cultural framework that is not necessarily complimentary to the biopsychosocial model of Western medicine" (Chalmers et al, 2014, pp.…”