Indigenous Australians have high rates of mental illness comorbid with substance misuse. The complex needs of this client group create challenges for the alcohol and other drug (AOD) workforce. This paper describes the outcomes of an Indigenous-specific “Yarning about Mental Health” training for the AOD workforce to strengthen knowledge and skills in mental health approaches and in their engagement with Indigenous clients. The training provides culturally adapted strategies and tools for understanding mental health, promoting wellbeing, and delivering brief interventions in the substance misuse setting. A nonexperimental evaluation which incorporated pre-post questionnaires was conducted with workshop participants attending one of four trainings. The training was perceived to be highly appropriate and helpful in participants’ work with Indigenous AOD clients. There was significant improvement in confidence and knowledge related to Indigenous mental health and wellbeing and qualitative data supported these positive outcomes. This study supports the need to blend Indigenous concepts of health and wellbeing with non-Indigenous ways of understanding and treating illness in order to develop services which are appropriate to Indigenous peoples. It also suggests research is required to understand whether self-reported increases in knowledge and confidence can translate into behavioural changes in participants' teaching and practice of culturally competent care and to improved client outcomes.
Mental illness is associated with substantial disability, yet many people with mental disorders do not seek help from any health professional for their mental health problems [
Alcohol and other drug services are reporting a steady increase in the number of Indigenous clients with comorbid mental health problems [
Australian guidelines on the management of cooccurring alcohol and other drug and mental health conditions provide evidence-based information to assist with the management of comorbid AOD and mental health conditions [
Studies among New Zealand Māori AOD treatment workers have shown that both Māori and Western knowledge bases and practices are seen as not only equally relevant but also complementary in the treatment of addiction for Maori people. Accordingly, it is recommended that specific training for this workforce integrate Māori and Western knowledge, skills and processes of learning [
The Aboriginal and Islander Mental health initiative (AIMhi) has developed a brief, culturally adapted intervention for strengthening mental health and wellbeing in Indigenous communities [
The authors recognise that education and training comprise only a part of workforce development, taking equal places with support strategies for skills and knowledge and workplace structure and policy [
The Yarning about Mental Health training is embedded within a consumer empowerment and recovery approach and provides culturally appropriate strategies and tools for understanding mental health, promoting wellbeing and delivering brief interventions in the setting of mental illness, substance misuse, and physical illness. The content is described in the “
From 2008 to 2010, four Yarning about Mental Health one-day training workshops were conducted with members of Western Australian Network of Alcohol and other Drug Agencies (WANADA) and Network of Alcohol and Drug Agencies (NADA). Each workshop was followed by a one-day train the trainer workshop. The training was in response to a request from both networks to address the identified gap in knowledge, confidence, and skills within the AOD workforce in addressing mental health and wellbeing issues specifically among Indigenous clients. Indigenous and non-Indigenous participants attended one of the four workshops held in Kununurra and Albany in Western Australia and in Sydney, New South Wales.
The project received approval from the Human Research Ethics Committee of the Northern Territory Department of Health and Families and the Menzies School of Health Research. Informed consent was obtained from participants prior to the pre-workshop evaluation. Confidentiality was maintained by the allocation of a unique identification number, necessary for matching pre- and post-workshop responses.
The design was a nonexperimental evaluation which incorporated pre-post questionnaires with workshop participants attending the Yarning about Mental Health training workshops. A structured questionnaire incorporating ordinal scales and open-ended questions complemented the quantitative data to provide further insight into participant’s perspectives and experiences. Participants completed questionnaires at the beginning of the training (pre-workshop) and at the end of the training (post-workshop). The findings of post-training questionnaires administered immediately following the train the trainer workshop as well as 12–24 months after the workshop are outside the scope of the paper and a detailed discussion of this data is forthcoming.
The pre-workshop questionnaire included sociodemographic questions and examined experience, training, and current client load. Participants were asked about confidence in assessment and treatment of Indigenous people with mental illness and their knowledge of causes, treatment, and early warning signs of mental health problems, specifically for Indigenous people. Knowledge and confidence were rated on a scale from 1 (not much/not confident) to 9 (a lot/very confident). Participants were also asked to rate their use of AIMhi resources on a scale from 1 (not at all) to 5 (all of the time). The post-workshop questionnaire included the same questions with additional questions rating the training on a scale of 1 (not at all) to 4 (very) in terms of usefulness, interest, and building of cross-cultural partnerships.
Analysis was conducted using the statistical data analysis program “STATA” [
Fifty-nine members of the AOD workforce participated in four workshops and the majority (75%) of participants was female. Most participants identified as AOD workers or AOD counsellors, mental health and allied health workers. Although over half of participants had formal mental health training and worked in partnership with Indigenous colleagues, most were relatively new to the care of Indigenous clients (Table
Participant self-reported workplace experience and training.
Participant characteristics | Value |
---|---|
Female* | 43 (75.4) |
Service provider role | |
AOD worker/AOD counsellor | 12 (20.3) |
Mental health worker | 10 (16.9) |
Allied health worker | 10 (16.9) |
Coordinator/manager | 7 (11.8) |
Case worker/counsellor | 7 (11.8) |
Aboriginal mental health worker | 4 (6.7) |
Other | 8 (15.2) |
Number of current clients# | |
0–5 | 24 (41.4) |
6–10 | 15 (25.9) |
11–20 | 8 (13.8) |
>20 | 9 (15.5) |
Unknown | 1 (1.7) |
Formal training in mental health | |
<2 weeks | 14 (23.7) |
2 weeks to 3 months | 12 (20.3) |
>3 months | 32 (54.2) |
Unknown | 1 (1.7) |
Years experience working in Indigenous mental health† | |
<2 years | 30 (51.7) |
2–5 years | 11 (19) |
>5 years | 17 (29.3) |
Work in partnership with Indigenous colleagues‡ | |
None | 5 (8.9) |
Little | 11 (19.6) |
Some | 7 (12.5) |
Most | 9 (16.1) |
All the time | 24 (42.9) |
*2 values missing; #2 values missing; †1 value missing; ‡3 values missing.
Fifty-nine participants completed the pre- and post-workshop questionnaire. Pre-to-post workshop comparison of confidence and knowledge showed significant change in all measures excluding “knowledge of the cause of mental illness” (Table
Participant mental health knowledge and confidencea.
Subscale | Pre-training | Post-training | Wilcoxon |
---|---|---|---|
Know about causes | 6.77 (1.78) | 7.28 (1.43) | −1.199 (0.2306) |
Know about treatment | 5.82 (2.08) | 7.12 (1.46) | −3.932 (0.0001) |
Know early warning signs | 5.87 (2.11) | 6.91 (1.74) | −2.931 (0.034) |
Confidence to communicate | 5.78 (2.06) | 6.98 (1.65) | −3.251 (0.0012) |
Confidence to assess | 4.96 (1.97) | 6.81 (1.65) | −4.511 (0.0000) |
Confidence to treat | 4.79 (2.10) | 6.64 (1.88) | −4.453 (0.0000) |
aScale 1–9. Higher score indicative of a greater level of confidence and knowledge of mental health.
Participants (
The training helped participants to overcome lack of confidence in working cross-culturally with comorbid clients as an AOD counsellor highlighted:
At baseline, the majority of participants (
Participant post-workshop ratings of the Yarning about Mental Health training.
Item | A little | Some | A lot |
---|---|---|---|
Workshop was interesting | 11 (19) | 46 (81) | |
Resources are useful | 7 (12) | 50 (88) | |
Training and resources build my confidence and knowledge | 6 (11) | 51 (89) | |
Training will help me to build cross cultural partnerships | 1 (2) | 10 (17) | 46 (81) |
The majority of participants (89%) reported that the training and resources would contribute to building confidence and knowledge in the assessment and treatment of mental illness among Indigenous AOD clients. Participants were also asked to consider the extent to which the training and resources would help to build cross-cultural partnerships in assessment and treatment of mental illness. The majority of participants (81%) responded that the training and resources would be beneficial, for example,
Several participants (
The final two questions of the post-workshop questionnaire asked participants to consider their experience of the workshop and opportunities for change in practice. Fifty-one (86%) participants responded to the question on their experience and the majority (
Participants’ responses to workshop applicability related to the culturally-specific information, tools, strategies, and resources that were introduced and examined as part of the training. This practical approach appeared to help to demystify and simplify the management of mental health and wellbeing concerns of Indigenous AOD clients, and in turn, provide participants with new skills, knowledge and confidence to apply their learning in practice. As several participants explained:
Five participants suggested ways to improve the training, which in all cases related to practical outcomes and the application of the tools. Their responses could also reflect the different experience and knowledge among the professional mix of participants and the challenge of tailoring the training to meet this diversity:
Three main themes emerged from participants’ responses (
Culturally appropriate intervention strategies in Indigenous mental health can contribute to countering the disproportionate burden of disease in the Indigenous population through increasing accessing to services [
In the current context of high prevalence of emotional distress among Indigenous AOD clients, there is a particular need to resource and train the AOD workforce. This includes a need to blend Indigenous concepts of health and wellbeing and non-Indigenous ways of understanding and treating illness in order to develop services which are appropriate to Indigenous peoples [
Despite a number of important findings, the results should be interpreted in the context of the study’s limitations. The majority of participants reported that they would change their practice as a result of the training, although the findings do not show the extent to which the training is sustained and implemented as part of routine clinical practice or whether it contributed to improved client outcomes. Mentoring, observation, and supervision of participants post-training was outside the scope of this project and other studies have shown that training of AOD practitioners in screening for mental health disorders, combined with supervision, improved detection rates, and the quality of interventions in AOD services [
The study provides support for the use of AIMhi resources and approach to Indigenous mental health within the AOD workforce. The training is useful and applicable for experienced practitioners as well as those new to mental health. In the field of AOD workforce development, an important question for future research is whether self-reported increases in knowledge and confidence translate to changes in participants’ teaching and practice of culturally competent care and improved client outcomes.
The authors would like to acknowledge the contribution of Mr. Neil Spencer to this paper and thank the AIMhi trainers and the participants of the four Yarning about Mental Health trainings.