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Purro Birik - (Healthy Spirit)
5.3 Culturally
Appropriate Service Provision
The consultations
highlighted the many problems that arise when mental health services do not
consult with Koori health services when assessing, admitting and planning
treatment for Koori people. Questionable diagnosis and prescribing
practices, insensitive lines of questioning from clinical staff
(particularly doctors), inadequate provision of information about illness,
and a sense of feeling vulnerable in an unfamiliar environment are all
issues that are believed to impact on service outcomes.
The unwillingness of some
mental health services to see Koori people at home or at a Koori health
service, poor understanding of the significance of gender and family issues,
and the absence of culturally defined healing places were also issues
frequently raised throughout the consultation process.
5.4 Service Development
Issues
Service development issues
were raised consistently throughout the consultations. In the main, these
issues related to the need for the development of social, emotional and
cultural wellbeing services provided by Koori health services.
The main concerns were
that:
-
mental illness carries a
heavy stigma within Koori communities;
-
there is no clear Statewide
vision for the delivery of social, emotional and cultural wellbeing
services;
-
there are a number of
serious Social, emotional and cultural wellbeing issues that communities are
struggling to respond to, even where strong relationships have been formed
with mainstream services (such as suicide and substance abuse);
-
there is an absence of
culturally defined healing places which could play an important role in
resolving emotional distress;
-
there are insufficient
opportunities for Koori health workers to meet and develop effective ways of
addressing social, emotional and cultural wellbeing issues;
-
Koori health service
general practitioners need to be recognised as having a role in addressing
social, emotional and cultural wellbeing issues and in the ongoing
management of mental illness medications;
-
the relationship between
social, emotional and cultural wellbeing issues and overall community
participation in the job market, sport, recreation, housing and so on, needs
to be recognised and acted on to promote long term well being;
-
there does not seem to be a
clear strategy for providing social, emotional and cultural wellbeing
support to Koori people in prison.
Significantly, the
perceived need for a distinction between general health workers and social,
emotional and cultural wellbeing workers within Koori health services varied
between community controlled services. Generally, it was agreed that each
Koori health service needs to be able to determine how it will structure its
workforce, and that dynamics such as the size of the community, availability
of workers with particular skills, and overall funding will affect the level
of specialisation that a service undertakes.
The metropolitan
consultation clearly endorsed the existing level of service specialisation
in place at the Victorian Aboriginal Health Service Mental Health Network.
The service is seen as a State, wide specialist mental health service
consisting of adult, youth and children's programs with a combination of
clinical mental health approaches and social, emotional and cultural
wellbeing approaches.
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