Medication safety challenges in Aboriginal Health Care services.

OBJECTIVE: The aim of this study is to examine the challenges faced by the Aboriginal Health Practitioners in the community assisting their clients to manage medicines. DESIGN: Qualitative, in depth interviews with eight Aboriginal Health Practitioners employed at various Aboriginal Community Controlled Health services in Victoria were undertaken. SETTING: Rural Aboriginal Community Controlled Health Service. PARTICIPANTS: Aboriginal Health Practitioners who are registered with the Aboriginal and Torres Strait Islander Health Practice Board of Australia as an Aboriginal Health Practitioner and who have experience in the planning, provision, management and evaluation of health services within their scope of practice. RESULTS: This study revealed multiples challenges faced by Aboriginal Health Practitioners assisting clients with medication management. These were mainly divided into the attitudes and the culture of the workplace and barriers with medications use faced by the clients. The following subthemes were identified within the attitudes and workplace culture theme. These were reporting of errors, pamphlets not culturally appropriate, lack of education of Aboriginal Health Practitioner role and doctors' understanding of Aboriginal culture. The subthemes identified by the Aboriginal Health Practitioners that were specific to the clients included language barriers, immediacy, sharing medications by family members, medications disposal, self-diagnosis, traditional medicine, not feeling comfortable with doctors, literacy and alcohol use. CONCLUSION: This study has identified many barriers to medication safety in the Aboriginal community, and strategies to improve some of the challenges identified.

Evaluation of the pilot phase of an Aboriginal and Torres Strait Islander Male Health Module.

This article evaluates the pilot phase of an Aboriginal and Torres Strait Islander Male Health Module. Although men experience higher levels of illness and die younger than women, educational programs to support health workers utilise a gender-based approach to increase participation of Aboriginal and Torres Strait Islander males in health care are rare and lack appropriate content. Recognising this gap in service provision, and under the guidance of a Reference Group comprising community leaders in Aboriginal and Torres Strait male health, a comprehensive and culturally appropriate Male Health Module has been developed to enhance the capacity of health workers to improve access to services for Aboriginal and Torres Strait Islander males. Methods used were: in-depth interviews with Module developers, pilot workshops for trainers and health workers, questionnaires and focus group discussions with workshop participants, and participant observations. As well as enhancing capacity to facilitate access to health services for men, the Module was deemed relevant because of its potential to promote health worker empowerment and wellbeing. Findings revealed that improving access to services for men required male and female health workers working in partnership. Despite overall enthusiasm for the Module, the findings also revealed deep fear that it would end up 'collecting dust on shelves'. Strategies to improve the Module quality and accessibility are highlighted.

Help seeking by Aboriginal men who are mentally unwell: a pilot study.

AIMS: Mental illness is widespread among Aboriginal men in Australia. However, they do not access mental health services in proportion to their need. Although several reports implicate cultural differences of mental health services as the cause of underutilization, very little is known about help seeking by Aboriginal men who are mentally unwell. This study explores the help-seeking behaviour of Aboriginal men who are mentally unwell in a rural Victorian community. METHODS: The study was carried out using a combination of culturally appropriate research methodologies. Within a Qualitative Description design, semi-structured interviews were conducted with a range of Aboriginal people including men, carers and those involved in service delivery. A total of 17 Aboriginal people were interviewed, of whom 15 were men. Data were analysed thematically. RESULTS: Four themes emerged from the data collected. They included 'Difficulty in recognizing mental health problems', 'Barriers to disclosing one's problems', 'Reluctance to contact services' and 'Alternate coping strategies'. CONCLUSIONS: These findings suggest that there is a need for programmes that aim to improve mental health literacy and promote help seeking among Aboriginal men who are mentally unwell. Such programmes need to be developed jointly by mental health services as well as Aboriginal stakeholders, and implemented in a culturally sensitive and acceptable way.

Mental health services for aboriginal men: mismatches and solutions.

This paper describes the perceptions of Aboriginal stakeholders as well as mental health personnel on improving Aboriginal men's access to mental health services. From January 2009 to June 2010, 23 semi-structured interviews and three focus groups were conducted with 17 Aboriginal stakeholders and 29 mental health staff from a regional mental health service in Victoria. A qualitative description design was adopted and data were analysed thematically. Seven themes emerged from the data. Three themes focused on the mismatch between mainstream mental health service provision and the mental health needs of Aboriginal men. They include barriers to gaining entry into services, barriers to engagement with services, and staffing problems in the services. The remaining four themes related to possible solutions to improving men's access to services and included building men's confidence in services, developing relationships with the Aboriginal Community, enhancing flexibility of services, and strengthening the role of the Koori Mental Health Liaison Officer. The dual perspectives of Aboriginal stakeholders and service providers provide a more comprehensive picture of the ground realities concerning Aboriginal men's access to mental health services. The findings have implications for the provision of culturally sensitive mental health services for Aboriginal men.

Barriers and facilitators to the utilization of adult mental health services by Australia's Indigenous people: seeking a way forward.

Mental disorders are the second leading cause of disease burden among Australia's Indigenous people after cardiovascular disease. Yet Indigenous people do not access mental health services in proportion to their need. This paper explores the barriers and facilitators for Indigenous people seeking mental health services in Australia and identifies key elements in the development and maintenance of partnerships for improved service delivery and future research. The process of seeking help for mental illness has been conceptualized as four consecutive steps starting from recognizing that there is a problem to actually contacting the mental health service. We have attempted to explore the factors affecting each of these stages. While people in the general population experience barriers across all four stages of the process of seeking treatment for a mental disorder, there are many more barriers for Indigenous people at the stage of actually contacting a mental health service. These include a history of racism and discrimination and resultant lack of trust in mainstream services, misunderstandings due to cultural and language differences, and inadequate measures to reduce the stigma associated with mental illness. Further research is required to understand the mental health literacy of Indigenous people, their different perceptions of mental health and well-being, issues around stigma, and the natural history of mental illness among Indigenous people who do not access any form of professional help. Collaborations between mainstream mental health services and Aboriginal organizations have been promoted as a way to conduct research into developing appropriate services for Indigenous people.