Aboriginal and Torres Strait Islander mental health and well-being

Paul Cooper; Raymond Tini; Alice Standfield

8 Aboriginal and Torres Strait Islander mental health and well-being

Acknowledgement/Authors Note

The Authors would like to acknowledge the traditional custodians of the lands on which they live, work and learn. We pay our respect to Elders past, present, and future. We acknowledge that the spiritual connection that First Nations People hold with the land has spanned thousands of years and continues to be of importance to those living today. We would also like to acknowledge and pay respect to the Aboriginal ways of knowing and being, which hold significance and value in our Australian health care settings and services.

Learning Objectives

Describe the importance of working in culturally responsive and safe ways within health care settings
Identify key considerations for supporting Aboriginal and Torres Strait Islander wellbeing
Understand that health and wellbeing can include more than just the person
Understand that cultural safety is not a ‘one size fits all’ way of working

Authors Note: In an effort to promote First Nations voices, and to protect sovereignty over their own knowledges, the authors have drawn upon a range of materials written by, or in collaboration with Aboriginal authors, organisations, and experts. The authors strongly encourage any use of the below material to be done so using the original source, i.e. the references used by the authors.

Whilst many nations have First Peoples, within Australia the Indigenous population are identified as Aboriginal and Torres Strait Islander Peoples. As the First People of Australia, they have a unique connection to Country, including land, air and waterways (Kinglsey et al., 2013) – traditional lands, governed by smaller clans and communities, being known as Country.

The historical treatment of Aboriginal and Torres Strait Islander People in Australia has been increasingly acknowledged over the last 20 years. Many departments, organisations, and services will have dedicated Reconciliation Action Plans to implement strategies that are aimed at addressing ongoing inequality, oppression, and discrimination of First Nations Peoples. This section aims to take a strengths-based approach in the discussion of Aboriginal and Torres Strait Islander Peoples health and wellbeing and promote the First Nations perspectives of what contributes to health and wellbeing of individuals and communities.

Within the Aboriginal ways of knowing and being, there is an understanding of one’s spirit being in-tune with, and irrevocably connected, to the land. This stands in contrast to western perspectives of ownership and development of land, as well as governmental views and systems that guide and measure social and emotional wellbeing outcomes from economic and productivity perspectives. Aboriginal and Torres Strait Islander People view wellbeing from a holistic and collective perspective, one that includes community connection or relationships, connection to country, traditional knowledge, kinship and the 4 domains of wellbeing; physical, social, emotional, and spiritual (Kinsgley et al., 2013). This outlines that health can be understood as social and emotional wellbeing (SEWB) of a person or community (Dudgeon, Milroy & Walker, 2014), with this understanding set, it also needs to be highlighted that there are different experiences of what SEWB look like and mean for differing Aboriginal and Torres Strait Islander communities.

For those of us who do not identify as one of the First Nations People of Australia what we need to understand is the deep connection held to the ancestral lands are a central component to wellbeing for Aboriginal and Torres Strait Islander peoples (Stephens, Parkes & Chang, 2007), this shows us how connection to country is central to mental health and spiritual wellbeing for First Nations Australians.

For non-Indigenous people, it is important to acknowledge that a deep connection to ancestral lands, as well as traditional cultural practices such as ceremony and ritual, are central components to wellbeing for Aboriginal and Torres Strait Islander Peoples (Rigney et al, 2022; Stephens, Parkes & Chang, 2007). See the below figure for all the interconnected determinants of health for First Nations People.

What this can mean is that when disconnected from country there can be a potential for increased distress and a sense of inequality in experience (Stephens, Parkes & Chang, 2007).

The following image displays a clear example of how these connections are understood by Aboriginal Community Controlled Health Services (ACCHS), noting that mental health is not seen as separate from physical health or any other elements of wellbeing. https://www.ahcwa.org.au/wp-content/uploads/2022/07/AHCWA_ModelofCareGraphicCopyright_OCT18-scaled.jpg

As health professionals we are guided to provide culturally safe care. NMBA standards for practice (2016) highlight some key points that can be explicitly linked to culturally safe and appropriate care for Aboriginal and Torres strait Islander people. Whilst these standards are related to nursing and midwifery, it is acknowledged that all health professional groups in Australia will have relevant codes of conduct and standards for practice that will reflect these core aspects of health care practice within Australian contexts.

2.2 ‘communicates effectively, and is respectful of a person’s dignity, culture, values, beliefs and rights.’

4.1 ‘conducts assessments that are holistic as well as culturally appropriate.’

These highlight the importance for the clinicians to understand that culture can influence wellbeing and mental health differently for different people and that we must understand these differences to ensure a holistic and person-centred approach to care is met.

In Australian health and social services there can be roles identified as Aboriginal Liaison Officer (ALO), but this cannot be mistaken for a one size fits all when engaging with Aboriginal and Torres Strait Islander people. The role of the ALO is not to educate staff or meet with all patients who identify as Aboriginal or Torres Strait Islander. They can be a contact point for connection, familiarity, or address issues around someone presenting to a healthcare setting off country. Some health units also employ Aboriginal and Torres Strait Islander people as mental health professionals and where possible, from the community or country to where they identify (Hungerford et al., 2024). This can be for various roles such as a clinical role, liaison role, health education and promotion, community care or policy development (Hungerford et al., 2024), and whilst underrepresented in healthcare roles we advocate for their involvement where possible, to strengthen the skillset, diversity and knowledge of our health workforce.

Aboriginal and Torres Strait Islander people utilise ‘yarning’ and deep listening as a way of connecting and providing a culturally safe space to address issues (Hercelinskyj & Alexander, 2020; Procter et al., 2022), this suggests that connection with ALO or an Aboriginal Community Controlled Health Organisation (ACCHO) could be beneficial in healthcare provision to ensure culturally safe and appropriate provision of care is met.

The National Aboriginal Community Controlled Health Organisation (NACCHO) is the national leadership body for Aboriginal and Torres Strait Islander health within Australia.

The authors recommend visiting the following link: www.naccho .org.au

‘We represent our members – 145 Aboriginal Community Controlled Health Organisations (ACCHOs) that operate in over 300 clinics across Australia, delivering holistic, comprehensive and culturally competent primary health care services. These ACCHOs are initiated and operated by local Aboriginal and Torres Strait Islander communities. The sector is the largest employer of Aboriginal and Torres Strait Islander people across Australia, with well over half of its 6,000 staff being Aboriginal and Torres Strait Islander.’ (NACCHO, 2024).

As health professionals we need to be aware of the 2004 SEWB framework that established a series of nine guiding principles for approaching and delivering health care for Aboriginal and Torres Strait Islander People (NIAA.gov.au, 2017):

Aboriginal and Torres Strait Islander health is viewed in a holistic context, that encompasses mental health and physical, cultural and spiritual health. Land is central to wellbeing. Crucially, it must be understood that when the harmony of these interrelations is disrupted, Aboriginal and Torres Strait Islander ill health will persist.
Self-determination is central to the provision of Aboriginal and Torres Strait Islander health services.
Culturally valid understandings must shape the provision of services and must guide assessment, care and management of Aboriginal and Torres Strait Islander people’s health problems generally, and mental health problems, in particular.
It must be recognised that the experiences of trauma and loss, present since European invasion, are a direct outcome of the disruption to cultural wellbeing. Trauma and loss of this magnitude continues to have inter-generational effects.
The human rights of Aboriginal and Torres Strait Islander people must be recognised and respected. Failure to respect these human rights constitutes continuous disruption to mental health. Human rights relevant to mental illness must be specifically addressed.
Racism, stigma, environmental adversity and social disadvantage constitute ongoing stressors and have negative impacts on Aboriginal and Torres Strait Islander people’s mental health and wellbeing.
The centrality of Aboriginal and Torres Strait Islander family and kinship must be recognised as well as the broader concepts of family and the bonds of reciprocal affection, responsibility and sharing.
There is no single Aboriginal or Torres Strait Islander culture or group, but numerous groupings, languages, kinships, and tribes, as well as ways of living. Furthermore, Aboriginal and Torres Strait Islander people may currently live in urban, rural or remote settings, in traditional or other lifestyles, and frequently move between these ways of living.
It must be recognised that Aboriginal and Torres Strait Islander people have great strengths, creativity and endurance and a deep understanding of the relationships between human beings and their environment.

https://www.niaa.gov.au/sites/default/files/documents/publications/mhsewb-framework_0.pdf

Summary

When delivering health care services within Australia, it is important to consider the needs and perspectives of our First Nations People. Cultural and spiritual connections to their community and Country is essential to supporting social and emotional wellbeing. Health care professionals can draw upon resources, such as ACCHOs and Aboriginal Liaison Officers to assist them in providing culturally safe and responsive care.

Reflection Exercises

Where has your my understanding of health come from, what has influenced or guided it?
How might that align or contrast with Aboriginal ways of being, doing and knowing when considering health and wellbeing?
What can I do to ensure I am a culturally safe practitioner for all of the people I provide healthcare for?
What if my role in ensuring cultural needs are met in the healthcare setting I am working in?

References:

Dudgeon, P., Milroy, H., & Walker, R. (Eds.). (2014). Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice (2nd edition.). Kulunga Research Network.

Kingsley, J., Townsend, M., Henderson-Wilson, C., & Bolam, B. (2013). Developing an exploratory framework linking Australian Aboriginal peoples’ connection to country and concepts of wellbeing. International Journal of Environmental Research and Public Health, 10(2), 678–698. https://doi.org/10.3390/ijerph10020678

Hercelinskyj, G. (Julie), & Alexander, L. (2020). Mental health nursing: applying theory to practice. Cengage Learning Australia.

National Aboriginal Community Controlled Health Organisation (NACCHO). 2024. https://www.naccho.org.au/

National Indigenous Australians Agency. NIAA. (2024). https://www.niaa.gov.au/resource-centre/national-strategic-framework-aboriginal-and-torres-strait-islander-peoples-mental

Nursing and Midwifery Board of Australia. NMBA Standards for practice (2016). https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx

Procter, N. G., Wilson, R. L., Hamer, H. P., McGarry, D., & Loughhead, M. (2022). Mental health: a person-centred approach (Third edition.). Cambridge University Press.

Rigney, D., Bignall, S., Vivian, A., & Hemming, S. (2022). Indigenous Nation Building and the Political Determinants of Health and Wellbeing. Lowitja Institute

Stephens, C., Parkes, M. W., & Chang, H. (2007). Indigenous perspectives on ecosystem sustainability and health. EcoHealth, 4(4), 369–370. https://doi.org/10.1007/s10393-007-0140-2

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Mental and Physical Health Dimensions Copyright © 2025 by Flinders University, Paul Cooper and Alice Standfield is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, except where otherwise noted.

Acknowledgement/Authors Note

Summary

References:

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