Introduction
Methods
Aboriginal and Torres Strait Islander community approval and ethical clearance
Setting
Study design
Participants, sampling and recruitment
Data collection and analysis
Results and discussion
Theme 1. Responsiveness to community needs
Mental health care at the Centre of Excellence versus mainstream services
If I had to travel across town, I probably wouldn’t have done it. That would have just been [impossible]– well, at that point in time (Woman, 53 years old).
I was seeing other psychologists outside the services and I went through about 10 of them. Didn’t click. So I thought it might have been a cultural difference (Woman, 43 years old).
I think mental health in Queensland is poorly done. Access to services for Aboriginal people is pretty pathetic (GP: Focus group).There have definitely been lots of individual reports from people about how they might have been referred to psychological services … in the past but never actually went for reasons: comfort talking to another Indigenous person; no local clinic; payment … stigma and misunderstanding (Psychologist: Interview).
Holistic, culturally appropriate care
[The Centre of Excellence provides] holistic care. There’s one young fellow came in quite disturbed and then I referred him to the social worker and then just seeing him about a month down the track, smile on his face. And so the system does work and I just was thrilled about holistic care because I’ve worked in a lot of places and all (PN: Focus group).They do a lot better than – in my opinion, than the mental health mainstream system does because they’re easily accessible and they are culturally appropriate. The turnover is quite good. I think within a week you can see [someone] (AHW: Focus group).There was a different type of atmosphere working with our community, with your own community. Like I know a lot of clients from a family perspective … and still have that professional boundaries (Social Worker: Interview).
I say to [patients] ‘[The agencies] can refer you to our service and they can refer you to our clinic or my name on that plan but not actually tell me or ask me … but once you come here, how often we meet and what we talk about is up to us’. If [the agencies] tell someone they’ve got to come weekly I will decide whether I need to see them weekly or not and I give [the agencies] that feedback and they often accept it (Psychologist: Interview).
Theme 2. Trusted relationships
The whole Inala [Indigenous] Health [Service], Murri Health, they’re so approachable, and the nurses. Somebody should do something big for them. They’re just beautiful, comfortable, and it’s so caring that it’s not – I can’t think of the word for that, not feel sorry for you (Woman, 43 years old).
There’d be elements of trust, where they trust the psychologist because they’re under our roof – I think there’d be elements of just the access where they know where it is and they know how to get there and they’re comfortable in that surroundings (GP: Focus group).It comforts the patient too to know that that’s a one-stop shop and they don’t have to go outside, because so many patients feel comfortable in our service (Dietician: Interview).
Also, [the social worker and psychologist are] quite – they’re full-time so it’s not something [clients] have to wait around for either, so it’s – they get in quite quickly and they can build a relationship because they’re there all the time, so they don’t have to go from one to the other and then, I guess, the thing is when people have to travel outside of Inala, the chance of them going isn’t always quite high (AHW: Focus group).More freely [refer] – often there’s lots of issues. People never come in with one – with their sore foot or whatever. They might have the sore foot but there’s all the other stuff that goes on. So you could actually talk about that and say that we have these services but if you’re thinking, trying to refer that externally that just wouldn’t work (PN: Focus group).
I think they appreciate it, being so close and not having to travel … I don’t think – no, I don’t think anyone’s worried about going to see the psychologist (Receptionist: Focus group).
Theme 3. Shared cultural background and understanding
Shared cultural identity
I think it helped that she [the psychologist] was a black woman … young and Aboriginal … because we have this – deal with the same issues and stuff. I don’t know her background and stuff but as black women, we get dealt with the same stuff in everyday society (Woman, 29 years old).She knew where we were coming from, ‘cause she’s an Aboriginal lady too, like – so she knew half the problems and that and where I was coming from and even with the kids and stuff like that (Man, 49 years old).
Having Aboriginal and Torres Strait Islander staff outstandingly builds trust – there is a risk for mainstream services to not really understand the barriers or the difficulties that people face in their life – they think they are going to get judged … and so it has outstandingly overcome those barriers of access (GP: Focus group).Often they’ll know a relative of the social worker so, straight away, they feel that connection and they’re happy to go – because, definitely having somebody of Aboriginal background in the social worker or psychology role is, I think in the service, really crucial, so that’s often that turning point for people in that decision-making process (Dietician: Interview).
I’ve got a girl at the moment who’s got postnatal depression and she said that she didn’t want to know the psychologist. “I don’t want – I’m Murri [an Aboriginal person from Queensland]. I’m Murri”. She didn’t want a Murri, because that just conflicts with her and the family members might find out (Nurse: Focus group).
Shame and mental health
It was in another part of the building which – I guess again, you know, we’ve always got those issues around, you know, we don’t want people blabbing about our business to all them other fellas, and I sort of felt that I could trust her that way (Woman, 53 years old).I was a bit sceptic at the start because Aboriginal people being – like, everyone knows someone of someone. … Yeah, once I’d met ‘em spoke to ‘em, I was really, really at ease, yeah (Man, 32 years old).Sometimes I felt like people knew if you were going to counselling, and when you’re down and out like that it’s big shame. Yeah, I don’t feel shamed now but when you’re down and you do feel that, at that time. At first I thought it would be that way, but she just greeted me (Woman, 43 years old).
It’s probably shameful for any Murri person to sit there and access a service, so the fact that they’re located just around the corner, it’s isolated and there’s a few different staff members that sit there, so they don’t always know that it’s about mental health issues (AHW: Focus group).And it’s trust too because the families are very big and they don’t want everyone to know that they’ve been here to see you (Social Worker: Interview).