By AMA ( Australian Medical Association) President Dr Steve Hambleton

In recent years, Australians have become increasingly aware that poor mental health can affect any of us at any time. Government health policy has also sought a more concerted focus on this area of health.

There is less awareness, though, of the distinctive needs and vulnerabilities of particular groups in Australia concerning mental health and wellbeing.

The factors that contribute to poor mental health and social and emotional wellbeing among Aboriginal peoples and Torres Strait Islanders are complex, and their effects cross generations.

The AMA believes that the mental health and social and emotional wellbeing of Aboriginal peoples and Torres Strait Islanders should be given greater priority in the nation’s health policy agenda.

According to the latest research, nearly one-third of Aboriginal and Torres Strait Islander adults report high to very high levels of psychological distress in their lives – two and a half times the rate reported by other Australians.

There were more than 990 reported suicides of Aboriginal people and Torres Strait Islanders between 2001 and 2010, which is twice the rate of other Australians.

The situation is even more dire among Stolen Generation survivors, who have mental health conditions at twice the rate of other Aboriginal people and Torres Strait Islanders who were not removed from their families.

Young Aboriginal people and Torres Strait Islanders are particularly at risk.

Those between 18 and 24 years of age are twice as likely as other Australians to have experienced high levels of psychological distress, and those between 12 and 24 years of age are more than three times more likely to be hospitalised for mental and behavioural disorders than other Australians of that age.

The suicide rates for young Aboriginal and Torres Strait Islander men between 15 and 19 years of age are nearly six times that of other Australian men of that age.

Poor social and emotional wellbeing and psychological distress is associated with exposure to major life stressors, such as illness, disability, exposure to violence, unemployment, the death of a family member or friend and persistent economic struggle. Aboriginal people and Torres Strait Islanders experience these major life stressors, and their associated levels of psychological distress, at higher rates than other Australians.

Research shows that there is an association between in utero stressors and a child’s developmental outcomes.

Children whose mothers experience more than three major stressors while they are in utero are at higher risk of exhibiting difficult behaviours in childhood.

The quality of a child’s early life can also affect their resilience and mental health later in life.

The AMA reported in 2008 on the problematic life circumstances and health risks of Aboriginal and Torres Strait Islander children, and will report on the evidence around healthy early development for Aboriginal and Torres Strait Islander children later this year.

For Aboriginal peoples and Torres Strait Islanders, mental health and social and emotional wellbeing are very much bound up with strength of their cultural identity, and the amount of control they have over their own lives. That’s why, among other things, the AMA has advocated for the formal recognition of Aboriginal peoples and Torres Strait Islanders in the Australian Constitution (see Recognition a step toward closing Indigenous health gap, px).

The AMA also believes that a national strategic approach to Aboriginal and Torres Strait Islander mental health is needed which, among other things, ensures that:

• there are enough culturally specific mental health and wellbeing services in the right locations, and built into the comprehensive primary care provided by Aboriginal community-controlled health services;
• child and maternal health services have the capacity to support healthy early childhood development for Aboriginal people and Torres Strait Islanders; and
• mainstream mental health services and general practices are supported to provide culturally competent services for Aboriginal people and Torres Strait Islanders.

Importantly, Indigenous leadership must be preserved in the development and implementation of this strategic approach.

A positive state of mental health and happiness can be a buffer against adverse circumstances and health conditions. The physical health and mental health of Aboriginal people and Torres Strait Islanders are therefore intertwined.

This means that, in measuring what it will take to close the gap in Indigenous health, it is critical to include mental health and social and emotional wellbeing in the equation