Cultural barriers affecting the mental health of Indigenous people

Cultural barriers certainly have a crucial impact in affecting the mental health of Indigenous people. This is evident as Indigenous people tend to have considerably high levels of stress and anxiety in their lives stemming from the consequences of trauma and grief of stolen generation and dispossession which is intricately linked to mental health and disorder (Craven, 2006).This common pattern of loss of culture, land, voice, family and dignity resulted in poor mental wellbeing for many Indigenous generations over the past century (Brown, 2001). However, problems still continue due to the inadequate research in the mental health of indigenous people. This results in mental illnesses being undiagnosed, undetected for Indigenous people, which makes them disadvantaged with from the rest of the population (Vukic, Gregory, Misener & Etowa, 2001). In addition, if they are diagnosed, they are assessed using Western mainstream methods, such as the DSM-IVclassification system, which does not suit their cultural differences and is culturally inappropriate (Craven, 2006).Also, being treated in the mainstream, it is evident that that their treatment will not be from an Indigenous perspective or worldview, and thus their underlying concerns will be ignored and overlooked (Valmae, Stephen, Melissa, Komla, 2007). There needs to be an understanding of Indigenous culture by healthcare professionals in the mainstream services in order to minimise cultural biases and to help address their mental health concerns.
Westerman (2004) conducted a study that targeted 3993 Indigenous children aged between 4 and 17 years. Of the Indigenous children sampled, for the ages of 4–11, 26.3% were at high risk of clinically significant emotional or behavioural difficulties, whereas 20.5% of Indigenous children aged from 12–17 were at high risk. In comparison, only 16.9% of non-Indigenous children aged from 4–11 and 12.5% aged from 12–17 were at high risk. A number of significant influences on emotional and behavioural problems were found with factors most strongly associated with greater psychological risk including stressful life events such as illness, financial and family difficulties. Of the Indigenous children, 22% reported more than seven stressful life events in the 12-month period, and these children were five and a half times more likely to be at high risk from clinical emotional and behavioural difficulties. In addition, other factors included poor quality in parenting, poor family functioning, sole children who had lived in five or more homes since birth. The non-Indigenous parents were more likely to seek professional mental help to deal with their children’s emotional or behavioural difficulties than Indigenous parents. On the other hand, Indigenous parents may find it insulting when seeking mental health intervention. This is due to Western therapists encouraging children to be verbally, emotionally and behaviourally expressive, however, these actions may be viewed as disrespecting and undermining a parent’s authority (Paradies, 2006). Since cultural based values are not integrated into the treatment goals and plans of Indigenous people, these children may learn to distrust traditional mental health professionals and avoid seeking professional help in the future (Craven, 2006).

It was found that within Hunter’s (2007) study of indigenous teenagers, one in six youths have seriously considered suicide in the last year, with 39% of those actually attempting suicide. Although these figures did not differ significantly from the non-Indigenous sample, a number of important variables were found to be associated with suicidal thoughts. Self-esteem acted as a potential protective mechanism whereas family violence, emotional or behavioural difficulties, and knowing a friend who also had thought about suicide increased the risk of suicidal thoughts. Based upon these findings, Hunter (2007) stressed the need for a stronger self-esteem through not only physical activity, but also through gaining access to psychological services. However, Indigenous teenagers might avoid accessing traditional psychological services for support because of the cultural biases that exist within many of the mental health services. For instance, Western counselling and psychotherapy techniques focus mainly on independence and individuality, whereas indigenous cultures are collectivist and emphasise social interdependence. If a mental health professional is unfamiliar and unaware with the cultural norms of Indigenous people, such as emotional expression, these expressions may be misinterpreted and could affect the course of the treatment (Craven, 2006).Thus, indigenous teenagers will find Western approaches ineffective as they do not suit their cultural contexts (Paradies, 2006).

Paradies, (2006) has found that almost one third of Indigenous youth were bullied sometime at school, with the patterns of bullying being very similar for males and females. The most frequent ages for being bullied occurred at 12 and 17 years and it was also found that if the Indigenous youth’s primary carers were both non-Indigenous, they were significantly more likely to be bullied. With regard to problematic behaviours, it was found that bullying was associated with increased levels of smoking and marijuana use. One in five Indigenous youth reported being discriminated against because of their Aboriginality. Like bullying, racism was associated with increased smoking and marijuana use and also alcohol consumption. This reveals the Indigenous people’s alienation and not belonging within mainstream society. While this study contributes significantly to the knowledge base about the reasons Indigenous youth are bullied, it is limited in providing clear understandings of how Indigenous people should cope with racism. Since racist events are culturally specific stressors, they can have an enormous negative impact on the physical and mental health of Indigenous youth (Santhanam, Hunter, Wilkinson, Whiteford, & McEwan, 2006).These experiences are implicated in the person's self-esteem development and how they cope with various life stressors at later critical stages of emotional growth, thus they need to be addressed (Vukic, Gregory, Misener & Etowa, 2001). Research has suggested that using emotion coping to reduce the negative racial experiences. This focuses on active responses to such as social support from Indigenous community members as it helps block passive and internalizing responses, have been found to reduce the risk of depression associated with racism (Paradies, 2006).

Psychological constructs are cross culturally variant, hence mental health professionals need to recognise that culture affects the individual behaviour and worldview of Indigenous people (Vukic et al, 2001). Indigenous people have the ability to hear the voices of the dead calling to them from the afterlife (Craven, 2006). The ability to hear voices is viewed as a psychological disorder . However, In Western society hearing voices is viewed as a psychological disorder. In this case, this reveals the role that western culture plays as labelling behaviour as abnormal. Furthermore, the DSM- IV varies according to culture as abnormal behaviour is a reflection of the society in which an individual lives in (Brown, 2001). An understanding that abnormal behaviour is shaped by cultural norms, helps put the DSM-IV into context. Since, the DSM-IV is mostly based on Western cultural contexts, it may not be relevant to the Indigenous people. They have psychological disorders that do not correspond to any DSM-IV categories. In addition, if western perspectives are applied to categorise abnormal behaviour in Indigenous cultures, inappropriate cultural biases may occur (Vukic et al, 2001). There is a lack of Indigenous labels for mental disorders and a difficulty in understanding the Western biomedical model with its associated diagnoses and labelling (Paradies, 2006). Increased knowledge may help overcome the stigma attached to mental disorders and mental health problems and hence increase help-seeking behaviours and earlier access to mental health care A concern often expressed by Indigenous people is that Western treatment models for mental health delivery do not take into account the Indigenous people’s worldview or their cultural beliefs concerning mental health (Craven, 2006). The solution to increasing access to mental health services by Aboriginal people lies in the integration of specific cultural and clinical competencies within the system and practitioner levels

Overall, it is crucial in understanding Indigenous explanations and perceptions of mental health issues, which is fundamental in beginning to make connections between their communities and Western mental health professionals. Also, it is essential in including in-depth understanding of Indigenous mental health issues, from their perspectives in order to avoid cultural barriers. Furthermore, the social and cultural changes experienced by Indigenous people should be an expansion of bio psychosocial approach to encompass sociocultural and spiritual aspects (Paradies, 2006).There needs to be more empirical research in order to examine which approaches of mental health are related to the best outcomes for Indigenous people. Further empirical research should ultimately aim to increase the cultural respectfulness of mental health, and to improve engagement and outcomes for Indigenous people. Vukic et al (2001), maintains that minority group mental health has been seriously understudied because there have been few minority researchers, and ethnic groups have not been specifically represented in populations surveyed for epidemiological research. These approaches provide an exclusive opportunity to develop ‘two-way understandings’ between Indigenous people and Western models of care that will go a long way to apprehending successful mental health outcomes by and for Indigenous people.

References
Brown, R. (2001). Australian Indigenous mental health, Australian and New Zealand Journal of Mental Health Nursing, 10, 33–41
Craven, G, R (2006). New Solutions for Addressing Indigenous Mental Health: A Call to Counsellors to Introduce the New Positive Psychology of Success, Australian Journal of Guidance & Counselling , 16, 1-15
Hunter, H, (2007), Disadvantage and discontent: A review of issues relevant to the mental health of rural and remote Indigenous Australians, Australian Journal of Rural Health, 15, 88–93
Paradies, Y. (2006). Ethnicity and health: A systematic review of empirical research on self-reported racism and health, International Journal of Epidemiology, 35, 888–901. doi:10.1093/ije/dyl056
Santhanam, R., Hunter, E., Wilkinson, Y., Whiteford, H., & McEwan, A. (2006). Care, Community, Capacity: Rethinking Mental Health Services in Remote Indigenous Settings, Australian Journal of Primary Health, 12, 2-12.
Valmae A. Y, Stephen A. M, Melissa H. E, Komla, T. (2007)Indigenous Australians’ understandings regarding mental health and disorders, Australian and New Zealand Journal of Psychiatry ,41,467-478
Vukic, A., Gregory, D., Misener, R. M., Etowa, J. (2001). Aboriginal and Western Conceptions of Mental Health and Illness. Journal of Aboriginal and Indigenous Community Health, 9, 65-85.
Westerman, T. (2004). Engagement of Indigenous Clients in Mental Health Services: What role do cultural differences play? Australian e-Journal for the Advancement of Mental Health , 3, 28-39.