Mental health

Despite the importance of mental health to the total wellbeing of the whole Indigenous community [1], ‘there are glaring deficiencies in our knowledge’ about mental health disorders [2, p.150]. The deficiencies in knowledge are complicated by the complexity of the general area of mental health, in which ‘diverse views exist and where terms are used in different ways’ [3, p.5].

In trying to clarify the terms used, The National Mental Health Plan, 2003-2008 defines mental health as ‘a state of emotional and social wellbeing in which the individual can cope with the normal stresses of life and achieve his or her potential’ [3, p.5]. (The Plan notes that the term ‘social and emotional wellbeing’ is preferred by some people, including Indigenous people, because of its more positive and holistic connotations.)

The Plan recognises a continuum between mental health (or social and emotional wellbeing) and mental illness – ‘a clinically diagnosable disorder that significantly interferes with an individual’s cognitive, emotional and social abilities’ [3, p.5]. Using this terminology, mental illness includes potentially life-threatening conditions like chronic depression and schizophrenia, for which a person needs professional help, often from a psychiatrist. The Plan uses the term ‘mental health problems’ for those issues that interfere with a person’s cognitive, emotional and social abilities to a lesser extent than a clinical mental illness. Trauma and grief – related to ‘the history of invasion, the ongoing impact of colonisation, loss of land and culture, high rates of premature mortality, high levels of incarceration, high levels of family separations … and also Aboriginal deaths in custody’ – have been identified as underlying the great burden among Indigenous people of ‘mental health problems’, which may lead to ‘mental illness’ [1, 3].

The distinction between ‘mental illness’ and ‘mental health problems’ is not well defined [3], but it is an important distinction in ensuring that all aspects of the lack of mental health (or social and emotional wellbeing) are addressed adequately in Indigenous, and other, populations.

The combination of the Plan with the Social and emotional well being framework: a national strategic framework for Aboriginal and Torres Strait Islander peoples’ mental health and social and emotional well being, 2004-2009 [4], provide the foundation for greater coordination of Indigenous-specific initiatives with relevant general developments in the mental health area, and thus enhance the prospects of much more rapid progress than has been achieved to date. Importantly, the policy statements include appropriate monitoring mechanisms involving the high-level committees responsible nationally for monitoring overall progress on Indigenous health and for mental health.

Extent of mental illness and mental health problems among Indigenous people

The extent of mental illness and mental health problems has been recognised as ‘a major difficulty for most [Indigenous] communities’ [1], but, as noted above, the precise details are poorly documented.

Data on the incidence or prevalence of mental illness and mental health problems among Indigenous people are not available [5], and the Indigenous supplement of the 2001 NHS did not include specific questions related to mental health [6].

The 2002 NATSISS didn’t include questions relating specifically to mental health, but did direct attention to stressors experienced in the previous 12 months. Overall, Indigenous people aged 18 years or older were almost one-and-a-half times more likely to report experiencing at least one stressor (82%) than non-Indigenous people did (57%, as reported in the 2002 ABS General Social Survey) [7]. The stressors reported most frequently by Indigenous people were: death of a family member or close friend (46%); serious illness or disability (31%); and inability to get a job (27%) (Table 15). Indigenous people living in remote areas were slightly more likely than those living in non-remote areas to report experiencing a stressor (86% compared with 81%). There were also differences between remote and non-remote areas in the proportions of people reporting the various types of stressors.

 

Table 1 Proportions (%) of Indigenous people reporting stressors in the previous 12 months, by region of residence and stressor type, Australia , 2002

Type of stressor Residence
  Australia Remote Non-remote
Death of a family
member or friend 		46 55 42
Serious illness or
disability 		31 34 30
Not able to get a job 27 25 28
Alcohol or drug related problem 25 37 21
Overcrowding at home 21 42 13
Member of family sent to jail/in jail 20 25 17
Trouble with police 18 22 17
Discrimination/racism 18 16 18
Any stressor 82 86 81

Source: ABS, 2004 [7]

There were 5,642 hospital separations with a principal diagnosis of ‘mental and behavioural disorders’ identified as Indigenous in Australia in 2004-05 (5.9% of separations identified as Indigenous, excluding those for renal dialysis) [8].1 The rate for Indigenous people was 1.7 times that for non-Indigenous people.

Information about hospitalisation for the specific sub-categories within this ICD chapter is not available for 2004-05, but the separation rates of Indigenous people for ‘mental and behavioural disorders due to psychoactive substance use’ in 2003-04 were 4.4 times higher for males and 3.3 times higher for females than those for their non-Indigenous counterparts [9] Rates for Indigenous males and females for ‘schizophrenia, schizotypal and delusional disorders’ were more than double those for non-Indigenous males and females, and those for ‘mood and neurotic disorders’ and ‘organic mental disorders’ slightly higher.

In 1999-2003, 174 Indigenous people living in Queensland, WA, SA, and the NT died as a result of ‘mental and behavioural disorders’: 5.5 times as many deaths as expected for Indigenous males and 2.2 times as many deaths as expected for Indigenous females (based on total Australian rates) [9]. A further 347 deaths of Indigenous people were attributed to 'intentional self harm' (suicide).

The overall numbers of suicide conceal, however, the very high rates of suicide among young Indigenous people. From the more detailed data available for WA, SA, and the NT in 1997–2001, the Indigenous: non-Indigenous rate ratios were 3.4 for males and 6.1 for females in the 15–24 age groups (see Table 2). The exceptionally high rate for Indigenous females aged less than 24 years – higher even than for non-Indigenous males in that age group – reflects the fact that 20 of the 32 Indigenous female suicides involved females in that age group (four were of females less than 15 years old).

Table 2 Age-specific suicide rates, by Indigenous status and sex, and rate ratios, for WA, SA, and NT (1997-2001)

Age group Indigenous Non-Indigenous Rate ratio
  Males Females Males Females Males Females
<24 87.3 29.5 25.5 4.8 3.4 6.1
25-34 104.8 5.0 40.9 7.4 2.6 0.7
35-44 45.9 18.7 33.8 8.6 1.4 2.2
45-54 4.4 4.0 24.0 7.4 0.2 0.5
55-64 17.0 0 16.9 5.5 1.0 0
65-74 0 0 19.7 5.2 0 0
75+ 41.4 10.3 22.8 5.3 1.8 2.0

Source: Derived from data provided by the AIHW National Mortality Database and ABS low-series population projections (based on 1996 Census)

Notes:

  1. Rates are per 100,000 population; rate ratio is the Indigenous rate divided by the non-Indigenous rate
  2. Caution should be exercised in the interpretation of these figures, as some rates for Indigenous people were based on very small numbers of deaths
  3. Rates for the <24 years age group include deaths of people aged 14 years or under, but the rates have been calculated using the population figures for the 15-24 years age groups as the denominators

Research in Queensland, NSW and the ACT has highlighted the increasing impact of suicide among young Indigenous people [10, 11]. It may be, as Tatz argues, that suicide and attempted suicide among Indigenous youth (at least in NSW and the ACT) is not the result of mental illness ‘in the strict pathological sense’ [11, p.80], but it is certainly a manifestation of mental health problems.

Unfortunately, there is little recent information available about the extent of mental illness among Indigenous people, apart from that about some aspects of hospitalisation. There is, on the other hand, a considerable number of detailed studies – the most recent from the 1980s – which support the conclusion that ‘serious psychiatric disorders occur in Indigenous populations, and are at least as common as in the mainstream population’ [2, p.140].

References

1 Swan P, Raphael B (1995) 'Ways forward': National Consultancy Report on Aboriginal and Torres Strait Islander Mental Health. Part 1. Canberra: AGPS

2 Hunter E(2003) Mental health. In: Thomson N, ed. The health of Indigenous Australians. South Melbourne: Oxford University Press:127-157

3 Australian Health Ministers (2003) National Mental Health Plan, 2003-2008. Canberra, ACT: Australian Government

4 Social Health Reference Group (2004) Social and emotional well being framework: a national strategic framework for Aboriginal and Torres Strait Islander mental health and social and emotional well being 2004-2009. Canberra: Australian Government

5 Australian Institute of Health and Welfare (2004) Australia's health 2004: the ninth biennial report of the Australian Institute of Health and Welfare. Canberra: Australian Institute of Health and Welfare

6 Australian Bureau of Statistics (2002) National Health Survey: Aboriginal and Torres Strait Islander results, Australia 2001. (ABS Catalogue no. 4715.0) Canberra: Australian Bureau of Statistics

7 Australian Bureau of Statistics (2004) National Aboriginal and Torres Strait Islander Social Survey, 2002. (ABS Cat. no. 4714.0) Canberra: Australian Bureau of Statistics

8 Australian Institute of Health and Welfare (2006) Australian hospital statistics 2004-05. (AIHW catalogue no. HSE 41) Canberra: Australian Institute of Health and Welfare

9 Australian Bureau of Statistics, Australian Institute of Health and Welfare (2005) The health and welfare of Australia's Aboriginal and Torres Strait Islander peoples 2005. (ABS catalogue no. 4704.0) Canberra: Australian Institute of Health and Welfare and the Australian Bureau of Statistics

10 Hunter E, Reser J, Baird M, Reser P (2001) An analysis of suicide in Indigenous communities of North Queensland: the historical, cultural and symbolic landscape. Canberra, ACT: Commonwealth Department of Health and Aged Care

11 Tatz C (2001) Aboriginal suicide is different: a portrait of life and self-destruction. Canberra, ACT: Aboriginal Studies Press

Endnotes

1 The ICD chapter ‘Mental and behavioural disorders’, used for the classification of both hospitalisation and mortality, is very broad. As well as mental illness and mental health problems, it includes mental retardation and a broad sub-category for disorders relating to the use of psychoactive substances (including alcohol, tobacco, other drugs and volatile substances). The chapter doesn’t include, however, the results of intentional self-harm, which are classified within the ICD chapter ‘External causes of morbidity and mortality’.

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Last updated: 1 November 2007