Aboriginal mothers in prison in Australia: a study of social,emotional and physical wellbeing

Objective : To describe the social, emotional and physical wellbeing of Aboriginal mothers in prison. Methods : Cross‐sectional survey, including a Short Form Health Survey (SF‐12) and Kessler Psychological Distress Scale (5‐item version) administered to Aboriginal women who self‐identified as mothers. Results : Seventy‐seven Aboriginal mothers in New South Wales (NSW) and 84 in Western Australia (WA) participated in the study. Eighty‐three per cent (n=59) of mothers in NSW were in prison for drug‐related offences, 64.8% (n=46) of mothers in WA were in prison for offences committed under the influence of alcohol. Sixty‐eight per cent (n=52) of mothers in NSW and 35% (n=28) of mothers in WA reported mental health problems. Physical (PCS) and Mental (MCS) component scores of SF‐12 varied for mothers in NSW and WA. Mothers in NSW experienced poorer health and functioning than mothers in WA (NSW: PCS 49.5, MCS 40.6; WA: PCS 54.4, MCS 48.3) and high levels of psychological distress (NSW: 13.1; WA 10.1). Conclusions : Aboriginal mothers in prison have significant health needs associated with physical and mental health, and psychological distress. Implications for public health : Adoption of social and emotional wellbeing as an explanatory framework for culturally secure healthcare in prison is essential to improving health outcomes of Aboriginal mothers in prison in Australia.     

Racism, social resources and mental health for Aboriginal people living in Adelaide

Background: This paper examines whether reported experience of racism by Aboriginal people living in Adelaide is negatively associated with mental health, and whether social resources ameliorate the mental health effects of racism. Methods: Face‐to‐face structured and semi‐structured interviews were conducted with 153 Aboriginal people. Data on self‐reported experiences of racism (average regularity of racism across a number of settings, regular racism in at least one setting), social resources (socialising, group membership, social support, talking/expressing self about racism), health behaviours (smoking, alcohol), socio‐demographic (age, gender, education, financial situation) and mental health (SF‐12 measure) are reported. Separate staged linear regression models assessed the association between the two measures of racism and mental health, after accounting for socio‐demographic characteristics and health behaviours. Social resource variables were added to these models to see if they attenuated any relationship between racism and mental health. Results: The two measures of racism were negatively associated with mental health after controlling for socioeconomic factors and health behaviours. These relationships remained after adding social resource measures. Non‐smokers had better mental health, and mental health increased with positive assessments of financial situation. Conclusion and Implications: Reducing racism should be a central strategy in improving mental health for Aboriginal people.     

Rethinking professional prerogative: managed mental health care providers

Managed care represents a response to the wider institutional demand for technical rationality and efficiency. In the US, managed care exemplifies the commodification of health and is governed by a technocratic-rationality that often conflicts with the professionally governed value rationality of providers. Providers must negotiate between contradictory institutional demands for cost containment and quality care in their everyday work practices, and consequently experience a series of ethical dilemmas. This paper examines the effect the commodification of health care has had upon the work of mental health care providers, their loss of professional prerogative, their concrete experience of the ethical dilemmas which result from the commodification of care, and evidence of countervailing power.     

Social and emotional wellbeing in Indigenous Australians: identifying promising interventions

Objective : To review the empirical evidence that exists to support the delivery of the range of psycho‐social interventions that have been implemented to improve social and emotional wellbeing (SEWB) in Aboriginal and Torres Strait Islander individuals and communities. Methods : A systematic review of the available literature, with relevant evaluations classified using the Maryland Scientific Methods Scale. Results : Despite a substantial literature on topics relevant to SEWB being identified, only a small number of program evaluations have been published that meet the criteria for inclusion in a systematic review, making it impossible to articulate what might be considered evidence‐based practice in this area. Examples of those programs with the strongest empirical support are outlined. Conclusions : The results are discussed in terms of the need to develop key indicators of improvement in SEWB, such that more robust evidence about program outcomes can be gathered. The diversity of the identified programs further suggests the need to develop a broader and over‐arching framework from which to approach low levels of SEWB, drawing on the concepts of ‘grief and loss’ and ‘healing’ and how high levels of social disadvantage have an impact on service utilisation and outcomes. Implications : From a public health perspective, the pressing need to implement programs that have positive impacts on low levels of social and emotional well‐being in Aboriginal and Torres Strait Islander communities in Australia seems clear.     

A process for the inclusion of Aboriginal People in health research: lessons from the Determinants of TB Transmission project

The Determinants of TB Transmission (DTT) project, a federally-funded study covering the period April 1, 2006-March 31, 2013, and examining the determinants of TB transmission amongst the Canadian-born population (Aboriginal and non-Aboriginal) in the prairie provinces of Canada, took a novel approach to health research involving Aboriginal people. The methodology aligned itself with the recently published Canadian Institutes of Health Research (CIHR) Guidelines for Health Research Involving Aboriginal People and the established principles of Ownership, Control, Access, and Possession (OCAP). This article details the process by which collaboration with Aboriginal peoples was achieved, including the involvement of Aboriginal researchers, the development of Provincial Network Committees (PNCs), and communications with First Nations Chiefs and Council. Strengths of this methodology included Aboriginal organizational and community support with a high rate of participation; PNC leadership, which brought together Aboriginal stakeholders with provincial and federal TB program planners; and the exploration of both on and off-reserve transmission factors. Challenges of the methodology included meeting funding agency timelines and expectations given the gradual process of trust development and PNC-reviewed publication; respecting both community and individual participants' autonomy regarding study participation; and political discomfort with strong Aboriginal involvement. While the methodology required a dedicated investment from researchers and funding agencies alike, the process was worthwhile and achieved a high degree of support from its major collaborators: the Aboriginal peoples.     

Developing a collaborative research system for Aboriginal health

OBJECTIVE: Investigator-driven research and the use of peer review are contentious in community-based research and are particularly problematic in Indigenous research. In this project, we conducted a qualitative study among stakeholders in an Australian Aboriginal majority-controlled research-funding organisation to examine the research funding process. METHODS: A steering group guided the project and contributed to the research findings. In-depth interviews (n=18) with stakeholders in the Cooperative Research Centre for Aboriginal Health were conducted to canvass views on the research funding process and options for alternate processes. A discussion document, supported by an extensive literature review, was provided prior to interview. This research was an iterative process where the discussion document and interview schedule were revised as the research findings informed the project. FINDINGS: Participants overwhelmingly endorsed a move to a more collaborative research culture, although the form the culture might take varied. Suggested elements included involvement of grant funding bodies as brokers in building collaborative networks and the substitution of named 'critical friends' for blinded peer review. Barriers to changing the research culture to a more collaborative model were described. CONCLUSIONS AND IMPLICATIONS: A collaborative structure with targeted project development would permit redistribution of the time and effort (previously expended on peer review) into research development and would increase community participation in decision-making in the research funding process.     

Peer supporters' mental health and emotional wellbeing needs: Key factors and opportunities for co-produced training

Introduction

Peer supporters are a valuable asset to mental health and support services, but their own mental health needs are often overlooked in research and practice. This study explored peer supporters' perceived challenges of maintaining their mental health and emotional wellbeing and co-produced training needs.

Methods

A qualitative approach was used to explore factors affecting peer supporters' mental health and emotional wellbeing. Semi-structured interviews and focus groups were conducted online with 11 peer supporters across North East England.

Results

A thematic analysis identified: ‘Lack of training and support’, ‘Role ambiguity’ and ‘Emotional labour’ as challenges experienced by peer supporters in relation to maintaining their mental health and emotional wellbeing. Peer supporters' own lived experiences had the potential to act as a barrier towards providing support to others. Conflict with peer ‘supportees’ sometimes negatively impacted on the peer supporter experience. Participant responses emphasised a need for person-centred, co-produced training.

Conclusion

This work highlights the need for targeted training for peer supporters, including both role-specific education and strategies to support their mental health and emotional wellbeing.

Patient or Public Contribution

Participants were contacted and asked to provide feedback on finalised themes to ensure the analysis was congruent with their experiences, further enabling the future development of an emotional wellbeing training programme for peer supporters.     

SESAMI study of employment support for people with severe mental health problems: 12-month outcomes

In the context of UK policy to promote employment for people with disability as a means to greater social inclusion, this study investigated how people with severe mental health problems fare in existing supported employment agencies. The aim of the study was to identify factors associated with successful placement in work and to test the impact of working on psychological well-being in this group. One hundred and fifty-five users of six English agencies were followed up for 1 year (2005-2006). Information was collected about their employment status, job-seeking behaviour, perceived obstacles to work, self-esteem and hope, and the employment support received. Eighty-two per cent of those working at baseline were still in work a year later. The support agencies helped 25% of unemployed clients into work, a statistically significant increase in the proportion of clients in employment. Gaining employment was associated with improvements in financial satisfaction and self-esteem. There was a trend towards working half time. People who had been out of work longer were less likely to secure employment. No significant associations were found between getting a job and personal characteristics, the quantity of employment support given, nor the recipient's rating of the support offered. The odds of moving into work were nearly four times higher for those people who visited a job centre prior to the start of the study. Clients of specialist agencies rated their provision more highly than clients of pan-disability agencies. These results demonstrate the benefits of working for this group and support the development of employment services with an individualised, rapid placement approach, linked to job centre advice and expert mental health service input. This is consistent with the Individual Placement and Support model, and highlights in addition the importance of job centres for its implementation in England.     

骨骼肌肉功能失调对卫生专业技术人员职业活动和健康影响的研究

目的骨骼肌肉功能失调是一个危害广泛的职业卫生问题。本研究旨在了解我国骨骼肌肉功能失调对职业活动和健康的影响。方法对334名卫生专业技术人员进行了骨骼肌肉功能问卷调查,内容包括骨骼肌肉功能失调的身体部位及对职业活动和健康的影响。结果本次问卷调查的应答率为99.4%,其中308人主诉在过去12个月有骨骼肌肉功能失调的表现如疼痛、不适或麻木,以颈部、肩部和腰部最多,分别为72.2%、59.9%和59.9%。在这些症状中持续时间超过24小时的占56%,影响到职业工作的占23%,需要医院就医的占15.9%。手腕部和肩部骨骼肌肉功能失调的持续时间多超过24小时,其OR值分别为3.1(95%CI1.6~6.4,P<0.01)和2.6(95%CI1.4~4.7,P<0.01);而腰部、大腿和手腕部骨骼肌肉功能失调常常引起工作能力的下降,其OR值分别为2.7(95%CI1.6~4.7,P<0.01)、2.4(95%CI1.1~5.0,P<0.05)和2.2(95%CI1.3~3.9,P<0.01);腰部和膝部骨骼肌肉功能失调到医院就医的需求最高,OR值分别为2.8(95%CI1.5~5.4,P<0.01)和2.1(95%CI1.1~4.0,P<0.05);女性职业者出现骨骼肌肉功能失调的相对危险性为男性5.2倍(OR=5.2,95%CI1.3~21.0,P<0.05)。结论在卫生专业技术人员中,骨骼肌肉功能失调是影响健康和职业活动的重要因素之一。     

Delayed discharge from mental health hospitals: results of an English postal survey

This paper reports findings from a postal survey conducted by the UK's NHS Confederation to explore the rate and cause of delayed hospital discharges in mental health inpatient services. With delayed discharges the subject of considerable UK government activity in general hospital settings, there has been debate about extending recent financial penalties to mental health, fining social services departments for delayed discharges (a system known as reimbursement). Against this background, the NHS Confederation sent a postal survey to all 83 English mental health trusts and Primary Care Trusts with responsibility for providing mental health services. This asked respondents about delayed discharges from mental health inpatient beds in terms of number of delays, duration of delay, specialty and cause. Responses were then analysed quantitatively (in terms of number and extent of delays) and qualitatively (attitudes to reimbursement and other policies that might help resolve the issue). Overall, the survey reveals high levels of delayed discharges (with from 4% to 16% of beds affected and some 25 to 2,366 bed days lost depending on specialty). The causes of delayed discharge are varied, with a range of factors interacting. Although opinion was divided on the benefits of extending reimbursement, closer analysis revealed greater agreement than may at first be apparent. In particular, those favouring extension tended not to be 'pro-reimbursement' per se, but rather desperate to tackle delayed discharges and prepared to consider any policy that might help. This is an important addition to the current literature and debate, as it suggests that those seemingly in favour of reimbursement may actually be more motivated by a desire to try anything that might reduce delays rather than by commitment to this particular policy.     

Housing and health in Indigenous communities: key issues for housing and health improvement in remote Aboriginal and Torres Strait Islander communities

Indigenous people living in remote communities face some particular difficulties with regard to housing and its impact on their health. This paper reviews the contemporary international understanding of the relationship between housing and health, the history of settlement and housing conditions in remote Aboriginal and Torres Strait Islander communities, and some of the recent initiatives to improve housing in these communities.