Challenges to relapse prevention: Psychiatric care of Indigenous in-patients - Tricia Nagel,Carolyn Thompson and Neil Spencer

Australian e-Journal for the Advancement of Mental Health (AeJAMH), Volume 7, Issue 2, 2008
ISSN: 1446-7984
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Abstract
Relapse is one of the major contributing factors to the high burden of disability of mental
illness. Strategies for relapse prevention are needed. Aboriginal and Torres Strait Islander
people continue to be over-represented in mental health care nationwide. Partnerships
between Aboriginal Mental Health Workers (AMHWs) and non-Indigenous health
professionals can assist in provision of culturally appropriate in-patient care and promotion of
self-management and relapse prevention strategies. The Australian Integrated Mental Health
Initiative in the Northern Territory (AIMhiNT) aims to improve outcomes for Indigenous
people with mental illness. This article reviews the quality of care provided in the Top End
in-patient setting, and the involvement of AMHWs in the care of Indigenous people who are
hospitalised for mental illness. Findings from a series of clinical file audits (1995, 2001 and
2004) at Royal Darwin Hospital in-patient unit are presented. The files were audited for
assessment and care planning activities. The audits reveal that significant improvements in
in-patient care between 1995 and 2001 were not sustained in 2004. Recording of social
history, and appointment of a case manager, were less likely to occur in 2004 compared with
2001, for both non-Indigenous and Indigenous clients. AMHWs were involved in the care of
only 55% of Indigenous clients. Busy in-patient units are at risk of focusing on acute care to
the detriment of relapse prevention activities and culturally appropriate care. There is a need
to develop models of practice that support relapse prevention for in-patient clients. Key
strategies will include improved communication with clients, development of selfmanagement
skills, and enhanced partnerships with Indigenous service providers.

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Received 14 December 2007; Revised 16 July 2008; Accepted 16 July 2008