Year

1997

Degree Name

Doctor of Public Health

Department

Department of Public Health and Nutrition

Abstract

Legge ( 1992:97) argues for a recognition that "health is created beyond the health system there is a need to ensure that health problems are seen from the perspective of the local community rather than as technical problems for health professionals to define or treat". The improvements in Aboriginal & Torres Strait Islander health that are badly needed in Australia create an imperative to develop Indigenous participatory planning processes in health services. It is necessary to identify processes which facilitate involvement and ownership of a participatory process thereby ensuring an Indigenous perspective is bought bear on health problems.

The aim of this study was to examine the effects of an action research partnership between the Tweed Valley Health Service (TVHS) and the Aboriginal & Torres Strait Islander community for the development and delivery of Aboriginal & Torres Strait Islander Mental Health Services. It was proposed adoption of Labonte's (1989) view that empowerment means to have increased capacity to define, analyse and act upon one's problems, in an action research partnership between the local Aboriginal & Torres Strait Islander community and TVHS, would assist in operationalising Indigenous community participation in TVHS planning. To achieve this type of 'partnership' the health service had to be willing to the partnership and to give the authority to the Aboriginal & Torres Strait Islander Health Outcome Council to seek and trial solutions on Aboriginal & Torres Strait Islander Mental Health matters. This represents a structual change and a sharing of power. Key outcomes were defined as the extent to which the re-organised services proved to be acceptable and utilised by the local Aboriginal & Torres Strait Islander population. Outcomes were operationalised through measures of service utilisation and consumer satisfaction with accessibility, process and outcomes.

The study trialed participatory action research as a method for Indigenous participation Mental Health Service planning and development and concludes that it is a valid model for cross cultural research and health service development in a complex medical setting. The method facilitated the accommodation of different cultural perspectives on health and research and the operationalisation of Indigenous participation in health service planning development.

The TVHS and Aboriginal & Torres Strait Islander partnership in service development and delivery resulted in a set of components that were considered essential for the provision effective Aboriginal & Torres Strait Islander Mental Health Service:

1. Acknowledgement by the TVHS that life is experienced as stressful for Aboriginal & Torres Strait Islander's with grief and loss being experienced more frequently by members of the Aboriginal & Torres Strait Islander community.

2. Acknowledgement by the T V H S that Aboriginal &Torres Strait Islander persons experience public health facilities as discriminatory and not culturally accepting.

3. The first point of contact with TVHS for an Aboriginal & Torres Strait Islander person in distress should where possible be with an Aboriginal & Torres Strait Islander person available 24 hours per day and able to provide an outreach service.

4. The service must represent an Aboriginal & Torres Strait Islander solution with Aboriginal & Torres Strait Islander control.

5. The TVHS should provide a context that is accepting of Aboriginal & Torres Strait Islander people.

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