ABORIGINAL AND TORRES STRAIT ISLANDER PEOPLE WITH A MENTAL HEALTH CONDITION

The journey for each person living with a mental illness is unique, and should be viewed in the context of their lived experiences and hopes of leading a full and contributing life. While a strong cultural identity and connections to country, family and community can be protective factors for Aboriginal and Torres Strait Islander people, many also experience disadvantage in the form of unemployment, poverty, isolation, trauma, discrimination, trouble with the law and alcohol and substance abuse. For some people, this disadvantage is coupled with a mental health condition. While the causal direction of mental health conditions and other indicators of socioeconomic disadvantage are unclear, there is a strong association. Recommendation 5 from the National Mental Health Commission in its 2012 National Report Card on Mental Health and Suicide Prevention recognises this:

"We must combat the vicious cycles of disadvantage that exacerbate mental and physical health issues. Poor mental health contributes to suicide risk and high rates of smoking, alcohol and substance abuse and obesity, that in turn progresses chronic disease: the biggest killer of Aboriginal and Torres Strait Islander peoples."[1]

The 2014–15 National Aboriginal and Torres Strait Islander Social Survey (NATSISS) provides a range of information about the social and economic circumstances of Aboriginal and Torres Strait Islander people aged 15 years and over who said they had been told by a doctor or nurse that they have a mental health condition. In this article, the 29% of Aboriginal and Torres Strait Islander people who self-reported: depression; anxiety; behavioural or emotional problems; and/or harmful use of, or dependence on drugs or alcohol; are described as having a mental health condition. Almost one-quarter (23%) of Aboriginal and Torres Strait Islander people reported having both a mental health condition and one or more other long-term health conditions.

Almost two-thirds (65%) of Aboriginal and Torres Strait Islander people had a long-term health condition, including 29% who reported a diagnosed mental health condition (25% of males and 34% of females). Mental health conditions were less likely to have been reported by young people (22%) than by those in older age groups (ranging from 30% to 35%). In addition, mental health conditions were twice as likely to have been reported by Aboriginal and Torres Strait Islander people in non-remote areas than in remote areas (33% compared with 16%) (Table 10.1).

Table 10.1. Whether has a mental health condition (a), by sex, age and remoteness

Has long-term health condition
	Mental health condition (b)		Other long-term health condition (c)		Total		No long-term health condition		Total
	('000)	(%)	('000)	(%)	('000)	(%)	('000)	(%)	('000)	(%)
Males	52.3	(d) 24.6	77.0	36.2	129.2	(d) 60.8	83.0	(d) 39.1	212.6	100.0
Females	77.8	(d) 33.7	81.1	35.1	158.7	(d) 68.7	72.1	(d) 31.2	231.1	100.0
15-24	30.6	22.2	35.1	25.5	65.4	47.5	72.1	52.4	137.7	100.0
25-34	29.5	30.7	25.6	26.6	55.2	57.4	40.9	42.6	96.1	100.0
35-44	26.9	35.4	26.9	35.4	53.9	71.0	21.9	28.9	76.0	100.0
45-54	22.8	34.6	30.2	46.0	53.1	80.8	12.7	19.3	65.7	100.0
55 and over	20.3	29.8	40.0	58.8	60.1	88.2	7.7	11.4	68.1	100.0
Non-remote	114.6	(e) 33.1	120.1	(e) 34.6	234.9	(e) 67.7	112.0	(e) 32.3	346.8	100.0
Remote	15.7	(e) 16.2	37.8	(e) 39.1	53.3	(e) 55.1	43.3	(e) 44.8	96.7	100.0
Total persons 15 years and over	130.0	29.3	158.0	35.6	288.2	65.0	155.4	35.0	443.4	100.0

(a) Aboriginal and Torres Strait Islander people aged 15 years and over.
(b) Includes 100,900 Aboriginal and Torres Strait Islander people (23%) who had one or more other long-term health conditions.
(c) Excludes Aboriginal and Torres Strait Islander people with a mental health condition.
(d) The difference between male and female data is statistically significant.
(e) The difference between non-remote and remote data is statistically significant.
Source(s): 2014–15 National Aboriginal and Torres Strait Islander Social Survey.

In the remainder of this article, the outcomes for Aboriginal and Torres Strait Islander people with a mental health condition are compared with those for people with other long-term health conditions (but no mental health condition), and those with no long-term health condition.

Overall life satisfaction

Across a range of measures, outcomes for Aboriginal and Torres Strait Islander people with a mental health condition are generally poorer than for people with other long-term health conditions or no long-term health condition. This is reflected in relative overall life satisfaction ratings on a scale of 0 to 10 in which 0 is 'not at all satisfied' and 10 is 'completely satisfied'.

In 2014–15, around one in six (18%) Aboriginal and Torres Strait Islander people with a mental health condition reported an overall life satisfaction rating at the lower end of the scale (0–4), compared with 5% of people with other long-term health conditions and 5% of those with no long-term health condition. Conversely, 10% of Aboriginal and Torres Strait Islander people with a mental health condition provided a rating of 10, compared with 19% of people with other long-term health conditions and 21% of those with no long-term health condition (Figure 10.1 and Table 18).

Figure 10.1. Overall life satisfaction rating(a)(b), by whether has a mental health condition — 2014–15


Factors which can have a positive influence on the mental wellbeing of Aboriginal and Torres Strait Islander people include paid employment, participation in education and the community, and access to social networks, affordable and secure housing, and culturally safe services and support. However, people with a mental health condition may be less able to participate in the labour force, effectively interact in the community or access appropriate services due to their condition.

Health status and risk factors

In 2014–15, just over one in five (23%) Aboriginal and Torres Strait Islander people with a mental health condition reported excellent or very good self-assessed health, compared with 35% of those with other long-term health conditions and 58% of people with no long-term health condition. Aboriginal and Torres Strait Islander people with a mental health condition were almost three times as likely to have experienced high or very high psychological distress levels (60%) as those with other long-term health conditions (21%) or no long-term health condition (22%) (Table 19).

Similar proportions of Aboriginal and Torres Strait Islander people, with or without a mental health condition, had exceeded the 2009 NHMRC alcohol consumption guidelines[2] for lifetime risk (14% to 16%) and single occasion risk (30% to 33%) in 2014–15. However, Aboriginal and Torres Strait Islander people with a mental health condition were more likely to be a daily smoker (46%) and to have used substances in the last 12 months (39%) than were people with other long-term health conditions (33% and 24%, respectively) or those with no long term health condition (39% and 29%, respectively) (Figure 10.2 and Table 19).

Figure 10.2. Smoking and substance use(a), by whether has a mental health condition — 2014–15


In 2014–15, Aboriginal and Torres Strait Islander people with a mental health condition were more likely than those without a mental health condition to have experienced one or more stressors in the last 12 months. The majority (84%) of people with a mental health condition reported experiencing one or more stressors, compared with 64% of those with other long-term health conditions and 60% of people with no long-term health condition. In addition, a higher proportion of people with a mental health condition had experienced three or more stressors — 30% compared with 11% of those with other long-term health conditions and 8% of people with no long-term health condition (Table 19).

Most of the more commonly reported stressors were more prevalent among Aboriginal and Torres Strait Islander people with a mental health condition, including:

• serious illness — 17% compared with 13% of those with other long-term health conditions and 7% of people with no long-term health condition;
• alcohol-related problems — 11% compared with 5% of those with other long-term health conditions and 4% of people with no long-term health condition;
• overcrowding at home — 10% compared with 6% of those with other long-term health conditions and 5% of people with no long-term health condition;
• being treated badly/discrimination — 9% compared with 4% of those with other long-term health conditions and 3% of people with no long-term health condition; and
• drug-related problems — 8% compared with 3% of those with other long-term health conditions and 3% of people with no long-term health condition (Table 19).

Aboriginal and Torres Strait Islander people with a mental health condition were also more likely to have been removed, or to have had relatives removed, from their natural family (50%) and to have experienced racial discrimination in the last 12 months (44%) than were people with other long-term health conditions (42% and 31%, respectively) and those with no long-term health condition (34% and 28%, respectively) (Table 19).

Access to health services

In 2014–15, Aboriginal and Torres Strait Islander people with a mental health condition were more likely to have experienced problems accessing health services (23%) than were people with other long-term health conditions (13%) or no long-term health condition (10%). The relative disparity in access was apparent across the majority of health services, including dentists, doctors and hospitals (Figure 10.3 and Table 19).

Figure 10.3. Difficulty accessing selected health services(a), by whether has a mental health condition — 2014–15



Trust in own doctor was lower for Aboriginal and Torres Strait Islander people with a mental health condition (79%) than for people with other long-term health conditions (84%). Aboriginal and Torres Strait Islander people with a mental health condition were also less likely to have expressed trust in hospitals (55%) than were people with other long-term health conditions (67%) or no long-term health condition (72%) (Table 19).

Educational attainment

In 2014–15, Aboriginal and Torres Strait Islander people with a mental health condition and those with other long-term health conditions reported similar levels of educational attainment.

When compared with people who did not have a long-term health condition, Aboriginal and Torres Strait Islander people with a mental health condition were more likely to have attained a Certificate III or IV (26% compared with 19%) and were less likely to have reported Year 10 (18% compared with 23%) or Year 11 (8% compared with 15%) as their highest educational attainment, however, these differences are largely due to the younger age profile of people with no long-term health condition. Similarly, Aboriginal and Torres Strait Islander people with a mental health condition were less likely than those with no long-term health condition to be studying (21% compared with 26%), and were more likely to have reported educational attainment below Year 10 (24% compared with 19%), reflecting normative changes in minimum levels of educational attainment over time (Table 18).

Employment and equivalised household income

Paid employment provides income and is an important source of self-esteem and economic security, as well as providing opportunities for social engagement. In 2014–15, Aboriginal and Torres Strait Islander people with a mental health condition were less likely to be participating in the labour force (50%) than were people with other long-term health conditions (58%) or no long-term health condition (65%). While part-time employment rates were similar for all three groups (at around 18%), only 21% of people with a mental health condition were employed full-time, compared with 31% of those with other long-term health conditions and 30% of people with no long-term health condition (Figure 10.4 and Table 18).

Figure 10.4. Employment status(a), by whether has a mental health condition — 2014–15



Aboriginal and Torres Strait Islander people with a mental health condition also had a higher unemployment rate than those with other long-term health conditions (24% compared with 15%). Overall, people with no long-term health condition had the same unemployment rate as those with a mental health condition (24%). However, the different age profiles of these two groups mask the extent to which experiences of unemployment can vary according to age. For instance, a greater proportion of Aboriginal and Torres Strait Islander people with no long-term health condition were aged 15–24 years (46%) than was the case for people with a mental health condition (24%). As younger people tend to experience higher rates of unemployment, it is likely that if these two groups had a similar age profile, people with a mental health condition would have a higher unemployment rate than people with no long-term health condition (Table 18 and Table 4).

Equivalised gross household income provides an indication of how much money is likely to be available to each person in a given household, assuming that income is shared, and taking into account the combined income, size and composition of the household in which they live. In 2014–15, Aboriginal and Torres Strait Islander people with a mental health condition were more likely than those with other long-term health conditions to be living in households in the lowest quintile (40% compared with 34%) and were less likely than people with no long-term health condition to be living in households in the highest quintile (5% compared with 8%) (Table 18).

Family and community connections

Relationships and engagement with the community are important for mental wellbeing as they can lessen feelings of isolation and provide people with supportive networks. In 2014–15, Aboriginal and Torres Strait Islander people with a mental health condition were less likely than people with other long-term health conditions to be married (39% compared with 49%) and were more likely to be living in one parent families (23% compared with 16%). In addition, Aboriginal and Torres Strait Islander people with a mental health condition were less likely to be living in a couple family household (39%) than were people with other long-term health conditions or no long-term condition (both 45%). Aboriginal and Torres Strait Islander people with a mental health condition were more likely than those with no long-term health condition to be living alone (14% compared with 6%) (Table 18).

The majority of Aboriginal and Torres Strait Islander people (97%), with or without a mental health condition, had participated in sporting, social or community activities in the last 12 months. Aboriginal and Torres Strait Islander people also enjoyed high levels of support in times of crisis from people living outside their household, however the rates for those with a mental health condition (89%) were slightly lower than for those with other long-term health conditions or no long-term condition (both 93%). Specifically, Aboriginal and Torres Strait Islander people with a mental health condition were less likely to receive support from a family member (75%) or work colleague (14%) in a time of crisis, than were people with other long-term health conditions (84% and 19%, respectively) or no long-term health condition (85% and 18%, respectively) (Table 19).

Aboriginal and Torres Strait Islander people with a mental health condition were less likely to have had daily face-to-face contact with family or friends outside their household (36%) than were people with other long-term health conditions (41%) or no long-term health condition (52%). In addition, a smaller proportion of Aboriginal and Torres Strait Islander people with a mental health condition felt that they were able to have a say within their community on important issues (23%) than was the case for people with other long-term health conditions (29%) (Table 19).

Aboriginal and Torres Strait Islander people with a mental health condition were more likely than those with no long-term health condition to have provided support to relatives living outside their household (53% compared with 44%) and to have cared for a person with a disability, long term health condition or old age in the last four weeks (29% compared with 22%), however these differences could be due to the younger age profile of those with no long-term health condition (Table 19).

Cultural identity

In 2014–15, similar proportions of Aboriginal and Torres Strait Islander people, with and without a mental health condition, recognised an area as homelands/traditional country (73% to 76%) and identified with a clan, tribal or language group (60% to 64%). Just under two-thirds (62% to 64%) of Aboriginal and Torres Strait Islander people had been involved in cultural events, ceremonies or organisations in the last 12 months, such as NAIDOC week activities and art, craft, music or sporting festivals (Table 19).

Aboriginal and Torres Strait Islander people with a mental health condition were less likely than those without a mental health condition to have participated in selected cultural activities, such as hunting or gathering bush food, storytelling or performing music, dance or theatre. Some 60% of people with a mental health condition had participated in these kinds of activities in the last 12 months, compared with 66% of those with other long-term health conditions and 67% of people with no long-term health condition. In addition, a smaller proportion of people with a mental health condition (12%) said they could speak an Australian Indigenous language, compared with 20% of those with other long-term health conditions and 22% of people with no long-term condition. However, these differences also reflect the geographic profiles of these groups. For example, Aboriginal and Torres Strait Islander people in non-remote areas comprised 88% of those with a mental health condition, 76% of people with other long-term health conditions and 72% of those with no long-term health condition (Table 10.1). Nationally, the proportions of Australian Indigenous language speakers were 8% in non-remote areas and 55% in remote areas (Table 19 and Table 9).

Crime and safety

In 2014–15, Aboriginal and Torres Strait Islander people with a mental health condition were more likely to have experienced physical violence in the last 12 months (20%) than were people with other long-term health conditions (9%) or no long-term health condition (12%). For more than half of those who had experienced physical violence, alcohol and/or other substances were a contributing factor in the most recent incident, reported by 14% of people with a mental health condition, 6% of those with other long-term health conditions and 8% of people with no long-term health condition (Table 19).

Consistent with a greater likelihood of having experienced physical violence, a lower proportion of Aboriginal and Torres Strait Islander people with a mental health condition said they felt safe at home alone after dark (77%) or safe walking alone in their local area after dark (46%) than was the case for people with other long-term health conditions (86% and 52% respectively) or no long-term health condition (87% and 62%, respectively) (Table 19).

Mobility and housing impermanence

In 2014–15, Aboriginal and Torres Strait Islander people with a mental health condition were more likely than those with other long-term health conditions to have moved house in the last five years (65% compared with 55%) (Table 18).

A higher proportion of Aboriginal and Torres Strait Islander people with a mental health condition had experienced a lack of somewhere permanent to live at some time in their life (55%) than was the case for people with other long-term health conditions (39%) or no long-term health condition (32%).

Reasons for housing impermanence which were more prevalent among Aboriginal and Torres Strait Islander people with a mental health condition included:

• family/friend/relationship problems — 27% compared with 14% of those with other long-term health conditions and 12% of people with no long-term health condition;
• violence/abuse/neglect — 12% compared with 3% of those with other long-term health conditions and 3% of people with no long-term health condition;
• financial problems — 11% compared with 5% of those with other long-term health conditions and 4% of people with no long-term health condition; and
• a tight housing/rental market/not enough housing — 10% compared with 6% of those with other long-term health conditions and 5% of people with no long-term health condition (Figure 10.5 and Table 18).

Figure 10.5. Selected reasons for housing impermanence(a), by whether has a mental health condition — 2014–15



In addition, just under half (45%) of Aboriginal and Torres Strait Islander people with a mental health condition had experienced homelessness, compared with 24% of people who had other long-term health conditions and 20% of those with no long-term condition (Table 18).

Endnotes

1 National Mental Health Commission (NHMC), 2012. A Contributing Life, the 2012 National Report Card on Mental Health and Suicide Prevention, Sydney: NMHC. <http://www.mentalhealthcommission.gov.au/our-reports/our-national-report-cards/2012-report-card.aspx>; last accessed 19/04/2016.

2 National Health and Medical Research Council (NHMRC), 2009. Australian guidelines to reduce health risks from drinking alcohol, Canberra: NHMRC. <http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/ds10-alcohol.pdf>; last accessed 19/04/2016.