Purpose: This study aimed to explore risk factors for suicide in Aboriginal and non-Aboriginal people following hospital admission for suicidal ideation and self-harm in the Northern Territory, Australia to help clarify opportunities for improved care and intervention for these population groups.

Methods: Individuals with at least one hospital admission involving suicidal ideation and/or self-harm between 1 July 2001 and 31 December 2013 were retrospectively recruited and followed up using linked mortality records to 31 December 2014. Survival analyses stratified by Indigenous status identified socio-demographic and clinical characteristics from index hospital admissions associated with suicide.

Results: Just over half of the 4391 cohort members identified as Aboriginal (n = 2304; 52.4%). By 2014, 281 deaths were observed comprising 68 suicides, representing a 2.6% and 2.0% probability of suicide for Aboriginal and non-Aboriginal people, respectively. After adjusting for other characteristics, a higher risk of suicide was associated with male sex (Aboriginal adjusted hazard ratio: 4.14; 95% confidence interval: [1.76, 9.75]; non-Aboriginal adjusted hazard ratio: 5.96; 95% confidence interval: [1.98, 17.88]) and repeat hospital admissions involving self-harm (Aboriginal adjusted hazard ratio: 1.37; 95% confidence interval: [1.21, 1.55]; non-Aboriginal adjusted hazard ratio: 1.29; 95% confidence interval: [1.10, 1.51]). Severe mental disorders were associated with a four times higher risk of suicide (adjusted hazard ratio: 4.23; 95% confidence interval: [1.93, 9.27]) in Aboriginal people only.

Conclusion: The findings highlight non-clinical risk factors for suicide that suggest the need for comprehensive psychosocial assessment tailored to Aboriginal and non-Aboriginal people hospitalised with suicidal ideation or self-harm. Implementing appropriate management and aftercare within a broader public health framework is needed to support recovery and reduce long-term suicide risk in the community, especially for Aboriginal people and males.

Introduction: Globally, Indigenous populations have higher rates of suicidal behavior and psychological distress compared to non-Indigenous populations. Indigenous populations also report high rates of exposure to discrimination, which could potentially contribute to poor mental health outcomes. The objectives of this paper were to estimate the prevalence of discrimination among Aboriginal and Torres Strait Islander males in Australia and to examine the role of discrimination in the association between Aboriginal and Torres Strait Islander status and suicidal thoughts and depressive symptoms.

Methods: We used cross-sectional data on 13,697 males aged 18-55 years from the Australian Longitudinal Study on Male Health. We undertook a Poisson regression with robust standard error analyses to examine Aboriginal and Torres Strait Islander status and self-perceived exposure to discrimination in the past 2 years as correlates of recent suicidal ideation. We used zero-inflated negative binomial regression to assess Aboriginal and Torres Strait Islander status and self-perceived exposure to discrimination as correlates of recent depressive symptoms.

Results: Aboriginal and Torres Strait Islander males have a twofold higher prevalence of self-perceived discrimination (39.2% vs 19.3%, p < 0.001), suicidal ideation (21.8% vs 9.4%, p < 0.001) and moderate or worse depressive symptoms (24.0% vs 12.2%, p < 0.001) as compared to their non-Indigenous counterparts. After adjusting for sociodemographics and substance use, Aboriginal and Torres Strait Islander status was significantly associated with suicidal thoughts (odds ratio = 1.49, p = 0.019) and depressive symptoms (prevalence rate ratio = 1.19, p = 0.018). About 15.3% and 28.7% of the association between Aboriginal and Torres Strait Islander status and suicidal thoughts and depressive symptoms, respectively, was explained by discrimination.

Conclusion: Our analyses add to evidence that discrimination is a contributor to mental health disparities between Aboriginal and Torres Strait Islander and non-Indigenous populations in Australia. Reducing discrimination ought to be considered as part of strategies to improve the social and emotional well-being of Aboriginal and Torres Strait Islander people.

Objectives: To examine associations between community cultural connectedness indicators and suicide mortality rates for young Aboriginal and Torres Strait Islander people.

Study design: Retrospective mortality study. Setting, participants: Suicide deaths of people aged 10‒19 years recorded by the Queensland Suicide Register, 2001‒2015. Main outcome measures: Age-standardised suicide death rates, by Indigenous status, sex, and age group; age-standardised suicide death rates for young First Nations people by area level remoteness and Index of Relative Socioeconomic Advantage and Disadvantage, and by cultural connectedness indicators (at statistical area level 2): cultural social capital index score, community Indigenous language use, and reported discrimination.

Results: The age-specific suicide rate was 21.1 deaths per 100 000 persons/year for First Nations young people and 5.0 deaths per 100 000 persons/year for non-Indigenous young people (rate ratio [RR], 4.3; 95% CI, 3.5‒5.1). The rate for Aboriginal and Torres Strait Islander young people was higher in areas with low levels of cultural social capital (greater participation of community members in cultural events, ceremonies, organisations, and community activities) than in areas classified as having high levels (RR, 1.8; 95% CI, 1.2‒2.7), and also in communities with high levels of reported discrimination (RR, 2.7; 95% CI, 1.7‒ 4.3). Associations with proportions of Indigenous language speakers and area level socio-economic resource levels were not statistically significant.

Conclusion: We found that suicide mortality rates for Aboriginal and Torres Strait Islander young people in Queensland were influenced by community level culturally specific risk and protective factors. Our findings suggest that strategies for increasing community cultural connectedness at the community level and reducing institutional and personal discrimination could reduce suicide rates.

Objective: The study aimed to examine associations of community cultural connectedness with Aboriginal and Torres Strait Islander young peoples’ suicide rates in areas with elevated risk factors.

Methods: Age-specific suicide rates (ASSRs) were calculated using suicides recorded by the Queensland Suicide Register (QSR) of Aboriginal and Torres Strait Islander young people (aged 15–24 years) in Queensland from 2001–2015. Rate Ratios (RRs) compared young peoples’ suicide rates in areas with high and low levels of cultural connectedness indicators (cultural social capital and Indigenous language use) within areas with elevated risk factors (high rates of discrimination, low socioeconomic resources, and remoteness).

Results: Within low socioeconomically resourced areas and where Aboriginal and Torres Strait Islander people experienced more discrimination, greater engagement and involvement with cultural events, ceremonies and organisations was associated with 36% and 47% lower young peoples’ suicide rates respectively (RR=1.57, 95%CI=1.13–2.21, p=0.04).

Conclusion: Cultural connectedness indicators were associated with lower Aboriginal and Torres Strait Islander young peoples’ suicide rates in communities experiencing the most disadvantage. Implications for public health: This provides initial evidence for trialling and evaluating interventions using cultural practices and engagement to mitigate against the impacts of community risk factors on Aboriginal and Torres Islander suicide.

It is well known that Aboriginal Australians are at increased risk of suicide. Contributors to suicide differ for Indigenous and non-Indigenous populations (Westerman, 2003; 2019). This study evaluated whole of community suicide prevention forums conducted across six locations. Attendees were youth (N = 136), service providers (N = 225), and community members (N = 158). The content of the forums was empirically based and, for service providers and community members, covered knowledge of suicide, and depression specific to Aboriginal people, skills relating to working with depressed and suicidal Aboriginal people, and intentions to help an Aboriginal person who is suicidal. Content for youth attendees focused on knowledge of suicide and depression, coping skills, intentions to help a friend, and beliefs about suicide. While the results demonstrated significant gains across most domains, there was a potentiating effect with some skills increases becoming more significant over each phase. This demonstrates that a whole of community approach to Indigenous suicide prevention is required, and that clinical and cultural skills require a longer-term approach for impact and sustainability.

Background: Despite increasing investment in suicide prevention, Australian suicide rates have increased steadily in the past decade. In response to growing evidence for multicomponent intervention models for reducing suicide, the LifeSpan model has been developed as the first multicomponent, evidence-based, system-wide approach to suicide prevention in Australia. The LifeSpan model consists of nine evidence-based strategies. These include indicated, selective and universal interventions which are delivered simultaneously to community and healthcare systems over a 2-year implementation period. This study will evaluate the effectiveness of the LifeSpan model in reducing suicide attempts and suicide deaths in four geographically defined regions in New South Wales, Australia.

Methods: We outline the protocol for a stepped-wedge, cluster randomized controlled trial. Following a 6-month transition phase, the trial sites will move to the 2-year active implementation phase in 4-monthly intervals with evaluation extending a minimum of 24 months after establishment of the full active period. Analysis will be undertaken of the change attributable to the invention across the four sites. The primary outcome for the study is the rate of attempted suicide in the regions involved. Rate of suicide deaths within each site is a secondary outcome.

Discussion: If proven effective, the LifeSpan model for suicide prevention could be more widely delivered in Australian communities, providing a valuable new approach to tackle rising suicide rates. LifeSpan has the potential to significantly contribute to the mental health of Australians by improving help-seeking for suicide, facilitating early detection, and improving aftercare to reduce re-attempts. The findings from this research should also contribute to the evidence base for multilevel suicide prevention programs internationally.

Background: Indigenous Australians experience a suicide rate over twice that of the general population. With nonfatal deliberate self-harm (DSH) being the single most important risk factor for suicide, characterizing the incidence and repetition of DSH in this population is essential.

Aims: To investigate the incidence and repetition of DSH in three remote Indigenous communities in Far North Queensland, Australia.

Method: DSH presentation data at a primary health-care center in each community were analyzed over a 6-year period from January 1, 2006 to December 31, 2011.

Results: A DSH presentation rate of 1,638 per 100,000 population was found within the communities. Rates were higher in age groups 15–24 and 25–34, varied between communities, and were not significantly different between genders; 60% of DSH repetitions occurred within 6 months of an earlier episode. Of the 227 DSH presentations, 32% involved hanging. Limitations: This study was based on a subset of a larger dataset not specifically designed for DSH data collection and assesses the subset of the communities that presented to the primary health-care centers.

Conclusion: A dedicated DSH monitoring study is required to provide a better understanding of DSH in these communities and to inform early intervention strategies.

Background: Suicide amongst Australian Aboriginal and Torres Strait Islander communities occurs at twice the rate of the general population and, with significant barriers to treatment, help-seeking prior to a suicide attempt is low. This trial aims to test the effectiveness of an app (iBobbly) designed with Aboriginal and Torres Strait Islander people for reducing suicidal ideation.

Methods/Design: This is a two-arm randomised controlled trial that will compare iBobbly to a wait-list control condition. The trial aims to recruit Aboriginal and Torres Strait Islander participants aged 16 years and over to test iBobbly, which is a self-help app delivering content based on acceptance and commitment therapy. The primary outcome for the study is suicidal ideation, and secondary outcomes include depression, hopelessness, distress tolerance, perceived burdensomeness and thwarted belonging, and help-seeking intentions. Data will be collected for both groups at baseline, post-intervention (after 6 weeks of app use), and at 6 months post-baseline (with a final 12-month follow-up for the iBobbly group). Primary analysis will compare changes in suicidal ideation for the intervention condition relative to the wait-list control condition using mixed models. An examination of the cost-effectiveness of the intervention compared to the control condition will be conducted.

Discussion: If effective, iBobbly could overcome many barriers to help-seeking amongst a group of people who are at increased risk of suicide. It may provide a low-cost, accessible intervention that can reach more people. This trial will add to a sparse literature on indigenous suicide prevention and will increase our knowledge about the effectiveness of e-health interventions for suicide prevention.

This systematic review analyses research measuring or evaluating primary health care interventions that focused on improving the mental health of Indigenous children via intersectoral service integration processes and tools. Of the eleven studies included five were conducted with Indigenous children (aged 4 to 17 years) in Australia, the remaining studies included New Zealand, Canada, Norway and/or the United States. Among the nine key strategies adopted by service integration interventions of note were: Engaging the members of the Indigenous community; Empowerment of families; Adapting interventions and care to the specific socio-cultural circumstances; and Cultural strengthening and empowerment of Indigenous children’s identity.  Six factors enabling effective implementation of service integration included: Including and involving the community and stakeholders, Sensitivity to culture, including to historical background and inter-generational trauma, Multi-disciplinary and collaborative health services and Resourcing factors (e.g. funding, costs, time availability, staff/organisation capacity). The authors conclude that while the research evidence for interventions focused on improving the mental health of Indigenous children via intersectoral service integration is preliminary the findings hold potential. Importantly, the main outcomes where strategies focused on intersectoral integration were: Improvements in children’s psychosocial functioning, stress management, and individual empowerment; Improvements in health service access and use; Empowerment of both families and communities; and Increased links and collaboration between the community and health services. The authors identify the need for further research, particularly to incorporate Indigenous voices in evaluation, help clarify impact, and to evaluate costs.

Suicide and self-harm represent serious global health problems and appear to be especially elevated amongst indigenous (sic) minority groups, and particularly amongst young people (aged 24 years or younger). This systematic review investigates for the first time the antecedents and prevalence of suicide, self-harm and suicide ideation among Australian Aboriginal and Torres Strait Islander youth. Web of Science, PubMed, PsychINFO, CINAHL databases and grey literature were searched from earliest records to April 2019 for eligible articles. Twenty-two empirical articles met the inclusion criteria. The data confirmed that indigenous (sic) youth in Australia have elevated rates of suicide, self-harm and suicidal ideation relative to the non indigenous (sic) population. Risk factors included being incarcerated, substance use and greater social and emotional distress. Notably, though, information on predictors of suicide and self-harm remains scarce. The findings support and justify the increasing implementation of public health programs specifically aimed at tackling this crisis. Based on the review findings, we argued that Aboriginal communities are best positioned to identify and understand the antecedents of youth self-harm, suicide ideation and suicide, and to take the lead in the development of more effective mental health preventive strategies and public policies within their communities.

All available data suggest that, like many other indigenous peoples, Australian Aborigines (sic) are significantly more likely to kill themselves than are non-Aboriginal Australians. This statistical disparity is normally positioned an objective, ontological and undeniable social fact, a fact best explained as a function of endemic community disadvantage and disenfranchisement. This research explores the possibility that higher-than-normal Aboriginal suicide rates may also be a function of coronial decision-making practices. Based upon in-depth interviews with 32 coroners from across Australia, the following conclusions emerged from the data. First, coroners have differing perceptions of Indigenous capacity, and are less likely to have concerns about intent when the suicide is committed by an Indigenous person. Second, coroners have identified divergent scripts of Indigenous suicide, particularly its spontaneity and public location, and this supports rather than challenges, a finding of suicide. Third, the coronial perception of Indigenous life is a factor which influences a suicide determination for Indigenous deaths. Finally, the low level of Indigenous engagement with the coronial system, and the unlikelihood of a challenge to the finding of suicide by Indigenous families, means that a coronial determination of suicide is more likely.

Background: Suicide is a leading cause of death among Indigenous Australians. Friends, family and frontline workers (for example, teachers, youth workers) are often best positioned to provide initial assistance if someone is suicidal. Culturally appropriate expert consensus guidelines on how to provide mental health first aid to Australian Aboriginal and Torres Strait Islander persons who are experiencing suicidal thoughts or behaviour were developed in 2009. This study describes the re-development of these guidelines to ensure they contain the most current recommended helping actions.

Methods: The Delphi consensus method was used to elicit consensus on potential helping statements to be included in the guidelines. These statements describe helping actions that Indigenous community members and non- Indigenous frontline workers can take, and information they should have, to help someone who is experiencing suicidal thoughts or displaying suicidal behaviour. A panel was formed, comprising 27 Aboriginal and Torres Strait Islander people who have expertise in Indigenous suicide prevention. The panellists were presented with the helping statements via online questionnaires and were encouraged to suggest re-wording of statements and any additional helping statements that were not included in the original questionnaire. Statements were only accepted for inclusion in the guidelines if they were endorsed by ≥90% of panellists as essential or important.

Results: From a total of 301 statements shown to the expert panel, 172 were endorsed as helping statements to be including in the re-developed guidelines.

Conclusions: Aboriginal and Torres Strait Islander suicide prevention experts were able to reach consensus on appropriate strategies for providing mental health first aid to an Aboriginal or Torres Strait Islander person experiencing suicidal thoughts or behaviour. The re-development of the guidelines has resulted in more comprehensive guidance than the earlier version, for which the panel had rated 166 helping statements and had endorsed 52. These re-developed guidelines can be used to inform Indigenous suicide gatekeeper training courses.

Background: Little is known of the appropriateness of existing gatekeeper suicide prevention programs for Indigenous communities. Despite the high rates of Indigenous suicide in Australia, especially among Indigenous youth, it is unclear how effective existing suicide prevention programs are in providing appropriate management of Indigenous people at risk of suicide.

Methods: In-depth, semi-structured interviews and focus groups were conducted with Indigenous communities in rural and regional areas of Southern Queensland. Thematic analysis was performed on the gathered information.

Results: Existing programs were time-intensive and included content irrelevant to Indigenous people. There was inconsistency in the content and delivery of gatekeeper training. Programs were also not sustainable for rural and regional Indigenous communities.

Conclusions: Appropriate programs should be practical, relevant, and sustainable across all Indigenous communities, with a focus on the social, emotional, cultural and spiritual underpinnings of community wellbeing. Programs need to be developed in thorough consultation with Indigenous communities. Indigenous-led suicide intervention training programs are needed to mitigate the increasing rates of suicide experienced by Indigenous peoples living in rural and remote locations.

Background: Suicide is a leading cause of death among Indigenous youth worldwide. The aim of this literature review was to determine the cultural appropriateness and identify evidence for the effectiveness of current gatekeeper suicide prevention training programs within the international Indigenous community.

Method: Using a systematic strategy, relevant databases and targeted resources were searched using the following terms: ‘suicide’, ‘gatekeeper’, ‘training’, ‘suicide prevention training’, ‘suicide intervention training’ and ‘Indigenous’. Other internationally relevant descriptors for the keyword “Indigenous” (e.g. “Maori”, “First Nations”, “Native American”, “Inuit”, “Metis” and “Aboriginal”) were also used.

Results: Six articles, comprising five studies, met criteria for inclusion; two Australian, two from USA and one Canadian. While pre and post follow up studies reported positive outcomes, this was not confirmed in the single randomised controlled trial identified. However, the randomised controlled trial may have been underpowered and contained participants who were at higher risk of suicide pre-training.

Conclusion: Uncontrolled evidence suggests that gatekeeper training may be a promising suicide intervention in Indigenous communities but needs to be culturally tailored to the target population. Further RCT evidence is required.

Aboriginal people in Australia take their lives at rates that are twice that of non-Aboriginal people (Australian Bureau of Statistics,  2012). Although there is a National Strategy for the prevention of Aboriginal suicide (Australian Government, 2013), there is currently little evidence on effective suicide prevention strategies (Ridani et al., 2015>). This is probably due to several reasons. For instance, Aboriginal suicidology is considered different from that of suicidology of mainstream populations (Elliott-Farrelly, 2004) and hence requires a unique approach. Factors associated with Aboriginal suicide are remarkably complex and almost always include intergenerational trauma, grief and loss (Australian Government, 2013) as well as obstacles to seeking help (Isaacs, Sutton, Hearn, Wanganeen, & Dudgeon, 2016). Furthermore, factors that may promote social and emotional well-being such as social connectedness and strengthening family bonds (Hunter & Milroy, 2006; Tsey, Patterson, Whiteside, Baird, & Baird, 2002) require a whole of community effort with substantial support from mainstream stakeholders.

This special issue was proposed to showcase small but significant community models that were developed to address the problem of Aboriginal suicide in Australia that have the potential to make a difference to the current suicide prevention landscape. Nonetheless, it is becoming increasingly clear that for any meaningful change to occur, mainstream services and Aboriginal communities need to ‘work together’ (Dudgeon, Milroy, & Walker, 2014; Sheldon, 2001). Currently there is some way to go before this can be achieved.

Background: Understanding and encouraging social and emotional well-being (SEWB) among Indigenous adolescents is vital in countering the impacts of colonisation and intergenerational trauma. As self-harm and suicidality are considered markers of poor SEWB among Indigenous communities, we aimed to identify the individual-level and community-level factors protecting Indigenous adolescents from self-harm and suicidality.

Methods: Data came from Footprints in Time—The Longitudinal Study of Indigenous Children (waves 10 and 11), conducted among Indigenous families across Australia. A strengths-based analysis fitted multilevel logistic regression to explore associations with factors proposed as protective against self-reported self-harm and suicidality among Indigenous adolescents.

Results: Our study cohort included 365 adolescents with complete data for the variables of interest. Adolescents had a mean (SD) age of 14.04 (0.45) years and a sex ratio of almost 1:1, and most were attending school (96.2%). Previous self-harm was reported by 8.2% (n = 30); previous suicidality was reported by 4.1% (n = 15). Individual-level factors protecting against self-harm and suicidality were being male, living in a cohesive family, and having low total Strengths and Difficulty Questionnaire scores (p < 0.05 for all). Residing in major cities compared with regional/remote areas was protective against self-harm (OR 5.94, 95% CI 1.31–26.81). Strong cultural identity was not found to be a protective factor against self-harm and/or suicidality in the sample.

Conclusions: This study identified key individual- and community-level factors that can protect Australian Indigenous adolescents against self-harm and suicidality, particularly family cohesion. Identifying strengths for this at-risk population can inform prevention strategies, particularly for rural living adolescents with high distress.

Objective: To describe a community developed Aboriginal model for early identification and referral of people with psychological distress and suicidal ideation.

Method:  A description of an Aboriginal mental health service model is presented, as established at the Njernda Aboriginal Corporation, Echuca, Victoria.

Results: The model is presented under five headings: Setting; Recruitment and appointment of Voluntary Trained Support Persons; Identifying persons at risk; Follow-up and referral by Voluntary Trained Support Persons; Expansion and Sustainability.

Conclusions: The Jekkora group model is in its early stages of implementation and no evaluation data are available on its outcomes. However, the model has potential to enable early identification, treatment and follow-up support for Aboriginal people in distress that is undisclosed. Factors that support its acceptability in the community are that the model was developed by Aboriginal people for their community. The network of voluntary trained and untrained support persons might help strengthen bonds and build resilience in the community.

Implications: The principles used in this model can be used to develop models for suicide prevention in other settings.

Connections to community are an important source of resilience for Indigenous Australians. Previous research has shown that being connected to community builds a sense of cultural identity which can reduce suicide. Although clinically based evidence is vital to targeted interventions with at-risk individuals, an understanding of social determinants of suicide is increasingly important in developing prevention strategies, interventions, and initiatives that connect people to community support.

Based on a review of literature from scholarly articles, government reports and grey literature, the authors establish that strong and healthy connections to community protect people from suicide. The paper discusses several protective factors resulting from community connection that work to prevent suicide by strengthening resilience and increasing social and emotional wellbeing. It also identifies approaches that do not work to prevent suicide among Indigenous Australians, gaps in research on this topic and concludes with several recommendations for further research.

Most of the evidence for suicide and suicide-related behaviour in the community is not reported or monitored, so the national and international evidence base for suicide prevention policies and programs is underdeveloped. The way evidence is defined may also exclude some successful interventions for Aboriginal and Torres Strait Islander people. The development of practice-based evidence complements evidence-based practice as it recognises the complexity of the system in which suicide interventions take place. It also allows the intervention to become embedded in the community organically and has the potential to achieve holistic and long-term positive change. Complex interventions such as suicide prevention initiatives are best evaluated using a realist review and narrative synthesis approach to understand the success or otherwise of such initiatives.

Dudgeon believesDudgeon believes many lessons can be learned about grief and trauma from the loss of land and culture that Aboriginal people have experienced. She says psychology can move away from the Western tradition of expert and patient, towards a more narrative form based on Aboriginal traditions and reconnecting with the land. And as more psychologists begin to incorporate these Aboriginal concepts into their practice, such a combined approach might help farmers dealing with drought to reconnect with the land and improve their mental health, too.

A strong sense of responsibility to the land, of being “custodians of the land we live on”, is intrinsic to Australian Aboriginal culture. It means looking after the water and the land for the next generation. But climate change has made the weather chaotic, with drier winters and erratic or failing rains, especially in the south and east. No one can remember it being so dry, so little water in the dams and creeks. Many of Australia’s iconic gum trees have failed to flower.

Water is a symbol of knowledge in at least one Aboriginal culture. In languages of the Northern Territory, the word ‘ganma’ means a place where salt water and fresh water meet. It is used as a metaphor for different people coming together to share knowledge and reach mutual understanding. It’s also the basis of what Aboriginal people call ‘yarning’ – sitting in a circle on the ground, sharing stories.

The mental health system in Australia is undergoing significant change. Reforms such as the National Disability Insurance Scheme (NDIS), the Fifth National Mental Health and Suicide Prevention Plan (Fifth Plan), Primary Health Networks (PHNs) and activities in suicide prevention are all occurring simultaneously. These reforms are ambitious in their scope. They are also interrelated which adds to the complexity of their implementation, and it will take time before their implementation leads to sustained change for consumers and carers.

In response to the Royal Commission into Institutional Responses to Child Sexual Abuse this report sets out a culturally based healing framework for understanding and responding to trauma experienced by Aboriginal and Torres Strait Islander people who as children were sexually abused within public or private institutions. The report draws on the views of Aboriginal and Torres Strait Islander survivors and service providers involved in healing work, the work of the Healing Foundation and the broader literature on trauma and healing. It provides a cultural perspective on the incidence of child sexual abuse in this context, the nature and impact of trauma, healing strategies and practices, and healing responses.

This report presents the recommendations and outcomes from the national roundtable Empowering Aboriginal and Torres Strait Islander people through the Family Wellbeing Program. The Family Wellbeing Program is an effective social and emotional wellbeing program originally developed and delivered by and for Aboriginal people. The objective of the program is to develop people’s skills and capacity to move from a position of disempowerment to empowerment. It aims to empower Aboriginal and Torres Strait Islander people with a way to control and change their lives.

This report presents a wellbeing framework designed to assist healthcare services to improve the quality of life and quality of care, as well as the health outcomes, for Aboriginal and Torres Strait Islander peoples living with chronic disease. Guided by a national reference group, the framework incorporates physical and social, emotional, cultural and spiritual aspects of health and wellbeing.

This review summarises existing research on healing internationally and nationally, highlighting what constitutes an effective Aboriginal and Torres Strait Islander healing process. This evidence enables the identification of what constitutes an effective healing program and the gaps in our knowledge that can inform future evaluation and research priorities. The literature revealed that to be successful, a healing program needs to be created within the local context; respond to needs identified by local community members and be supported by the local community. Sustainability needs to be multi-level and include development and transfer of knowledge and resources. This includes strong evaluation frameworks that are consistent with an Aboriginal and Torres Strait Islander world view.  The literature review has provided an inter-country context for healing that clearly demonstrates what constitutes an effective healing program; the interface between healing and health and the need for quality evaluations that incorporate Aboriginal knowledge systems. The depth of this material enables the Healing Foundation to identify a clear pathway to building and developing the evidence of healing into the future.

Trauma is associated with an increased likelihood of experiencing suicidality, indicating the need for and potential value of trauma-informed suicide prevention strategies. The aim of this study is to systematically review published literature regarding trauma-informed approaches for suicide prevention, and the impact on suicide outcomes. Systematic searches were conducted in eight databases (Medline, Embase, PsycInfo, Emcare, Nursing, and JBI in the Ovidplatform; as well as ProQuest Psychology Database and The Cochrane Library) in March 2022, with no publication date limit. Four studies met the inclusion criteria: two randomized controlled trials and two quasi-experimental studies. Two studies reported reductions in ideation, intent, and behaviour among youth and a cultural minority group. Few studies directly reporting suicide outcomes were identified, all were quantitative, and heterogeneity prevents generalizability across population groups. Currently, there is limited evidence focusing specifically on trauma-informed suicide prevention across the lifespan. Additional research, incorporating lived experience voices, is needed to understand the potential of this approach, as well as how mental health nurses can incorporate these approaches into their practice.

Indigenous young people in Canada are disproportionately overrepresented in suicide rates and alarmingly, young children are accounted for in these disparities. Since children spend much of their day at school, schools are a vital context for suicide prevention, identification, and intervention. However, research indicates that educators often report that they feel unprepared to address mental health challenges within the classroom. Indigenous communities are developing community driven responses to suicide that are culturally relevant and strengths based. It is critical that these models are considered when developing such suicide prevention within schools as they diverge from medicalized focused approaches and attend to broader social dimensions. It is imperative that educators and the education system are properly equipped with the training and resources to provide suicide prevention within schools and communities servicing Indigenous children. School psychologists can play an important role in providing this prevention leadership. Through interviews with educators, we learned about the types of supports that are needed within schools to address Indigenous child suicide, and in what ways school psychologists could enhance prevention efforts. Using a reflexive approach to thematic analysis, we identified four main themes related to support needed. Findings are discussed in conversation with the current state of child specific suicide and suicide prevention literature. Applied implications for suicide prevention within schools for Indigenous children, as well as future research and community-based recommendations are considered.

Background: Indigenous peoples of Canada, United States, Australia, and New Zealand experience disproportionately high rates of suicide as a result of the collective and shared trauma experienced with colonization and ongoing marginalization. Dominant, Western approaches to suicide prevention—typically involving individual-level efforts for behavioural change via mental health professional intervention—by themselves have largely failed at addressing suicide in Indigenous populations, possibly due to cultural misalignment with Indigenous paradigms. Consequently, many Indigenous communities, organizations and governments have been undertaking more cultural and community-based approaches to suicide prevention. To provide a foundation for future research and inform prevention efforts in this context, this critical scoping review summarizes how Indigenous approaches have been integrated in suicide prevention initiatives targeting Indigenous populations.

Methods: A systematic search guided by a community-based participatory research (CBPR) approach was conducted in twelve electronic bibliographic databases for academic literature and six databases for grey literature to identify relevant articles. the reference lists of articles that were selected via the search strategy were hand-searched in order to include any further articles that may have been missed. Articles were screened and assessed for eligibility. From eligible articles, data including authors, year of publication, type of publication, objectives of the study, country, target population, type of suicide prevention strategy, description of suicide prevention strategy, and main outcomes of the study were extracted. A thematic analysis approach guided by Métis knowledge and practices was also applied to synthesize and summarize the findings.

Results: Fifty-six academic articles and 16 articles from the grey literature were examined. Four overarching and intersecting thematic areas emerged out of analysis of the academic and grey literature: (1) engaging culture and strengthening connectedness; (2) integrating Indigenous knowledge; (3) Indigenous selfdetermination; and (4) employing decolonial approaches.

Conclusions: Findings demonstrate how centering Indigenous knowledge and approaches within suicide prevention positively contribute to suicide-related outcomes. Initiatives built upon comprehensive community engagement processes and which incorporate Indigenous culture, knowledge, and decolonizing methods have been shown to have substantial impact on suicide-related outcomes at the individual- and community-level. Indigenous approaches to suicide prevention are diverse, drawing on local culture, knowledge, need and priorities.

Indigenous peoples experience high rates of suicide from historical and ongoing colonization. This systematic review examines the effectiveness, involvement of Indigenous peoples, and cultural content of interventions addressing suicide among Indigenous adults in Canada, the United States, New Zealand, and Australia. Through a systematic search of scholarly articles and grey literature, 10 articles met the inclusion criteria. In nine studies, Indigenous people made decisions at the study design level and implemented and delivered research activities, and eight studies included cultural content. There were statistically significant reductions in suicide outcomes in four studies, and in self-harm and hopelessness in two studies each. Study quality was largely weak (n = 9) or moderate (n = 1). There is a paucity of high-quality data on interventions addressing suicide among Indigenous adults and strengthened reporting of health research involving Indigenous peoples in interventions.

Suicide and self-harm are major health and societal issues worldwide, but the greatest burden of both behaviours occurs in low-income and middle-income countries. Although rates of suicide are higher in male than in female individuals, self-harm is more common in female individuals. Rather than having a single cause, suicide and self-harm are the result of a complex interplay of several factors that occur throughout the life course, and vary by gender, age, ethnicity, and geography. Several clinical and public health interventions show promise, although our understanding of their effectiveness has largely originated from high-income countries. Attempting to predict suicide is unlikely to be helpful. Intervention and prevention must include both a clinical and community focus, and every health professional has a crucial part to play.

The ongoing challenge of American Indian and Alaska Native (AIAN) youth suicide is a public health crisis of relatively recent historical origin inadequately addressed by contemporary prevention science. A promising development in AIAN suicide prevention highlights the role of protective factors. A protective factor framework adopts a social ecological perspective and community-level intervention paradigm. Emphasis on protection highlights strength-based AIAN cultural strategies in prevention of youth suicide. Attention to multiple intersecting levels incorporates strategies promoting community as well as individual resilience processes, seeking to influence larger contexts as well as individuals within them. This approach expands the scope of suicide prevention strategies beyond the individual level and tertiary prevention strategies. Interventions that focus on mechanisms of protection offer a rigorous, replicable, and complementary prevention science alternative to risk reduction approaches. This selected review critically examines recent AIAN protective factor suicide prevention science. One aim is to clarify key concepts including protection, resilience, and cultural continuity. A broader aim is to describe the evolution of this promising new framework for conducting primary research about AIAN suicide, and for designing and testing more effective intervention. Recommendations emphasize focus on mechanisms, multilevel interactions, more precise use of theory and terms, implications for new intervention development, alertness to unanticipated impacts, and culture as fundamental in a protective factors framework for AIAN suicide prevention. A protective factor framework holds significant potential for advancing AIAN suicide prevention and for work with other culturally distinct suicide disparity groups, with broad implications for other areas of prevention science.

Background: Complex interacting social, economic and historical factors influence the availability and uptake of alcohol and drugs, including among Indigenous communities. Self-harm and suicide as well as homelessness and incarceration, can both precede and result from drug and alcohol use. Rates of self-harm, suicide and incarceration among Aboriginal and Torres Strait Islander people in Australia are among the highest in the world and drug and alcohol treatment programs need to address these underlying complexities. This study examines whether an ‘holistic’ residential drug and alcohol treatment program for adolescents, with over 30% of clients identifying as Aboriginal and Torres Strait Islander, can improve outcomes post-discharge, including reducing self-harm, suicide attempts, arrests and alcohol and drug use. The program addresses substance use, mental health, employment, accommodation, social/community and family life. Program admission and 3 months’ post-discharge data from 2007 to 2016 were analysed.

Results: From 2007 to 2016, 619 Aboriginal and Torres Strait Islander young people were admitted to the program; 247 stayed in the program for 30 days or more; 89 were successfully followed up three months post-discharge to determine whether there was a significant improvement from baseline using the McNemar’s Test and the Wilcoxon Signed Ranks Test. On admission, 18 people (20%) of the study population reported attempting suicide in the last 3 months and 23 people (30%) reported self-harm. Most had been engaged in the criminal justice system, with 67 people (75%) having been to court and 62 people (70%) arrested one or more times in the past 3 months, with 35 people (41%) in unstable housing, reporting having lived in three or more places in the previous 6 months. At 3 months post-treatment, all (n = 18) who reported suicide attempts in the 3 months prior to admission reported no attempts in the prior 3 months at follow-up. There was also a significant reduction in self-harm with 23 young people out of the 27 who reported self-harm at baseline not reporting self-harm at follow up (85%) and in the proportion of adolescents who reported using cannabis, amphetamines and alcohol, as well as a reduction in the proportion who reported being arrested.

Conclusions: The findings provide support for an ‘holistic’ residential treatment program as an approach to improve health and related outcomes for Aboriginal and Torres Strait Islander young people. In addition to a focus on multiple aspects of a young person’s life in treatment, culturally relevant modes of treatment and support should be a future focus to further strengthen programs when Aboriginal and Torres Strait Islander young people are over-represented in the client group.

Recent studies introduced the suicide crisis syndrome (SCS), a condition associated with imminent suicidal behavior and characterized by (a) a pervasive feeling of entrapment in which the escape from an unbearable life situation is perceived as both urgent and impossible (Criterion A) and (b) affective disturbance, loss of cognitive control, hyperarousal, and social withdrawal (Criterion B). The goal of the present study was to use some of the analytic tools provided by network analyses to further the understanding of the psychological, emotional, cognitive, behavioral, and physiological processes involved in the SCS by testing (a) whether the different symptoms of the proposed syndrome are related to each other, (b) whether symptoms form meaningful clusters, and (c) whether certain symptoms are more central than others. The study included 500 outpatient and 223 inpatient participants. A network analysis of the participants’ scores on the various symptoms of the SCS was conducted. The network analysis suggested that most SCS symptoms are linked by strong connections and that entrapment and ruminative flooding are highly correlated with the other SCS symptoms. Three clusters of symptoms were identified, suggesting the existence of several interdependent psychological processes potentially involved in SCS phenomenology. Our findings support both the suggested symptoms of the SCS and the central role of entrapment in the proposed criteria for the syndrome. Emotional pain appears to be closely linked to entrapment and may belong in Criterion A.

The associations of individualistic versus collectivistic value orientations with suicidal ideation and attempts, attitudes towards suicide and towards suicidal individuals, and psychological distress were investigated across 12 nations (N = 5572 university students). We expected differential associations of value orientations with suicidal behavior and moderating effects of the prevailing value orientations in the various countries. Findings showed that intermediate levels of individualism appeared protective against suicide attempts across all investigated nations, but that, otherwise, there seemingly are no universal associations of individualism and collectivism with suicidal behaviors. High collectivism was associated with less suicidal ideation only in individualistic countries. Low individualism appeared to be a risk factor for suicidal ideation specifically in Muslim collectivistic cultures, whereas high individualism in Asian collectivistic cultures. Collectivistic values are uniformly associated with less permissive attitudes to suicide, whereas individualistic values with a more stigmatized view of suicidal behavior. Both individualistic and collectivistic values were associated with socially accepting attitudes to a suicidal peer, helping a suicidal friend, and emotional involvement. The associations of individualistic and collectivistic values with disapproving attitudes to suicidal disclosure were complex. Beliefs in punishment after death for suicide, seeing suicide as mental illness, and emotional involvement with a suicidal friend were lower in high-suicide-rate countries. These evidence patterns are discussed in the light of related research evidence, along with directions for future research in this area.

This article contextualises my perspectives of Indigenous knowledge within a cultural cosmology, used to address the suicide epidemic in an Indigenous community in the Far North Queensland Tropics of Australia. I use my personal narrative from the philosophical standpoint theory of an Indigenous female with first-hand experience of living under the residues of the Queensland Government Act (1897).

This paper presents the findings of a recently completed exploratory data gathering exercise on Māori suicide in Te Waipounamu (South Island of New Zealand). The data gathering exercise was conducted through Te Pūtahitanga o Te Waipounamu, the Whānau Ora commissioning agency in the South Island. Data from the Coronial Services of New Zealand and relevant information from the District Health Boards were explored for the South Island. In-depth interviews with whānau (families) and a pilot survey on mental wellbeing were also conducted. Results from the exercise indicate that whānau access suicide intervention health services only after a suicide incident or suicide attempt. On the whole, these health services generally use a clinical/health-based approach. Whānau, however, pointed out that a culturally grounded whole-of-whānau approach is required to address issues around mental health and suicide, particularly among young whānau. Strengthening and maintaining cultural relational ties, networks, and whānau connections have been consistently identified by whānau in Te Waipounamu as important not only for Māori mental and emotional wellbeing more generally, but also for preventing suicide.

Background: Suicide is the second leading cause of death among adolescents worldwide, and is a major driver of health inequity among Indigenous people in high-income countries. However, little is known about the burden of suicide among Indigenous populations in low- and middle-income nations, and no synthesis of the global data is currently available. Our objective was to examine the global incidence of suicide among Indigenous peoples and assess disparities through comparisons with non-Indigenous populations.

Methods: We conducted a systematic review of suicide rates among Indigenous peoples worldwide and assessed disparities between Indigenous and non-Indigenous populations. We performed text word and Medical Subject Headings searches in PubMed, MEDLINE, Embase, Cumulative Index of Nursing and Allied Health (CINAHL), PsycINFO, Latin American and Caribbean Health Sciences Literature (LILACS), and Scientific Electronic Library Online (SciELO) for observational studies in any language, indexed from database inception until June 1, 2017. Eligible studies examined crude or standardized suicide rates in Indigenous populations at national, regional, or local levels, and examined rate ratios for comparisons to non-Indigenous populations.

Results: The search identified 13,736 papers and we included 99. Eligible studies examined suicide rates among Indigenous peoples in 30 countries and territories, though the majority focused on populations in high-income nations. Results showed that suicide rates are elevated in many Indigenous populations worldwide, though rate variation is common, and suicide incidence ranges from 0 to 187.5 suicide deaths per 100,000 population. We found evidence of suicide rate parity between Indigenous and non-Indigenous populations in some contexts, while elsewhere rates were more than 20 times higher among Indigenous peoples.

Conclusions: This review showed that suicide rates in Indigenous populations vary globally, and that suicide rate disparities between Indigenous and non-Indigenous populations are substantial in some settings but not universal. Including Indigenous identifiers and disaggregating national suicide mortality data by geography and ethnicity will improve the quality and relevance of evidence that informs community, clinical, and public health practice in Indigenous suicide prevention.

Objective: To undertake a systematic review of non‐suicidal self‐injury (NSSI) prevalence, patterns, functions, and behavioural correlates for the Indigenous populations of Australia (Aboriginal and Torres Strait Islanders) and New Zealand (NZ; Maori).

Method: We searched the following electronic databases: PubMed, MedLine, Scopus, Web of Science, ScienceDirect, PsycInfo, and PsycArticles, CINAHL, and the Informit Health and Indigenous Peoples collections. Studies were included for review if they were published within the last 25 years and reported on NSSI in Australia and NZ’s Indigenous populations.

Results: Seven studies were included, six of which came from Australia. The prevalence of NSSI in Australia ranged from 0.9% up to 22.50%; statistics varied by the different samples, types of prevalence, and relationship to alcohol. Several studies found that Aboriginal and Torres Strait Islander peoples had higher rates of NSSI than other Australians, but that this was not significantly higher. Two studies indicated that NSSI was linked to alcohol use, incarceration, and a younger age. The one NZ study was of injury and not specifically NSSI.

Conclusions: Findings are limited due to a small pool of literature. Cultural variations in NSSI presentation should be considered when working with Indigenous populations. Further research is required to help determine what cultural variations may exist.

This paper considers how Indigenous studies can inform the evolution of critical research on suicide. Aligned with critiques of mainstream suicidology, these methodological approaches provide a roadmap for structural analysis of complex systems and logics in which the phenomenon of suicide emerges. Moving beyond mere naming of social determinants of suicide and consistent with calls for a theory of justice within suicide research, Indigenous studies helps to advance conceptual knowledge of suicide in descriptive means and enhance ethical responses to suicide beyond psychocentric domains. Through centering Indigenous theories of affect, biosociality, and land-based relations, this article examines what new knowledge of suicide can emerge, as well as what ethical responses are possible to suicide and to a world where suicide exists. This new knowledge can inform practices for critical suicide studies which are invested in resisting structural violence, nourish agency, dignity and freedom for those living and dying in often-unlivable presents, and enhancing livability for individuals, communities, and the environment living under shadows of empire. Implications for theory, ethics, and suicide research and prevention practice are considered.

While the last three decades have seen substantial investments in suicidology research within the Canadian context, rates of Indigenous deaths by suicide have remained relatively stable, and little remains known about effective means to reduce Indigenous deaths by suicide. A movement of critical suicidology scholars across health and social sciences is beginning to challenge the mainstream approach of suicidology research and suicide prevention, citing concerns about the ideological and epistemic foundations. In this article, the author highlights how these critiques are relevant to Indigenous contexts. Challenging a range of assumptions, the author considers the need to rethink the ideological foundations of research on Indigenous suicide. Finally, the author considers two methodological projects that are integral to forming a critical approach to Indigenous suicidology research and Indigenous suicide prevention praxis–culturally grounded research and decolonizing research.

In 2014, the first dedicated National Māori Suicide Prevention Programme: Waka Hourua was launched by Te Rau Matatini. One of its five streams was the operation of a National Coordination Centre for Māori Community Suicide Prevention. The major programme championed by the Centre included fostering Māori leadership, and building their capacity and capability to lead the development of whole of community plans. In drawing on what differentiates Waka Hourua from other programmes, it is the distinction of being privileged to work as informed insiders to Māori communities. This article provides an account of the Ko Au, Ko Koe, Ko Tātou Māori Suicide Prevention Community Programme and Māori Champions working in communities – the Pou Ārahi role.

Indigenous youth suicide incidence is high globally, and mostly involves young males. However, the Inuit of Arctic Canada have a suicide rate that is among the highest in the world (and ten times that for the rest of Canada). The author suggests that suicide increase has emerged because of changes stemming in part from the Canadian government era in the Arctic in the 1950s and 1960s. The effects of government intervention dramatically affected kin relations, roles, and responsibilities, and affinal/romantic relationships. Suicide is embedded in these relationships. The author also discusses the polarization between psychiatric and indigenous/community methods of healing, demonstrating that government-based intervention approaches to mental health are not working well, and traditional cultural healing practices often take place outside of the mainstream clinics in these communities. The main questions of the paper are: Who should control suicide prevention? What is the best knowledge base for suicide prevention?

In the National Inuit Suicide Prevention Strategy (NISPS), suicide is identified as “the most urgent challenge facing our people” (Inuit Tapiriit Kanatami, 2016, p. 4). Given the seriousness of the issue, and recognizing that more work is needed to mobilize Inuit knowledge for resilience and suicide prevention across Inuit Nunangat (one of the NISPS’s six priority areas), Inuit Tapiriit Kanatami (ITK) and the NISPS Working Group have a shared interest in:

• Developing a more complete picture of the actions and interventions currently in place to address the elevated rate of suicide across Inuit Nunangat;
• Gathering and sharing information about actions and interventions that appear to be effective/showing promise in addressing elevated rates of suicide among Inuit;
• Identifying opportunities to improve outcomes concerning suicide rates in Inuit Nunangat; and
• Identifying opportunities to effectively mobilize knowledge across the six areas noted above.

This report presents findings from an environmental scan that was undertaken to support these objectives. The scan involved a review of both grey and academic literature, and a series of key informant interviews with individuals who have experience working on suicide prevention and related initiatives across Inuit Nunangat. The literature review and interviews were organized around the following six topic areas:

1. Links between childhood adversity and suicide;
2. Promising practices with respect to addressing child sexual abuse across Inuit Nunangat;
3. Promising practices with respect to social emotional development in Inuit Nunangat;
4. Promising practices with respect to safe shelters focusing on children and youth within Inuit Nunangat;
5. Promising practices with respect to current supports for Inuit within the justice system with a specific focus addressing child sexual abuse; and
6. Promising practices with respect to parenting and family support programs.

Key informants were identified by ITK staff and the NISPS Working Group. 20 people were interviewed in total.

This review provides an overview of treatments for problem alcohol and other drug (AOD) use for Aboriginal and Torres Strait Islander people. It includes information on the available research and discusses core principles for providing treatment. The review outlines how effective mainstream treatment approaches can be adapted to be more suitable for Aboriginal and Torres Strait Islander ways of being or worldview. It also highlights that services, such as those offered by Aboriginal community controlled health organisations are in a unique position to offer culturally secure treatment approaches. The barriers to accessing treatment are discussed as well as recommendations for future strategic directions in service delivery such as collaboration and two-way learning.

This review is part of a suite of knowledge exchange products that includes a summary, video, and factsheet.

Aboriginal Australians have a fundamental human right to opportunities that lead to healthy and flourishing lives. While the impact of trauma on Aboriginal Australians is well-documented, a pervasive deficit narrative that focuses on problems and pathology persists in research and policy discourse. This narrative risks further exacerbating Aboriginal disadvantage through a focus on ‘fixing what is wrong’ with Aboriginal Australians and the internalising of these narratives by Aboriginal Australians. While a growing body of research adopts strength-based models, limited research has sought to explore Aboriginal flourishing. This conceptual paper seeks to contribute to a burgeoning paradigm shift in Aboriginal research, seeking to understand what can be learned from Aboriginal people who flourish, how we best determine this, and in what contexts this can be impactful. Within, we argue the case for a new approach to exploring Aboriginal wellbeing that integrates salutogenic, positive psychology concepts with complex systems theory to understand and promote Aboriginal wellbeing and flourishing. While deeper work may be required to establish the parameters of a strength-based, culturally aligned Aboriginal conceptualisation of positive psychology, we suggest the integration of Aboriginal and Western methodologies offers a unique and potent means of shifting the dial on seemingly intractable problems.

Indigenous communities shoulder a disproportionate burden of ill health compounded by climate change. In Australia, the oldest surviving cultures have adapted their ecological knowledge over millennia and across climatic ages. However, European colonization has severely curtailed Indigenous peoples’ ability to adjust to climate change. An effective response to the climate crisis requires decolonizing processes to reform our relationship with the planet. From an Australian Indigenous perspective, precursors for a self-determined and healthier future are justice, culture, and relationships. We review existing studies on Indigenous-led contemporary climate and health initiatives to assess these precursors. There are examples that highlight the need to attend to issues of restorative justice as the basis for respectful valuing of culture and genuine collaboration to address the climate crisis.

Progress has been sluggish, and social factors and access to major health service schemes need much more attention.

This study documents evaluation of the Her Tribe and His Tribe Aboriginal-designed empowerment pilot programs. The programs were designed to support Victorian Aboriginal people to strengthen mental health, social and emotional wellbeing, community connection, and to reduce psychological distress. A second aim was to explore participants’ experiences of the programs, including the feasibility and acceptability of the evaluation component. Her Tribe ran for 16 weeks and His Tribe for 12 weeks. In total, 43 women and 26 men completed assessments at pre- and post-program completion, and 17 and 10, respectively, participated in yarning circles at the 6-month follow up. For both programs, there were significant increases in participants’ access to personal strengths and resources, relationship–community–cultural strengths and resources, and decreases in psychological distress. These changes were associated with small to moderate effects that were maintained at the 6-month follow up. There was a significant increase in aerobic fitness for female but not male participants, and no significant changes in weight for either group. Participants described a range of benefits from the programs, including positive elements and areas for improvement. They also viewed the evaluation as feasible and acceptable, and the findings of value. The outcomes from both pilot programs provide evidence that Aboriginal-designed programs, with a focus on physical and cultural activities, can help to strengthen mental health and wellbeing, community connection, and reduce psychological distress in Victorian Aboriginal communities.

Objective: The excess burden of mental disorders experienced by Indigenous Australians is complexly overdetermined. Social and political factors contributing to the intransigence of vulnerability are reviewed, and the wider arena of neoliberal political change considered.

Conclusions: The dynamic relationship between disadvantage and mental health vulnerability requires that practitioners should be attuned to both the ‘big picture’ and ‘modest and practical ways’ to contribute to reducing the developmental embedding of social disadvantage and transgenerational vulnerability.

Objective: Discrimination and prejudice have significant implications for individuals and communities and are prevalent throughout the world towards marginalised groups. This study investigated the role of psychological sense of community (PSOC), values of self‐transcendence and openness‐to‐change, and demographic variables, with attitudes towards two different groups in Australia.

Method: A convenience sample of adults living in Australia (N = 396) was randomly assigned to complete one of two online surveys; reporting on their attitudes towards Australia’s First Nations People (N = 198), or towards people seeking asylum (N = 198). The study assessed the extent to which a PSOC (in reference to local, national, and global communities), self‐transcendence, and openness‐to‐change, predicted attitudes towards the two groups.

Results: Self‐transcendence and psychological sense of global community consistently predicted attitudes towards both groups, with psychological sense of global community partially mediating the relationship between self‐transcendence and attitudes. Bivariately, those holding a stronger local psychological sense of community reported more positive attitudes towards people seeking asylum, whereas those holding a stronger psychological sense of national community reported more positive attitudes towards Australia’s First Nations People. However, in multivariable regression models with self‐transcendence and demographic characteristics, only a higher psychological sense of national community significantly predicted more negative attitudes towards people seeking asylum.

Conclusions: This research suggests that where people have a strong sense they are part of a global community they hold more positive attitudes towards people from various cultures both near and far. The research has implications for social cohesion and social policy.

This article will build on the definition of social and emotional wellbeing (SEWB) used within an Indigenous health framework. We intend to distance it from its current discipline of mental health, the Eurocentric term commonly used in social science literature. This is to emphasize that, within Aboriginal (Rudder and Grant, 2005) and Torres Strait Islander, Maori, and First Nations (Canadian) languages, there is no specific word for “health.” Indigenous peoples from within these countries have a holistic view of health that encompasses the physical, mental, emotional, and environmental spectrum of wellbeing. This article therefore uses “social and emotional wellbeing” rather than the generic Eurocentric terms of “health” or “mental health” to give this a stronger Indigenous voice. The elements of social and emotional wellbeing are discussed from an Indigenous viewpoint and from extracts compiled in work undertaken by Sutherland (2017). The elements explored may offer new perspectives to others. Similarly, this article offers an explanation as to why elements are siloed within the context of mental and physical health. This has led to some parts of SEWB gaining advantages over others within policy and funding models.

Background: Racism is a pervasive experience in the life of Aboriginal Australians that begins in childhood. As a psychosocial stressor, racism compromises wellbeing and impacts developmental trajectories. The purpose of the present study was to estimate the effect of racism on indicators of Australian Aboriginal child socio-emotional wellbeing (SEWB) at one to two years after exposure. Age-related differences in the onset of symptoms were explored. Methods: Data from the B- and K-cohorts of the Longitudinal Study of Indigenous Children were used (aged 6 to 12 years). Racism, confounding variables, and the Strengths and Difficulties Questionnaire (a measure of SEWB) were collected by questionnaires and guided interviews with each child’s main caregiver. Adjusted Poisson regression was used to estimate the relative risk (RR) effects of racism on SEWB for both cohorts separately. RR were pooled in a random effects meta-analysis.

Results: Exposure to racism was associated with an adjusted point estimate indicating a 41% increased risk for total emotional and behavioural difficulties, although the confidence intervals were wide (pooled RR 1.41, 95% CI 0.75, 2.07). Analyses by cohort showed younger children had higher RR for total difficulties (RR 1.72, 95% CI 1.16, 2.54), whilst older children had higher RR for hyperactive behaviour (RR 1.66, 95% CI 1.01, 2.73).

Conclusions: The effects observed contributes to our understanding of the impact of racism on Aboriginal Australian children. Support for emotional and behavioural difficulties, and hyperactive behaviour, for Aboriginal children might help counteract the effects of racism. Future longitudinal research and policies aimed at reducing racism in Australian society are necessary.

Traditional languages are a key element of Indigenous peoples’ identity, cultural expression, autonomy, spiritual and intellectual sovereignty, and wellbeing. While the links between Indigenous language loss and poor mental health have been demonstrated in several settings, little research has sought to identify the potential psychological benefits that may derive from language reclamation. The revival of the Barngarla language on the Eyre Peninsula, South Australia, offers a unique opportunity to examine whether improvements in mental health and social and emotional wellbeing can occur during and following the language reclamation process. This paper presents findings from 16 semi-structured interviews conducted with Barngarla community members describing their own experienced or observed mental health and wellbeing impacts of language reclamation activities. Aligning with a social and emotional wellbeing framework from an Aboriginal and Torres Strait Islander perspective, key themes included connection to spirituality and ancestors; connection to Country; connection to culture; connection to community; connection to family and kinship; connection to mind and emotions; and impacts upon identity and cultural pride at an individual level. These themes will form the foundation of assessment of the impacts of language reclamation in future stages of the project.

Traditional languages are a key element of Indigenous peoples’ identity, cultural expression, autonomy, spiritual and intellectual sovereignty, and wellbeing. While the links between Indigenous language loss and poor mental health have been demonstrated in several settings, little research has sought to identify the potential psychological benefits that may derive from language reclamation. The revival of the Barngarla language on the Eyre Peninsula, South Australia, offers a unique opportunity to examine whether improvements in mental health and social and emotional wellbeing can occur during and following the language reclamation process. This paper presents findings from 16 semi-structured interviews conducted with Barngarla community members describing their own experienced or observed mental health and wellbeing impacts of language reclamation activities. Aligning with a social and emotional wellbeing framework from an Aboriginal and Torres Strait Islander perspective, key themes included connection to spirituality and ancestors; connection to Country; connection to culture; connection to community; connection to family and kinship; connection to mind and emotions; and impacts upon identity and cultural pride at an individual level. These themes will form the foundation of assessment of the impacts of language reclamation in future stages of the project.

There are significant health and social disparities between the world’s Indigenous and non-Indigenous people on factors likely to influence quality of life (QOL) and wellbeing. However, these disparities in wellbeing are not captured in conventional QOL instruments, as they often do not include dimensions that are likely to be relevant to Indigenous people. The objective of this comprehensive literature review was to identify these wellbeing domains for Aboriginal and Torres Strait Islander people in Australia (hereafter, respectfully referred to collectively as Indigenous Australians). We searched PsycINFO, MEDLINE, Econlit, CINAHL, and Embase (from inception to June 2017, and updated in March 2019), and grey literature sources using keywords relating to adult Indigenous Australians’ QOL and wellbeing. From 278 full-text articles assessed for eligibility, 95 were included in a thematic analysis. This synthesis revealed nine broad interconnected wellbeing dimensions: autonomy, empowerment and recognition; family and community; culture, spirituality and identity; Country; basic needs; work, roles and responsibilities; education; physical health; and mental health. The findings suggest domains of wellbeing relevant to and valued by Indigenous Australians that may not be included in existing QOL and wellbeing instruments, domains that may be shared with Indigenous populations globally. This indicates the need for a tailored wellbeing instrument that includes factors relevant to Indigenous Australians. Developing such an instrument will ensure meaningful, culturally-relevant measurement of Indigenous Australians’ wellbeing.

Objective: An expert reference group met on four occasions to consider ways forward in terms of Indigenous mental health. This paper summarises the discussion and recommendations.

Conclusion: While the negative effects of colonisation and trans-generational trauma continue, we propose renewed emphasis on improving access, cultural orientation and trauma-informed care, and a focus on the needs of young Indigenous Australians.

Objective: Addressing the continued health disparities between Australia’s Indigenous and non-Indigenous peoples requires a multi-sector approach in which the discipline of psychology has a central role. These disparities are partially driven by a lack of culturally appropriate methods of health delivery. This study aimed to explore urban Aboriginal and Torres Strait Islanders’ perceptions of health and wellbeing through social emotional wellbeing and strengths-based frameworks.

Methods: A qualitative study was conducted with 19 urban Australian Aboriginal and Torres Strait Islander people. Data was collected via individual semi-structured interviews and focus groups. Thematic analysis was conducted to identify strengths-based themes within the data.

Results: Several attributes and values emerged from participants’ understandings of enhancing mental health and wellbeing. These included acceptance, respect, forgiveness and integrity, honesty, courage, empathy, mindfulness, and spirituality.

Conclusions: There are similarities between the central tenets of the strengths and values-based frameworks and a model of social emotional wellbeing. It is important to note that these attributes and values are understood at the individual, community, and cultural level. Each of these attributes and values are intricately linked to being mentally healthy and having strong cultural identity. These similarities may provide an avenue for shared cross-cultural understandings and knowledges of mental health and well-being that will support culturally appropriate service delivery.

Aboriginal and Torres Strait Islander peoples are Australia’s first peoples and have been connected to the land for ≥65 000 years. Their enduring cultures and values are considered critical to health and wellbeing, alongside physical, psychological and social factors. We currently lack large-scale data that adequately represent the experiences of Aboriginal and Torres Strait Islander people; the absence of evidence on cultural practice and expression is particularly striking, given its foundational importance to wellbeing.

Lateral violence describes how members of oppressed groups direct their dissatisfaction inward. This inward deflection has been associated with the Aboriginal community in Adelaide, South Australia and has shown to be destructive. Interviews with 30 Aboriginal participants examining their ways of dealing with and strategising to prevent lateral violence in the community have been presented in a thematic analysis. Overall seven major interpretive themes emerged from these interviews: education is central; support provides unity; champions and role models are essential; culture and identity are empowering; avoidance of Aboriginal spaces by Aboriginal people can be protective; lateral violence can be challenged; and positively reinterpreted. Given that many participants drew on a number of coping strategies to deal with lateral violence, it is hoped that such information will benefit individuals, community, governments and funding agencies to support future research, education and services within communities in order for Aboriginal people to heal and prevent lateral violence.

Background: Wellbeing has been difficult to understand, measure and strengthen for Aboriginal people in remote Australia. Part of the challenge has been genuinely involving community members and incorporating their values and priorities into assessment and policy. Taking a ‘shared space’ collaborative approach between remote Aboriginal communities, governments and scientists, we merged Aboriginal knowledge with western science – by bringing together stories and numbers. This research aims to statistically validate the holistic Interplay Wellbeing Framework and Survey that bring together Aboriginal-identified priorities of culture, empowerment and community with government priorities including education, employment and health.

Method: Quantitative survey data were collected from a cohort of 842 Aboriginal people aged 15-34 years, recruited from four different Aboriginal communities in remote Australia. Aboriginal community researchers designed and administered the survey.

Results: Structural equation modeling showed good fit statistics (χ/df = 2.69, CFI = 0.95 and RMSEA = 0.045) confirming the holistic nature of the Interplay Wellbeing Framework. The strongest direct impacts on wellbeing were ‘social and emotional wellbeing’ (r = 0.23; p < 0.001), ‘English literacy and numeracy’ (r = 0.15; p < 0.001), ‘Aboriginal literacy’ (r = 0.14; p < 0.001), ‘substances’ (lack thereof; r = 0.13; p = 0.003), ‘work’ (r = 0.12; p = 0.02) and ‘community’ (r = 0.08; p = 0.05). Correlation analyses suggested cultural factors have indirect impacts on wellbeing, such as through Aboriginal literacy. All cultural variables correlated highly with each other, and with empowerment and community. Empowerment also correlated highly with all education and work variables. ‘Substances’ (lack thereof) was linked with positive outcomes across culture, education and work. Specific interrelationships will be explored in detail separately.

Conclusion: The Interplay Wellbeing Framework and Survey were statistically validated as a collaborative approach to assessing wellbeing that is inclusive of other cultural worldviews, values and practices. New community-derived social and cultural indicators were established, contributing valuable insight to psychometric assessment across cultures. These analyses confirm that culture, empowerment and community play key roles in the interplay with education, employment and health, as part of a holistic and quantifiable system of wellbeing. This research supports the holistic concept of wellbeing confirming that everything is interrelated and needs to be considered at the ‘whole of system’ level in policy approaches.

This article is based on a literature review that was conducted in 2013 as part of the NSW Aboriginal Grief and Loss Training Project funded by the NSW Ministry of Health and delivered by the NSW Institute of Psychiatry (see Appendix, 1.). A series of workshops and resources in Aboriginal grief and loss has been developed and delivered for Aboriginal Mental Health and Wellbeing Workers across NSW, to support them with working with grief and loss in their communities. The aim of the review was to examine the existing literature, training and resources on Australian Aboriginal grief and loss, identifying areas for further research, and to confirm the need for the project. Other Indigenous literature on grief and loss was not reviewed, due to limited resources.

Connections to community are an important source of resilience for Indigenous Australians. Previous research has shown that being connected to community builds a sense of cultural identity which can reduce suicide. Although clinically based evidence is vital to targeted interventions with at-risk individuals, an understanding of social determinants of suicide is increasingly important in developing prevention strategies, interventions, and initiatives that connect people to community support.

Based on a review of literature from scholarly articles, government reports and grey literature, the authors establish that strong and healthy connections to community protect people from suicide. The paper discusses several protective factors resulting from community connection that work to prevent suicide by strengthening resilience and increasing social and emotional wellbeing. It also identifies approaches that do not work to prevent suicide among Indigenous Australians, gaps in research on this topic and concludes with several recommendations for further research.

Most of the evidence for suicide and suicide-related behaviour in the community is not reported or monitored, so the national and international evidence base for suicide prevention policies and programs is underdeveloped. The way evidence is defined may also exclude some successful interventions for Aboriginal and Torres Strait Islander people. The development of practice-based evidence complements evidence-based practice as it recognises the complexity of the system in which suicide interventions take place. It also allows the intervention to become embedded in the community organically and has the potential to achieve holistic and long-term positive change. Complex interventions such as suicide prevention initiatives are best evaluated using a realist review and narrative synthesis approach to understand the success or otherwise of such initiatives.

Dudgeon believesDudgeon believes many lessons can be learned about grief and trauma from the loss of land and culture that Aboriginal people have experienced. She says psychology can move away from the Western tradition of expert and patient, towards a more narrative form based on Aboriginal traditions and reconnecting with the land. And as more psychologists begin to incorporate these Aboriginal concepts into their practice, such a combined approach might help farmers dealing with drought to reconnect with the land and improve their mental health, too.

A strong sense of responsibility to the land, of being “custodians of the land we live on”, is intrinsic to Australian Aboriginal culture. It means looking after the water and the land for the next generation. But climate change has made the weather chaotic, with drier winters and erratic or failing rains, especially in the south and east. No one can remember it being so dry, so little water in the dams and creeks. Many of Australia’s iconic gum trees have failed to flower.

Water is a symbol of knowledge in at least one Aboriginal culture. In languages of the Northern Territory, the word ‘ganma’ means a place where salt water and fresh water meet. It is used as a metaphor for different people coming together to share knowledge and reach mutual understanding. It’s also the basis of what Aboriginal people call ‘yarning’ – sitting in a circle on the ground, sharing stories.

The mental health system in Australia is undergoing significant change. Reforms such as the National Disability Insurance Scheme (NDIS), the Fifth National Mental Health and Suicide Prevention Plan (Fifth Plan), Primary Health Networks (PHNs) and activities in suicide prevention are all occurring simultaneously. These reforms are ambitious in their scope. They are also interrelated which adds to the complexity of their implementation, and it will take time before their implementation leads to sustained change for consumers and carers.

In response to the Royal Commission into Institutional Responses to Child Sexual Abuse this report sets out a culturally based healing framework for understanding and responding to trauma experienced by Aboriginal and Torres Strait Islander people who as children were sexually abused within public or private institutions. The report draws on the views of Aboriginal and Torres Strait Islander survivors and service providers involved in healing work, the work of the Healing Foundation and the broader literature on trauma and healing. It provides a cultural perspective on the incidence of child sexual abuse in this context, the nature and impact of trauma, healing strategies and practices, and healing responses.

This report presents the recommendations and outcomes from the national roundtable Empowering Aboriginal and Torres Strait Islander people through the Family Wellbeing Program. The Family Wellbeing Program is an effective social and emotional wellbeing program originally developed and delivered by and for Aboriginal people. The objective of the program is to develop people’s skills and capacity to move from a position of disempowerment to empowerment. It aims to empower Aboriginal and Torres Strait Islander people with a way to control and change their lives.

This report presents a wellbeing framework designed to assist healthcare services to improve the quality of life and quality of care, as well as the health outcomes, for Aboriginal and Torres Strait Islander peoples living with chronic disease. Guided by a national reference group, the framework incorporates physical and social, emotional, cultural and spiritual aspects of health and wellbeing.

This review summarises existing research on healing internationally and nationally, highlighting what constitutes an effective Aboriginal and Torres Strait Islander healing process. This evidence enables the identification of what constitutes an effective healing program and the gaps in our knowledge that can inform future evaluation and research priorities. The literature revealed that to be successful, a healing program needs to be created within the local context; respond to needs identified by local community members and be supported by the local community. Sustainability needs to be multi-level and include development and transfer of knowledge and resources. This includes strong evaluation frameworks that are consistent with an Aboriginal and Torres Strait Islander world view.  The literature review has provided an inter-country context for healing that clearly demonstrates what constitutes an effective healing program; the interface between healing and health and the need for quality evaluations that incorporate Aboriginal knowledge systems. The depth of this material enables the Healing Foundation to identify a clear pathway to building and developing the evidence of healing into the future.

Through colonisation in Australia, Western paradigms of health and mental health have dominated the discourse on mental health and excluded Indigenous knowledges, which consider wellbeing from a more holistic perspective. Aboriginal and Torres Strait Islander peoples (the Indigenous peoples of Australia) understand health through the Social and Emotional WellBeing model (SEWB), which considers the body and mind, as well as spiritual, cultural, kinship, community and physical dimensions, as well as the impact of historical, political, social, and cultural determinants on wellbeing. An inclusive science of wellbeing requires Western and Indigenous knowledges to be valued alongside each other, accepting their differences. In this chapter we will begin by outlining the path from colonisation toward the recognition of Indigenous knowledges, and we will describe the SEWB model and interventions developed using this model. Finally, we will provide an example of how the SEWB model can be operationalised for health and mental health settings, through the ‘Dance of Life’ framework, which uses the culturally relevant medium of art to facilitate discussion of holistic wellbeing.

This book highlights the health gap that exists between Indigenous and other Australians and proposes that one solution is to empower Indigenous Australians to take control of their own health and wellbeing. In particular, the book describes an Aboriginal family wellbeing model of empowerment which has been used successfully in programs across Australia. The book provides evidence for what can happen when communities accept change, and acknowledges the importance of future resourcing for empowerment programs which do make a difference in the lives of Indigenous Australians.

Indigenous psychology draws on the oldest continuing knowledge systems but remains largely ignored by dominant Western psychological theories and practices. This exclusion results in ongoing negative effects on Indigenous social and emotional wellbeing and requires urgent decolonization efforts.

This paper has two goals regarding cultural rigor, defined as privileging cultural ways of knowing and being as a means to achieving health and well-being for future generations. First, we move the continuum of health practices beyond cultural grounding to include Indigenous Culture-as-Health. Second, this project expands the concept of Indigenous Culture-as-Health in addiction and recovery to include a broader range of health, inclusive of prevention, to further understand this emerging model. Our review of the literature yielded an expanded cultural continuum that includes Indigenous Culture-as-Health, which appears to rely on four modalities: 1) Indigenous ways of knowing, 2) Indigenous cultural practices, 3) place-based/sacred sites, and 4) Indigenous spirituality. For Indigenous health, standards are defined by centuries of ancestral consciousness among Indigenous people across generations, in spite of settler-colonial systems that do not serve them. In other words, Indigenous Culture-as-Health practices contribute to self-determination, sovereignty, and liberation. Incorporating these strategies also will ameliorate other problems related to White supremacy and health, such as epistemic exploitation. Additional implications for prevention practice and policy are described.

Indigenous Peoples have resiliently weathered continued assaults on their sovereignty and rights throughout colonialism and its continuing effects. Indigenous Peoples’ sovereignty has been strained by the increasing effects of global environmental change within their territories, including climate change and pollution, and by threats and impositions against their land and water rights. This continuing strain against sovereignty has prompted a call to action to conceptualise the determinants of planetary health from a perspective that embodied Indigenous-specific methods of knowledge gathering from around the globe. A group of Indigenous scholars, practitioners, land and water defenders, respected Elders, and knowledge-holders came together to define the determinants of planetary health from an Indigenous perspective. Three overarching levels of interconnected determinants, in addition to ten individual-level determinants, were identified as being integral to the health and sustainability of the planet, Mother Earth.

Culturally safe and responsive interventions that acknowledge Aboriginal models of selfhood are needed. Such interventions empower Aboriginal peoples and communities by increasing self-determination over individual and community social and emotional wellbeing (SEWB). In response to this need, the National Empowerment Project developed the Cultural, Social, and Emotional Wellbeing Program (CSEWB). The CSEWB aims to strengthen SEWB and cultural identity and subsequently reduce psychological distress in Aboriginal peoples. An Aboriginal Participatory Action Research approach ensured community ownership and engagement. Seven research questions and a culturally modified adaption of the Most Significant Change technique informed a thematic analysis of the evaluation content. Aboriginal adults (n = 49; 53% ≥50 years, 66% female, 34% male) from three Western Australian urban communities participated in the program evaluation workshops. Participants reported the benefits of enhanced SEWB and reduced psychological distress. This research reaffirms the need for culturally safe programs that acknowledge social determinants of health and are guided by the SEWB framework. Long-term commitment from the government is needed to support such programs.

To understand the overrepresentation of First Nations peoples in the criminal justice system, we need to understand the historical context, together with unresolved contemporary issues of sovereignty, self-determination, and the need for truth-telling. In this article, we provide an overview of the current situation, we discuss the historical and contemporary contexts which contribute to the risk of young First Nations peoples coming into contact with the justice system, and we make recommendations for prevention and healing, from a First Nations perspective. Overall, we argue that offending behaviours lie at the end of a continuum of risk. This continuum includes exposure to intergenerational and current trauma within the historical context of genocide, and the ongoing issues of generational poverty, social disadvantage, and discrimination.

This supplement explores some of the critical opportunities that we need to focus on now to improve the health and wellbeing of all Australians over the coming decade. Chapter 1 takes us on a journey to 2030 where the status quo has been challenged and replaced with progressive, committed and genuine action to address the social determinants of health. Chapter 2 challenges our understanding and acknowledgement of culture as a key determinant of Aboriginal and Torres Strait Islander health and wellbeing. A call for collaborative and urgent evidence-based action to address urban planning for both human and planetary health is made in Chapter 3. Chapter 4 explores the ecological determinants of health, presenting threats to and opportunities for public health and health promotion. The commercial determinants of health and options for countering the negative practices of the private sector are discussed in Chapter 5. In Chapter 6 we look at the implications of the digital revolution for public health. Finally, in Chapter 7 we again fast forward to 2030 where transformative change in governance has occurred to achieve health, sustainability and equity outcomes and, ultimately, a better Australia.

Lifecourse studies examine ways to prevent ill-health, by determining how issues develop and when there are good periods in the lifecourse to intervene. For this reason, lifecourse findings and longitudinal data are increasingly being used to inform government policies and practice, regarding for whom, when, and how prevention and intervention programmes are implemented. Māori and Indigenous peoples experience wide and enduring ethnic inequalities across a broad range of outcomes throughout the lifecourse. There has been limited Māori lifecourse research to date. In this paper, we describe current lifecourse approaches being used by Māori researchers and discuss the value of a taking a lifecourse approach for Māori health and wellbeing. We address issues around longitudinal data. In particular, the need for Māori leadership in the collection, analysis, management, and governance of longitudinal data that can be used to inform health and social policy to guide programmes and interventions that support positive Māori outcomes throughout life.

The numerous iwi (tribes) and hapū (subtribes) of Te Tai Tokerau (Northland) have a long whakapapa (genealogy) of influential leaders that have made a significant impact on the Māori world and beyond. However, ruinous media narratives that focus without relent on poverty, low employment, inadequate housing, and lagging educational outcomes—particularly among Māori—continue to negatively impact the ways students from this region define their identity. This paper presents a number of strengths-based narratives—focusing on tūpuna (ancestors) from Te Tai Tokerau whakapapa—that act as counter-narratives to this rhetoric. The paper discusses how these narratives can be used as powerful pedagogical tools that enhance Te Tai Tokerau Māori students’ self-efficacy, aspiration, optimism, and cultural pride, presenting them as powerful agents of their own destiny. This paper draws on data produced from a Marsden-funded study—led by Te Tai Tokerau descendents—that has collected and re-presented multifaceted hapū/iwi-based narratives that celebrate Te Tai Tokerau distinctiveness, success, history, and identity. This wider study has examined, contextualised, and celebrated diverse characteristics recurring in Te Tai Tokerau pūrākau (genealogical stories), pepeha (tribal sayings), waiata (songs), karakia (incantations), televisual materials, and written histories.

One of the chief questions confronting mental health professionals who serve American Indian communities is how best to offer genuinely helpful services that do not simultaneously and surreptitiously reproduce colonial power relations. To ensure that counselors and therapists do not engage in psycolonization, it is crucial to recognize the sometimes divergent cultural foundations of mental distress, disorder, and well-being in “Indian Country.” In this article, I will consider four excerpts from a research interview undertaken among my own people, the Aaniiih Gros Ventres of north-central Montana. At a superficial level, these excerpts seem to reinforce reigning sensibilities that are readily familiar within the mental health professions. And yet, closer analysis of these interview excerpts reveals several tantalizing facets of an indigenous cultural psychology that may well continue to shape life and experience among tribal members in this setting. I recover this distinctive cultural psychology through archival representations of cultural and community life, including analysis of an important tribal myth. This analysis makes possible an alterNative interpretation of these interview excerpts, grounded in an aboriginal cosmology, that yields important implications for conceiving a more inclusive knowledge base for psychology that only robust community engagement can reveal.

Background: Despite being at heightened risk of developing mental illness, there has been little research into the experience of depression in Australian Aboriginal populations. This study aimed to outline the expression, experience, manifestations and consequences of emotional distress and depression in Aboriginal men in central Australia.

Methods: Utilizing a grounded theory approach, in depth semi-structured interviews were conducted with 22 theoretically sampled young, middle aged and senior Aboriginal men and traditional healers. Analysis was conducted by a single investigator using constant comparison methods.

Results: Depressive symptoms were common and identifiable, and largely consistent with symptom profiles seen in non-Aboriginal groups. For Aboriginal men, depression was expressed and understood as primarily related to weakness or injury of the spirit, with a lack of reference to hopelessness and specific somatic complaints. The primary contributors to depression related to the loss of connection to social and cultural features of Aboriginal life, cumulative stress and marginalisation.

Conclusions: Depression and depressive symptomatology clearly exists in Aboriginal men, however its determinants and expression differ from mainstream populations. Emotions were understood within the construction of spirit, Kurunpa, which was vulnerable to repetitive and powerful negative social forces, loss, and stress across the life course, and served to frame the physical and emotional experience and expression of depression.

This article provides a summary of the evolving definition of trauma, including different forms of trauma and its impact on the health, behaviours and well-being of individuals and communities. Specifically, it discusses collective, historical and intergenerational trauma and the value of these concepts in understanding the health and social challenges we see within colonized Indigenous communities, particularly within Australian Aboriginal communities. The article argues that the current approach to addressing challenges within Australian Indigenous communities will have limited impact unless accompanied by a significant focus on understanding and addressing the level of trauma that permeates these communities. Programmes and initiatives that focus on reducing the rates of certain variables, such as rates of infant mortality, rates of incarceration or rates of school completion, are very important but are only treating symptoms unless the underlying trauma is addressed. Due to the ongoing devastation caused by many years of forced child removal, this is especially important for health, legal and welfare practitioners within the child protection system and the social work field if we are to break the cycles of family and cultural disruption.

The link between exposure to trauma and increased risk of poor mental health is well established. Where trauma is unacknowledged, it can result in the re-traumatisation of later generations. The colonisation of Aboriginal and Torres Strait Islander peoples and the oppressive practices that followed has resulted in a legacy of unaddressed intergenerational trauma. This prolonged and continuing exposure to trauma and risk factors places Indigenous Australians at a heightened risk of mental ill-health.

This paper aims to define the link between intergenerational trauma and Aboriginal and Torres Strait Islander peoples’ mental health and to identify current best-practice policies and programs to address this issue. A comprehensive review of electronic databases was conducted to identify relevant literature. The paper adopts an Indigenous Standpoints approach meaning that Indigenous research and voices are privileged within the report. The review highlights that there is a strong policy framework to address Indigenous Australians’ social and emotional wellbeing (SEWB), but few that explicitly address the interaction between intergenerational trauma and SEWB. Additionally, trauma-informed and healing-aware approaches are essential to program success in addressing intergenerational trauma. Finally, there should be a focus on funding locally developed and Indigenous-led programs that promote community governance and self-determination.

Nargneit Birrang (To see the river) is for all Victorian Aboriginal people - adults, children, young people and families - who are impacted by family violence and need holistic healing; and for the Aboriginal services and communities who support them on their healing journeys. The purpose of the Nargneit Birrang Framework is to guide the flexible design, funding, implementation and evaluation of Aboriginal-led holistic healing programs for family violence in Victoria, informed by the principle of self-determination. Nargneit Birrang (pronounced 'Nar-neat Be-rang') is a Woiwurrung word meaning “To see the river”).

In settler-colonies such as Canada, Australia, New Zealand and the United States, the historical impacts of colonisation on the health, social, economic and cultural experiences of Indigenous peoples are well documented. However, despite being a commonly deployed trope, there has been scant attention paid to precisely how colonial processes contribute to contemporary disparities in health between indigenous and non-indigenous peoples in these nation-states. After considering pertinent issues in defining indigeneity, this paper focuses on operationalising colonisation as a driver of indigenous health, with reference to emerging concepts such as historical trauma. Conceptualisations of coloniality vis-à-vis health and their critiques are then examined alongside the role of racism as an intersecting and overlapping phenomenon. To conclude, approaches to understanding and explaining Indigenous disadvantage are considered alongside the potential of decolonisation, before exploring ramifications for the future of settler-indigenous relations.

Background: Finding Your Way is a culturally adapted shared decision making (SDM) resource for Aboriginal (First Nations) people of Australia. It integrates the Eight Ways of Aboriginal Learning (8 Ways) and was created by Aboriginal health workers and community members in New South Wales (NSW), Australia.

Objective: To explore the perceived acceptability, usability, and feasibility of Finding Your Way as a SDM resource for Aboriginal people making health and wellbeing decisions.

Methods: The web-based resources were disseminated using social media, professional networks, publications, and the ‘Koori grapevine’. Thirteen ‘champions’ also promoted the resources. An online questionnaire was available on the website for three months. Framework analysis determined early indications of its acceptability, usability, and feasibility. Web and social media analytics were also analysed. Partnership with and leadership by Aboriginal people was integrated at all phases of the project.

Results: The main landing page was accessed 5219 times by 4259 users. 132 users completed the questionnaire. The non-linear and visual aspects of the resources ‘speak to mob’ and identified with Aboriginal culture. The inclusion of social and emotional well-being, and the holistic approach were well received by the small number of users who opted to provide feedback. They suggested that non-digital formats and guidance on the resources are required to support use in clinical practice.

Conclusion: The 8 Ways enabled the development of a culturally safe SDM resource for Aboriginal people, which was well received by users who took the time to provide feedback after a brief dissemination process. Additional accessible formats, practice guides and training are required to support uptake in clinical practice.

Practice implications: Finding Your Way could be used to help improve experiences, health literacy, decision making quality and outcomes of healthcare for Aboriginal Australians.

Background: The purpose of this study was to develop and to validate a measure of cultural responsiveness that would assist mental health practitioners across a range of disciplines, in Australia, to work with Indigenous clients.

Aim: The Cultural Responsiveness Assessment Measure (CRAM) was developed to provide a tool for practitioners and students to evaluate their own culturally responsive practice and professional development.

Method: Following expert review for face validity the psychometric properties of the measure were assessed quantitatively, from the responses of 400 mental health practitioners.

Results: Confirmatory Factor Analysis yielded a nine factor, 36 item instrument that demonstrated strong convergent and discriminant validity as well as test-retest reliability.

Conclusions: It is anticipated that the CRAM will have utility as both a learning tool and an assessment measure, for mental health practitioners to ensure that services are culturally responsive for Aboriginal and Torres Strait Islander people.

Established tools that assess cultural competency in the health workforce could contribute to providing culturally safe care to First Nations peoples. Using a rapid review approach, we searched several databases to evaluate the characteristics of self-assessment tools used to assess cultural competency and ascertain the context and outcomes of their use. Out of 529 documents, six articles fitted the study’s inclusion criteria. The main capabilities assessed by self-assessment tools ranged from knowledge, interest, and familiarity with First peoples’ history and culture to providing cultural support, application, and behaviour. Data were limited on outcomes of cultural competency and safety as determined by the health care recipient. Overall, the tools showed significant variability in characteristics and how cultural competency and culturally safe practice was assessed. However, data were lacking to confirm whether the enhanced cultural competency and culturally safe practice demonstrated using these self-assessment tools improved health outcomes for First Nations peoples.

Objective Develop a comprehensive socially inclusive measure to assess child resilience factors.

Design A socioecological model of resilience, community-based participatory research methods and two rounds of psychometric testing created the Child Resilience Questionnaire (parent/caregiver report, child report, school report). The parent/caregiver report (CRQ-P/C) is the focus of this paper.

Setting Australia.

Participants Culturally and socially diverse parents/ caregivers of children aged 5–12 years completed the CRQ-P/C in the pilot (n=489) and validation study (n=1114). Recruitment via a large tertiary hospital’s outpatient clinics, Aboriginal and refugee background communities (Aboriginal and bicultural researchers networks) and nested follow-up of mothers in a pregnancy cohort and a cohort of Aboriginal families.

Analysis Exploratory and confirmatory factor analyses conducted to assess the structure and construct validity of CRQ-P/C subscales. Cronbach’s alpha used to assess internal consistency of subscales. Criterion validity assessed with the Strengths and Difficulties Questionnaire (SDQ) parent report.

Results Conceptually developed CRQ comprised 169 items in 19 subscales across five socioecological domains (self, family, friends, school and community). Two rounds of psychometric revision and community consultations created a CRQ-P/C with 43 items in 11 scales: self (positive self, positive future, managing emotions), family (connectedness, guidance, basic needs), school (teacher support, engagement, friends) and culture (connectedness, language). Excellent scale reliability (α=0.7–0.9), except basic needs scale (α=0.61) (where a highly endorsed item was retained for conceptual integrity). Criterion validity was supported: scales had low to moderate negative correlations with SDQ total difficulty score (Rs= -0.2/– 0.5. p<0.001); children with emotion/behavioural difficulties had lower CRQ-P/C scores (β=−14.5, 95% CI −17.5 to −11.6, adjusted for gender).

Objective: This paper describes the validation of culture-bound syndromes with Urban (N=34) and Rural (N=31) Aboriginal participants. While culture bound syndromes have long been discussed in the international literature (see Cuellar & Paniagua, 2000), published empirical research with Aboriginal Australian populations remains absent. Critically, the secret nature of Aboriginal cultural practices presents additional research challenges which arguably do not impact to the same extent in other Indigenous cultures. The impacts on ensuring culturally and clinically competent assessment in the context of escalating rates of Indigenous suicide and mental health are significant.

Method: Thematic analysis occurred with data generated from three phases of focus groups to address study objectives. The final stage involved a critical analysis of the DSM-IV Outline for Cultural Formulation (“OCF”) for the Aboriginal Australian context.

Results: Validation of seven culture bound syndromes with predominant symptom consistency across locations is presented as well as determination of the cultural triggers implicated in the development of culture bound syndromes. Finally, an adaptation of the OCF is proposed to enable clinicians to undertake clinically and culturally valid assessment of Aboriginal clients.

Conclusions: Practitioners are provided with guidance in the identification and formulation of culture-bound syndromes with Aboriginal Australian clients.

Objective: This study determined the cultural appropriateness of the Structured Clinical Interview for the DSM-IV Axis I Disorders (SCID-I) as an acceptable tool for diagnosing mental illness among Indigenous people.

Methods: De-identified qualitative feedback from participants and psychologists regarding the cultural appropriateness of the SCID-I for Indigenous people using open-ended anonymous questionnaires was gathered. Aboriginal Medial Service staff and Indigenous Support Workers participated in a focus group.

Results: A total of 95.6% of participants felt comfortable during the 498 questionnaires completed. Psychologists also provided qualitative feedback for 502 (92.3%) interviews, of whom 40.4% established a good rapport with participants. Of the participants, 77.7% understood the SCID-I questions well, while 72.5% did not require any cultural allowances to reach a clinical diagnosis.

Conclusion: When administered by a culturally safe trained psychologist, SCID-I is well tolerated in this group.

Background and Objectives: The lack of appropriate quality of life (QoL) measures is a major barrier to planning and delivering health and aged care services for older Indigenous peoples worldwide. QoL is dependent on cultural values and priorities may vary between age groups. This project aims to develop a QoL tool for older Aboriginal Australians.

Research Design and Methods: The study was completed with Aboriginal Australians aged over 45 years living in Perth and Melbourne, Australia. Participatory Action Research methods were applied with an Indigenous research paradigm. Semi-structured interviews were undertaken to identify the factors important to having a good life. Factors were further explored in yarning groups with older Aboriginal peoples to develop the draft QoL tool questions. Face validity of the tool was completed in two regions.

Results: The participants preferred the term “a good life” to QoL. Having a good spirit is at the core of having a good life. The protective factors for a good life were family and friends, health, culture, Elder role, respect, Country, spirituality, services and supports, community, future plans, safety and security, and basic needs.

Discussion and Implications: Twelve factors were identified and developed into key questions for the Good Spirit, Good Life tool. The draft tool will undergo quantitative validity testing, prior to embedding in service provision to inform care for older Aboriginal peoples. With local adaptation, the tool, accompanying framework, and participatory methods for development may have wider applicability to other Indigenous populations worldwide

Objectives: To determine the validity, sensitivity, specificity and acceptability of the culturally adapted nine-item Patient Health Questionnaire (aPHQ-9) as a screening tool for depression in Aboriginal and Torres Strait Islander people.

Design: Prospective observational validation study, 25 March 2015 – 2 November 2016. Setting, participants: 500 adults (18 years or older) who identified as Aboriginal or Torres Strait Islander people and attended one of ten primary health care services or service events in urban, rural and remote Australia that predominantly serve Indigenous Australians, and were able to communicate sufficiently to respond to questionnaire and interview questions.

Main outcome measures: Criterion validity of the aPHQ-9, with the depression module of the Mini-International Neuropsychiatric Interview (MINI) 6.0.0 as the criterion standard.

Results: 108 of 500 participants (22%; 95% CI, 18–25%) had a current episode of major depression according to the MINI criterion. The sensitivity of the aPHQ-9 algorithm for diagnosing a current major depressive episode was 54% (95% CI, 40–68%), its specificity was 91% (95% CI, 88–94%), with a positive predictive value of 64%. For screening for a current major depressive episode, the area under the receiver operator characteristic curve was 0.88 (95% CI, 0.85–0.92); with a cut-point of 10 points its sensitivity was 84% (95% CI, 74–91%) and its specificity 77% (95% CI, 71–83%). The aPHQ-9 was deemed acceptable by more than 80% of participants.

Conclusions: Indigenous Australians found the aPHQ-9 acceptable as a screening tool for depression. Applying a cut-point of 10 points, the performance characteristics of the aPHQ were good.

Adopting a process-oriented framework for test validation can help to establish whether this tool has the potential to be an acceptable, valid and reliable indicator of depression for mothers and mothers-to-be. This mixed-methods research protocol seeks to explore the views and experiences of Aboriginal mothers and healthcare professionals in relation to the Edinburgh Postnatal Depression Scale (EPDS), and is intended to highlight potential barriers in perinatal mental health conceptualisation, engagement and response style.

Background: The Getting it Right study determined the validity, sensitivity, specificity and acceptability of the culturally adapted 9-item Patient Health Questionnaire (aPHQ-9) as a screening tool for depression in Aboriginal and Torres Strait Islander (hereafter referred to as Indigenous) people. In this process evaluation we aimed to explore staff perceptions about whether Getting it Right was conducted per protocol, and if the aPHQ-9 was considered an acceptable and feasible screening tool for depression in primary healthcare. This process evaluation will provide information for clinicians and policy makers about the experiences of staff and patients with Getting it Right and what they thought about using the aPHQ-9.

Methods: Process evaluation using grounded theory approaches. Semi-structured interviews with primary healthcare staff from services participating in Getting it Right were triangulated with feedback (free-text and elicited) from participants collected during the validation study and field notes. Data were thematically analysed according to the Getting it Right study protocol to identify the acceptability and feasibility of the aPHQ-9.

Results: Primary healthcare staff (n = 36) and community members (n = 4) from nine of the ten participating Getting it Right services and Indigenous participants (n = 500) from the ten services that took part. Most staff reported that the research was conducted according to the study protocol. Staff from two services reported sometimes recruiting opportunistically (rather than recruiting consecutive patients attending the service as outlined in the main study protocol), when they spoke to patients who they knew from previous interactions, because they perceived their previous relationship may increase the likelihood of patients participating. All Getting it Right participants responded to at least six of the seven feedback questions and 20% provided free-text feedback. Most staff said they would use the aPHQ-9 and most participants said that the questions were easy to understand (87%), the response categories made sense (89%) and that they felt comfortable answering the questions (91%).

Conclusion: Getting it Right was predominantly conducted according to the study protocol. The aPHQ-9, the first culturally adapted, nationally validated, freely available depression screening tool for use by Indigenous people, appears to be acceptable and feasible to use.

Introduction: Resilience is enabled by internal, individual assets as well as the resources available in a person’s environment to support healthy development. For Indigenous people, these resources and assets can include those which enhance cultural resilience. Measurement instruments which capture these core resilience constructs are needed, yet there is a lack of evidence about which instruments are most appropriate and valid for use with Indigenous adolescents. The current study reviews instruments which have been used to measure the resilience of Indigenous adolescents in Canada, Australia, New Zealand, and the United States (the CANZUS nations). The aim is to provide guidance for the future use of instruments to measure resilience among Indigenous adolescents and provide recommendations for research to strengthen evidence in this area.

Method: Instruments were identified through a systematic search of resilience intervention and indicator studies targeting Indigenous youth from CANZUS nations. The studies were analyzed for information on the constructs of resilience measured in the instruments, their use with the targeted groups, and their psychometric properties. A second search was conducted to fill in any gaps in information. Instruments were included if they measured at least one construct of resilience reflecting individual assets, environmental resources, and/or cultural resilience.

Results: A total of 20 instruments were identified that measured constructs of resilience and had been administered to Indigenous adolescents in the CANZUS nations. Instruments which measured both individual assets and environmental resources (n = 7), or only environmental resources (n = 6) were most common. Several instruments (n = 5) also measured constructs of cultural resilience, and two instruments included items addressing all three constructs of individual assets, environmental resources, and cultural resilience. The majority of the reviewed studies tested the reliability (75%) and content or face validity (80%) of instruments with the target population.

Conclusion: There are several validated instruments available to appropriately measure constructs of resilience with Indigenous adolescents from CANZUS nations. Further work is needed on developing a consistent framework of resilience constructs to guide research efforts. Future instrument development and testing ought to focus on measures which include elements of all three core constructs critical to Indigenous adolescent resilience.

Despite high rates of perinatal depression and anxiety, little is known about how Aboriginal women in Australia experience these disorders and the acceptability of current clinical screening tools. In a 2014 study, the Kimberley Mum's Mood Scale (KMMS) was validated as an acceptable perinatal depression and anxiety screening tool for Aboriginal women in the Kimberley region of Western Australia. In the current study, we explored if it was appropriate to trial and validate the KMMS with Aboriginal women in the Pilbara. Yarning as a methodology was used to guide interviews with 15 Aboriginal women in the Pilbara who had received maternal and child health care within the last three years. Data were analysed thematically, the results revealing that this cohort of participants shared similar experiences of stress and hardship during the perinatal period. Participants valued the KMMS for its narrative-based approach to screening that explored the individual’s risk and protective factors. While support for the KMMS was apparent, particular qualities of the administering health care professional were viewed as critical to the tool being well received and culturally safe. Building on these findings, we will work with our partner health services in the Pilbara to validate the KMMS with Pilbara Aboriginal women.

To determine, using face-to-face diagnostic interviews, the prevalence of common mental disorders (CMD) in a cohort of adult Indigenous Australians, the cultural acceptability of the interviews, the rates of comorbid CMD and concordance with psychiatrists’ diagnoses. Cross-sectional study July 2014-November 2016. Psychologists conducted Structured Clinical Interviews for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision Axis I Disorders (SCID-I) (n=544). Psychiatrists interviewed a subsample (n=78). Four Aboriginal Medical Services and the general community located in urban, regional and remote areas of Southern Queensland and two Aboriginal Reserves located in New South Wales.

Introduction: ‘Baby Coming – You Ready?’ is an audacious innovation to perinatal social and emotional wellbeing assessment screening and supportive management for vulnerable parents-to-be. This digitalised screening rubric, called ‘Baby Coming-You Ready?’, uses touch screen images to provide an engaging culturally safe solution to the many barriers to effective screening and primary prevention currently faced by both non-Indigenous service providers and Indigenous women. It has been developed through a strong collaboration between Aboriginal Australians, midwives, child health nurses and researchers through the participatory action research (PAR) called Kalyakool Moort- Always Family. Indigenous Australians are historically cautious, acute observers and frequently over-ridden in research and health care processes. Embarking on PAR and adopting an Aboriginal world view in the research process has seen a curious interface of cultures that is both complex and challenging. However, it has been critical to its success.

Aim: This paper describes this process which resulted in a solid effective research structure, a commitment to working from the Aboriginal world view and a strong research translational pathway. It will explain the significance of strong community commitment and the extensive organisational and community collaboration.

Method: A desire based approach to narrative inquiry through an Indigenous lens is a key feature of this process. Through analysis of the current context of perinatal mental health screening among Indigenous mothers and fathers, the perspectives of three separate target groups has been included: that of Indigenous women, Indigenous fathers and health professionals involved in routine perinatal care. Data triangulation of results included a state-wide online questionnaires and thematic analysis of semi-structured interviews with health professionals, ‘yarning’ sessions with Indigenous women and fathers, extensive analysis of current screening surveillance data through a cultural lens and metasynthesis of current literature.

Findings: Emergent from this process is the touch screen image driven screening and assessment ‘rubric’ called ‘Baby Coming-You Ready?’. It embodies four key elements: good engagement, a sense of safety, a trusting relationship, and the capacity to embrace the strengths in the Aboriginal and Torres Strait peoples cultural viewpoint which is central to family/community centred-care. This goes far beyond current woman/family-centred care. Culture is fluid, traditional roles/expectations are changing and many Indigenous Australian fathers are becoming increasingly vulnerable as a result. Therefore developing a parallel version of the ‘Baby Coming-You Ready? rubric for fathers was considered vital.

Conclusion: Widespread community acceptance to this innovative approach to perinatal mental health screening and primary prevention is now possible as the ‘Baby Coming-You Ready?’ rubric is being piloted across the health care sector.

The prevalence of dementia and cognitive impairment is higher in Aboriginal Australians compared to the national population, increasing the need to understand cognitive impairment in this at‐risk population. This article Report normative data for a range of commonly used cognitive tests, in a population‐based small normative sample of older Aboriginal Australians living in urban/regional New South Wales.

Objective: There is limited research available regarding the prevalence rates of psychiatric illness in Indigenous Australians, and the available literature varies widely in terms of methods and findings. Culturally valid and appropriate tools are needed to ensure accurate outcomes. The purpose of this review is to examine the methods used to diagnose psychiatric disorders in Indigenous Australians and identify whether these are culturally appropriate or valid.

Method: A systematic search of available literature was undertaken in electronic databases (PubMed, Scopus, PsycInfo, PsycArticles, Web of Science, Medline, and Informit Health Indigenous Australians Peoples Collections). Narrative synthesis was used to analyse the data obtained, with a quantitative evaluations of study quality and cultural validity.

Results: Twelve articles were included for review. Six studies were of diagnostic tools and none had been validated for use with Indigenous Australians. Another six used practitioner assessment. Some studies indirectly referenced cultural competence on behalf of the practitioner, but again on the whole this was lacking.

Conclusions: Further validation of the use of diagnostic instruments in Indigenous Australians is needed so that the prevalence of psychiatric disorders in this population can be accurately determined. In addition, practitioners working with Indigenous Australians should have some training in cultural awareness or competence, and consider the cultural appropriateness of diagnostic tools when applied to this population.

Evaluation of minority-culture specific treatment centres for substance use and mental health is challenging. The challenge is compounded by a paucity of validated instruments for assessing substance use and mental ill health. In the field of Australian Indigenous alcohol and other drug service provision there are few guidelines to determine which instruments should be targets for validation for use with Indigenous clients. As such, reliable, validated, evaluable data on the client population is limited, posing multifaceted concerns for clinicians and service providers as well as evaluators. The aim of this study was to pilot the use of a participatory expert consensus approach to evaluate, rate and select suitable majority-culture substance use and mental health assessment instruments for use with their clients. Eight practitioners of an Indigenous-specific substance misuse residential treatment centre participated. The findings reinforce the value of consensus approaches for stakeholder engagement and to provide a sense of ownership of the results. In this setting, consensus on the implementation of an agreed set of Indigenous-specific and non-Indigenous specific instruments improved the ownership of the instruments by clinicians allowing for the use of valid and/or reliable instruments that also had good face validity. This makes it more probable that reliable client wellbeing data will be collected. This is crucial to program evaluation at a later point in time. This study was a novel approach to generating evidence to inform practice in the absence of normative practice guidelines.

Background: The Edinburgh Postnatal Depression Scale (EPDS) is widely recommended for perinatal anxiety and depression screening. However, many Aboriginal women find EPDS language complex and confusing, and providers find using it with Aboriginal women challenging. The two part Kimberley Mum’s Mood Scale (KMMS) was developed to improve screening: Part 1 is a Kimberley version of EPDS; Part 2 is a psychosocial tool that enables contextualisation of Part 1 scores. We aimed to determine if KMMS is a valid and acceptable method of identifying Kimberley Aboriginal perinatal women at risk of anxiety or depressive disorders compared to a semi-structured clinical interview.

Methods: Across 15 sites in the Kimberley, Western Australia, 97 Aboriginal women aged 16 years and older who intended to continue with their pregnancy or had a baby within the previous 12 months were administered the KMMS by trained healthcare providers who provided an overall assessment of no, low, moderate or high risk; 91 participants were then independently assessed by a blinded clinical expert using Diagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria. A qualitative approach was used to determine KMMS’ acceptability.

Results: Part 1 had high internal consistency (Cronbach’s alpha, 0.89), and overall KMMS risk equivalence for screening for anxiety or depressive disorders was moderate (sensitivity, 83%; specificity, 87%; positive predictive value, 68%). Participants found the process easy and useful, and healthcare providers found KMMS more useful than EPDS. Part 2 allowed healthcare providers to ask questions that gave participants an opportunity to express themselves, resulting in a deeper understanding between them.

Conclusion: KMMS is an effective tool for identifying Kimberley Aboriginal perinatal women at risk of anxiety and depressive disorders. Adoption of KMMS with culturally safe training and support is likely to improve screening processes, and with further validation may have broader applicability across remote Australia.

Rationale: There is growing recognition that in addition to universally recognised domains and indicators of wellbeing (such as population health and life expectancy), additional frameworks are required to fully explain and measure Indigenous wellbeing. In particular, Indigenous Australian wellbeing is largely determined by colonisation, historical trauma, grief, loss, and ongoing social marginalisation. Dominant mainstream indicators of wellbeing based on the biomedical model may therefore be inadequate and not entirely relevant in the Indigenous context. It is possible that “standard” wellbeing instruments fail to adequately assess indicators of health and wellbeing within societies that have a more holistic view of health.

Objective: The aim of this critical review was to identify, document, and evaluate the use of social and emotional wellbeing measures within the Australian Indigenous community. 

Method: The instruments were systematically described regarding their intrinsic properties (e.g., generic v. disease-specific, domains assessed, extent of cross-cultural adaptation and psychometric characteristics) and their purpose of utilisation in studies (e.g., study setting, intervention, clinical purpose or survey). We included 33 studies, in which 22 distinct instruments were used. 

Results: Three major categories of social and emotional wellbeing instruments were identified: unmodified standard instruments (10), cross-culturally adapted standard instruments (6), and Indigenous developed measures (6). Recommendations are made for researchers and practitioners who assess social and emotional wellbeing in Indigenous Australians, which may also be applicable to other minority groups where a more holistic framework of wellbeing is applied.

Conclusion: It is advised that standard instruments only be used if they have been subject to a formal cross-cultural adaptation process, and Indigenous developed measures continue to be developed, refined, and validated within a diverse range of research and clinical settings

Introduction: A freely available, culturally valid depression screening tool is required for use by primary care services across Australia to screen for depression in Aboriginal and/or Torres Strait Islander populations. This is the protocol for a study aiming to determine the validity, sensitivity and specificity of the culturally adapted 9-item Patient Health Questionnaire (aPHQ-9).

Methods and analysis: Cross-sectional validation study. A total of 500 people who self-identify as Aboriginal and/or Torres Strait Islander, are ≥18 years of age, attending 1 of 10 primary healthcare services or service events across Australia and able to communicate sufficiently to answer study questions will be recruited. All participants will complete the aPHQ-9 and the criterion standard MINI International Neuropsychiatric Interview (MINI) 6.0.0. The primary outcome is the criterion validity of the aPHQ-9. Process outcomes related to acceptability and feasibility of the aPHQ-9 will be analysed only if the measure is found to be valid.

Ethics and dissemination: Lead ethical approval was obtained jointly from the University of Sydney Human Research Ethics Committee (project 2014/361) and the Aboriginal Health and Medical Research Council of New South Wales (project 1044/14). Results will be disseminated via the usual scientific forums, including peer-reviewed publications and presentations at international conferences following presentation to, discussion with and approval by participating primary healthcare service staff and community.

Addressing low levels of social and emotional well‐being (SEWB) in Indigenous communities has been a national strategic priority for over 10 years and yet progress in assessing the impact of interventions has been slow. One of the key factors limiting the development of evidence‐based practice has been the lack of well‐validated instruments to assess SEWB and how it changes over time as a result of intervention. This article systematically reviews available measures, classifying them in terms of the evidence base that exists to support their use. It is concluded that there is an ongoing need to develop psychometrically sound, comprehensive, culturally appropriate measures to operationalise Indigenous SEWB at a population health, programme evaluation, and clinical level. It is suggested that seven pathways be followed to achieve this goal, including the need to recognise that the gold standard status for Indigenous measurement tools cannot be ascribed based on evidence‐based assessment criteria alone.

Abstract: Introduction: In Australia, there is little empirical research of the racial identity of Indigenous children and youth as the majority of the current literature focuses on adults. Furthermore, there are no instruments developed with cultural appropriateness when exploring the identity and self-esteem of the Australian Aboriginal population, especially children. The IRISE_C (Racial Identity and Self-Esteem of children) inventory was developed to explore the elements of racial identity and self-esteem of urban, rural and regional Aboriginal children. This paper describes the development and validation of the IRISE_C instrument with over 250 Aboriginal children aged 8 to 12 years.

Methods: A pilot of the IRISE C instrument was combined with individual interviews and was undertaken with 35 urban Aboriginal children aged 8–12 years. An exploratory factor analysis was performed to refine the survey and reduce redundant items in readiness for the main study. In the main study, the IRISE C was employed to 229 Aboriginal children aged 6–13 years across three sites (rural, regional and urban) in Western Australia. An exploratory factor analysis using Principal axis factoring was used to assess the fit of items and survey structure. A confirmatory factor analysis was then employed using LISREL (diagonally weighted least squares) to assess factor structures across domains. Internal consistency and reliability of subscales were assessed using Cronbach’s coefficient alpha.

Results: The pilot testing identified two key concepts – children’s knowledge of issues related to their racial identity, and the importance, or salience, that they attach to these issues. In the main study, factor analyses showed two clear factors relating to: Aboriginal culture and traditions; and a sense of belonging to an Aboriginal community. Principal Axis Factoring of the Knowledge items supported a 2-factor solution, which explained 38.7 % of variance. Factor One (Aboriginal culture) had a Cronbach’s alpha of 0.835; Factor 2 (racial identity) had a Cronbach’s alpha of 0.800, thus demonstrating high internal reliability of the scales.

Conclusion: The IRISE_C has been shown to be a valid instrument useful of exploring the development of racial identity of Australian Aboriginal children across the 8–12 year old age range and across urban, rural and regional geographical locations.

Recent qualitative research conducted in metropolitan Perth and the Kimberley region of Western Australia has highlighted major gaps in service delivery to Aboriginal clientele suffering depression and suicidal ideation (Vicary, 2002). Seventy Aboriginal people were interviewed about their beliefs and attitudes towards mental health, western psychology and western practitioners, and strategies for improving mental health care delivery. The study highlights that participants consistently perceived the course and treatment of depression as following a different aetiology to that of mainstream Australia. The authors’ references to depression do not conform with Eurocentric perceptions, but rather to the Aboriginal Australians’ conceptualisation, as explained within the paper. Almost three in four respondents indicated that they believed that Aboriginal people did not perceive depression as a state that could be addressed via treatment. Instead they perceived it as a characteristic of the individual concerned stating ‘that’s just the way he is’. Subsequently they reported that individuals might not get the assistance they require in overcoming their illness.

In this chapter, concepts and history of assessment and testing in the context of Aboriginal and Torres Strait Islander social and emotional wellbeing and mental health are discussed. Importantly, recently revised diagnostic guidelines and the National Practice Standards for the Mental Health Workforce 20131 and their appropriateness for meeting the distinctive needs of Aboriginal people are reviewed. Various assessment tools and measures that have been validated or proved appropriate for use with particular Aboriginal populations, i.e. youth, women and older people, are described. We conclude that practitioners need to be critically reflective in their role in assessment, and position themselves to play an important transformative role in conducting assessment. This extends to acknowledging and enacting culturally responsive principles, procedures and practices to ensure that Aboriginal people have access to effective, culturally secure mental health care.

Indigenous people are a vulnerable and disadvantaged population whom collectively face much higher levels of health risks and challenges than non-Indigenous people. Indigenous youth in particular represent a population that are at even greater risk, as interaction between socio-economic, geographic, and cultural differences contributes to a lack of opportunity for youth to experience positive outcomes in a school environment. This cumulative disadvantage is problematic as it not only has a negative impact on young person’s social, emotional, and psychological well-being, but serves to potentially undermine initiatives that aim to ‘Close the Gap.’ Unfortunately, one of the difficulties in assessing psychosocial well-being amongst Indigenous young people relates to the fundamentally different concepts of what constitutes ‘mental health’ across Indigenous and non-Indigenous cultures. In response to this, Westerman (2007) developed a set of scales to measure the social and emotional well-being of Indigenous adolescents, the Westerman Aboriginal Symptom Checklist – Youth (WASC-Y). While she has provided preliminary evidence of the reliability and validity of this measure, further independent evaluation is important. The current research involved the large-scale survey of Indigenous young people attending an independent school for Indigenous students (i.e., the Murri School) located in Brisbane, Queensland. Parents, teachers, and youths were requested to complete relevant versions of measures, including: the WASC-Y, SDQ, and ASEBA (viz. the CBCL, TRF and YSF, respectively). Result found internal consistency of the WASC-Y subscales to be acceptable, and cross-scale correlations indicate that all subscales assess relatively independent constructs. Further, the concurrent validity of the WASC-Y was good with the subscales correlating in a theoretically meaningful way with other measures of psychopathology. High levels of mental health problems were reported on the WASC-Y, with all males and 88.9% of females scoring above the clinical cut-off on two or more subscales. Prevalence rates of mental health problems as measured by the SDQ, YSR, and TRF scales were also high, but varied in accordance with the relative agreement between informants across measures. Implications of these results, including a discussion of the methodological difficulties (e.g., obtaining a reliable outcome measure, parental engagement) and recommendations for future research that can address these issues are discussed.

This study explored medical doctors’ clinical assessment of suicide risk and suicide attempters’ self-reported suicide intent. Three years of archival assessment records related to suicide attempters who were admitted to the emergency department of a large teaching hospital in Singapore were subjected to analysis. Records related to 460 suicide attempters (70.4% females; 28.6% males) were analysed using logistic regressions. Their ages ranged from 12 to 85 (M = 29.08, SD = 12.86). The strongest predictor of suicide intent was habitual poor coping, followed by serious financial problems, and expressed regret. The strongest predictor of suicide risk was hiding the attempt followed by prior planning. The findings were discussed in regards to implications in clinical assessments and suicide prevention efforts.

Background: Despite being at heightened risk of developing mental illness, there has been little research into the experience of depression in Australian Aboriginal populations. This study aimed to outline the expression, experience, manifestations and consequences of emotional distress and depression in Aboriginal men in central Australia.

Methods: Utilizing a grounded theory approach, in depth semi-structured interviews were conducted with 22 theoretically sampled young, middle aged and senior Aboriginal men and traditional healers. Analysis was conducted by a single investigator using constant comparison methods.

Results: Depressive symptoms were common and identifiable, and largely consistent with symptom profiles seen in non-Aboriginal groups. For Aboriginal men, depression was expressed and understood as primarily related to weakness or injury of the spirit, with a lack of reference to hopelessness and specific somatic complaints. The primary contributors to depression related to the loss of connection to social and cultural features of Aboriginal life, cumulative stress and marginalisation.

Conclusions: Depression and depressive symptomatology clearly exists in Aboriginal men, however its determinants and expression differ from mainstream populations. Emotions were understood within the construction of spirit, Kurunpa, which was vulnerable to repetitive and powerful negative social forces, loss, and stress across the life course, and served to frame the physical and emotional experience and expression of depression.

The risk of suicidal behaviour in Australia varies by age, sex, sexual preference and Indigenous status. Suicide stigma is known to affect suicide rates and help-seeking for suicidal crises. The aim of this study was to investigate the sociodemographic correlates of suicide stigma to assist in prevention efforts. We surveyed community members and individuals who had attended specific emergency departments for suicidal crisis. The respondents were part of a large-scale suicide prevention trial in New South Wales, Australia. The data collected included demographic characteristics, measures of help-seeking and suicide stigma. The linear regression analyses conducted sought to identify the factors associated with suicide stigma. The 5426 participants were predominantly female (71.4%) with a mean (SD) age of 41.7 (14.8) years, and 3.9% were Indigenous. Around one-third of participants reported a previous suicide attempt (n = 1690, 31.5%) with two-thirds (n = 3545, 65.3%) seeking help for suicidal crisis in the past year. Higher stigma scores were associated with Indigenous status (β 0.123, 95%CI 0.074–0.172), male sex (β 0.527, 95%CI 0.375–0.626) and regional residence (β 0.079, 95%CI 0.015–0.143). Lower stigma scores were associated with younger age (β −0.002, 95%CI −0.004–−0.001), mental illness (β −0.095, 95%CI −0.139 to −0.050), male bisexuality (β −0.202, 95%CI −0.351 to −0.052) and males who glorified suicide (β −0.075, 95%CI −0.119 to −0.031). These results suggested that suicide stigma differed across the community, varying significantly by sex, sexual orientation and Indigenous status. Targeted educational programs to address suicide stigma could assist in suicide prevention efforts.

Suicide is a major public health concern worldwide. Yet suicide has only emerged in the past half century for Aboriginal and Torres Strait Islander (hereafter, respectfully referred to as Aboriginal) peoples. Since then, the increase in suicide deaths in Aboriginal communities has been alarming, with an increase of 49% between 2006 and 2018. Suicide rates in Aboriginal peoples are at least twice the rate of non- Indigenous people across gender and age groups; for youths aged 15–24 years, the rate is over five times higher.

COVID-19 does not discriminate against age, race, religion or socio-economic status. Still, the impact of the COVID-19 pandemic is disproportionately greater for Aboriginal peoples and communities, due to the systemic historical, political, social and economic determinants of health that influence the uptake, access and efficacy of health and mental health services. These systemic factors underscore the Social and Emotional Wellbeing (SEWB) model. This model is a strengths based, holistic health framework for Aboriginal peoples, which reflects the complex interrelationships between self, protective cultural domains, and the encompassing determinants.

Objectives: Canada's Indian Residential School (IRS) system aimed to annihilate Indigenous culture among Indigenous children. Negative health impacts have been documented not only among survivors but also among their descendants. Reconnection with culture has been promoted as a means to recovery for people affected by this historical trauma. This study aimed to assess whether cultural connectedness has a specific protective effect on mental health among the descendants of IRS survivors.

Study design: Cross-sectional survey.

Methods: A randomly selected cross section of Anishinabe people, aged 18–39 years, from one community were invited to complete a brief questionnaire. Associations were calculated between IRS attendance, cultural connectedness, and mental health.

Results: A total of 147 people participated. Among participants without a family history of IRS attendance, cultural connectedness was not significantly associated with improved mental health. Among participants with a family history of IRS attendance, a high level of cultural connectedness was significantly associated with a 31% greater probability of reporting high mental health and mental health status similar to those with no family history of IRS attendance.

Conclusions: Cultural connectedness appears to act as a strong and specific protective factor against the intergenerational effects of IRS on the mental health of Anishinabe young adults, providing epidemiological support for the notion of ‘culture as treatment.

Indigenous youth suicide remains a substantial health disparity in circumpolar communities, despite prevention efforts through primary health care, public health campaigns, school systems, and social services. Innovations in prevention practice move away from expert‐driven approaches to emphasize local control through processes that utilize research evidence, but privilege self‐ determined action based on local and personal contexts, meanings, and frameworks for action. “Promoting Community Conversations About Research to End Suicide” is a community health intervention that draws on networks of Indigenous health educators in rural Alaska, who host learning circles in which research evidence is used to spark conversations and empower community members to consider individual and collective action to support vulnerable people and create health‐promoting conditions that reduce suicide risk. The first of nine learning circles focuses on narratives of local people who link the contemporary youth suicide epidemic to 20th century American colonialism, and situates prevention within this context. We describe the theoretical framework and feasibility and acceptability outcomes for this learning circle, and elucidate how the educational model engages community members in decolonial approaches to suicide prevention education and practice, thus serving as a bridge between Western and Indigenous traditions to generate collective knowledge and catalyze community healing.

The wellbeing of Indigenous youth living in Canada’s northern communities continues to lag behind the rest of the Canadian population. To a large extent, these health inequities are perpetuated by processes of colonisation that significantly impact the social determinants of health in Canada’s Indigenous north. The purpose of this article is to review the history of colonisation and its impacts on the wellbeing of Indigenous youth in Canada’s north, as well as processes of resilience that have helped Indigenous youth live healthy lives despite social challenges. Academic articles published between 2000 and 2016 outlining resilience from Indigenous perspectives are reviewed in the contexts of Canada’s Indigenous north. Analysis focuses on what insights about resilience emerge from Indigenous communities, particularly as they related to the health inequities of circumpolar regions. The concept of Âhkamêyimo is discussed and how systems of Indigenous knowledge offer important insights into resilience in general, and can be utilised in health promotion, education, and prevention programs targeting Indigenous youth in northern Canada. We conclude that attention should be turned toward issues of social justice and health equity that are desperately needed in order to create healthy environments whereby Indigenous youth within northern Canadian communities can be assisted to flourish

As the world journeys towards the endemic phase that follows a pandemic, public health authorities are reviewing the efficacy of COVID-19 pandemic responses. The responses by Aboriginal and Torres Strait Islander communities in Australia have been heralded across the globe as an exemplary demonstration of how self-determination can achieve optimal health outcomes for Indigenous peoples. Despite this success, the impacts of pandemic stressors and public health responses on immediate and long-term mental health and wellbeing require examination. In December 2021, Aboriginal and Torres Strait Islander mental health and wellbeing leaders and allies (N = 50) attended a virtual roundtable to determine the key issues facing Aboriginal and Torres Strait Islander peoples and communities, and the actions required to address these issues. Roundtable attendees critically reviewed how the rapidly evolving pandemic context has impacted Aboriginal and Torres Strait Islander mental health and social and emotional wellbeing (SEWB). This paper presents an overview of this national collaborative consultation process, and a summary of the key issues and actions identified. These results build on evidence from other roundtables held in Australia during 2020, and the emerging consensus across the globe that Indigenous self-determination remains essential to Indigenous SEWB, especially during and following a pandemic.

System-wide racial discrimination and inequitable access to justice impedes Indigenous rights to health and wellbeing.

Background: Native American youth, primarily living on reservations, suffer the highest burden of suicide of any racial group in the USA. Implementation and sustainability of culturally grounded, evidence-based interventions are needed to address suicide in Native American populations. For nearly 40 years, Montana has ranked at or near the top nationwide for suicide. Fort Peck Tribal leadership declared a state of emergency in 2010 after six suicides and 20 attempts that occurred over a 5-month period.

Methods: We used a community-based participatory research approach for adapting the Celebrating Life (CL) program with a specific focus on long-term sustainability, which has demonstrated efficacy in addressing suicide with the White Mountain Apache. The aims were to (1) adapt the CL program intake forms through roundtable discussions, (2) conduct asset and resource mapping to identify community and cultural resources to leverage for the CL program within the Fort Peck context, and (3) develop a sustainability plan for CL in Fort Peck through qualitative approaches informed by the Program Sustainability Assessment Tool.

Results: Roundtable discussions resulted in adapted intake forms that capture variables relevant to the Fort Peck context. Asset mapping identified 13 community assets and 10 cultural resources to incorporate within the CL implementation process. Focus group discussions yielded four key themes that were incorporated into a plan for sustainability: (1) strategic partnerships, (2) long-term funding, (3) communication planning, and (4) workforce planning and engagement.

Conclusions: This paper outlines an avenue for using culturally adapted tools to design an implementation system driven by community and cultural assets within tribal communities and for integrating program planning for sustainability early in the implementation process.

Background: There is a significant push to change the trajectory of youth mental ill-health and suicide globally. Ensuring that young people have access to services that meet their individual needs and are easily accessible is a priority. Genuine stakeholder engagement in mental health system design is critical to ensure that system strengthening is likely to be successful within these complex environments. There is limited literature describing engagement processes undertaken by research teams in mental health program implementation and planning. This protocol describes the methods that will be used to engage local communities using systems science methods to mobilize knowledge and action to strengthen youth mental health services.

Methods: Using participatory action research principles, the research team will actively engage with local communities to ensure genuine user-led participatory systems modelling processes and enhance knowledge mobilisation within research sites. Ensuring that culturally diverse and Aboriginal and Torres Strait Islander community voices are included will support this process. A rigorous site selection process will be undertaken to ensure that the community is committed and has capacity to actively engage in the research activities. Stakeholder engagement commences from the site selection process with the aim to build trust between researchers and key stakeholders. The research team will establish a variety of engagement resources and make opportunities available to each site depending on their local context, needs and audiences they wish to target during the process.

Discussion: This protocol describes the inclusive community engagement and knowledge mobilization process for the Right care, first time, where you live research Program. This Program will use an iterative and adaptive approach that considers the social, economic, and political context of each community and attempts to maximise research engagement. A theoretical framework for applying systems approaches to knowledge mobilization that is flexible will enable the implementation of a participatory action research approach. This protocol commits to a rigorous and genuine stakeholder engagement process that can be applied in mental health research implementation.

Objective: This conceptual article addresses “best practices” for Indigenous Peoples in the United States and Canada. This topic is “thorny” both pragmatically (e.g., rare representation in clinical trials) and ethically (e.g., ongoing settler colonialism).

Method: We outline four potential approaches, or “paths”, in conceptualizing best practices for psychotherapy: (a) limiting psychotherapy to empirically supported treatments, (b) prioritizing the use of culturally adapted interventions, (c) focusing on common factors of psychotherapy, and (d) promoting grassroots Indigenous approaches and traditional healing.

Results: Lessons from our four-path journey include (a) the limits of empirically supported treatments, which are inadequate in number and scope when it comes to Indigenous clients, (b) the value of prioritizing interventions that are culturally adapted and/or evaluated for use with Indigenous populations, (c) the importance of common factors of evidence-based practice, alongside the danger of psychotherapy as a covert assimilative enterprise, and (d) the need to support traditional and grassroots cultural interventions that promote “culture-as-treatment”.

Conclusions: A greater commitment to community-engaged research and cultural humility is necessary to promote Indigenous mental health, including greater attention to supporting traditional healing and Indigenous-led cultural interventions.

Indigenous Americans are not well represented by mainstream psychology and its reductionistic tenets. As psychology developed, it could not help but to be implicitly biased by the surrounding hierarchical colonial culture—a culture in which Indigenous people and many others were conquered, oppressed, dehumanized, devalued, neglected, and excluded. An Indigenous worldview views humans as co-equal partners of an interdependent holistic system. Striving for healthy relationships with others is foundational to psychological health and well-being from an Indigenous perspective. Discrete entities (including self), independence, autonomy, and hierarchy are considered artificial mainstream conceptualizations that have negatively impacted the well-being of humans and the natural world. Indigenous American psychology appreciates the sacred nature of the whole and its entities, approaching professional psychology with the humility and respect that interacting with sacred entities warrants. Essential tenets of an Indigenous American Psychological Paradigm (IAPP) are discussed therein as an alternative to existing mainstream beliefs. An IAPP offers the ability to address intergenerational psychological problems holistically across time in ways that mainstream psychology has been unable. Psychology is ultimately strengthened by an ability to conceptualize psychology through the new lenses of alternative paradigms such as this one.

There are 600 diverse American Indian/Alaska Native communities that represent strong and resilient nations throughout Indian Country. However, a history of genocidal practices, cultural assaults, and continuing oppression contribute to high rates of mental health and substance use disorders. Underresourced mental health care and numerous barriers to services maintain these disparities. Indigenous community mental health workers hold local understandings of history, culture, and traditional views of health and wellness and may reduce barriers to care while promoting tribal health and economic self-determination and sovereignty. The combination of Native community mental health workers alongside a growing workforce of Indigenous mental health professionals may create an ideal system in which tribal communities are empowered to restore balance and overall wellness, aligning with Native worldviews and healing traditions.

Despite high rates of perinatal depression and anxiety, little is known about how Aboriginal women in Australia experience these disorders and the acceptability of current clinical screening tools. In a 2014 study, the Kimberley Mum’s Mood Scale (KMMS) was validated as an acceptable perinatal depression and anxiety screening tool for Aboriginal women in the Kimberley region of Western Australia. In the current study, we explored if it was appropriate to trial and validate the KMMS with Aboriginal women in the Pilbara. Yarning as a methodology was used to guide interviews with 15 Aboriginal women in the Pilbara who had received maternal and child health care within the last three years. Data were analysed thematically, the results revealing that this cohort of participants shared similar experiences of stress and hardship during the perinatal period. Participants valued the KMMS for its narrative-based approach to screening that explored the individual’s risk and protective factors. While support for the KMMS was apparent, particular qualities of the administering health care professional were viewed as critical to the tool being well received and culturally safe. Building on these findings, we will work with our partner health services in the Pilbara to validate the KMMS with Pilbara Aboriginal women.

Indigenous Australian women are among the most disadvantaged women in the world. Over two centuries of colonization have had a damaging impact on perceptions of their gender roles and status as well as many other consequential oppressions. These experiences have affected the social and emotional wellbeing of Indigenous women of all ages, resulting in socio-economic ghettoization, higher suicide rates, psychological distress, illness, and poverty. Generations of women have experienced the forced removal of their children, resulting in complex forms of historical trauma. Despite this, Indigenous women have also maintained strong leadership roles and have kept families and communities intact. In the last few decades, the Australian Indigenous mental health movement has emerged within the context of a broader self-determination movement, restoring and strengthening women’s traditional therapeutic practices. This article offers an overview of the social and emotional wellbeing of Indigenous women within neocolonial Australia and explores women’s relationship to traditional therapeutic practices. Future directions and key issues for the capacity building of Indigenous women’s healing are explored.

 Yarning with Minjungbal women incorporates the testimonial narratives of five women from the Minjungbal community of Tweed Heads in far northern New South Wales. Our combined metanarrative explores how we have been able to interrupt transgenerational trauma, which is the process that explains how the impacts of historical suffering are inherited by successive generations. Minjungbal women’s experiences of transgenerational trauma are discussed firstly through our ties to country and culture, secondly within the relationships in our community, and finally inside the dynamics of our families. Minjungbal women explain how we have experienced transgressions, resisted oppression, engendered healing and spread strength within each of these spheres. Minjungbal women’s relationships to country and culture, community and family have been influenced by the legacies of the past, and Minjungbal women still experience ongoing injustices from government policies and the attitudes of the dominant society. Nevertheless, this thesis contends that Minjungbal women have always been actors in resisting oppression, agents in interrupting the cycle of transgenerational trauma and instrumental in facilitating positive changes. Yarning with Minjungbal Women proposes that the key to resistance, resilience and healing lies within the teaching and learning that occurs within the context of relationships. Yarning with Minjungbal Women is therefore an embodiment of activism research as it is informed by the sharing of stories and the strengthening of relationships. Yarning with Minjungbal Women is a contribution to the field of research about the history of Minjungbal country. It contributes to existing research that explains the mechanisms by which the transgenerational transfer of trauma is inherited and passed on. This research is focussed though an Indigenous feminist heuristic perspective as the most culturally appropriate and immersive methodology for me to employ as a Minjungbal woman who has been shaped by transgenerational trauma, as I am perfectly suited to elucidate sensitive information from women in my community. The testimonial narratives were recorded using yarning as a communication method. Yarning facilitated the release of information in a way that Minjungbal women were comfortable with, giving them agency in the research process, as well as retaining the integrity of Minjungbal communication practises.

The settler colonial lens deficit approach to Indigenous peoples’ health constructs us as ill, which sets the stage for our eventual erasure. In contrast to this deficit-based approach, in this paper I employed an Anishinaabeg research paradigm and followed Anishinaabeg protocols to understand how Anishinaabeg women are creating wellbeing for themselves, their families, and communities through engaging in physical activity. Based on seven interviews with Anishinaabeg women who are engaged in decolonized physicality, the Anishinaabeg women participants promote gwesayjitodoon indo bimaadiziiwin, which means to transform oneself into a better life. The participants showed how if one can apply the concept of gwesayjitodoon indo bimaadiziiwin to his or her physical activity, it has potential to enact broader community wellbeing that can confront the settler colonial deficit lens that requires Indigenous peoples’ erasure, and through which Aboriginal health research has for too long been examined.

It is likely that young people who are both Aboriginal and Torres Strait Islander and LGBTQA+ would be at increased risk for poor mental health outcomes due to the layered impacts of discrimination they experience; however, there is very little empirical evidence focused on the mental health and wellbeing of Aboriginal and Torres Strait Islander LGBTQA+ young people. The current study represents a qualitative exploration of wellbeing among Aboriginal LGBTQA+ young people. This study consisted of semi-structured interviews and focus groups with Aboriginal LGBTQA+ young people aged 14–25 years old in the Perth metropolitan area of Western Australia. Thematic analysis identified seven major themes that were significant to participants’ wellbeing: identity, family, community, visibility, services, stigma and navigating.

There has been scant exploration of the social and emotional wellbeing (SEWB) of young Indigenous populations that identify as LGBTQA+ (Lesbian, Gay, Bisexual, Transgender, Queer/Questioning, Asexual +). Given the vulnerability of this cohort living in Western settler colonial societies, wider investigation is called for to respond to their needs, experiences and aspirations. This paper summarizes existing research on the topic highlighting the lack of scholarship on the intersection of youth, Indigeneity, LGBTQA+ and SEWB. The paper takes a holistic approach to provide a global perspective that draws on an emerging body of literature and research driven by Indigenous scholars in settler colonial societies. The paper points to the importance of understanding converging colonial influences and ongoing contemporary elements, such as racism and marginalization that impact on young Indigenous LGBTQA+ wellbeing.

Understanding the multiple identity groups of Aboriginal and Torres Strait Islander LGBTQ+ young people can assist in meeting their health care needs.

Methods: We employed a decolonizing research methodology, ‘community collaborative participatory action research’, involving consultation with Aboriginal communities prior to the study and establishment of a Project Advisory Group (PAG) of community expert Aboriginal women to guide the project. Forty-three semi-structured interviews were conducted in 2013 with Aboriginal women in urban and regional prisons in NSW. We applied a grounded theory approach for the data analysis with guidance from the PAG.

Results: Whilst Aboriginal women reported positive and negative experiences of prison healthcare, the custodial system created numerous barriers to accessing healthcare. Aboriginal women experienced institutional racism and discrimination in the form of not being listened to, stereotyping, and inequitable healthcare compared with non-Indigenous women in prison and the community.

Conclusions: ‘Equal treatment’ is an inappropriate strategy for providing equitable healthcare, which is required because incarcerated Aboriginal women experience significantly poorer health. Taking a decolonizing approach, we unpack and demonstrate the systems level changes needed to make health and justice agencies culturally relevant and safe. This requires further acknowledgment of the oppressive transgenerational effects of ongoing colonial policy, a true embracing of diversity of worldviews, and critically the integration of Aboriginal concepts of health at all organizational levels to uphold Aboriginal women’s rights to culturally safe healthcare in prison and the community.

Purpose: This article describes the protocol for a randomized effectiveness and cost-effectiveness trial of Stanley and Brown’s Safety Planning Intervention (SPI) during pretrial jail detention to reduce post-release suicide events (suicide attempts, suicide behaviours, and suicide-related hospitalizations).

Background: With 10 million admissions per year and short stays (often days), U.S. jails touch many individuals at risk for suicide, providing an important opportunity for suicide prevention that is currently being missed. This study (N = 800) is the first randomized evaluation of an intervention to reduce suicide risk in the vulnerable year after jail release. Given that roughly 10% of all suicides in the U.S. with known circumstances occur in the context of a criminal legal stressor, reducing suicide risk in the year after arrest and jail detention could have a noticeable impact on national suicide rates.

Design: Pretrial jail detainees at risk for suicide were randomized to SPI during jail detention plus post-release phone follow-up or to enhanced Standard Care. Outcomes assessed through 12 months post-release include suicide events, suicide attempts, weeks of active suicide ideation, severity of suicide ideation, time to first event, psychiatric symptoms, functioning, and cost-effectiveness. Methods accommodate short jail stays and maximize trial safety and follow-up in a large sample with severe suicide risk, access to lethal means including substances and firearms, high rates of psychiatric illness, and unstable circumstances.

Conclusion: Adequate funding was important to create the infrastructure needed to run this large trial cleanly. We encourage funders to provide adequate resources to ensure clean, well-run trials.

Arts-based prison programs are often viewed as hobbies or as activities that have little impact on prisoner rehabilitation according to conventional understandings of the term. This is despite growing evidence that arts-based programs can assist with learning retention and can improve self-confidence and ways of coping with emotions. Generally, arts practices have been found to assist Aboriginal and Torres Strait Islander people who have grown up or live in urban areas with asserting and strengthening their cultural identity, but we know little about the effects of arts-based prison programs on Aboriginal and Torres Strait Islander prisoner wellbeing. This article focuses on a creative writing program for Aboriginal and Torres Strait Islander prisoners at Junee Correctional Centre, New South Wales. The program, Dreaming Inside, has produced seven volumes of poetry and stories. This article combines and reports findings from two evaluations of the program, one using program feedback forms and the other using semi-structured interviews with prisoners who participated in the program. The themes that emerged from both evaluations affirm the program’s efficacy in improving prisoner self-esteem, confidence and wellbeing, and in reigniting and strengthening cultural engagement.

Background: High rates of suicidal behaviours among Indigenous Australians have been documented. Justice- involved individuals are also at a higher risk for engaging in suicidal behaviours. This study sought to ascertain the prevalence and correlates of suicidal behaviours for 107 Indigenous adult males in custody in Victoria, Australia.

Methods: Participants undertook a structured interview comprising a psychiatric assessment. Information on suicidal behaviours (ideation and attempts), socio-demographics, environmental stressors, negative life events and mental health was obtained.

Results: A high proportion of Indigenous males in custody experienced lifetime suicidal ideation (63.7%) and over one- half had attempted suicide (54.5%). A smaller, yet significant number of participants experienced ideation over the past 12 months (27.9%). Having a loved one pass away within the past 12 months predicted recent ideation; lifetime ideation and a diagnosis of Post-Traumatic Stress Disorder predicted a lifetime suicide attempt.

Conclusions: The prevalence of suicidal behaviours among Indigenous people in custody is remarkably high. Correlates of suicidal behaviours for Indigenous people in custody in this study likely manifest in the community, denoting an urgent public health response. Prevention must begin in communities at-risk for suicidal behaviours. The development of low intensity mental health service infrastructure in communities to promote awareness and provide accessible, least restrictive support and treatment is necessary. Correctional institutions must also continue to improve custodial suicide prevention and management initiatives.

Background: Histories of self-harm and suicide attempts are common among people in prison in Australia, and substance dependence is an established risk factor for these lifetime experiences. We describe the prevalence of self-reported history of non-suicidal self-injury (NSSI) and suicide attempts in a cohort of men with recent histories of injecting drug use (IDU) imprisoned in Victoria, Australia. Baseline interviews from the Prison and Transition Health (PATH) prospective cohort study were conducted in the weeks prior to release from prison among 400 incarcerated men who reported regular IDU in the six months prior to incarceration.

Results: Participants completed a researcher-administered structured questionnaire that collected information on socio-demographics, substance use patterns, and physical and mental health indicators. More than one third (37%) reported a history of NSSI and almost half of participants (47%) reported a history of suicide attempts. In multivariable Poisson regression models, a history of NSSI was associated with: being aged 30–39 years; moving accommodation three or more times in the year prior to current sentence; self-reporting a history of mental illness diagnosis; current poor psychiatric well-being; and self-reporting three or more previous drug overdoses. History of suicide attempts was significantly associated with: self-reporting a history of mental illness diagnosis; current poor psychiatric well-being; and self-reporting a history of 1–2 and > 3 drug overdoses.

Conclusion: We observed a disconcertingly high lifetime prevalence of non-suicidal self-injury and suicide attempts among incarcerated males with a history of recent regular injecting drug use. Significant associations with indicators of mental illness and drug related harms support the need to prioritise in-prison screening and early intervention to reduce the risk of future harms for this population.

Objective: Aboriginal art is an effective, culture-specific therapy for Aboriginal people. This may have important implications for Aboriginal prisoners at risk of suicide/self-harm. This project aimed to evaluate the potential positive effects of Aboriginal art activities on the suicide/self-harm risk behaviours of Aboriginal prisoners.

Method: A retrospective audit was undertaken of data related to the incidence of suicide/self-harm risk assessments for a cohort of male Aboriginal prisoners (N = 335) incarcerated in a single Australian prison between 11th December 2008 and 22nd December 2010.

Results: Of the 335 Aboriginal prisoners, 108 (32.2%) attended the Aboriginal art program at least once and 227 did not. Univariate analyses of the sample characteristics showed that those who attended the Aboriginal art program were less likely to have a history of psychiatric illness (10.2% versus 19.8%), but more likely to have a history of violent offences (90.7% versus 67.4%) and more likely to have presented with grief/loss issues at receptions (24.1% versus 14.5%). Univariate analyses using binomial regression showed that both suicide/self-harm history and number of days attending Aboriginal art was associated with the incidence rate of suicide/self-harm risk assessments. Controlling for a history of suicide self-harm, we found that each day (and additional day) of attendance to the Aboriginal art program reduced the incidence rate of suicide/self-harm assessment by a factor of 0.81 (CI 95%: 0.70–0.95).

Discussion: This study provides some evidence of the protective effect of engaging in Aboriginal art for reducing suicide or selfharm behaviours for Aboriginal prisoners. Clinical implications and recommendations for future studies are discussed.

The objective of this review was to synthesise evidence on the health and social support needs of Aboriginal and Torres Strait Islander people leaving prison and on programs which aid successful community re-entry. A systematic literature review was undertaken of peer-reviewed and grey literature published between 2001 and 2013, focusing on the post-release needs of Aboriginal and Torres Strait Islander adults and pre- and post-release programs. Aboriginal and Torres Strait Islander people have high health and social support needs on leaving prison. There is little literature evidence that re-entry programs commonly consider health needs, support linkages with primary care or Aboriginal Medical Services, or are designed in consideration of the particular needs of Aboriginal and Torres Strait Islander people. In the absence of evaluative evidence on re-entry programs in this group, we have synthesised the best practice recommendations. Re-entry programs must be culturally competent in design and delivery, holistic, take a longterm view, involve families and communities, demonstrate interagency coordination and promote linkages between prison and community-based services. There is an urgent need for accessible pre- and post-release programs which meet the particular needs of Aboriginal and Torres Strait Islander people, including their health needs. Programs must be flexible, comprehensive and accessible to those on remand or with short sentences. Stronger linkage with primary care and Aboriginal and Torres Strait Islander community controlled health organisations is recommended.

Although a large number of studies offer consistent and persuasive evidence that exposure to childhood maltreatment and subsequent juvenile offending behaviours are related, relatively few studies have investigated the mechanisms by which maltreatment might increase risk in young offender populations. The aim of this pilot study was to collate data on the key areas of need from 28 young male offenders in secure care in an Australian jurisdiction, with a specific focus on the inter-relationship between scores on self-report measures of maltreatment, trauma, and mental health. The findings provide preliminary evidence that these key constructs are linked to other proximal risk factors for juvenile offending, such as poor anger regulation and antisocial thinking patterns. They offer a rationale for considering the sequelae of maltreatment in the development of service delivery frameworks for young offenders.

Background: Aboriginal Australians are more likely than other Australians to cycle in and out of prison on remand or by serving multiple short sentences—a form of serial incarceration and institutionalisation. This cycle contributes to the over-representation of Aboriginal Australians in prison and higher rates of recidivism. Our research examined how primary health care can better meet the health care and social support needs of Aboriginal Australians transitioning from prison to the community.

Methods: Purposive sampling was used to identify 30 interviewees. Twelve interviews were with Aboriginal people who had been in prison; ten were with family members and eight with community service providers who worked with former inmates. Thematic analysis was conducted on the interviewees’ description of their experience of services provided to prisoners both during incarceration and on transition to the community.

Results: Interviewees believed that effective access to primary health care on release and during transition was positively influenced by providing appropriate healthcare to inmates in custody and by properly planning for their release. Further, interviewees felt that poor communication between health care providers in custody and in the community prior to an inmate’s release, contributed to a lack of comprehensive management of chronic conditions. System level barriers to timely communication between in-custody and community providers included inmates being placed on remand which contributed to uncertainty regarding release dates and therefore difficulties planning for release, cycling in and out of prison on short sentences and being released to freedom without access to support services.

Conclusions: For Aboriginal former inmates and family members, release from prison was a period of significant emotional stress and commonly involved managing complex needs. To support their transition into the community, Aboriginal former inmates would benefit from immediate access to culturally- responsive community -primary health care services. At present, however, pre-release planning is not always available, especially for Aboriginal inmates who are more likely to be on remand or in custody for less than six months.

This article reports on research undertaken in Western Australia and the Northern Territory to develop effective throughcare strategies for Indigenous people leaving prison. The findings are based on interviews with Indigenous men and women in communities, with and without lived experience of prison, and local service providers. The interviews demonstrate that a thorough exit plan from prison is essential. However, for throughcare strategies to be effective, they should acknowledge the context of Indigenous involvement in the criminal justice system and the ongoing consequences of colonisation. The paper discusses the main areas that need to be addressed during imprisonment and after release, which form the basis of recommendations. Effective throughcare strategies must involve Indigenous people and the broader community, to break the cycle of offending and reoffending and address the over-representation of Indigenous people in prison.

Objective: Over the last decade, the literature relating to older Aboriginal and Torres Strait Islander people’s preferences for social and emotional wellbeing services has grown. However, little evidence exists in relation to older Aboriginal and Torres Strait Islander people’s experiences of services relating to social and emotional wellbeing. This paper highlights older Aboriginal and Torres Strait Islander people’s experiences of social and emotional wellbeing services in Australia and then uses these key findings of the research, along with the literature, to develop a strength-based approach for service providers.

Methods: Yarning was the preferred research method for the older Aboriginal community. In total, 16 older Aboriginal people, including eight women and eight men participated in the research yarning sessions. A modified version of an existing thematic analysis process supported yarning members to participate in each stage of the research, including data analysis.

Results: The themes emerging from the voices of the yarning members are they couldn’t give a damn about them, You’ve got to get the right one and ticking the box. The themes focus on negative, positive and preferred experiences of social and emotional wellbeing service provision.

Conclusion: The key findings and related literature contribute to the development of a strength-based approach, which supports the implementation of responsive and effective services that address Elders, older peoples and their communities’ social and emotional wellbeing issues and aspirations.

Aboriginal Australians experience higher levels of psychological distress, which may develop from the long-term sequelae of social determinants and adversities in early and mid-life. There is little evidence available on the impact of these on the mental health of older Aboriginal Australians. This study enrolled 336 Aboriginal Australian participants over 60 years from 5 major urban and regional areas in NSW, utilizing a structured interview on social determinants, and life-time history of physical and mental conditions; current psychosocial determinants and mental health. Univariate and multivariate analyses were utilized to examine the link between these determinants and current depressive scores and suicidality. There was a high rate of life-time depression (33.3%), current late-life depression (18.1%), and suicidal ideation (11.1%). Risk factors strongly associated with late-life depression included sleep disturbances, a history of suicidal behaviour, suicidal ideation in late-life and living in a regional location. This study supports certain historical and psychosocial factors predicting later depression in old age, and highlights areas to target for prevention strategies.

High rates of Indigenous suicide are a distressing phenomenon that plague several postcolonial countries. In Australia, suicide is a leading cause of mortality for Aboriginal and Torres Strait Islander people. In the period 2012 to 2016, the suicide rate for Indigenous Australians was estimated to be 23.7 per 100,000, twice the rate (11.6 per 100,000) for non-Indigenous Australians. Data presented by the National Coronial Information System highlights a major disparity in suicide rates between Indigenous and non-Indigenous Australians in younger age groups; the Indigenous suicide rate was 31.5 per 100,000 among those aged 15–44 years, compared to 11.1 per 100,000 for non-Indigenous people. Meanwhile, among those aged 45 years and older, there appeared to be no or minimal disparity in suicide rates by Indigenous identification. This paper explores the interaction between age and ‘unknown’ Indigenous status in regards to deaths by suicide.

Aim: The meaning of spiritual well‐being as a health dimension is often contested and neglected in policy and practice. This paper explores spiritual well‐being from both an Indigenous and a non‐Indigenous perspective.

Method: We drew on Indigenous and non‐Indigenous methodologies to explore the existing knowledge around spiritual well‐being and its relationship with health.

Results: The Indigenous perspective proposed that spiritual well‐being is founded in The Dreaming, informs everyday relationships and can impact on health. The non‐Indigenous perspective suggested that spiritual well‐being is shaped by culture and religion, is of increased importance as one ages, and can improve coping and resilience stressors.

Conclusions: Situating these perspectives side by side allows us to learn from both, and understand the importance of spirituality in people’s lives. Further research is required to better address the spiritual well‐being/health connection in policy and practice.

Background: Despite unique gender patterns of suicide among older people in rural China, research addressing this issue is scarce.  is study aims to clarify the gender-specific risk factors of late-life suicide in rural China.

Methods: The study included 242 persons (51% male) aged 60 and above who had committed suicide between June 2014 and September 2015 in the rural areas of three provinces of China. Using 1:1 matched case-control design, 242 living controls matched in age, gender and neighbourhood were randomly selected. Psychological autopsy interviews and psychological assessments were conducted with two informants for each suicide and living control, respectively.

Results: Men used alcohol before suicide more than women (12.6 versus 4.7%, P < 0.05).  ere was no gender difference in suicide method, suicide intent and previous attempts. Univariate analysis showed that married status, mental disorder, depressive symptoms, hopelessness, impulsivity, loneliness, social support, family function and quality of life were associated with suicide in both genders. For men, other risk factors were chronic physical illness and functions of daily living. Variables remaining in the multivariable model for both men and women were depressive symptoms and hopelessness.

Discussion: Depression and hopelessness are the two major risk factors for suicide among both older men and woman in rural China. Suicide prevention programmes focusing on depression and hopelessness in this population are indicated. Also needed are continued efforts to develop and refined gender-specialised strategies to identify high-risk individuals or groups and to enhance targeted support in the rural community.

Background: Previous studies revealed that there was a significant increase in suicide deaths among those aged 65 and over in 2003. The peak coincided with the majority of SARS cases being reported in April 2003.

Aims: In this paper we examine the mechanism of how the SARS outbreak resulted in a higher completed suicide rate especially among older adults in Hong Kong.

Methods: We used Qualitative data analysis to uncover the association between the occurrence of SARS and older adult suicide. Furthermore, we used a qualitative study based on the Coroner Court reports to provide empirical evidence about the relationship between SARS and the excessive number of suicide deaths among the elderly. Results: SARS-related older adult suicide victims were more likely to be afraid of contracting the disease and had fears of disconnection. The suicide motives among SARS-related suicide deaths were more closely associated with stress over fears of being a burden to their families during the negative impact of the epidemic. Social disengagement, mental stress, and anxiety at the time of the SARS epidemic among a certain group of older adults resulted in an exceptionally high rate of suicide deaths.

Conclusions: We recommend that the mental and psychological well-being of the community, in particular older adults, be taken into careful account when developing epidemic control measures to combat the future outbreak of diseases in the community. In addition, it is important to alert family members to vulnerable individuals who are at potential risk because of their illnesses or anxieties.

The human rights of both LGBTIQ+ and Indigenous peoples are far from realized. When conjoined, intersecting identities reveal how racism and queer phobia affect well-being, negating the right to health and resulting in devastating impacts on people’s social, cultural, and emotional well-being. This paper documents the lived experiences of a sample of young gender- and sexuality-diverse Aboriginal and Torres Strait Islander peoples from a research project conducted in New South Wales, Australia. Their perspectives reveal how, for this cohort, discrimination and privation is manifest at the family, community, and institutional levels. This paper informs an understanding of human rights as experienced by Aboriginal and Torres Strait Islander LGBTIQ+-identified peoples, where racism and queer phobia are evident in the spheres of education, employment, and service provision. Adopting a critical human rights stance, our analysis illustrates how settler colonialism manifests through the processes and outcomes of settler colonial institutions and structures.

Background: Racism is a pervasive experience in the life of Aboriginal Australians that begins in childhood. As a psychosocial stressor, racism compromises wellbeing and impacts developmental trajectories. The purpose of the present study was to estimate the effect of racism on indicators of Australian Aboriginal child socio-emotional wellbeing (SEWB) at one to two years after exposure. Age-related differences in the onset of symptoms were explored. Methods: Data from the B- and K-cohorts of the Longitudinal Study of Indigenous Children were used (aged 6 to 12 years). Racism, confounding variables, and the Strengths and Difficulties Questionnaire (a measure of SEWB) were collected by questionnaires and guided interviews with each child’s main caregiver. Adjusted Poisson regression was used to estimate the relative risk (RR) effects of racism on SEWB for both cohorts separately. RR were pooled in a random effects meta-analysis.

Results: Exposure to racism was associated with an adjusted point estimate indicating a 41% increased risk for total emotional and behavioural difficulties, although the confidence intervals were wide (pooled RR 1.41, 95% CI 0.75, 2.07). Analyses by cohort showed younger children had higher RR for total difficulties (RR 1.72, 95% CI 1.16, 2.54), whilst older children had higher RR for hyperactive behaviour (RR 1.66, 95% CI 1.01, 2.73).

Conclusions: The effects observed contributes to our understanding of the impact of racism on Aboriginal Australian children. Support for emotional and behavioural difficulties, and hyperactive behaviour, for Aboriginal children might help counteract the effects of racism. Future longitudinal research and policies aimed at reducing racism in Australian society are necessary.

Aboriginal children in Australia are over-represented in both the child protection and juvenile justice systems. Using Western therapeutic models of practice with Aboriginal people who live in remote communities can be highly problematic. Moreover, the historical legacy of past and present legislation, government interventions and racist service provision needs to be acknowledged and addressed prior to any service implementation. This paper presents a therapeutic model of practice that incorporates Aboriginal concepts of healing and spirit within a creative therapeutic framework. It will demonstrate how the model works through principles of community engagement and capacity building, enabling the provision of a culturally derived therapeutic intervention that involves a synergy of both Aboriginal- and Western-based healing practices. The findings from the implementation of the TeaH model affirm the need to incorporate Aboriginal concepts of healing, spirit and creative therapies into mainstream practice with Aboriginal people.

This systematic review analyses research measuring or evaluating primary health care interventions that focused on improving the mental health of Indigenous children via intersectoral service integration processes and tools.  Of the eleven studies included five were conducted with Indigenous children (aged 4 to 17 years) in Australia, the remaining studies included New Zealand, Canada, Norway and/or the United States. Among thenine key strategies adopted by service integration interventions of note were: Engaging the members of the Indigenous community; Empowerment of families; Adapting interventions and care to the specific socio-cultural circumstances; and Cultural strengthening and empowerment of Indigenous children’s identity.  Six factors enabling effective implementation of service integration included: Including and involving the community and stakeholders, Sensitivity to culture, including to historical background and inter-generational trauma, Multi-disciplinary and collaborative health services and Resourcing factors (e.g. funding, costs, time availability, staff/organisation capacity). The authors conclude that while the research evidence for interventions focused on improving the mental health of Indigenous children via intersectoral service integration is preliminary the findings hold potential. Importantly, the main outcomes where strategies focused on intersectoral integration were: Improvements in children’s psychosocial functioning, stress management, and individual empowerment; Improvements in health service access and use; Empowerment of both families and communities; and Increased links and collaboration between the community and health services. The authors identify the need for further research, particularly to incorporate Indigenous voices in evaluation, help clarify impact, and to evaluate costs.

Objectives: This study investigates the protective role of ethnic-racial identity (ERI) affirmation on the longitudinal association between racism and Aboriginal Australian children’s social and emotional well-being (SEWB). Methods: 408 children from the K-Cohort of the Longitudinal Study of Indigenous Children were included in the analysis. Data were collected through questionnaire-guided interviews at 7–10 and 9–12 years of age. Children’s racism experience, SEWB (Strengths and Difficulties Questionnaire), and confounding were reported by caregivers. ERI was reported by children and dichotomized into high versus low. Generalized linear models with log-Poisson links and robust errors were used to estimate adjusted Risk Ratios (RR) for the effect of racism on SEWB domains. Effect-measure modification analysis was used to verify differences on effect sizes per strata of ERI affirmation. The presence of modification was indicated by the Relative Excess Risk due to Interaction (RERI).

Results: Slightly above half (51.4%) of the children presented high ERI affirmation. Children exposed to racism and with low ERI affirmation were at increased risk of hyperactive behavior (RR 2.53, 95% CI 1.17, 5.48), conduct problems (RR 2.35, 95% CI 1.07, 5.15), and total difficulties (RR 1.73, 95% CI 0.84, 3.55). Positive RERIs indicated the joint effects of racism and low ERI affirmation surpassed the sum of their separate effects in these domains. Children with high ERI affirmation were at increased risk of peer problems (RR 1.66, 95% CI 0.78, 3.52).

Conclusions: These findings suggest that ERI may mitigate the risk of poor SEWB due to racism. Fostering affirmative ERI can be an important strategy in promoting resilience in Aboriginal Australian children.

Suicide and self-harm represent serious global health problems and appear to be especially elevated amongst indigenous minority groups, and particularly amongst young people (aged 24 years or younger). This systematic review investigates for the first time the antecedents and prevalence of suicide, self-harm and suicide ideation among Australian Aboriginal and Torres Strait Islander youth. Web of Science, PubMed, PsychINFO, CINAHL databases and grey literature were searched from earliest records to April 2019 for eligible articles. Twenty-two empirical articles met the inclusion criteria. The data confirmed that indigenous youth in Australia have elevated rates of suicide, self-harm and suicidal ideation relative to the nonindigenous population. Risk factors included being incarcerated, substance use and greater social and emotional distress. Notably, though, information on predictors of suicide and self-harm remains scarce. The findings support and justify the increasing implementation of public health programs specifically aimed at tackling this crisis. Based on the review findings, we argued that Aboriginal communities are best positioned to identify and understand the antecedents of youth self-harm, suicide ideation and suicide, and to take the lead in the development of more effective mental health preventive strategies and public policies within their communities.

Aim: Aboriginal and Torres Strait Islander young people are more likely to experience mental health issues or end their life by suicide than non-Aboriginal youth, but are less likely to access mental health services for support. Systemic change is required if mainstream youth mental health services are to be relevant and culturally secure for Aboriginal and Torres Strait Islander young people.

Methods: Building Bridges (2017-2019) is a three-year participatory action research project being conducted in partnership with the Nyoongar community and three main-stream youth mental health services in Perth, Western Australia. The project involves Nyoongar Elders and Aboriginal and Torres Strait Islander young people working directly with senior management and key staff of youth mental health services to co-design, implement and evaluate a framework for systems change. The aim of the project is to increase Aboriginal and Torres Strait Islander young people’s engagement with services and improve mental health outcomes for young people and their families.

Results: This paper outlines the engagement process that underpinned the first phase of the project. Our research methods are premised by an investment in establishing safe spaces for the Elders, young people and service staff to engage in open, honest dialogue. We present two key activities that illustrate this process of building trust and deepening understanding, namely: spending time “On Country” and engaging in a “storying” process.

Conclusions: Building Bridges demonstrates the centrality of trusting relationships for systemic change and the way in which meaningful engagement is at the core of both the process and the outcome.

Objective: The suicide rate for Queensland’s Aboriginal and Torres Strait Islander young people is over four times that of their non- Indigenous counterparts, with Aboriginal and Torres Strait Islander children (under 15) dying by suicide at 12 times the non-Indigenous rate. There is a need for interventions that are culturally validated and community-endorsed. The aim of this article is to describe the design and implementation of a group-based intervention, as well to report the results of the various qualitative and quantitative measures.

Method: Sixty-one Aboriginal and Torres Strait Islander persons aged 11–21 years completed a social–emotional wellbeing (SEWB) program at headspace Inala. Data were available through to 2-month follow-up for 49 participants. The program was designed and delivered in collaboration with the local Aboriginal and Torres Strait Islander community.

Results: There was a statistically significant decrease in suicidal ideation experienced by the participants after completing the program. Qualitative measures indicated that participants experienced improved understanding of holistic health and an increased number of coping skills.

Conclusions: Not only was this the first evaluated intervention in Aboriginal and Torres Strait Islander youth to ever report a decrease in individual suicidality, the program was carefully designed and implemented in consultation with community in a culturally sensitive manner and thus provides an invaluable framework for future SEWB work.

Results: The Aboriginal youth suicide prevention project was designed and implemented by Njernda Aboriginal Corporation over a period of three years. The main components of the project were building resilience, early intervention response and immediate postvention support. Resilience was built through the Bullroarer program, the Red Dust Healing program and community awareness programs. Another program, the Jekkora group was developed and implemented as an early intervention response. A postvention service is in the planning stage.

Conclusions: During a three-year period Njernda Aboriginal Corporation established community resilience building and early intervention programs. Developing and implementing a comprehensive suicide prevention plan at the community level requires adequate time as well as support from mainstream services. These findings therefore have implications for future planning of Aboriginal suicide prevention projects.

It is currently estimated that up to 40% of Aboriginal youth (aged 13–17) will experience some form of mental health problem within their lifetime. Of greater concern is the evidence that indicates that Aboriginal youth fail to access mental health services commensurate with this need. This is due, in part, to the characteristically monocultural nature of service delivery of existing services. This paper overviews a model that has been developed specifically for the engagement of Aboriginal youth (aged 13–17 years) in mental health settings. Importantly, a mix of urban (N = 43) and rural (N = 68) Aboriginal youth were represented within the sample to determine its efficacy across different language and tribal groups. The model proved to be effective in engaging 97% of Aboriginal youth (n = 108), with only a small number not effectively engaged (n = 3). The model provides a foundation for the further development of evidence-based models of best practice that have so far provided to be elusive within this complex field.

The State Coroner conducted an inquest hearing into the deaths of thirteen children and young persons in the Kimberley Region of Western Australia. These deaths were investigated during one Inquest because there were similar circumstances, life events, developmental experiences and behaviours that appear to have contributed to making them vulnerable to suicide. As part of the Inquest process, the State Coroner made forty-two recommendations across a range of areas including:

• Fetal alcohol spectrum disorder (FASD)
• Alcohol restrictions
• Housing
• Mental health support
• Employment
• Cultural healing

The Can we talk? Seven year youth mental health report – 2012-2018 Youth Survey findings of the past seven years – is co-authored with Black Dog Institute experts – to ascertain and investigate rates of psychological distress experienced by young people in Australia who are aged 15-19. The report further examines the concerns, general wellbeing and help-seeking behaviours of the close to 27,000 participants of the 2018 Youth Survey aged 15-19, including those who are experiencing psychological distress – highlighting the vital role that friends, parents, services, schools and the internet play as sources of help for young people who are struggling with their mental health. Part 2 is about meeting the diversity of young people’s need  : Dedicated focus on Aboriginal and Torres Strait Islander young people.

This is an ethnographic study about young Aboriginal people in Central Australia. The voices and opinions of more than 150 Aboriginal youth were analysed. My findings show that Indigenous Ecological Knowledge (IEK) is an active part of their lives. This knowledge and practice contributes to the identity and pride of youth from Central Australia. Young Aboriginal people are commonly portrayed in the media as problems. Negative stereotypes and deficit narratives imply they occupy a failed space within and between Aboriginal and non-Aboriginal worlds. Youth are said to be lacking in culture and disinterested in cultural practices. My findings contradict such stereotypes and deficiencies. The lived experiences of Aboriginal people are often invisible to mainstream Australian society. Rarely do we hear from young Aboriginal people themselves. Their role as players in a system of knowledge is simultaneously ignored and assumed. IEK is characterised as the domain of the older generation but not younger generations. This thesis goes beyond academic attention to IEK in environmental programs, developmental theories or the nexus between Indigenous and Western or scientific knowledge. The study explores the social lives of young Aboriginal adults. Mixed methods were used to examine the learning practices, learning contexts and cultural acquisition processes that underpin IEK. Qualitative results from interviews, surveys and observations are presented. I look at how IEK is made to happen, how knowledge and practice is realised in contemporary contexts. The study shows that people’s everyday lived experience integrates IEK. Cultural knowledge is vulnerable to the stresses and forces of modern life; yet it persists. Factors that enable IEK to persevere are examined. I have found that hunting, bush food and medicine harvesting, and natural resource use contribute to IEK. Practices and beliefs are enriched through ceremonial life, health and healing, and in observances in bereavement and funerals. Amongst younger people there is an ongoing belief in the sentience of country. This research revealed that IEK is a vital part of youth values and beliefs. Beliefs inform youth practice. IEK is expressed through relationship to families and people’s connections to each other. Young people demonstrate their care for older and younger generations through the collection, preparation and use of natural resources. ‘Relatedness’ continues to be the currency of knowledge transmission. Feelings of love, duty and care motivate young people to listen, learn and do things for their older and younger loved ones. Deep and powerful feelings for family members call young people to action. Young people are integral to the future of Indigenous Ecological Knowledge and practice in Central Australia.

Death by suicide and attempted suicide among Inuit youth is now considered a public health emergency of epidemic proportion, with rates among the highest worldwide. A strong sense of cultural identity and pride, as well as social capital, has been identified as being protective against suicide. The Canadian Institute for Health Research (CIHR) Guidelines for Health Research Involving Aboriginal People call for communities to be included in the conception, planning and implementation of research. The authors took first steps towards sharing the responsibility of designing a community initiative with the youth of Naujaat, Nunavut, a community located directly on the Arctic Circle. With the objectives of promoting open listening and exploration of community needs and enhancing self-determination and sustainability, we postulated a youth resiliency project that will be co-authored by the community. This paper describes the joint work process. We recount how Inuit youth take ownership of the project with the guidance of Ms. Elizabeth Haqpi, a Naujaat Elder. The article will particularly reflect on the process of balancing the different perspectives and expectations while enjoying the richness of mutual learning through keeping each other accountable.

Indigenous youth suicide remains a substantial health disparity in circumpolar communities, despite prevention efforts through primary health care, public health campaigns, school systems, and social services. Innovations in prevention practice move away from expert‐driven approaches to emphasize local control through processes that utilize research evidence, but privilege self‐ determined action based on local and personal contexts, meanings, and frameworks for action. “Promoting Community Conversations About Research to End Suicide” is a community health intervention that draws on networks of Indigenous health educators in rural Alaska, who host learning circles in which research evidence is used to spark conversations and empower community members to consider individual and collective action to support vulnerable people and create health‐promoting conditions that reduce suicide risk. The first of nine learning circles focuses on narratives of local people who link the contemporary youth suicide epidemic to 20th century American colonialism, and situates prevention within this context. We describe the theoretical framework and feasibility and acceptability outcomes for this learning circle, and elucidate how the educational model engages community members in decolonial approaches to suicide prevention education and practice, thus serving as a bridge between Western and Indigenous traditions to generate collective knowledge and catalyze community healing.

Métis peoples are descendants of unions between French or Scottish fur traders and First Nations women in Canada. Alberta is the only province in Canada with land-based Métis who live in self-governing communities known as Métis Settlements. University of Alberta’s Faculty of Extension and four Métis Settlements partnered in a community based participatory research project aimed at increasing children’s resilience through inner strength and support from peers and mentors. While working with community members, the learning needs of children were identified, prioritised, and included in a summer day-camp program for children (7 – 14 years). Pre- and post-program surveys with children used an adaption of the Youth Resiliency: Assessing Developmental Strengths Questionnaire. Results are presented using descriptive statistics and were tested for significance using the non-parametric Wilcoxon rank sum test. Positive change occurred in several areas of internal strength, including self-esteem, drug resistance, and planning and decision making. Risk factors also saw positive change, as did the area of external family support. Significant areas of positive change are encouraging given that they demonstrate success in major goals of the summer camp program. Significant areas of negative change require further analysis in order to understand the complexity of Métis youth resiliency.

The wellbeing of Indigenous youth living in Canada’s northern communities continues to lag behind the rest of the Canadian population. To a large extent, these health inequities are perpetuated by processes of colonisation that significantly impact the social determinants of health in Canada’s Indigenous north. The purpose of this article is to review the history of colonisation and its impacts on the wellbeing of Indigenous youth in Canada’s north, as well as processes of resilience that have helped Indigenous youth live healthy lives despite social challenges. Academic articles published between 2000 and 2016 outlining resilience from Indigenous perspectives are reviewed in the contexts of Canada’s Indigenous north. Analysis focuses on what insights about resilience emerge from Indigenous communities, particularly as they related to the health inequities of circumpolar regions. The concept of Âhkamêyimo is discussed and how systems of Indigenous knowledge offer important insights into resilience in general, and can be utilised in health promotion, education, and prevention programs targeting Indigenous youth in northern Canada. We conclude that attention should be turned toward issues of social justice and health equity that are desperately needed in order to create healthy environments whereby Indigenous youth within northern Canadian communities can be assisted to flourish.

Introduction: The disparity in mental health outcomes compared with non-Indigenous Australians means that there is an urgent need to develop an evidence base around how services can better support Aboriginal and Torres Strait Islander communities. A critical first step is to embed cultural safety into research methodologies.

Objective: Here, we aim to establish the foundation of a research project through co-designing a qualitative interview with Aboriginal and Torres Strait Islander consumers and community members about experiences of cultural safety with mainstream mental health services.

Design: Voices of Aboriginal and Torres Strait Islander peoples must be empowered across all stages of research. An Aboriginal-led research team conducted focus groups to understand clear, sensitive, and culturally appropriate ways of asking about experiences in mental health care, to co-design an interview on this topic. Participants were Aboriginal and Torres Strait Islander consumers of mental health services, carers, mental health workers, Elders and Cultural Healers, living in Metropolitan and Regional Western Australia.

Findings: Results suggest that Indigenous governance, together with investing in ongoing, and meaningful cultural awareness and cultural safety training (cultural awareness being a first step towards safety) for non-Indigenous researchers, together with taking the time to build respectful partnerships with communities through ongoing consultation, were appropriate and comprehensive methods of co-designing an interview.

Discussion: The process of working with Aboriginal and Torres Strait Islander peoples in research is as important as the outcome. Aboriginal and Torres Strait Islander leadership, self-determination, and relationship building with communities are essential.

Conclusion: Empowering co-design methodologies are flexible, iterative, and ensure that the experiences and views of participants are valued, leading to more meaningful results.

Objective: This paper describes the validation of culture-bound syndromes with Urban (N=34) and Rural (N=31) Aboriginal participants. While culture bound syndromes have long been discussed in the international literature (see Cuellar & Paniagua, 2000), published empirical research with Aboriginal Australian populations remains absent. Critically, the secret nature of Aboriginal cultural practices presents additional research challenges which arguably do not impact to the same extent in other Indigenous cultures. The impacts on ensuring culturally and clinically competent assessment in the context of escalating rates of Indigenous suicide and mental health are significant.

Method: Thematic analysis occurred with data generated from three phases of focus groups to address study objectives. The final stage involved a critical analysis of the DSM-IV Outline for Cultural Formulation (“OCF”) for the Aboriginal Australian context.

Results: Validation of seven culture bound syndromes with predominant symptom consistency across locations is presented as well as determination of the cultural triggers implicated in the development of culture bound syndromes. Finally, an adaptation of the OCF is proposed to enable clinicians to undertake clinically and culturally valid assessment of Aboriginal clients.

Conclusions: Practitioners are provided with guidance in the identification and formulation of culture-bound syndromes with Aboriginal Australian clients.

Objective: The excess burden of mental disorders experienced by Indigenous Australians is complexly overdetermined. Social and political factors contributing to the intransigence of vulnerability are reviewed, and the wider arena of neoliberal political change considered.

Conclusions: The dynamic relationship between disadvantage and mental health vulnerability requires that practitioners should be attuned to both the ‘big picture’ and ‘modest and practical ways’ to contribute to reducing the developmental embedding of social disadvantage and transgenerational vulnerability.

Aboriginal children in Australia are over-represented in both the child protection and juvenile justice systems. Using Western therapeutic models of practice with Aboriginal people who live in remote communities can be highly problematic. Moreover, the historical legacy of past and present legislation, government interventions and racist service provision needs to be acknowledged and addressed prior to any service implementation. This paper presents a therapeutic model of practice that incorporates Aboriginal concepts of healing and spirit within a creative therapeutic framework. It will demonstrate how the model works through principles of community engagement and capacity building, enabling the provision of a culturally derived therapeutic intervention that involves a synergy of both Aboriginal- and Western-based healing practices. The findings from the implementation of the TeaH model affirm the need to incorporate Aboriginal concepts of healing, spirit and creative therapies into mainstream practice with Aboriginal people.

Method:Using a systematic strategy, relevant databases and targeted resources were searched using the following terms: ‘suicide’, ‘gatekeeper’, ‘training’, ‘suicide prevention training’, ‘suicide intervention training’ and ‘Indigenous’. Other internationally relevant descriptors for the keyword “Indigenous” (e.g. “Maori”, “First Nations”, “Native American”, “Inuit”, “Metis” and “Aboriginal”) were also used.

Results: Six articles, comprising five studies, met criteria for inclusion; two Australian, two from USA and one Canadian. While pre and post follow up studies reported positive outcomes, this was not confirmed in the single randomised controlled trial identified. However, the randomised controlled trial may have been underpowered and contained participants who were at higher risk of suicide pre-training.

Conclusion:Uncontrolled evidence suggests that gatekeeper training may be a promising suicide intervention in Indigenous communities but needs to be culturally tailored to the target population. Further RCT evidence is required.

Focusing on key Indigenous wellbeing paradigms, discourses, and disciplines this discussion paper presents a distinctive Aboriginal Participatory Action Research (APAR) approach as a transformative Indigenous Research Methodology.

It also explores Indigenous Standpoint Theory, Indigenous Knowledge Systems, Indigenous Research Methods and Methodologies as key elements in decolonising research, building self-determination in communities, and contributing to Indigenous social and emotional wellbeing (SEWB) and Indigenous Psychology.

Drawing on three community projects — the Kimberley Empowerment, Healing and Leadership Program, the National Empowerment Project and the Cultural, Social and Emotional Wellbeing Program — this paper demonstrates how APAR contributes to Indigenous SEWB and Indigenous Psychology. Finally, it examines the interrelationship of core components of APAR articulating an Indigenous epistemology, ontology, axiology (Indigenous ways of knowing, being and doing) and methodology covering Indigenous specific methods, guiding principles, research protocols and ethical guidelines.

Métis peoples, while comprising over a third of the total Indigenous population in Canada, experience major gaps in health services that are culturally-safe. This is problematic given Métis peoples experience severe disparities in health determinants and outcomes compared to the non-Indigenous Canadian population. At the same time, Métis are unlikely to engage in health services that do not value their cultural identities, often utilising mainstream options. Traditionally, Métis women were central to the health and well-being of their communities. However, due to decades of colonial legislation and land displacement, female narratives have been silenced, and Métis identities have been fractured. This has resulted in having direct implications on Métis peoples current health and access to health services. Solutions to filling the Métis health service gap may lie in the all too often unacknowledged or missing voices of Métis women.  Given these contexts, this commentary aims to generate critical discussion on the culturally-safe health care gap for Métis peoples in Canada. It does this by calling on policymakers, health care workers, and researchers alike to engage with Métis women regarding the health of Métis communities, and finding solutions towards identifying and implementing pathways to culturally-safe healthcare.

Introduction The delivery of services to improve Aboriginal health and well-being must centre culture and integrate a social and emotional well-being understanding and approaches. These approaches are essential in increasing access to, and engagement with, health services, as well as ensuring culturally safe, person-centred and community-centred care. This study will evaluate the Aboriginal Health Council of Western Australia’s social and emotional well-being model of service being piloted in five Aboriginal Community Controlled Health Services across five of Western Australia’s regions. The model of service includes the establishment of interdisciplinary social and emotional well-being teams and a four-pillar approach to service delivery.

Methods and analysis An Aboriginal Participatory Action Research methodology will be undertaken which calls for Indigenous leadership and governance, capacity-building of community co-researchers and engagement in reflexive practice. The evaluation will take a mixed-methods approach to data collection, including at each pilot site, yarns with up to five clients engaging with social and emotional well-being services; qualitative interviews with up to five service providers at each site, and up to five key knowledge holders from stakeholders including funders and commissioning bodies; the collection of clinical data; facilitated discussion using the social and emotional well-being Systems Assessment Tool; and document analysis and cost-estimation. Analysis will be guided by a client journey mapping framework, and data will be collectively analysed through a socioecological framework to understand the connections and inter-relatedness between client outcomes and experiences, social and emotional well-being team and service provider experiences, service systems and governance structures.

Ethics and dissemination This evaluation was approved by the Western Australian Aboriginal Health Ethics Committee (HREC1204). The findings will be disseminated through the production of an evaluation report and academic publications and presentations. Findings will also be disseminated through community forums and plain language summaries. These outputs will detail evaluation findings and recommendations, the process of evaluation through an Aboriginal Participatory Action Research approach and the collaborative stakeholder relationship-building that underpinned the project.

The social and emotional wellbeing of young Aboriginal and Torres Strait Islander peoples should be supported through an Indigenous-led and community empowering approach. Applying systems thinking via participatory approaches is aligned with Aboriginal and Torres Strait Islander research paradigms and can be an effective method to deliver a decision support tool for mental health systems planning for Indigenous communities. Evaluations are necessary to understand the effectiveness and value of such methods, uncover protective and healing factors of social and emotional wellbeing, as well as to promote Aboriginal and Torres Strait Islander self-determination over allocation of funding and resources. This paper presents modifications to a published evaluation protocol for participatory systems modelling to align with critical Aboriginal and Torres Strait Islander guidelines and recommendations to support the social and emotional wellbeing of young people. This paper also presents a culturally relevant participatory systems modelling evaluation framework. Recognizing the reciprocity, strengths, and expertise Aboriginal and Torres Strait Islander methodologies can offer to broader research and evaluation practices, the amended framework presented in this paper facilitates empowering evaluation practices that should be adopted when working with Aboriginal and Torres Strait Islander peoples as well as when working with other diverse, non-Indigenous communities.

Australian Aboriginal and Torres Strait Islander communities have been targets of social and emotional wellbeing programs for many years. However, the few health‐care programs and services that are evaluated rarely provide insight into the participants’ perspectives of program success or failure. This systematic review assessed 33 social and emotional wellbeing programs across Australia to better understand what Aboriginal community members think about the programs and how they could be improved. Results highlighted the interesting and valuable insights provided by Aboriginal participants, including what kinds of program activities and approaches are most suitable, what program characteristics are successful or desired, and their experiences of wellbeing change before and after program participation. They likewise voiced opinions about poorly received programs, culturally inappropriate services and negative experiences. This review highlighted how health and wellbeing programs must better engage Aboriginal and Torres Strait Islander clients to ensure that services are culturally safe, holistic, integrate appropriate staffing, include culturally relevant activities and value patient/participant experiences. These findings have significant implications for the health and wellbeing sector; specifically, research, policy, program design and implementation, evaluation methods, and self‐determination.

Abstract: Participatory evaluation can be embedded in programs to support good governance and facilitate informed decision making in Aboriginal communities in remote and urban contexts. An Aboriginal Elder from the Tiwi Islands in the Northern Territory of Australia described participatory evaluation as a sea eagle looking “long way wide eyed.” The metaphor refers to the long-term and broad approach undertaken when a complex community development program used participatory processes to build evaluation capacity and solve problems. The evaluation approach ensured the program was inclusive, responsive, empowering, and resulted in direct benefits for the communities. This article addresses the lack of literature on applying developmental and empowerment evaluation approaches in practice by describing the methods, tools, and use of evaluation findings. The value of participating for the community members and partner organizations is shared and the benefits and implications for participants and the evaluator are discussed. The authors hope this article inspires practitioners and evaluators to consider participatory ways of working with communities to support community directed action and social change.

Lateral violence describes how members of oppressed groups direct their dissatisfaction toward each other. This inward deflection has been associated with Indigenous communities around the world and has shown to be destructive. The focus of this research concerns Aboriginal Strait Islander people in Adelaide, South Australia, as part of an evaluation of the preventing lateral violence workshops. The overall evaluation comprised both quantitative and qualitative components. This article reports on qualitative data, from interviews with seven Aboriginal participants, post workshop. These interviews, examined their ways of dealing with and strategizing to prevent lateral violence in various contexts as well as suggestions for improvements to the workshops. There were several interpretive themes that emerged from these interviews. This paper reports on the three main themes: improvements to workshops; participant support needs and their strategies to prevent lateral violence in their contexts. The information complemented and provided a deeper understanding of the phase one evaluation. It is hoped that such evaluation provides robust evidence for workshops to improve and be maintained as a useful resource for the Aboriginal and Torres Strait Islander communities to prevent lateral violence.

The suicide rate for Queensland’s Aboriginal and Torres Strait Islander young people is over four times that of their non‐Indigenous counterparts, with Aboriginal and Torres Strait Islander children (under 15) dying by suicide at 12 times the non‐Indigenous rate. There is a need for interventions that are culturally validated and community‐endorsed. The aim of this article is to describe the design and implementation of a group‐based intervention, as well to report the results of the various qualitative and quantitative measures.

Education and awareness workshops are important resources to the Indigenous community in Australia to tackle difficult issues and situations within communities. It is equally important that such workshops are appropriately evaluated to ensure that they are relevant, refined and continued within communities. This paper focuses on an evaluation of the one-day Preventing Lateral Violence workshop. A sample of six workshops were conducted predominately in Adelaide in 2014 using pre, post and three months post workshop measures to determine the impact on participants. Phase 1 measured participant changes in four areas which were awareness, understanding, knowledge as well as prevention strategies of lateral violence. Analysis of the quantitative data revealed the workshops’ success as an intervention tool both at completion and three months after the workshops. The results indicated that participants understood and resonated with the terminology and the impact on self and others, recognized their experiences of lateral violence, and had an awareness of and developed strategies to combat lateral violence. The qualitative response to open-ended questions suggested that various strategies of education and the challenging of behaviours were in place even after three months. The implications of these findings are discussed.

For more than 10 years, a program called Families And Schools Together (FAST) has been run in schools across the Northern Territory. These programs have always had an evaluation component built in. However, over time, the evaluations have changed. Initially, they were summative, built around a quantitative psychometric tool (with a positivist research paradigm). The intent of the summative evaluation was to demonstrate the effectiveness of the program. However, as the program was rolled out in remote contexts, the need for adaptation was recognised. Changes were made but it was soon recognised that other outcomes, not captured or explored in the methodology, were emerging. After six years of working together, the evaluator and the program manager felt that it was time to explore effectiveness in a different way with a more qualitative evaluation process (based on naturalistic and pragmatic paradigms). The purpose of this paper is to share learnings from this experience with other program managers and evaluators. The presentation will be an opportunity for participants to engage in a discussion about monitoring and evaluation from a program evaluation perspective, particularly taking account of the complexities of the northern Australian context. This paper explores the six year learning journey through evaluation that the evaluator and program manager have undertaken. It describes tensions between the need for reliable and generalizable objective quantitative data and the need for authentic and credible data based on participant experience.

In 2018 the Gift of Gallang was implemented in a local primary school in Inala for the first time. This represented the culmination of a three-year journey of ongoing community engagement and collaboration, which included the formation of the Committee of Hope and the development of community engagement activities such as cultural nights. The need for creating hope, resilience and wellbeing in the community of Inala was evident after a cluster of youth suicides occurred in 2016. Creating a community where children had a strong sense of culture and connection framed the Gift of Gallang activities with the long-term aim of reducing risk of suicide for Aboriginal and Torres Strait Islander children and young people. This work was supported by partnership between Mission Australia, and several other key stakeholders, including Inala Wangarra, local Elders, other Aboriginal Torres Strait Islander community and health organisations, and a local primary school. Mission Australia also funded evaluation of the processes involved throughout this work in order to document key learnings. Data was collected from members of the Committee of Hope, facilitators, educators, parents and carers. Before data collection Ethics approval was obtained through the Mission Australia research team as well as the Queensland Department of Education for data relating to school staff, children and families.

In 2015 the Indigenous Health Equity Unit (IHEU) at The University of Melbourne was commissioned to undertake an evaluation of 13 identified Aboriginal and Torres Strait Islander gathering places across the state. The focus of the evaluation was to explore the extent to which gathering places in Victoria impact on the health and wellbeing of Aboriginal and Torres Strait Islander communities across the state.

Abstract: Monitoring and evaluation (M&E) allows people to learn from past experiences, improve service delivery, plan and allocate resources and demonstrate results as part of accountability to stakeholders. M&E also assists in keeping projects on track, providing a basis for reassessing priorities and creating an evidence base for current and future projects There is a growing interest in the measurement of social impact across the business, government and nonprofit sectors. In recognising the role that non-profit organisations play in ‘enhancing the economic, social, cultural and environmental wellbeing of society’, the Australian Government has recently focused on improving the measurements of social impact This report describes the main monitoring and evaluating frameworks and methods used in Australia which include some assessment of social impact. Each of the following are discussed in terms of an overview of how it works (in terms of M&E), the benefits and limitations, examples of organisations using the technique and where to find further resources.

This report was undertaken by Ninti-One and provides useful material for staff working on new initiatives in monitoring and evaluation. Drawing on a review of the literature this report provide an overall analysis and recommendations regarding the conduct of monitoring and evaluation in Indigenous remote communities.

Introduction: Mainstream Australian mental health services are failing Aboriginal young people. Despite investing resources, improvements in well-being have not materialised. Culturally and age appropriate ways of working are needed to improve service access and responsiveness. This Aboriginal-led study brings Aboriginal Elders, young people and youth mental health service staff together to build relationships to co-design service models and evaluation tools. Currently, three Western Australian youth mental health services in the Perth metropolitan area and two regional services are working with local Elders and young people to improve their capacity for culturally and age appropriate services. Further Western Australian sites will be engaged as part of research translation.

Methods and analysis: Relationships ground the study, which utilises Indigenous methodologies and participatory action research. This involves Elders, young people and service staff as co-researchers and the application of a decolonising, strengths-based framework to create the conditions for engagement. It foregrounds experiential learning and Aboriginal ways of working to establish relationships and deepen non-Aboriginal co-researchers’ knowledge and understanding of local, place-based cultural practices. Once relationships are developed, codesign workshops occur at each site directed by local Elders and young people. Co-designed evaluation tools will assess any changes to community perceptions of youth mental health services and the enablers and barriers to service engagement.