Approach to treatment of mental illness and substance dependence in remote Indigenous communities: results of a mixed methods study.

OBJECTIVE

To develop and evaluate a culturally adapted brief intervention for Indigenous people with chronic mental illness.

DESIGN

A mixed methods design in which an exploratory phase of qualitative research was followed by a nested randomised controlled trial.

SETTING

Psycho-education resources and a brief intervention, motivational care planning (MCP), were developed and tested in collaboration with aboriginal mental health workers in three remote communities in northern Australia.

PARTICIPANTS

A total of 49 patients with mental illness and 37 carers were recruited to a randomised controlled trial that compared MCP (n = 24) with a clinical control condition (treatment as usual, n = 25).

INTERVENTION

The early treatment group received MCP at baseline and the late treatment group received delayed treatment at six months.

MAIN OUTCOME MEASURES

The primary outcome was mental health problem severity as measured by the health of the nation outcome scales. Secondary measures of well-being (Kessler 10), life skills, self-management and substance dependence were chosen. Outcome assessments were performed at baseline, six-month, 12-month and 18-month follow up.

RESULTS

Random effects regression analyses showed significant advantage for the treatment condition in terms of well-being with changes in health of the nation outcome scales (P < 0.001) and Kessler 10 (P = 0.001), which were sustained over time. There was also significant advantage for treatment for alcohol dependence (P = 0.05), with response also evident in cannabis dependence (P = 0.064) and with changes in substance dependence sustained over time.

CONCLUSIONS

These results suggest that MCP is an effective treatment for Indigenous people with mental illness and provide insight into the experience of mental illness in remote communities.