Hepworth Julie, Askew Deborah, Foley Wendy, Duthie Deb, Shuter Patricia, Combo Michelle, Clements Lesley-Ann
School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia.
Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Brisbane, Australia.
Int J Equity Health. 2015 Jun 6;14:51. doi: 10.1186/s12939-015-0183-x.
Aboriginal and Torres Strait Islander people experience higher levels of psychological distress and mental ill health than their non-Indigenous counterparts, but underuse mental health services. Interventions are required to address the structural and functional access barriers that cause this underuse. In 2012, the Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care employed a psychologist and a social worker to integrate mental health care into its primary health care services. This research study examines the impact of this innovation.
A mixed-method research design was used whereby a series of qualitative open-ended interviews were conducted with 7 psychology clients, 5 social work clients, the practice dietician, and the social worker and psychologist. General practitioners, practice nurses, Aboriginal Health Workers and receptionists participated in 4 focus groups. Key themes were identified, discussed, refined and agreed upon by the research team. Occasions of service by the psychologist and social worker were reviewed and quantitative data presented.
Clients and staff were overwhelmingly positive about the inclusion of a psychologist and a social worker as core members of a primary health care team. In one-year, the psychologist and social worker recorded 537 and 447 occasions of service respectively, and referrals to a psychologist, psychiatrist, mental health worker or counsellor increased from 17% of mental health clients in 2010 to 51% in 2012. Increased access by Aboriginal and Torres Strait Islander people to mental health care was related to three main themes: (1) Responsiveness to community needs; (2) Trusted relationships; and (3) Shared cultural background and understanding. The holistic nature and cultural safety of the primary health care service, its close proximity to where most people lived and the existing trusted relationships were identified as key factors in decreasing barriers to access.
Improving social and emotional well-being is critical to addressing the health inequalities experienced by Aboriginal and Torres Strait Islander peoples. This study demonstrates the benefits for clients and health professionals of integrating culturally safe mental health services into primary health care.
与非原住民相比，原住民和托雷斯海峡岛民经历着更高水平的心理困扰和心理健康问题，但他们对心理健康服务的利用率却很低。需要采取干预措施来解决导致这种低利用率的结构和功能方面的获取障碍。2012年，昆士兰南部原住民和托雷斯海峡岛民初级卫生保健卓越中心聘请了一名心理学家和一名社会工作者，将心理健康护理纳入其初级卫生保健服务中。本研究探讨了这一创新举措的影响。
采用混合方法研究设计，对7名心理治疗客户、5名社会工作客户、执业营养师、社会工作者和心理学家进行了一系列定性开放式访谈。全科医生、执业护士、原住民健康工作者和接待员参加了4个焦点小组。研究团队确定、讨论、完善并商定了关键主题。审查了心理学家和社会工作者的服务情况，并提供了定量数据。
客户和工作人员对将心理学家和社会工作者纳入初级卫生保健团队的核心成员一事普遍持积极态度。在一年时间里，心理学家和社会工作者分别记录了537次和447次服务情况，转介给心理学家、精神科医生、心理健康工作者或顾问的比例从2010年心理健康客户的17%增加到2012年的51%。原住民和托雷斯海峡岛民增加对心理健康护理的获取与三个主要主题相关：(1) 对社区需求的响应能力；(2) 可信赖的关系；(3) 共同的文化背景和理解。初级卫生保健服务的整体性质和文化安全性、其与大多数人居住地点的接近程度以及现有的可信赖关系被确定为减少获取障碍的关键因素。
改善社会和情感福祉对于解决原住民和托雷斯海峡岛民所经历的健康不平等问题至关重要。本研究证明了将具有文化安全性的心理健康服务纳入初级卫生保健对客户和卫生专业人员的益处。
