Advances in Mental Health, Vol 9, No 1 (2010)

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Considering culture in the psychiatric assessment of Aboriginal and Torres Strait Islander peoples

Anne Wand, Sandra J Eades, Melissa J Corr

Abstract


There is little information about referrals of Aboriginal and Torres Strait Islander peoples to general hospital psychiatry services. Even less is known about how culture is incorporated into their psychiatric assessment and management plans. This is important as culture is a fundamental aspect of the social and emotional health and wellbeing of Indigenous Australians. Consultation-liaison psychiatry services are referred patients admitted to the general hospital or Emergency Department. This study was conducted to evaluate whether and how culture is incorporated into the psychiatric assessment and management of Aboriginal and Torres Strait Islander peoples referred to a consultation-liaison psychiatry service. Thematic analysis, with a particular focus on cultural references, was used to retrospectively evaluate forty referrals. Results derived from the data analysis were verified by independent analysis of a subset of files by a former clinical nurse consultant in Aboriginal mental health and consultations with Aboriginal Health Workers from the study hospital and the local Aboriginal Medical Service. Culture was often only indirectly and infrequently documented in the consultation-liaison clinicians' assessment. The clinician demonstrated that culture was considered through direct references; patterns of communication; diagnostic labels; identification of strengths and resilience; and in the involvement of the Aboriginal Health Worker. Culture is a fundamental part of the identity of Indigenous Australians, and should be routinely included in psychiatric assessments. Placing the patient in context using a detailed psychiatric formulation may be more informative and helpful for both the patient and referrer than a diagnosis alone. Aboriginal Health Workers have numerous roles in this setting and may assist consultation-liaison clinicians to communicate better and to deliver more holistic care.






Advances in Mental Health
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