Effective strategies to strengthen the mental health and wellbeing of Aboriginal and Torres Strait Islander people

Introduction: The purpose of this paper is to draw on Aboriginal and Torres Strait Islander (Indigenous) perspectives, theoretical understandings, and available evidence to answer questions about what is required to effectively address Indigenous people’s mental health and social and emotional wellbeing. Social and emotional wellbeing is a multifaceted concept. Although the term is often used to describe issues of ‘mental health’ and ‘mental illness’, it has a broader scope in that Indigenous culture takes a holistic view of health. It recognises the importance of connection to land, culture, spirituality, ancestry, family and community, how these connections have been shaped across generations, and the processes by which they affect individual wellbeing. It is a whole-of-life view, and it includes the interdependent relationships between families, communities, land, sea and spirit and the cyclical concept of life–death–life. Importantly, these concepts and understandings of maintaining and restoring health and social and emotional wellbeing differ markedly to those in many non-Indigenous-specific (or mainstream) programs that tend to emphasise an individual’s behavioural and emotional strengths and ability to adapt and cope with the challenges of life. This paper explores the central question of ‘what are culturally appropriate mental health and social and emotional wellbeing programs and services for Indigenous people, and how are these best delivered?’. It identifies Indigenous perspectives of what is required for service provision and program delivery that align with Indigenous beliefs, values, needs and priorities. It explores the evidence and consensus around the principles of best practice in Indigenous mental health programs and services. It discusses these principles of best practice with examples of programs and research that show how these values and perspectives can be achieved in program design and delivery. This paper seeks to provide an evidence-based, theoretically coherent discussion of the factors that influence the effective development, implementation and outcomes of initiatives to address Indigenous mental health and wellbeing issues. It seeks to assess whether the current investment in Indigenous people’s mental health is aligned with available evidence on what works. To this end, the paper reviews Australian literature and government health, mental health and social and emotional wellbeing policies and programs. The scope of programs and their criteria for inclusion in this paper are informed by the Key Result Area 4, Social and Emotional Wellbeing objectives, within the National Strategic Framework for Aboriginal and Torres Strait Islander Health 2003–13: Australian Government Implementation Plan 2007–2013. This paper acknowledges the holistic nature of health, mental health and wellbeing, and the effects of Australia’s colonial history and legacy on the contemporary state of Indigenous social and emotional wellbeing. It recognises that there is a complex relationship between social and emotional wellbeing, harmful substance misuse, suicide, and a range of social and economic factors. Although this paper encompasses the broad priorities identified within the key Indigenous mental health policies and frameworks, it does not provide a detailed discussion of programs and resources that, although relevant here, are covered in a number of existing Closing the Gap Clearinghouse resource sheets and issues papers (see Appendix 1). These interweavings and overlaps are not surprising given the complexity and interconnectedness of the issues and determinants that are being addressed to strengthen Indigenous mental health and wellbeing

Alcohol Screening and Brief Interventions for Offenders in the Probation Setting (SIPS Trial): a Pragmatic Multicentre Cluster Randomized Controlled Trial

Aim - To evaluate the effectiveness of different brief intervention strategies at reducing hazardous or harmful drinking in the probation setting. Offender managers were randomized to three interventions, each of which built on the previous one: feedback on screening outcome and a client information leaflet control group, 5 min of structured brief advice and 20 min of brief lifestyle counselling. Methods - A pragmatic multicentre factorial cluster randomized controlled trial. The primary outcome was self-reported hazardous or harmful drinking status measured by Alcohol Use Disorders Identification Test (AUDIT) at 6 months (negative status was a score of <8). Secondary outcomes were AUDIT status at 12 months, experience of alcohol-related problems, health utility, service utilization, readiness to change and reduction in conviction rates. Results - Follow-up rates were 68% at 6 months and 60% at 12 months. At both time points, there was no significant advantage of more intensive interventions compared with the control group in terms of AUDIT status. Those in the brief advice and brief lifestyle counselling intervention groups were statistically significantly less likely to reoffend (36 and 38%, respectively) than those in the client information leaflet group (50%) in the year following intervention. Conclusion - Brief advice or brief lifestyle counselling provided no additional benefit in reducing hazardous or harmful drinking compared with feedback on screening outcome and a client information leaflet. The impact of more intensive brief intervention on reoffending warrants further research

Dark Matter in the Coming Decade: Complementary Paths to Discovery and Beyond

In this report we summarize the many dark matter searches currently being pursued through four complementary approaches: direct detection, indirect detection, collider experiments, and astrophysical probes. The essential features of broad classes of experiments are described, each with their own strengths and weaknesses. The complementarity of the different dark matter searches is discussed qualitatively and illustrated quantitatively in two simple theoretical frameworks. Our primary conclusion is that the diversity of possible dark matter candidates requires a balanced program drawing from all four approaches.Comment: Report prepared for the Community Summer Study (Snowmass) 2013, on behalf of Cosmic Frontier Working Groups 1-4 (CF1: WIMP Dark Matter Direct Detection, CF2: WIMP Dark Matter Indirect Detection, CF3: Non-WIMP Dark Matter, and CF4: Dark Matter Complementarity); published versio

The Definition and Function of Markan Intercalation as Illustrated in a Narrative Analysis of Six Passages

Intercalation of stories is a stylistic feature of the Gospel of Mark which has been recognized in scholarly research since the early twentieth century. However, two problems have not been satisfactorily solved in relation to intercalation in Mark. The first is obtaining a focused definition of this storytelling pattern. The second is to explain its function in the Markan story. The purpose of the current research was to resolve these two questions by a narrative analysis of six passages commonly accepted as illustrating intercalation. The six passages are Mark 3:20-35; 5:21-43; 6;7-32; 11:12-25; 14:1-11; and 14:53-72. These passages were each analyzed with respect to common categories of narrative analysis--settings, characters, actions and plot, time, narrator and implied reader, and stylistic features. The data generated by this analysis were presented and common features of all of the intercalations were noted. A series of narrative characteristics which all the intercalations share was established, leading to a narrative definition of intercalation. The Evangelist has brought two stories together in intercalation, while maintaining their separateness. It was established that the purpose, or function, of this pattern was to create a dramatized irony between two or more characters and their actions in the separate stories. The ironies produced by this pattern speak to major theological themes in Mark, especially Christology and discipleship

A Method for Characterizing the Noise Produced by an Agricultural Tractor in Terms of the Acoustic Power and Directivity

In agriculture, as in the civic, military and industrial areas, excessive noise is a problem that must be recognized. Tentative criteria have been established that specify the maximum noise levels that people can be exposed to for various time periods without receiving permanent hearing damage. In many cases, the noise produced at the operator’s location by agricultural machines is considerably above the maximum safe level for continuous daily exposure. The seriousness of the problem is further emphasized when it is realized that many young men in their teens are operating agricultural machines. The hearing damage that they receive will be with them for the rest of their lives. In attempting to solve a noise control problem, it is often helpful to consider the problem in the framework of a three part system. The three components of the system are the source, the path, and the receiver. In this investigation, an attempt was made to characterize the noise produced by an agricultural tractor (the source). In characterizing the source, the air (a path) was also used. No attempt was made to evaluate the effect of the noise on the operator (receiver), alter the path that the noise took in reaching the operator, or decrease the noise produced by the tractor. A straightforward, versatile, reliable method for characterizing the noise produced by a tractor will be valuable in solving the problem of excessive noise associated with agricultural machines