Making the difference – going beyond respect

Summary

Aim

To improve the physical, emotional, social and mental health wellbeing for Aboriginal patients in the Forensic Mental Health Hospital.

Objectives

• Increase the number of patients who have cultural assessment components in their care planning, from 6% to 100% by August 2019.
• Increase the number of therapeutic programs  available that  specifically target cultural needs, from one program to five programs by August 2019.

Benefits

• Collaborative care planning that engages patients in cultural care.
• Cultural knowledge, expertise and skills of Aboriginal and Torres Strait Islander health professionals are reflected in health services models and practice.
• Building a culturally responsive workforce.
• Development of co-designed cultural healing programs.

Background

Aboriginal patients in Australia have become one of the most incarcerated groups in the world. In 1988 in NSW they represented 8.2% of the incarcerated population. By 2015 that figure had risen to 24.6% (over 52% for women and 64% for adolescents). Health outcomes are poor and in many instances, continue to deteriorate. A culturally responsive health workforce is vital to ensuring the heath system has the capacity to provide culturally safe services that meet the needs of Aboriginal and Torres Strait Islander People and improve their health outcomes.

Aboriginal patients in the Forensic Mental Health Hospital often have complex and clinically challenging presentations. These include complex intergenerational trauma, mental health, drug and alcohol use disorders and comorbid chronic health conditions.

In addition, 79% of Forensic patients in the forensic hospital have metabolic syndrome, and 28% of patients have Type 2 diabetes. Aboriginal patients also had high rates of aggression and seclusion. This reflects significant intergenerational trauma, mistrust of mental health services and reduced engagement.

Implementation

Diagnostics

The project team, along with members of our Aboriginal workforce, were engaged very early.  In fact, 100% of all 16 Aboriginal patients were engaged.

Clinical and Aboriginal health staff also engaged in focus groups and diagnostics workshops. These focus groups took a ‘yarning group’ style approach and were led by Aboriginal staff.

The diagnostics changed the direction of the project from a workforce-focused project to a focus on culture connectedness and therapeutic programs. It also led to the exploration of patient led programs.

Solutions

Patients and staff involved in collaborative solution design processes. While some solutions were hospital-wide, other solutions were identified as unit based and designed to  specifically target the needs of adolescents, women and men.

Implementation

Engagement took place with local community groups to:

• support solution owners
• develop patient groups.

Engagement took place with hospital educators to incorporate Aboriginal cultural component and understanding into existing risk assessment and management training.

Status

Implementation – The project is ready for implementation or is currently being implemented, piloted or tested.

Dates

Implementation August 2019

Implementation sites

The six inpatient units of the Forensic Hospital, Justice Health Forensic Mental Health Service

Partnerships

ACI

Results

Actions implemented to date:

• Country maps are on display in each unit to promote and respect Aboriginal identity.
• Digeridoo and clapping sticks are used in art and music programs, led by local community members and co-facilitated by patients.
• Engagement of local community took place to make a possum skin cloak for use in welcoming new patients to the hospital, in other ceremonies and for Aboriginal patients to use in the sensory modulation room.
• Cultural assessment consideration was incorporated into existing clinical risk assessment and management process.

Evaluation

The number of therapeutic programs  available that specifically target cultural needs has increased to four programs, all co-facilitated by Aboriginal patients or community.

Audits of patient files are being conducted to assess the number of patients who have cultural assessment components in their care planning. This is due in November 2019.

Lessons learnt

• The importance of the patient voice. We engaged and collaborated with the patients throughout the entire project. They significantly changed our diagnostics and led the generation of our solutions
• The importance of having good sponsorship especially when progressing through the solutions and implementation phrases of the project.
• Trust the process. Our initial planning and thinking about the project shifted considerably as we started to explore the root causes and brought in the patient voice.
• Never underestimate the importance of managing resistance and be aware that it changes, the closer you get to implementation of the project.

Further reading

• NSW Ministry of Health. NSW Aboriginal Health Plan 2013-2023 (PD2012_066). North Sydney: NSW Ministry of Health; 2012.
• NSW Ministry of Health. NSW Health Good Health - Great Jobs: Aboriginal Workforce Strategic Framework 2016 - 2020 (PD2016_053). North Sydney: NSW Ministry of Health; 2016.

Contact

Michelle Eason
Director Organisational Development Unit
Justice Health and Forensic Mental Health Network
Phone: 02 9700 3829
Michelle.eason@health.nsw.gov.au