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

Nagel, Tricia, Robinson, Gary, Condon, John, and Trauer, Tom (2009) Approach to treatment of mental illness and substance dependence in remote Indigenous communities: results of a mixed methods study. Australian Journal of Rural Health, 17 (4). pp. 174-182.

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Abstract

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.

Item ID: 5487
Item Type: Article (Refereed Research - C1)
Keywords: co-morbidity, community psychiatry, health service, Indigenous, self-management
ISSN: 1440-1584
Date Deposited: 03 Nov 2009 21:32
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1103 Clinical Sciences > 110319 Psychiatry (incl Psychotherapy) @ 25%
11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111701 Aboriginal and Torres Strait Islander Health @ 50%
11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111708 Health and Community Services @ 25%
SEO Codes: 92 HEALTH > 9203 Indigenous Health > 920302 Aboriginal and Torres Strait Islander Health - Health Status and Outcomes @ 50%
92 HEALTH > 9205 Specific Population Health (excl. Indigenous Health) > 920506 Rural Health @ 25%
92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920111 Nervous System and Disorders @ 25%
Citation Count from Web of Science Web of Science 19
Downloads: Total: 3
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