NATSILMH Health in Culture Policy Concordance Health in Cultur… · (a) The Fifth National Mental...

33
National Aboriginal and Torres Strait Islander Leadership in Mental Health 2018 1 HEALTH IN CULTURE – POLICY CONCORDANCE The Interconnectedness of Aboriginal and Torres Strait Islander Social and Emotional Wellbeing, Mental Health and Suicide Prevention Policy

Transcript of NATSILMH Health in Culture Policy Concordance Health in Cultur… · (a) The Fifth National Mental...

Page 1: NATSILMH Health in Culture Policy Concordance Health in Cultur… · (a) The Fifth National Mental Health and Suicide Prevention Plan • Recognises the National Strategic Framework

NationalAboriginalandTorresStraitIslanderLeadershipinMentalHealth2018

1

HEALTHINCULTURE–POLICYCONCORDANCE

TheInterconnectednessofAboriginalandTorresStraitIslanderSocialandEmotionalWellbeing,MentalHealthandSuicidePreventionPolicy

Page 2: NATSILMH Health in Culture Policy Concordance Health in Cultur… · (a) The Fifth National Mental Health and Suicide Prevention Plan • Recognises the National Strategic Framework

NationalAboriginalandTorresStraitIslanderLeadershipinMentalHealth2018

2

TABLEOFCONTENTS1.INTRODUCTION,p.3.2.ABBREVIATIONS,GLOSSARYANDSOURCESp.4.3.CONCORDANCEp.6onwards.SUBJECTMATTERSASFOLLOWS:SYSTEMARCHITECTUREp.6• Nationalapproach• Targets• Nationalqualitystandards• MedicareBenefitsScheduleuse• Jurisdictionalalignment• Regionalfocus/PHNs• Steppedcare• Overarchingapproachofcomprehensivehealthcare“bestofbothworlds”• AboriginalandTorresStraitIslanderleadershipatsystemandservicelevels• Genuineeng/partnershipwAboriginal&TorresStraitIslandercommunities• PlanningpartnershipswithACCHSs• ACCHSpreferredproviders• Stakeholderpartnerships• Consumer&carerengagementWORKFORCEp.10• Overarchingworkforcestrategy/AboriginalandTorresStraitIslander

workers• UpskillingexistingAboriginalandTorresStraitIslanderworkers• SupportingAboriginalandTorresStraitIslanderstaffinmainstreamsettings• Training/supportallMHservicestaff• Educationsystem• Roleofprofessionalbodies• Peerworkforce• DataEVIDENCEBASE/DATA/RESEARCHp.12• Evidencebase• CulturallyappropriateIndicators• Identification• Datacollection• Evaluationofprogramsandservices• Research• Resources/tools

(a)REGIONALFOCUS

PROMOTIONp.13• Buildoncultureandcommunitystrengths• Buildonfamilystrengths• SupportingtheMH&SEWBofchildrenandyoungpeoplePRIMORDIALPREVENTIONp.14• Communitychallenges/socialdeterminants• AOD• Justice• Parentingprograms• Maternalhealth• ChildsexualabusePRIMARYPREVENTIONANDEARLYDETECTIONp.15• Frontlinegeneral

• Schools• ChildrenOOHC• Police• Youthjusticeofficers• Mentalhealthliteracy/stigmaROLEOFMAINSTREAMINPROMOTIONANDPREVENTIONp.16• RoleofmainstreamAOD• RoleofmainstreamMHservices

(b)SERVICEDELIVERY

INTEGRATIONOFSERVICESp.17• Integratedservices• Referralpathways• Co-locatedservices• Telehealth• MyHealthe-recordsROLEOFACCHS/‘SPECIALISEDAREASOFPRACTICE’p.18• ACCHSpreferredproviders• MH&SEWBTeamsinACCHS/expandedprimaryMHcarerole• Traditionalhealers/specialisedareasofpractice• HealingCSA(childsexualabuse)• HealingFoundationLOWINTENSITYSERVICESp.19• GPs• Focusedpsychstrategies• Lowintensityservices• DigitalMHandhelplinesMAINSTREAMMHSERVICESp.20• Counteringsystemicracism• GovernanceinclusiveofAboriginalandTorresStraitIslanderpeople• Physicalsafety• Mainstreamservicesrespondtocommunityneeds• Consumerfocusedservices• Accessible• Culturalsafetyandcompetenceasclinicalgovernancestandards• Culturalsafetyinservicedelivery• Culturalcompetence-languagebarriers• Hearingloss• Culturalcompetence-general• Proactivelyaddressesracism• Traumainformedcare

SERVICERESPONSETOSEVEREMENTALILLNESSp.23• Rights• Entryprocedures• Treatment• Supportedaccommodation• Continuityofcare• Exitprocedures• Self-managementofmentalhealthconditions• Recovery&rehab.• Children&youngpeople• NDIS/psychosocialdisability

• Carers• RoleofPHNs

PART2:SUICIDEPREVENTION

SYSTEMARCHITECTUREp.26• Nationalapproach• NationalSurveillance• Regionalfocus/PHNs• Empoweringcommunitiestorespondtosuicide• Integratedservices• Workforce• PartnershipwithACCHSs• ACCHSspreferredproviders• Research

PROMOTION&PRIMORDIALPREVENTIONINC.SYSTEMSAPPROACHp.28• Buildoncommunitystrengths/addresschallenges• AODusereduction• Buildonculturalstrengths• Buildonfamilystrengths/addresschallenges• Men’sstrengths• Beststarttolife/schoolandadolescence

PRIMARYANDSELECTIVEPREVENTIONINC.SYSTEMSAPPROACHp.29• Communitycontrolandempowerment• Employcommunitymembers• Meansrestriction• SPliteracy/stigmareduction• Gatekeepersandcommunityresources• Peertopeermentoring• GPs/PHC• Helplines• Trainingoffrontlinestaff• ExitinghospitalEDs• ExitingMHservices• Exitingincarceration• Familiesandchildrenatrisk• Males• Justiceissues• Substancemisuse• Mediaprotocols• Mentalhealth

SERVICES&INDICATEDRESPONSESINC.SYSTEMSAPPROACHp.31• Integratedservices• PartnershipwithACCHSs• ACCHSspreferredproviders• AboriginalandTorresStraitIslanderpeopleemployedinmainstreamservices• Timeprotocols/availability• Culturalsafetyinmainstreamservices• Treatments• Followupcare• Postvention• Datacollections• Evaluation

Page 3: NATSILMH Health in Culture Policy Concordance Health in Cultur… · (a) The Fifth National Mental Health and Suicide Prevention Plan • Recognises the National Strategic Framework

NationalAboriginalandTorresStraitIslanderLeadershipinMentalHealth2018

3

1.INTRODUCTION

1.HowtousethisdocumentThisconcordancecomprisesalistofmajorsubjectmattersfoundinAboriginalandTorresStraitIslanderandrelatedsocialandemotionalwellbeing,mentalhealthandsuicidepreventionpolicydocuments.Againsteacharecitationsforwherethesubjectmatterisreferredtoinpolicydocumentsandanextractofrelevanttext.ItisintendedtomakecrossreferencingacrossthelargenumberofdocumentsthattouchonAboriginalandTorresStraitIslanderandrelatedsocialandemotionalwellbeing,mentalhealthandsuicidepreventionpolicyaseasyaspossible,butshouldnotbeusedasasubstituteforthepolicydocumentsthemselves.Pleasenotethatthisconcordanceislimitedtonationallevelpolicydocuments.Overtime,NATSILMHhopetoextendittostateandterritorylevelpolicy.2.TheformalrelationshipsbetweenkeydocumentsintheAboriginalandTorresStraitIslandersocialandemotionalwellbeing,mentalhealthandsuicidepreventionspace.Inadditiontotheconnectionsbetweenvariousdocuments(asillustratedbythisconcordance)thereareadditionalformalrelationshipsbetweenthem,assetoutinthedocumentsthemselves.Whiletheseconnectionsarenumerous,themostimportantaresummarisedasbelow:(a)TheFifthNationalMentalHealthandSuicidePreventionPlan• RecognisestheNationalStrategicFrameworkforAboriginalandTorresStraitIslanderPeople’sMentalHealthandSocialandEmotionalWellbeing2017–2023asaguidingdocumentinimplementation(p.32).• IncludesactiontoimplementtheGayaaDhuwi(ProudSpirit)Declaration(Action12.3p.34).• IsinformedbytheworkoftheAboriginalandTorresStraitIslanderSuicidePreventionEvaluationProject(pp.24,32)andtheNationalAboriginalandTorresStraitIslanderSuicidePreventionStrategy(pp.2,24).• SeekstooperationalisetheCulturalRespectFrameworkforAboriginalandTorresStraitIslanderHealth2016-2026(Action4,Action11).(b)TheNationalStrategicFrameworkforAboriginalandTorresStraitIslanderPeople’sMentalHealthandSocialandEmotionalWellbeing2017–2023• Outcome3.3-toImplementtheNationalAboriginalandTorresStraitIslanderSuicidePreventionStrategy(c)TheNationalAboriginalandTorresStraitIslanderHealthPlanImplementationPlan• RecognisestheNationalStrategicFrameworkforAboriginalandTorresStraitIslanderPeople’sMentalHealthandSocialandEmotionalWellbeing2017–2023;NationalAboriginalandTorresStraitIslanderSuicidePreventionStrategy;andNational

AboriginalandTorresStraitIslanderPeoples’DrugStrategy2014–2019asguidingdocumentsforimplementation(p.8).• IncludestheimplementationoftheNationalAboriginalandTorresStraitIslanderSuicidePreventionStrategyasadeliverableby2018(Strategy1C)(p.15).• SupportstheimplementationoftheCulturalRespectFrameworkforAboriginalandTorresStraitIslanderHealth2016-2026(p.12).

Page 4: NATSILMH Health in Culture Policy Concordance Health in Cultur… · (a) The Fifth National Mental Health and Suicide Prevention Plan • Recognises the National Strategic Framework

NationalAboriginalandTorresStraitIslanderLeadershipinMentalHealth2018

4

2.ABBREVIATIONS,GLOSSARYANDSOURCES

Abbreviation Infull/explanation Source5NMHSPP/IP FifthNationalMentalHealthandSuicidePreventionPlananditsImplementationPlan(2017) http://www.coaghealthcouncil.gov.au/Portals/0/Fifth%20National%20Mental%20Health%20and%20Suicide%20Preve

ntion%20Plan.pdfImplementationPlan:http://www.coaghealthcouncil.gov.au/Portals/0/Fifth%20National%20Mental%20Health%20and%20Suicide%20Prevention%20Plan_Implementation%20Plan.pdf

ACCHSs AboriginalCommunityControlledHealthServices AOD AlcoholandOtherDrugServices ATSIMHSPSTOR AboriginalandTorresStraitIslanderMentalHealthandSuicidePreventionSubcommittee.Byaction(iii)ofthe

FifthNationalMentalHealthandSuicidePreventionPlan,thiswillreporttoMHDAPCandwillworkwiththeSuicidePreventionSubcommitteeonthedevelopmentofanationallyagreedapproachtosuicidepreventionforAboriginalandTorresStraitIslanderpeoples,forinclusionintheNationalSuicidePreventionImplementationStrategy.Action11includeseight‘TermsofReference’(TOR)forthebody.

ATSISPEPCRP AboriginalandTorresStraitIslanderSuicidePreventionEvaluationProject,ReportoftheCriticalResponsePilotProject(2017)

http://www.atsispep.sis.uwa.edu.au/__data/assets/pdf_file/0019/3050029/FINAL-CriticalResponsePilotProjectReport-WEB.pdf

ATSISPEPSTW AboriginalandTorresStraitIslanderSuicidePreventionEvaluationProject,SolutionsThatWork–WhattheEvidenceandourPeopleTellUs(2017)

http://www.atsispep.sis.uwa.edu.au/__data/assets/pdf_file/0006/2947299/ATSISPEP-Report-Final-Web.pdf

CulturalRF CulturalRespectFrameworkforAboriginalandTorresStraitIslanderHealth2016-2026 http://www.coaghealthcouncil.gov.au/Portals/0/National%20Cultural%20Respect%20Framework%20for%20Aboriginal%20and%20Torres%20Strait%20Islander%20Health%202016_2026_2.pdf

DrugStrategy NationalAboriginalandTorresStraitIslanderPeoples’DrugStrategy2014–2019acomponentoftheNationalDrugStrategy2017-2026

http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/Publishing.nsf/content/6EE311AA9F620C82CA257EAC0006A8F0/$File/FINAL%20National%20Aboriginal%20and%20Torres%20Strait%20Islander%20Peoples%27%20Drug%20Strategy%202014-2019.pdf

E-mentalHealthstrategy E-mentalHealthStrategyforAustralia(2012) http://www.health.gov.au/internet/main/publishing.nsf/content/7C7B0BFEB985D0EBCA257BF0001BB0A6/$File/emstrat.pdf

GDD GayaaDhuwi(ProudSpirit)DeclarationoftheNationalAboriginalandTorresStraitIslanderLeadershipinMentalHealth

http://natsilmh.org.au/sites/default/files/gayaa_dhuwi_declaration_A4.pdf

IAS IndigenousAdvancementStrategy http://www.indigenous.gov.au/indigenous-advancement-strategyLHD LocalHospitalDistrict,LocalHospitalNetwork Lifespan LifeSpanIntegratedSuicidePrevention(BlackDogInstitute).Therearenineelementsintheoverallapproach. https://www.blackdoginstitute.org.au/research/lifespanMH&SEWBFr NationalStrategicFrameworkforAboriginalandTorresStraitIslanderPeople’sMentalHealthandSocialand

EmotionalWellbeing2017–2023https://pmc.gov.au/resource-centre/indigenous-affairs/national-strategic-framework-mental-health-social-emotional-wellbeing-2017-23

MHDAPC MentalHealthDrugandAlcoholPrincipalCommittee.ThisadvisestheAustralianHealthMinisters’AdvisoryCouncil(AHMAC).Inturn,byaction(i)oftheFifthNationalMentalHealthandSuicidePreventionPlan,itwillbeadvisedbyaSuicidePreventionSubcommitteethatwilldevelopaNationalSuicidePreventionImplementationStrategy.

Action(i)and(ii)FifthNationalMentalHealthandSuicidePreventionPlan

MHS Mentalhealthservices NatStandards–MHServices NationalPracticeStandardsforMentalHealthServices,withspecificimplementationguidelinesaslisted

(2013)http://www.health.gov.au/internet/main/publishing.nsf/content/5D7909E82304E6D2CA257C430004E877/$File/wkstd13.pdf.Specificimplementationguidelinescanbefoundat:http://www.health.gov.au/internet/main/publishing.nsf/content/mental-pubs-i-public

NatStandards–MHWorkforce NationalPracticeStandardsfortheMentalHealthWorkforce(2013) http://www.health.gov.au/internet/main/publishing.nsf/content/5D7909E82304E6D2CA257C430004E877/$File/wkstd13.pdf

NATSIWS NationalAboriginalandTorresStraitIslanderWorkforceStrategy2016-2023 https://www.health.gov.au/internet/main/publishing.nsf/Content/4A716747859075FFCA257BF0001C9608/$File/National-Aboriginal-and-Torres-Strait-Islander-Health-Workforce-Strategic-Framework.pdf

NationalMHWorkforceStrategy NationalMentalHealthWorkforceStrategy(2011) https://www.aihw.gov.au/getmedia/f7a2eaf1-1e9e-43f8-8f03-b705ce38f272/National-mental-health-workforce-strategy-2011.pdf.aspx

NATSIHP/IP NationalAboriginalandTorresStraitIslanderHealthPlan2013-2023anditsImplementationPlan http://www.health.gov.au/natsihpNATSISPS NationalAboriginalandTorresStraitIslanderSuicidePreventionStrategy(2013) http://www.health.gov.au/internet/main/publishing.nsf/content/mental-pub-atsi-suicide-prevention-strategyNewNationalSPStrategy NationalSuicidePreventionImplementationStrategy.Byaction(ii)oftheFifthNationalMentalHealthand

SuicidePreventionPlan,aSuicidePreventionSubcommitteewilldevelopa(new)NationalSuicidePreventionImplementationStrategyforCOAGHealthCouncilendorsement.Page24oftheFifthNationalMentalHealthandSuicidePreventionPlanlists11elementsofthenewNationalSPStrategy.

Action(ii)FifthNationalMentalHealthandSuicidePreventionPlan

NSQHSStandards NationalSafetyandQualityHealthServiceStandards,andUserGuideforAboriginalandTorresStraitIslanderHealth(both2017)

https://www.safetyandquality.gov.au/wp-content/uploads/2017/12/National-Safety-and-Quality-Health-Service-Standards-second-edition.pdfandUserGuide:https://www.safetyandquality.gov.au/wp-content/uploads/2017/12/National-Safety-and-Quality-Health-Service-Standards-User-Guide-for-Aboriginal-and-Torres-Strait-Islander-Health.pdf

Page 5: NATSILMH Health in Culture Policy Concordance Health in Cultur… · (a) The Fifth National Mental Health and Suicide Prevention Plan • Recognises the National Strategic Framework

NationalAboriginalandTorresStraitIslanderLeadershipinMentalHealth2018

5

NTRC RoyalCommissionandBoardofInquiryintotheProtectionandDetentionofChildrenintheNorthernTerritory–FindingsandRecommendations(2017)

https://childdetentionnt.royalcommission.gov.au/Documents/Royal-Commission-NT-Findings-and-Recomendations.pdf

PHN PrimaryHealthNetwork PHNGuidelines PHNPrimaryMentalHealthCareFlexibleFundingPoolImplementationGuidance–individualguidelines

named(2016).http://www.health.gov.au/internet/main/publishing.nsf/content/phn-mental_tools

RecoveryFr Anationalframeworkforrecovery-orientedmentalhealthservices(2012)

https://www.health.gov.au/internet/main/publishing.nsf/content/67D17065514CF8E8CA257C1D00017A90/$File/recovgde.pdf

RoyalCommissionCSA RoyalCommissionintoInstitutionalResponsestoChildSexualAbuseFinalReport–Recommendations(2017) https://www.childabuseroyalcommission.gov.au/sites/default/files/final_report_-_recommendations.pdfSEWB Socialandemotionalwellbeing SP Suicideprevention SuicidePreventionSubcommittee Byaction(ii)oftheFifthNationalMentalHealthandSuicidePreventionPlan,theMHDAPCwillbeadvisedbya

SuicidePreventionSubcommitteethatwilldevelopaNationalSuicidePreventionImplementationStrategyforCOAGHealthCouncilendorsement.Priorityareasforconsiderationarelisted.

Page 6: NATSILMH Health in Culture Policy Concordance Health in Cultur… · (a) The Fifth National Mental Health and Suicide Prevention Plan • Recognises the National Strategic Framework

NationalAboriginalandTorresStraitIslanderLeadershipinMentalHealth2018

6

3.CONCORDANCE

PART1:MENTALHEALTH/SEWB(somecrossreferencingwithsuicideprevention,butalsoseededicatedsuicidepreventionsectionbelow)

SYSTEMARCHITECTURE

Nationalapproach

5NMHSPP Actioni,p.12 • GovernmentswillestablishaMentalHealthExpertAdvisoryGroup…willadviseAHMAC,throughMHDAPC,on5NMHSPPimplementation/analyseprogress(seealsoAction8)Actioniii,p.13 • AboriginalandTorresStraitIslanderMentalHealthandSuicidePreventionSubcommittee(ATSIMHSPC)–reporttoMHDAPC/AHMAC–(prioritytasksunderAction11listedbelow)

NATSIHP/IP Strategy1D(IP),p.16 • AustralianGovernmentmentalhealth,socialandemotionalwellbeing,alcoholanddruguse,andsuicidepreventionstrategieshavebeencoordinated.CulturalRF Domain5,p.16 • Stakeholderengagementandrelationships:Jointhealthandnon-healthpolicies,programsandservicesatcommunity,stateandnationallevelstoaddressthebroadersocial

determinantsimpactingonhealthTargets GDD Theme3(b),p.5 • LedbyAboriginalandTorresStraitIslanderpeoples,AboriginalandTorresStraitIslandervalues-basedsocialandemotionalwellbeingandmentalhealthtargetsincombinationwith

clinicaltargetsshouldbeadoptedacrossallpartsoftheAustralianmentalhealthsystem.Nationalqualitystandards

MH&SEWBFr Outcome1.1.7,p.29 • Progressinitiativesthatsupportqualityservicedelivery,qualityimprovement…5NMHSPP Action21,p.43 • GovernmentswilldevelopaNationalMentalHealthSafetyandQualityFramework[see–subactions]

Action22,p.44 • GovernmentswilldevelopaMentalHealthsupplementtotheNationalSafetyandQualityHealthServicesStandardsandNSMHSMBSuse MH&SEWBFr Outcome1.1.8,p.29 • Ensurethatworkers,emergingworkforcesandprofessionalservicesqualifyforMBSsubsidies.

Outcome4.2,p.40 • ExpandaccesstoFocusedPsychologicalStrategiesandMHprofessionalsthroughthepooledmentalhealthfundingavailabletoPHNs,andthroughsupportingaccesstoMBS-subsidisedservices.

Jurisdictionalalignment

MH&SEWBFr Outcome1.3,p.31 • Ensureplanningstrategiesincorporatethejointplanningprocessesofthestateandterritory-levelAboriginalandTorresStraitIslanderhealthplanningforaNATSIHP/IP Strategy1D,p.16 • Statesandterritories,theAustralianGovernmentandNACCHOAffiliateshavepreparedandimplementedworkplansthataddressregionalhealthplanprioritiesasrequiredundertheir

respectiveframeworkagreements(e.g.accesstohospital,dentalandsexuallytransmissibleinfectionservices).Regionalfocus/PHNs

NATSIHP/IP Strategy1D,p.15 • Improvedregionalplanningandcoordinationofhealthcareservicesacrosssectorsandproviders.5NMHSPP Action1.1(IP)p5-7 • TheCommonwealthwilldirectPHNstojointlydevelopregionalplanswithLHNsanddirecttopubliclyreleasedraftplansforpubliccomment

Action2.2,p.21 • GovernmentswillworkwithPHNsandLHNstoimplementintegratedplanningandservicedeliveryattheregionallevel.Thiswillinclude:• Engagingwiththelocalcommunity,includingconsumersandcarers,community-managedorganisations,ACCHSs,NDISproviders,theNDIA,privateprovidersandsocialservice

agenciesAction2.3,p.21 • …Undertakingjointregionalmentalhealthneedsassessmenttoidentifygaps,duplicationandinefficienciestoimprovesustainabilityAction2.5,p.21 • …DevelopingjointregionalmentalhealthandsuicidepreventionplansandcommissioningservicesaccordingtothoseplansAction2.7,p.21 • …Developingregion-widemulti-agencyagreements,sharedcarepathways,triageprotocolsandinformation-sharingprotocolstoimproveintegrationandassistconsumersandcarers

tonavigatethesystemPHNGuide Aboriginaland

TorresStraitIslanderMentalHealthServices,p.1

• In2016-17PHNsareexpectedto:o commissionculturallyappropriate,evidencebasedmentalhealthservicesforAboriginalandTorresStraitIslanderpeopletoimproveaccess,complementandlinktoexisting

activitiessuchasdrugandalcoholservices,suicidepreventionand/orbroadersocialandemotionalwellbeingservicesaswellasmainstreamservices.IndoingthisPHNsshould:o engagewithlocalcommunitiesandconsultwithrelevantlocalIndigenousandmainstreamprimaryhealthcareorganisationstoidentifythespecificmentalhealthneedsof

AboriginalandTorresStraitIslanderpeople;o determinethemostappropriatemixofservicedeliverymodalitiesforcommissioningineachregion;ando ensurereferralpathwaysareinplacetoenableandsupportpatientstoseamlesslytransitionbetweenservicesastheirneedschange.

• Longerterm,PHNswillbeexpectedto:o establishlinkagesbetweencommissionedandexistingservicestofacilitateajoinedup,integratedapproachtotheprovisionofmentalhealthservices;o supportproviderstodevelopandmaintainculturallyappropriateandsafeservicesthatholisticallymeettheneedsofpatientsandtheirfamilies;ando ensurereferralpathwaysareinplacetoenableandsupportpatientstoseamlesslytransitionbetweenservicesastheirneedschange.

DrugStrategy Outcome2.4,p.6 • Interventionsarebasedonlocallyidentifiedneedsandformpartofanintegratedandcross-sectoralapproachattheregionallevel.NATSISPS Outcome4.2,p.38 • Thereisdevelopmentofgovernanceandinfrastructuretoandcapacityforplanningtosupportregionalandlocalcoordinationofsuicideprevention

(i)Investigatefeasibilityofapproachestoregionalcoordinationofsuicidepreventionincluding,butnotlimitedto,rolesofkeygovernmentagenciesandpartners(ii)Identifymodelsforgovernancetosupportinteragencyapproachestocoordinatedsuicideprevention(iii)Developdata,informationandresourcestosupportregionallevelplanningandcoordinationofstrategies(iv)Examinemodelsforpoolingoffundstosupportcoordinatedapproachestoprevention

Steppedcare PHNGuide Steppedcare,p.1 • In2016-17PHNsareexpectedto:o undertakecomprehensiveregionalmentalhealthplanningandidentifyprimarymentalhealthcareservicegapswithinasteppedcareapproach;o developapproachestonewserviceareastobroadentheservicemix,suchaslowintensityservicesandservicesforyoungpeoplewithseverementalillness;o promoteasteppedcareapproachandbettertargetappropriatereferraltomentalhealthandrelatedservices;

Page 7: NATSILMH Health in Culture Policy Concordance Health in Cultur… · (a) The Fifth National Mental Health and Suicide Prevention Plan • Recognises the National Strategic Framework

NationalAboriginalandTorresStraitIslanderLeadershipinMentalHealth2018

7

o developlinkageswithandbetweenrelevantservicesandsupports;ando establishmentalhealthspecificclinicalgovernancearrangements.

• LongertermPHNswillbeexpectedto:o implementthecoreelementsofasteppedcareapproachoutlinedinthisguidance;o plan,develop,targetand/orcommissionservicestoachieveanappropriateservicemix;o addressthesixprioritiesidentifiedfortheflexiblefundingpoolwithinasteppedcareapproach;o ensurethemostefficientuseofresourcestodevelopandimplementtimelyservicepathways;o activelypromoteuseoftheDigitalMentalHealthGatewayasacoreelementofasteppedcareapproach;ando supportGPsintheircriticalroleinensuringpeoplearereferredtotherightcareattherighttime.

Overarchingapproachofcomprehensivehealthcare“bestofbothworlds”

5NMHSPP/IP • Manyreferencestoacollaborationwithhealthprofessionalsaroundclinicallyandculturallyappropriatecare.MH&SEWBFr • Manyreferencestoacollaborationwithhealthprofessionalsaroundclinicallyandculturallyappropriatecare.GDD Theme1,p.4 • TheholisticconceptofsocialandemotionalwellbeingincombinationwithclinicalapproachesshouldguideallAboriginalandTorresStraitIslanderMH,healingandSPpolicy

developmentandserviceandprogramdelivery.NATSIHP/IP Strategy1C/IP,p.14 • AboriginalandTorresStraitIslanderpeoplesareabletoaccessculturallyappropriatementalhealthandsocialandemotionalwellbeingservices.CulturalRF Domain4,p.15 • Consumer-centredcare:AboriginalandTorresStraitIslanderpeoplesphilosophiesofholistichealthandwellbeingarerecognisedinhealthpractice,withAboriginalandTorresStrait

Islanderpeoplesknowledge,values,beliefsandculturalneedsandhealthhistoryinformingdecisionmakingaboutclinicaldecisions,pathwaysandongoingcare,includingconsiderationofAboriginalandTorresStraitIslanderpeoplesfamilystructuresandresponsibilities

5NMHSPP Action11,ATSIMHSPS,TOR5,6

• overseethedevelopment,disseminationandpromotionincommunity,hospitalandcustodialsettingsofaresourcethatarticulatesamodelofculturallycompetentAboriginalandTorresStraitIslandermentalhealthcareacrossthehealthcarecontinuumandbringstogether(a)theholisticconceptofsocialandemotionalwellbeingand(b)mainstreamnotionsofsteppedcare,trauma-informedcareandrecovery-orientedpractice

• provideadviceonmodelsofservicedeliverythatembedculturalcapabilityintoallaspectsofclinicalcareandimplementtheCulturalRespectFrameworkforAboriginalandTorresStraitIslanderHealth2016–2026inmentalhealthservices

AboriginalandTorresStraitIslanderleadershipatsystemandservicelevels

5NMHSPP Action10,p.33

• Engagementinplanning…involvementofACCHSand…communities...[thisincludesfor]AboriginalandTorresStraitIslanderpeoplesattheregionallevelAboriginalandTorresStraitIslanderpresenceonPHN/LHDgovernancestructuresandAboriginalandTorresStraitIslanderpeoplesleadershiponlocalMentalHealth/relatedservices

Action12.3,p.34. • PromotingAboriginalandTorresStraitIslanderpeoplesleadership–bysupportingimplementationoftheGayaaDhuwiDeclaration.MH&SEWBFr Outcome1.1,p.27 • IncorporatespecificAboriginalandTorresStraitIslanderpeoples’leadershipinworkforceprogramdevelopment.

Outcome2.1,p.32 • EngageEldersandseniorcommunitymembersinleadershiprolesinaculturally-informedway…• Supportmen’sandwomen’sgroupsandgender-specificpromotionofleadership,SEWBandhealing.

GDD Theme4,p.5

• AboriginalandTorresStraitIslanderpeopleshouldbetrained,employed,empoweredandvaluedto:o leadacrossallpartsoftheAustralianmentalhealthsystemthatarededicatedtoimprovingAboriginalandTorresStraitIslanderwellbeingandmentalhealthandtoreducing

suicide,andinallpartsofthatsystemusedbyAboriginalandTorresStraitIslanderpeoples.o leadinallareasofgovernmentactivitythataffectthewellbeingandmentalhealthofAboriginalandTorresStraitIslanderpeople.

Theme5,p.5 • FourarticlesonsupportinguniqueelementsofAboriginalandTorresStraitIslanderleadership/professionalself-careandsupportsDrugStrategy Outcome1.1,p.5 • Community-controlledAODservicesaresupportedtoleadthedeliveryofprogramstoaddressharmfulAODuse.

Outcome3.2,p.6 • CommunityleadersandElderstakeresponsibilityandaleadingrole,inpartnershipwithgovernment,todesign,deliverandevaluatealcohol,tobaccoandotherdrugsprograms.NATSIHP/IP Strategy4A,p.30 • Youngpeoplehavebeensupportedtobeleaders/rolemodelsintheircommunitiesbyhavingaccesstorolemodelsandmentoringprogrammes(e.g.AboriginalKinshipGroup

(Granniesgroup)),Strategy6D,p.40 • Localeldersandseniorcommunitymemberschampionculturallyappropriatehealthandwellbeingchoices

• Localeldersandseniorcommunitymembersarerecognisedandvaluedasexpertswhocanhelpimprovelocalhealthandwellbeingoutcomes.• Implementationandreviewofleadershipandrolemodel/mentoringprogrammes(e.g.theAboriginalKinshipProgram)hasbeensupported

CulturalRF Domain1,p.12 • GovernanceandLeadership:Recognitionforleadersofculturalsafetyandresponsiveness,highlightingtheiractivityandsharingofbest-practiceinitiativesacrosstheorganisation• Investmentandresources:SustainablefundingandsupportforAboriginalandTorresStraitIslanderhealthstafftodevelop,leadandchampionculturallysafeandresponsivehealth

care

Domain3,p.14 • AboriginalandTorresStraitIslanderleadership:o AboriginalandTorresStraitIslanderleadershipandparticipationindecision-makingandgovernanceatalllevelsoftheAustralianhealthcaresystem,bothwithinAboriginaland

TorresStraitIslander-specificandmainstreamrolesandpositionso CulturalsafetyandresponsivenesseffortsaredirectedandguidedbyAboriginalandTorresStraitIslanderhealthprofessionalsand/orAboriginalandTorresStraitIslanderpeople

withculturalexpertiseand/orauthority• SpecificandtargetedsupporttodevelopexistingandpotentialAboriginalandTorresStraitIslanderleadersacrossalllevelsofhealthservicesandhealthprofessions• CulturallyResponsivehealthworkforce:Healthprofessionalscanidentifytheneedfor,andactivelyseek,advice,assistanceandinputfromAboriginalandTorresStraitIslanderstaff

whoareavailabletoinformculturallyresponsiveserviceprovision

Page 8: NATSILMH Health in Culture Policy Concordance Health in Cultur… · (a) The Fifth National Mental Health and Suicide Prevention Plan • Recognises the National Strategic Framework

NationalAboriginalandTorresStraitIslanderLeadershipinMentalHealth2018

8

• AboriginalandTorresStraitIslanderworkforce:AboriginalandTorresStraitIslanderhealthprofessionalsactivelysupportedandretainedinthehealthsystemthroughcapacitybuilding,mentoringinitiativesandongoingcareerprogression,inbothtargetedandmainstreampositions

GenuineEngagementandpartnershipwithAboriginalandTorresStraitIslandercommunities

5NMHSPP/IP Action10.P33

• Engagementinplanning…involvementofACCHSand…communities[andincludes]forAboriginalandTorresStraitIslanderpeoplesattheregionallevelAboriginalandTorresStraitIslanderpresenceonPHN/LHDgovernancestructuresandAboriginalandTorresStraitIslanderleadershiponlocalmentalhealth/relatedservices

Action11,ATSIMHSPSTOR4

• Provideadviceonsuitablegovernanceforservicesandthemostappropriatedistributionofrolesandresponsibilities,recognisingthattherightofAboriginalandTorresStraitIslandercommunitiestoself-determinationliesattheheartofcommunitycontrolintheprovisionofhealthservices

MH&SEWBFr Outcome2.1,p.32 • EngageEldersandseniorcommunitymembersinleadershiprolesinaculturally-informedway…• Supportmen’sandwomen’sgroupsandgender-specificpromotionofleadership...• Supportcommunitygovernancethroughcommunitycontrolledservicestodeliverhealthprogramsandservices.

Outcome1.3,p.31 • FormaliseeffectivepartnershipstoachievethebestpossibleMH&SEWB…outcomesforAboriginalandTorresStraitIslanderpeopleinallregions,includingbyimplementingintegratedplanningandservicedeliveryforAboriginalandTorresStraitIslanderpeopleattheregionallevel.

DrugStrategy Outcome2.2,p.6 • ParticipationofAboriginalandTorresStraitIslanderpeopleusingAODservicesisimproved.PriorityArea3,p.5 • StrengthenpartnershipsbasedonrespectbothwithinandbetweenAboriginalandTorresStraitIslanderpeoples,governmentandmainstreamserviceproviders,includinginlaw

enforcementandhealthorganisations,atalllevelsofplanning,deliveryandevaluation.Outcome3.1,p.6 • Communitydrivenpartnershipsarestrengthenedatthelocalleveltoaddressharmsassociatedwithalcoholandotherdrugs.Outcome3.2,p.6 • CommunityleadersandElderstakeresponsibilityandaleadingrole,inpartnershipwithgovernment,todesign,deliverandevaluatealcohol,tobaccoandotherdrugsprograms.

NATSIHP/IP Strategy5C,p.36 • AboriginalandTorresStraitIslanderadultscontributetothedevelopmentofstrategiesandservicesthatpromotehealthybehaviours,familycohesion,andsocialandemotionalwellbeing,

• ACCHSsarefundedtoengagelocallytoidentifyprioritiesanddevelopresponses.Strategy6D,p.40 • Localeldersandseniorcommunitymembersarerecognisedandvaluedasexpertswhocanhelpimprovelocalhealthandwellbeingoutcomes.

CulturalRF Domain5,p.16

• Participatoryandcollaborativepartnershipswithcommunitiesandavarietyofformalandinformalmechanismsaretofacilitatecommunityinvolvementindevelopingandimplementingculturalsafetyandresponsivenessrelatedactivities

• Governancestructuressupportsystematicandongoingtwo-waycommunicationwithAboriginalandTorresStraitIslandercommunities,particularlyinrelationtopolicydevelopment,programplanning,servicedelivery,evaluationofservices,andqualityimprovements

• CollaborationandpartnershipswithAboriginalandTorresStraitIslandercommunitiestoactivelyrespondtothechallengesfacedwhenengagingwiththehealthservice/systemDomain4,p.15 • GovernancestructuressupportandfacilitatepartnershipswithAboriginalandTorresStraitIslandercommunitiesandhealthconsumerstodesignthewaycareisdelivered

• PolicesandprocessesareestablishedandmaintainedtoincludeAboriginalandTorresStraitIslandercommunitiesandhealthconsumersinpolicydevelopment,serviceplanningandcaredesign

• OrganisationalcommitmenttotrainingofhealthprofessionalstosupportAboriginalandTorresStraitIslanderconsumersinvolvementinhealthcaredesignanddeliveryPHNGuide • SeePrimaryHealthNetworksandAboriginalCommunityControlledHealthOrganisationsGuidingPrinciples(March2016)

PlanningpartnershipswithACCHSs

MH&SEWBFr Outcome1.3,p.31

• EffectivepartnershipsbetweenPHNs/ACCHSs• FormaliseeffectivepartnershipstoachievethebestpossibleMH&SEWB…outcomesforAboriginalandTorresStraitIslanderpeopleinallregions,includingbyimplementingintegrated

planningandservicedeliveryforAboriginalandTorresStraitIslanderpeopleattheregionallevel.• Ensureplanningstrategiesincorporatethejointplanningprocessesofthestateandterritory-levelAboriginalandTorresStraitIslanderhealthplanningfora.

Outcome4.3,p.41 • PrimaryHealthNetworksworkinpartnershipwithAboriginalCommunityControlledHealthServicesonaregionalorothergeographicalbasisto:identifyandmaprelevantservicesandagencies;anddevelop,promoteandregularlyreviewculturallyandclinicallyappropriatepathwaysbetweenthem–inparticular,forthetreatmentoftraumaandemotionalandbehaviouraldifficultiesinchildren.

CulturalRF Domain3,p.14 • PartnershipsestablishedwithACCHSstocollaborateandsharebestpracticeinsupportinghealthprofessionalstoprovideculturallysafeandresponsivehealthservicestocommunitiesDomain5,p.16

• PartnershipswithAboriginalandTorresStraitIslanderorganisationstojointlyrecognise,celebrateandactivelyparticipateinhistoricaleventsofsignificanceandimportantannualeventsthatrecogniseandpromoteculture(e.g.ClosetheGap,NationalReconciliationWeek,MaboDay,NAIDOCWeek,ComingoftheLight,HarmonyDay,andNationalSorryDay)

Domain2,p.13 • WorkingwithlocalAboriginalandTorresStraitIslanderpeopleandorganisations,aswellasinterpreter/translationservices,tosupportcommunicationwithAboriginalandTorresStraitIslanderconsumerstoprovidemoreeffectiveandqualityhealthcare,whileimprovingaccessandpathwaysofcarebetweenorganisationsandmainstreamservices

DrugStrategy Outcome3.1p.6 • Communitydrivenpartnershipsarestrengthenedatthelocalleveltoaddressharmsassociatedwithalcoholandotherdrugs.Outcome3.2,p.6 • CommunityleadersandElderstakeresponsibilityandaleadingrole,inpartnershipwithgovernment,todesign,deliverandevaluatealcohol,tobaccoandotherdrugsprograms.Outcome3.3,p.6 • PartnershipsbetweenAboriginalandTorresStraitIslandercommunity-controlledAODservicesandmainstreamAODservicesareenhancedandstrengthenedOutcome3.4,p.6 • PartnershipsbetweengovernmentandAODserviceproviders(bothcommunity-controlledandmainstreamservices)arebasedonmutualrespectandcommunitystrengths.

NSQHSStandards

Action2.13,p.19 • ThehealthserviceorganisationworksinpartnershipwithAboriginalandTorresStraitIslandercommunitiestomeettheirhealthcareneeds

NSQHSStandardsUserguide

Reabove,keytasks,p.8

• IdentifyAboriginalandTorresStraitIslandercommunitieswithintheorganisation’scatchment,andtherelevantculturalprotocolstoguidebuildingofpartnerships• Identifykeycontacts,eldersandopinionleadersintheAboriginalandTorresStraitIslandercommunitiesandhealthservicesandmakecontactwiththem• EstablishandimplementmechanismsforformingandmaintainingpartnershipswithAboriginalandTorresStraitIslandercommunitiesandrepresentativeorganisations.

Standard4 • TheMHSdeliversservicesthattakeintoaccounttheculturalandsocialdiversityofitsconsumersandmeetstheirneedsandthoseoftheircarersandcommunitythroughoutallphases

Page 9: NATSILMH Health in Culture Policy Concordance Health in Cultur… · (a) The Fifth National Mental Health and Suicide Prevention Plan • Recognises the National Strategic Framework

NationalAboriginalandTorresStraitIslanderLeadershipinMentalHealth2018

9

NatStandardsMHServices

ofcare.Criteria4.2,p.12 • TheMHSwheneverpossibleutilisesavailableandreliabledataonidentifieddiversegroupstodocumentandregularlyreviewtheneedsofitscommunityandcommunicatesthis

informationtostaff.Criteria4.1 • Publicmentalhealthservicesandprivatehospitalsp.18.TheMHSidentifiesthediversegroups[inc.]AboriginalandTorresStraitIslanderpeoplethataccesstheservice.…This

informationshouldbeusedtoplananddevelopculturallycompetentservicesandstrategiestoimproveaccesstotheservice….TheMHSshouldprovideevidencethatitusesmethodssuchas:collaborationwithcommunityhealthandwelfareorganisationsandservicestodeveloplocalprotocolsforAboriginalandTorresStraitIslanderpeople….[and]developrelationshipswithlocalAboriginalandTorresStraitIslandereldersandpeakgroups.

Criteria4.4,p.19 • TheMHSshoulddevelopappropriatepartnershipswithotherserviceproviders,organisationsandprogramswithdiversityexperienceaspartofitscommitmenttoself-determinationforAboriginalandTorresStraitIslanderpeople

ACCHSpreferredproviders

MH&SEWBFr Outcome1.3,p.31 • GivepreferencetofundingACCHSstodelivermentalhealth,suicidepreventionandotherprimaryhealthprogramsandserviceswherefeasible.

Stakeholderpartnerships

CulturalRF Domain5,p.16

• Partnershipswithcommunitygroups,otherhealthorganisationsandprofessionalbodiestoplan,deliverandmonitoreffectivemodelsofservicesandpartnershipsthatimproveAboriginalandTorresStraitIslanderhealthandwellbeing

• Cross-agencyandcross-sectorforumsanddecision-makingbodiesthatincludekeyAboriginalandTorresStraitIslanderpeopleorganisations,agenciesandconsumerstoshareinformation,makedecisions,influence,anddevelopnetworksandtrust

• Jointhealthandnon-healthpolicies,programsandservicesatcommunity,stateandnationallevelstoaddressthebroadersocialdeterminantsimpactingonhealthNatStandardsMHServices

Criteria4.4,p.19 Publicmentalhealthservicesandprivatehospitals:TheMHSshoulddevelopappropriatepartnershipswithotherserviceproviders,organisationsandprogramswithdiversityexperienceaspartofitscommitmenttoself-determinationforAboriginalandTorresStraitIslanderpeople.

Consumer&carerengagement

CulturalRF Domain4,p.15

• ProcessessupportandenableactiveandinformedparticipationbyAboriginalandTorresStraitIslanderconsumersindecisionsabouttheirowncare• ArangeofresourcesusedtoinformAboriginalandTorresStraitIslanderconsumersaboutservicesavailable,theirrightsandthewayinwhichtheycanseekredressofanycomplaints• Designanddeliveryoforganisationalperformancemeasurementandevaluationofservicesincludingorganisationalself-assessmentsofculturalcompetencyactivitiesinvolves

AboriginalandTorresStraitIslanderhealthconsumers• AboriginalandTorresStraitIslanderconsumersareengagedinperformancemeasurementandevaluationofhealthservicesthroughaccessible,culturallyresponsiveandsafe

processes• AboriginalandTorresStraitIslanderhealthconsumersareencouragedtoparticipateinpatientexperiencefeedbackmechanismsaimedat,andusedfor,improvingservicedelivery• GovernancestructuressupportandfacilitatepartnershipswithAboriginalandTorresStraitIslandercommunitiesandhealthconsumerstodesignthewaycareisdelivered• PolicesandprocessesareestablishedandmaintainedtoincludeAboriginalandTorresStraitIslandercommunitiesandhealthconsumersinpolicydevelopment,serviceplanningand

caredesign• OrganisationalcommitmenttotrainingofhealthprofessionalstosupportAboriginalandTorresStraitIslanderconsumersinvolvementinhealthcaredesignanddelivery

5NMHSPP Action23,p.44 • GovernmentwillimplementmonitoringofconsumerandcarerexperiencesofcareNatStandardsMHServices

Standard3 • Consumersandcarersareactivelyinvolvedinthedevelopment,planning,deliveryandevaluationofservices.Criteria3.3 • ImplementationGuidelineforPublicMentalHealthServicesandPrivateHospitals,p.14.Consumersandcarerswhoareinvolvedwithmentalhealthservicesmusthaveaccessto

trainingandsupport…Consumerandcarerparticipationandrepresentationintrainingmustreflecttheethnicandracialdiversityofthepopulationserved.InitiativestoensurethisoccurscouldincludepracticalassistanceforAboriginalandTorresStraitIslanderconsumersandcarers.Thiscouldincludesuchthingsastransporttomeetings,paymentforattendanceortrainingsessionsinruralorremotecommunities.

PHNGuidelines

ConsumerandCarerengagementandparticipation,p.1

• In2016-17PHNSareexpectedto:o establishandfostercollaborativepartnershipswithconsumersandcarers;o identifyandaddressthegoalsofconsumersandcarersateachpointofthecommissioningcycle;o acknowledgethedifferentconsumerneedsacrossasteppedcaremodel,andconsultwiththoseconsumersmostlikelytouseparticularservicetypesontheirneedsandconcerns;o applyprinciplesofco-designwhencommissioningservices,withafocusonrecovery-orientedapproaches;o requireservicestoaccountforculturalandexperientialdifferencesinconsumerandcarerengagementandparticipationstrategies;o supportworkforcedevelopmentandplanning,whichisinclusiveoflivedexperiencetrainersandeducators;o recognisetherightsofconsumersandcarers,andseektoeliminatestigmatisingattitudesanddiscriminationinprimaryhealthcaresettings;ando comprehensivelyidentifyconsumerandcarersupportandadvocacyserviceswithintheregion,aswellasanygaps.

• LongertermPHNswillbeexpectedto:o embedconsumerandcarerco-designthroughoutthecommissioningcycle,includinginneedsassessment;policydevelopment;strategicplanning;prioritisation;procurementof

services;andmonitoringandevaluation;o establishcollaborativepartnershiparrangementswithAboriginalandTorresStraitIslandercommunitiesandtheirhealthandmentalhealthservices;o establishcollaborativepartnershiparrangementswithtransculturalmentalhealthservices,orthealternativesinstatesandterritorieswheresuchservicesdonotexist;ando movetocontractualarrangementswithserviceproviderswhichrequirethemtodemonstratearightsbasedapproachtoconsumersandcarers.

Page 10: NATSILMH Health in Culture Policy Concordance Health in Cultur… · (a) The Fifth National Mental Health and Suicide Prevention Plan • Recognises the National Strategic Framework

NationalAboriginalandTorresStraitIslanderLeadershipinMentalHealth2018

10

WORKFORCE

OverarchingWorkforcestrategy/AboriginalandTorresStraitIslanderworkers

5NMHSPP Action31,p.47 • WorkforceDevelopmentProgram-TomeetfutureworkforcesupplyrequirementsanddriverecruitmentandretentionofskilledstaffAction11,ATSIMHSPSTOR6

• ProvideadviceonworkforcedevelopmentinitiativesthatcangrowandsupportanAboriginalandTorresStraitIslanderMHworkforce,incorporateAboriginalandTorresStraitIslanderstaffintomultidisciplinaryteams….

MH&SEWBFr Outcome1.1,p.28 • IncreaseAboriginalandTorresStraitIslanderemploymentacrosstheentireMH&SEWBworkforce,includingpsychologistsandpsychiatrists,speechpathologists,mentalhealthworkersandotherprofessionalsandworkers.

Outcome4.2.p.40 • Ensuretherequiredmixandlevelofspecialistmentalhealthservicesandworkers,paraprofessionalsandprofessionalsrequiredtomeetthementalhealthneedsoftheAboriginalandTorresStraitIslanderpeople,includingspecialistsuicidepreventionservicesforpeopleatriskofsuicide

GDD Theme4,p.5 • AboriginalandTorresStraitIslanderpeopleshouldbetrained,employed,empoweredandvaluedtoworkatalllevelsandacrossallpartsoftheAustralianmentalhealthsystemandamongtheprofessionsthatworkinthatsystem.

NATSIHP/IP Strategy1A,p.11 • CoreservicesframeworkforcomprehensiveprimaryhealthcareandaccesstospecialistmedicalcarehasbeendefinedandconsideredbytheMinisterasamatterofpriority.(Thismodelwillbeinfluencedby,andwilldirectlyinfluence,theAboriginalandTorresStraitIslanderHealthWorkforceStrategicFramework).

Strategy1E,p.17

• AboriginalandcommunitycontrolledandmainstreamhealthsectorworkforcesarecapableofmeetingtheneedsofAboriginalandTorresStraitIslanderpeople• Support,growandincreasethecapabilityoftheworkforce…tomeetcurrentandfutureAboriginalandTorresStraitIslanderhealthneeds• TheNationalAboriginalandTorresStraitIslanderHealthWorkforceStrategicFramework(2011–2015)hasbeenreviewedandanewframeworkdevelopedandimplemented.

DrugStrategy PriorityArea1,p.5

• BuildcapacityandcapabilityoftheAODservicesystem,particularlyAboriginalandTorresStraitIslandercommunity-controlledservicesanditsworkforce,aspartofacross-sectoralapproachwiththemainstreamAODservicestoaddressharmfulAODuse.

Outcome1.3,p.5 • Workforceinitiativesaredevelopedtoenhancethecapacityandcapabilityofcommunity-controlledAODservices.CulturalRF Domain3,p.14

• AboriginalandTorresStraitIslanderpeopleworkinginallareasofthehealthsector,bothclinicalandnon-clinical,andadequateresourcesallocatedoverthelong-termtosupport

targetedemploymentstrategiesandinitiatives• AboriginalandTorresStraitIslanderhealthprofessionalsactivelysupportedandretainedinthehealthsystemthroughcapacitybuilding,mentoringinitiativesandongoingcareer

progression,inbothtargetedandmainstreampositionsNATSIWS Strategy1,p.8 • ImproverecruitmentandretentionofAboriginalandTorresStraitIslanderhealthprofessionalsinclinicalandnon-clinicalrolesacrossallhealthdisciplines(SeeSuggested

mechanisms)NationalMHWorkforceStrategy

p.17(text) • InordertoprovideculturallyappropriateservicesforpeoplefromAboriginalandTorresStraitIslanderandculturallyandlinguisticallydiverse(CALD)backgrounds,theworkforceneedstobetechnicallyandculturallycompetent.Insomesituations,theMHworkforcemaybeabletobedrawnfrompeopleofanappropriateculturalbackground,butinmostsituations,servicestopeoplefromAboriginalandTorresStraitIslanderandCALDbackgroundsareprovidedbyworkersfromadifferentculturalbackgroundwhoneedtrainingandsupporttoensuretheyareculturallyawareandcompetent.

• AboriginalandTorresStraitIslanderMHworkersmayneedsupport,owingtotheirdualrolesatworkandintheirownfamilygroupsandcommunities.Theseworkers,particularlyinremotecommunities,faceparticularpressuresandareoftenoncall24hoursaday,sevendaysaweek.Tocompoundthepressure,theyworkinmanyruralandremoteareasofAustralia,andIndigenousworkersmaynotbeeligibleforhousingandothersupportsmadeavailabletonon-Indigenousstaffandvisitingspecialists.

• Ongoingculturalcompetencein-servicetraining,ratherthanbriefawarenesssessions,wasthefavouredstrategyforbuildingworkforcecapacity.Thegeneralistmentalhealthworkforcemayalsobenefitfromeducationprogramsthatfocusonthesettlementchallengesofnewlyarrivedmigrantsandrefugees,andhowfailuretoovercomethesechallengescandevelopintoacculturationdifficultiesandsubsequentMHdeterioration…

Objective3.3.1,p.28 • WorkwiththeCALDsectorandMHservicestopromotecareeropportunitieswithintheMHsectortomeetthechangingdemographicsofMHpopulations.Objective3.2.1,p.28 • SupportthetrainingofAboriginalandTorresStraitIslandertobecomeMHworkersinarangeofdisciplinesbysupportingandpromotingexistingsuccessfulprogramsandpiloting

newprograms.UpskillingexistingAboriginalandTorresStraitIslanderworkers

MH&SEWBFr Outcome1.1,p.28

• ImprovethestatusofallAboriginalandTorresStraitIslanderMH&SEWBworkers,paraprofessionalsandprofessionalsandovertime,requireworkerstohavequalificationsthatensureprofessionalequity.

• Progressinitiativesthatsupport…workforce-wideup-skilling,includingappropriateclinicalsupervisionofMH&SEWBworkers,paraprofessionalsandprofessionals• Createcareerpathwaysbyreducingbarriersandpathwaystoeducationandtrainingincludingtrainingforemergingprofessionalworkforcesaccreditedworkers,paraprofessionals

andestablishedprofessionalsandprofessions.• Continuetodevelopaccreditationstandardsthataresystematicallymeasurable;anddevelopandsupportpathwaystotraininginexistingworkenvironmentstoincreaseworker

andprofessionalcapacities.NATSIHIP/IP Strategy1E,p.17 • TrainingopportunitiesprovidedtofurtherdeveloptheskillsofstafftomeetcurrentandfutureAboriginalandTorresStraitIslanderhealthserviceneedsandincreaseretention

levels.NATSIWS Strategy2,p.8 • ImprovetheskillsandcapacityoftheAboriginalandTorresStraitIslanderhealthworkforceinclinicalandnon-clinicalrolesacrossallhealthdisciplines(SeeSuggested

mechanisms)NationalMHWorkforceStrategy

Objective1.2.1,p.20 • Providebettercareerpathways,supervision,mentoringandlocumsupportprogramsforAboriginalMHworkersinarangeofsettings.

Page 11: NATSILMH Health in Culture Policy Concordance Health in Cultur… · (a) The Fifth National Mental Health and Suicide Prevention Plan • Recognises the National Strategic Framework

NationalAboriginalandTorresStraitIslanderLeadershipinMentalHealth2018

11

SupportingAboriginalandTorresStraitIslanderstaffinmainstreamsettings

NATSIWS Strategy3p9 • Healthandrelatedsectorsbesupportedtoprovideculturally-safeandresponsiveworkplaceenvironmentsfortheAboriginalandTorresStraitIslanderworkforce.(SeeSuggestedmechanisms)

Training/supportallMHservicestaff

NationalMHWorkforceStrategy

Objective1.2.2,p.20 • IncorporatetraininginAboriginalandTorresStraitIslandermentalhealthinMHworkforcetrainingprograms.

NSQHSStandards Action1.21 • ThehealthserviceorganisationhasstrategiestoimprovetheculturalawarenessandculturalcompetencyoftheworkforcetomeettheneedsofitsAboriginalandTorresStraitIslanderpatients

MH&SEWBFr Outcome1.1.10,p.29

• RequireculturalcompetenceofgeneralpractitionersandothermedicalpractitionersinordertoworkeffectivelywithAboriginalandTorresStraitIslanderwithMHproblemsandmentalillness

NATSIHIP/IP Strategy1E,p.17 • TrainingneedsofhealthsectorstaffworkingwithAboriginalandTorresStraitIslanderpeopleshavebeenidentifiedandaddressed,includingthedevelopmentanddeliveryofnewtrainingprogrammes.

5NMHSPP Action12.4,p.34 • TrainingallstaffdeliveringmentalhealthservicestoAboriginalandTorresStraitIslanderpeoples,particularlythoseinforensicsettings,intrauma-informedcare…CulturalRF Domain2,p.13 • Healthstaffhaveaccesstoresourcesandtrainingtoguideandsupportculturallysafecommunicationwithhealthconsumers(e.g.interpreters,liaisonofficers,traditionalhealers,

translatedresourcesandhealthinformationpackages)Domain3,p.14 • Budgetandresourcestosupportadequateculturalsafetyandresponsivenesstrainingofhealthstaffatalllevels(clinicalandnon-clinical)andacrossalldisciplines,including

ongoingprofessionaldevelopment,capacityforself-reflectionandmonitoringofhealthstaffskillsEducationsystem

MH&SEWBFr Outcome1.1.

• Improvenationalaccesstovocationaltraininginkeyevidencebasedtherapies(egcognitivebehaviouraltherapy,dialecticalbehaviouraltherapyandmindfulnesstherapies).• IncreaseAboriginalandTorresStraitIslanderparticipationratesintertiarycourses.• Encouragethedevelop.ofspecialistAboriginalandTorresStraitIslanderMHcourses.• Ensurealignmentofmeasurableprofessionaltrainingandeducationstandardsandserviceaccreditationstandardstoensureasystemwideapproachtoimprovingreportable

capabilitiesforworkingeffectivelywithAboriginalandTorresStraitIslanderpeopleOutcome2.4 • RequireevidencebasedapproachesonMHandwellbeingbeadoptedinearlychildhoodworkerandteachertrainingandcontinuingprofessionaldevelopment.

GDD Theme2,p.4 • Itistheresponsibilityofallmentalhealthprofessionalsandprofessionalassociations,andeducationalinstitutionsandstandard-settingbodiesthatworkinmentalhealth(andalsothoseinareasrelatedtomentalhealth,particularlysuicideprevention)tomaketheirpracticesand/orcurriculumrespectfulandinclusiveofthementalhealthandsuicidepreventionneedsofAboriginalandTorresStraitIslanderpeoples,

CulturalRF Domain3,p.14 • Professionalbodiesandtraininginstitutionsembedculturalcompetencyintheeducationofhealthprofessionals,includingAboriginalculturesandhistoriesandthehistoryofATSIhealth

NATSIWS Strategy4,p.9 • IncreasethenumberofAboriginalandTorresStraitIslanderstudentsstudyingforqualificationsinhealth(SeeSuggestedmechanisms)Strategy5,p.10 • Improvecompletion/graduationandemploymentratesforAboriginalandTorresStraitIslanderhealthstudents(SeeSuggestedmechanisms)

Roleofprofessionalbodies

CulturalRF Domain3,p.14 • Professionalbodiesandtraininginstitutionsembedculturalcompetencyintheeducationofhealthprofessionals,includingAboriginalculturesandhistoriesandthehistoryofATSIhealth

• ProfessionalbodiesprovidetheirmemberswithongoingopportunitiesforgenericandspecificstandardisedprofessionaldevelopmentinculturalsafetyMH&SEWBFr Outcome1.1.

• IncreaseAboriginalandTorresStraitIslanderemploymentacrosstheentireMH&SEWBworkforce,includingpsychologistsandpsychiatrists,speechpathologists,MHworkersand

otherprofessionalsandworkers• Continuetodevelopaccreditationstandardsthataresystematicallymeasurable;anddevelopandsupportpathwaystotraininginexistingworkenvironmentstoincreaseworker

andprofessionalcapacities.• Ensurealignmentofmeasurableprofessionaltrainingandeducationstandardsandserviceaccreditationstandardstoensureasystemwideapproachtoimprovingreportable

capabilitiesforworkingeffectivelywithAboriginalandTorresStraitIslanderpeople• RequireculturalcompetenceofgeneralpractitionersandothermedicalpractitionersinordertoworkeffectivelywithAboriginalandTorresStraitIslanderpeoplewithMH

problemsandmentalillnessOutcome4.2 • IncorporateculturalcompetencyintheprofessionalstandardsandresponsibilitiesofmentalhealthprofessionswithinaSEWBframework.

GDD Theme2,p.4 • Itistheresponsibilityofallmentalhealthprofessionalsandprofessionalassociations,andeducationalinstitutionsandstandard-settingbodiesthatworkinmentalhealth(andalsothoseinareasrelatedtomentalhealth,particularlysuicideprevention)tomaketheirpracticesand/orcurriculumrespectfulandinclusiveofthementalhealthandsuicidepreventionneedsofAboriginalandTorresStraitIslanderpeoples,

Peerworkforce

5NMHSPP Action29,p.47 • GovernmentswilldevelopPeerWorkforceDevelopmentGuidelinesAction30,p.47 • Governmentswillmonitorthegrowthofthenationalpeerworkforce

Data NATSIWS Strategy6,p.10 • Improveinformationforhealthworkforceplanningandpolicydevelopment

Page 12: NATSILMH Health in Culture Policy Concordance Health in Cultur… · (a) The Fifth National Mental Health and Suicide Prevention Plan • Recognises the National Strategic Framework

NationalAboriginalandTorresStraitIslanderLeadershipinMentalHealth2018

12

NationalMHWorkforceStrategy

Objective5.3.3,p.32 • SupportdevelopmentofconsistentmeasuresoftheethnicityandbilingualskillsoftheworkforcetobetterinformworkforceplanningissuesinrelationtoAboriginalandTorresStraitIslanderandCALDpopulations.

EVIDENCEBASE/DATA/RESEARCH

Evidencebase 5NMHSPP Action13,p.34Action13.5,p.34

• GovernmentswillstrengthentheevidencebaseforbetterAboriginalandTorresStraitIslanderMHoutcomes• UtilisingavailablehealthservicesdataandenhancingthosecollectionstoimproveservicesforAboriginalandTorresStraitIslanderpeoples.

MH&SEWBFr Outcome1.2,p.30 • Astrongevidencebase,includingasocialandemotionalwellbeingandmentalhealthresearchagenda,underAboriginalandTorresStraitIslanderleadership(seeactions)NATSIHP/IP Strategy1F,pp.18-19

• Strengthenedevidencebaseofknowledgeacrossthelifecourseandcarecontinuum,inparticularpreventativehealth,includingthefactorsthatimpactonchildhoodhealthanddevelopment.

• Qualityandcompletenessofdatatosupportcontinuedpolicydevelopmentandimprovedservicedesign,planningandevaluation.CulturallyappropriateIndicators

GDD Theme3,p.4 • LedbyAboriginalandTorresStraitIslanderpeoples,allpartsoftheAustralianmentalhealthsystemshoulduseAboriginalandTorresStraitIslandervalues-basedsocialandemotionalwellbeingandmentalhealthoutcomemeasuresincombinationwithclinicalmeasureswhendevelopingevaluationframeworksforAboriginalandTorresStraitIslandermentalhealthandsuicidepreventionservicesandprograms.ThisalsoappliestothedevelopmentofanevidencebaseforAboriginalandTorresStraitIslandersocialandemotionalwellbeing,mentalhealthandsuicideprevention.

MH&SEWBFr Outcome1.2p30 • DevelopculturallyappropriateindicatorstomeasureSEWBDrugStrategy Outcome4.1p6 • Performancemeasuresreflectmeaningfuloutcomesaimedattheindividual,familyandcommunity.

Identification 5NMHSPP Action13.2p34 • EnsuringthatallMHservicesworktoimprovethequalityofidentificationofAboriginalandTorresStraitIslanderpeoplesintheirinformationsystems.NATSIHP/IP Strategy1Fp19 • ImprovedidentificationasAboriginalandTorresStraitIslanderpeoplesindatacollectionsets.NSQHSStandards Action5.8,p.42 • ThehealthserviceorganisationhasprocessestoroutinelyaskpatientsiftheyidentifyasbeingofAboriginaland/orTorresStraitIslanderorigin,andtorecordthisinformationin

administrativeandclinicalinformationsystemsNSQHSStandards–UserGuide

KeyTask5.8,p.3 • ThehealthserviceorganisationhasprocessestoroutinelyaskpatientsiftheyidentifyasbeingofAboriginalandTorresStraitIslanderorigin,andtorecordthisinformationinadministrativeandclinicalinformationsystems

Datacollection

5NMHSPP Action13.4,p.34 • Reviewingexistingdatasetsacrossallsettingsforimproveddatacollectiononthementalhealthandwellbeingof,andtheprevalenceofmentalillnessin,AboriginalandTorresStraitIslanderpeoples

MH&SEWBFr Outcome4.1,p.27 • Supportandcoordinatethedatacollections,measurementandevaluationsrequiredtoinformsystemmonitoring,accountabilityandservicequalityimprovement.• Seealso4.2

DrugStrategy Outcome4.2,p.6 • Datasystemsandqualityassuranceprogramsareinplacetoinforminvestmentinsustainableprogramdelivery.Evaluationofprogramsandservices

5NMHSPP Action13.3,p.34 • EnsuringthatfutureAboriginalandTorresStraitIslanderinvestmentsareproperlyevaluatedtoinformwhatworksCulturalRF Domain6,p.17 • Requirementfornewservices,programsandinitiativestoincludeafocusonculturalsafetyandresponsivenessinprogramevaluations

• Mechanismsinplacefortheidentificationandcollectionofdataandrelevanthealthinformationrelatedtoculturalsafety• Disseminationofculturalsafetyrelatedinformation/datathroughouttheorganisationtoinformplanninganddevelopment• Organisationalassessmentsandauditsareundertakentoidentifylevelsofculturalresponsivenessandsafety,identifygaps,andinformimprovementstrategies• Programandpolicyevaluationsinformthedevelopment,planningandreviewofhealthservices

MH&SEWBFr Outcome1.2,p.30 • Ensurefutureinvestmentsinneworexpandedservicesareproperlyevaluated.Research 5NMHSPP Action28,p.47 • GovernmentswillrequesttheNationalMentalHealthCommissiontoworkincollaborationwiththeNationalHealthandMedicalResearchCouncil,consumersandcarers,states

andterritories,researchfundingbodiesandprominentresearcherstodeveloparesearchstrategytodrivebettertreatmentoutcomesacrossthementalhealthsectorCulturalRF Domain4,p.15 • HealthandhealthsystemsresearchforAboriginalandTorresStraitIslanderpeopleisledbyAboriginalandTorresStraitIslanderpeople,whoareinvolvedasresearchers,partners

anddriversofresearchprioritiesandprojectsDomain6,p.17 • MechanismsareinplacetoidentifyresearchquestionsrelevanttoculturalsafetythatreflectAboriginalandTorresStraitIslanderholisticphilosophiesandviewsofhealthand

wellbeing,andthehealthhistoryofAboriginalandTorresStraitIslanderpeoples• EstablishedcollaborationsandpartnershipswiththeresearcherstoundertakeresearchinculturalsafetyandresponsivenessforAboriginalandTorresStraitIslanderhealth

consumers• Integrateresearchfindings,monitoring,evaluationandknowledgetransferintoallrelevantorganisationalinitiatives• Repositoryofresearchandevaluationestablishedtoshareknowledge,learningsandbestpractice• PolicyandprocessessupportAboriginalandTorresStraitIslanderpeopleandcommunities’participationandleadershipinresearchactivitiesandplanning• StrategiesinplacetoensureanethicalapproachandappropriateethicsapprovalprocessesareundertakenwhenengaginginresearchandevaluationofAboriginalandTorres

StraitIslanderhealthMH&SEWBFr Outcome1.2p.30

• Supportpracticalappliedresearchtoprogressivelyenhanceservicedelivery.• PromoteparticipatoryactionresearchtoprogressivelyempowercommunitiesandrestoreandpromoteSEWB.

Page 13: NATSILMH Health in Culture Policy Concordance Health in Cultur… · (a) The Fifth National Mental Health and Suicide Prevention Plan • Recognises the National Strategic Framework

NationalAboriginalandTorresStraitIslanderLeadershipinMentalHealth2018

13

• EmbedtheprincipleofAboriginalandTorresStraitIslandercommunityleadershipandcontrolofresearchinguidelinesfortheethicalconductofresearchwithAboriginalandTorresStraitIslanderpeople.

Resources/tools

5NMHSPP Action12.1,p.34 • DevelopingcompendiumofAboriginalandTorresStraitIslanderresources,(1)BestpracticeAction12.2,p.34 • PromotingtheuseofculturallyappropriateassessmentandothertoolsandguidelinesAction13.1,p.34 • Establishingaclearinghouseofresources,toolsandprogramevaluationsforallsettingstosupportthedevelopmentofculturallysafemodelsofservicedelivery,includingtheuseof

culturalhealingandtrauma-informedcareAction11,ATSIMHSPSTOR5

• Overseethedevelopment,disseminationandpromotionincommunity,hospitalandcustodialsettingsofaresourcethatarticulatesamodelofculturallycompetentAboriginalandTorresStraitIslanderMHacrossthehealthcarecontinuumandbringstogether(a)theholisticconceptofSEWBand(b)mainstreamnotionsofsteppedcare,trauma-informedcareandrecovery-orientedpractice

MH&SEWBFr Outcome1.2.p.18 • DevelopculturallyappropriateMH&SEWBassessmenttoolsandclinicalpathways,particularlyforchildrenandyoungpeopleOutcome4.1,p.27

• Develop,implementandreviewgoodpracticemodelsforservicedeliverywithstructuredclinicaldecision-makingtoolstosupportconsistentstandardsfordiagnosis,treatmentandrehabilitation.Thisshouldincludetheuseofstandardisedoutcomemeasuresandauditingtoolstoassessthequalityandoutcomesfromtherapyaswellastheprovisionforadequatesupervisionandsupporttoalltherapistsandcaremanagementworkers.

• ExploreculturallyappropriatelowintensitytreatmentpathwaysthatcanbedeliveredbyAboriginalCommunityControlledHealthServices.Complementthesetreatmentoptionsthroughculturallyappropriateself-helpoptionsdeliveredthroughthedigitalmentalhealthgateway.

Outcome5.1,p.30 • Developculturallyadaptedassessmentandtreatmentinformationoptionsforthosewithseverementalillnessandtheirfamiliesandcarers.

REGIONALFOCUS

PROMOTION(seealsothesectiononsuicideprevention,below)

Buildoncultureandcommunitystrengths

MH&SEWBFr Outcome2.1,p.32 • AboriginalandTorresStraitIslandercommunitiesandculturesarestrongandsupportMH&SEWB.• Communitygovernancethroughcommunitycontrolledservicestodeliverhealthprogramsandservices.• Strengthencommunitycohesion,andrestoreandhealconnectionstocultureandcountryincludingthroughreclamationandrevitalization

Outcome2.4,p.35 • Adaptend-to-endschoolbasedMH&SEWBprogramsforAboriginalandTorresStraitIslanderchildrenthatincludeafocuson:Strengtheningprideinidentityandculture.CulturalRF Domain2,p.13 • Positivehealthmessagesandprogramsthatrespondtothediversity,strengthsandknowledgeofAboriginalandTorresStraitIslandersocial,cultural,linguistic,gender,religious

andspiritualbackgroundsIAS Cultureand

CapabilityProgramme

• TheCultureandCapabilityProgrammeaimstoincreaselevelsofunderstandingandrespectforIndigenousAustraliansandtheircultures…

Buildonfamilystrengths

MH&SEWBFr Outcome2.2,p.33 • AboriginalandTorresStraitIslanderfamiliesarestrongandsupported• Increasefamily-centricandculturally-safeservicesforfamiliesandcommunities.• SupporttheroleofmenandEldersinfamilylifeandtheraisingofchildreninaculturally-informedway.• Supportsingleparentfamiliesandextendedfamilyandkinsupportnetworks• Supportfamilyre-unificationformembersoftheStolenGenerations,prisoners,childrenremovedfromtheirfamiliesintoout-of-homecare,andyoungpeopleinjuveniledetention.

Outcome3.1.4,p.36

• SupportprogramsformembersoftheStolenGenerationsandtheirfamilies.

IAS ChildrenandSchoolingProgramme

• TheobjectiveoftheChildrenandSchoolingProgrammeistodeliveractivitiestoIndigenouschildren,youthandadultsthat:Supportfamiliestogivechildrenagoodstartinlifethroughimprovedearlychildhooddevelopment,care,educationandschoolreadiness.

RoyalCommissionCSA

Rec12.20,p.40 • Eachstateandterritorygovernment,inconsultationwithappropriateAboriginalandTorresStraitIslanderorganisationsandcommunityrepresentatives,shoulddevelopandimplementplansto:(d)investincommunitycapacitybuildingasarecognisedpartofkinshipcare,inadditiontosupportingindividualcarers,inrecognitionoftheroleofAboriginalandTorresStraitIslandercommunitiesinbringingupchildren.

SupportingtheMH&SEWBofchildrenandyoungpeopleinc.vulnerableyoungpeople

MH&SEWBFr Outcome2.4,p.35 • AboriginalandTorresStraitIslanderchildrenandyoungpeoplegettheservicesandsupporttheyneedtothriveandgrowintomentallyhealthyadults• Ensureaccesstoculturallyappropriatequalitypre-schoolcareandeducationforchildrenaged3and4andpromoteschoolattendance.• Adaptend-to-endschoolbasedMH&SEWBprogramsforAboriginalandTorresStraitIslanderchildrenthatincludeafocuson:

o Strengtheningprideinidentityandculture.o Addressingtheimpactofracismandbuildingresiliencetoracism.

• DevelopstrategicresponsestosupporttheSEWBofchildreninout-of-homecareandestablishappropriateconnectionsbetweenchildprotectionservicesandarangeoffamilyandchild-supportservices.

• SupporttheMH&SEWBofvulnerablechildrenincludingthosewithdisabilitiesandthoseincarerroles.

Page 14: NATSILMH Health in Culture Policy Concordance Health in Cultur… · (a) The Fifth National Mental Health and Suicide Prevention Plan • Recognises the National Strategic Framework

NationalAboriginalandTorresStraitIslanderLeadershipinMentalHealth2018

14

Outcome2.3,p34 • Infantsgetthebestpossibledevelopmentalstarttolifeandmentalhealthincludingthestrengtheningofuniversalmaternalandchildhealthservices.• Facilitatethemeasurementofdevelopmentalmilestonesofinfants.• Facilitatehealthchecksthroughinfancyandchildhood,particularlyforconditionsassociatedwithemotionalandbehaviouralproblemssuchashearinglossresultingfromchronic

otitismedia.• Supportthementalhealthandsocialandemotionalwellbeingofchildrenwithcognitiveanddevelopmentalimpairmentsanddisabilities.• ContinueimplementingtheNationalEarlyChildhoodDevelopmentStrategy,

NATSIHP/IP

Part3,p.30

ChildhoodHealthandDevelopment• 4A.Youngpeoplehaveavoiceinthedevelopmentandimplementationofprogrammesandpoliciesthatareaffectingthem.• 4B.Youngpeoplearesupportedtoberesilientandmakeinformedandhealthychoicesaboutliving,includingbeingproudofidentityandculture.• 4D.Youngpeoplehavegoodeducationandgoodemploymentprospects.

• Part4,-AdolescentandYouthHealthIAS Childrenand

SchoolingProgramme

• ThedesiredoutcomesoftheChildrenandSchoolingProgrammeinclude,butarenotlimitedto:o IncreasingaccessandparticipationofIndigenouschildreninearlychildhoodcareandeducation.o Increasingschoolattendanceandimprovingeducationaloutcomes,includingliteracyandnumeracy.o IncreasingYear12orequivalentattainment,includingvocationaltrainingandeducation.

PRIMORDIALPREVENTION(seealsothesectiononsuicideprevention,below)

Communitychallenges/socialdeterminants

MH&SEWBFr Outcome2.1,p.32 • AboriginalandTorresStraitIslandercommunitiesandculturesarestrongandsupportMH&SEWB• Empowercommunitiestoidentifyandaddresschallenges.• Encouragepracticaloutcomes,suchasemploymentofcommunitymembers,schoolattendanceandeducationalattainment.

IAS • SafetyandWellbeingProgramme• Jobs,LandandEconomyProgramme• RemoteAustraliaStrategiesProgramme

CulturalRF Domain5,p.16 • Jointhealthandnon-healthpolicies,programsandservicesatcommunity,stateandnationallevelstoaddressthebroadersocialdeterminantsimpactingonhealthAOD MH&SEWBFr Outcome2.1 • Supportcommunitiesthatwishtorestrictalcoholsupplyanduseamongtheirmembers.

• Encouragealcoholreductionstrategies,includingmainstreampolicyanalysisofpotentialpricingleversandtaxationoptions.Outcome2.4,p.35 • Adaptend-to-endschoolbasedMH&SEWBprogramsforAboriginalandTorresStraitIslanderchildrenthatincludeafocuson:Culturallyandageappropriatealcoholanddrug

usepreventionand/orreduction.DrugStrategy

PriorityArea2 • Increaseaccesstoafullrangeofculturallyresponsiveandappropriateprograms,includingpreventionandinterventionsaimedatthelocalneedsofindividuals,familiesandcommunitiestoaddressharmfulAODuse.

Outcome2.1,p.6 • CulturallyappropriateAboriginalandTorresStraitIslanderprogramsandservicesaresupportedthataddresspreventionprograms,theimpactofalcohol,tobaccoandotherdrugsonindividualsandfamilies,andwithintheircommunities.

NATSIHP/IP Strategy4C,p.30 • Youngpeopleareabletoaccessculturallyappropriateandnon-racistservicesthataddresshealthriskbehaviours.Justice MH&SEWBFr Outcome2.4,p.35 • Adaptend-to-endschoolbasedMH&SEWBprogramsforAboriginalandTorresStraitIslanderchildrenthatincludeafocuson:Reducingyoungpeople’scontactwiththecriminal

justicesystem.DrugStrategy PriorityArea3,p.5 • StrengthenpartnershipsbasedonrespectbothwithinandbetweenAboriginalandTorresStraitIslanderpeoples,governmentandmainstreamserviceproviders,includingin

lawenforcementandhealthorganisations,atalllevelsofplanning,deliveryandevaluation.Outcome3.5,p.6 • CurrentandemergingissuesassociatedwithAODuseandthecriminaljusticesystemareeffectivelyaddressed.

NTRC Rec15.1,p.33 • (2)Ontheadmissionofachildoryoungpersontoadetentioncentre:..(b)mentalhealthscreeningbeadopted,andifmentalhealthissuesareidentifiedinthatprocessorinthepre-sentencereportormedicalandhealthassessment,amentalhealthplanbedevelopedandongoingcounsellingforeachdetaineeincludingcontinuingtreatmentafterreleasebemadeavailable

• (3)Thecomprehensivemedicalandhealthassessmentrequiredtobecarriedout,shouldinclude;(a).anassessmentofbothphysicalandmentalhealth,and(b).abehaviouralquestionnairetodeterminewhetheraformalassessmentforFetalAlcoholSpectrumDisordershouldbeconducted,andifsodeterminedandifthedetaineehasnotpreviouslybeenthesubjectofaformalassessment,thatassessmenttobeconducted.

• (4)TheNorthernTerritoryGovernment:(a)ensurethatculturallycompetentandage-appropriatehealthprofessionalsdeliverservicestochildrenandyoungpeopleindetention(b)inconsultationwithAboriginalCommunityControlledOrganisations,revisehealthmanualsandtoolstoensuretheyareculturallyappropriate.

Rec24.1

• Anintegrated,evidence-basedthroughcareservicebeestablishedforchildrenandyoungpeopleindetentiontodeliver:adequateplanningforreleaseincluding,asappropriate,safeandstableaccommodation,accesstophysicalandMHsupport,accesstosubstanceabuseprograms,assistancewitheducationand/oremployment

RoyalCommissionCSA

Rec15.5,p.46 • Respondingtochildren’sdifferentneeds:StateandterritorygovernmentsshouldconsiderfurtherstrategiesthatprovidefortheculturalsafetyofAboriginalandTorresStraitIslanderchildreninyouthdetentionincluding:a.recruitinganddevelopingAboriginalandTorresStraitIslanderstafftoworkatalllevelsoftheyouthjusticesystem,includinginkeyrolesincomplainthandlingsystems

Page 15: NATSILMH Health in Culture Policy Concordance Health in Cultur… · (a) The Fifth National Mental Health and Suicide Prevention Plan • Recognises the National Strategic Framework

NationalAboriginalandTorresStraitIslanderLeadershipinMentalHealth2018

15

b.providingaccesstointerpreters,particularlywithrespecttoinductionandeducationprograms,andaccessinginternalandexternalcomplainthandlingsystemsc.ensuringthatallyouthdetentionfacilitieshaveculturallyappropriatepoliciesandproceduresthatfacilitateconnectionwithfamily,communityandculture,andreflectan

understandingof,andrespectfor,culturalpracticesindifferentclangroupsd.employing,trainingandprofessionallydevelopingculturallycompetentstaffwhounderstandtheparticularneedsandexperiencesofAboriginalandTorresStraitIslander

children,includingthespecificbarriersthatAboriginalandTorresStraitIslanderchildrenfaceindisclosingsexualabuse.Parentingprograms

MH&SEWBFr Outcome2.2,p.33 • AboriginalandTorresStraitIslanderfamiliesarestrongandsupported• Supportfamiliesbyprovidingaccesstoparentingprogramsandservicesinrelationtoearlychildhooddevelopment,familysupport,healthandwellbeing,alcoholandother

drugs.Outcome2.3p.34 • Facilitateattachmentandsecurityinchildhoodbyincreasingaccesstoappropriateparentingprograms.

NATSIHP/IP

Strategy2C,p22/24. • ExtendedfamilyarrangementsinAboriginalandTorresStraitIslandercommunitiesareacknowledgedandaccessbroadenedtoparenting,childcareandearlylearningenvironmentprogrammesandservices

• Mothers,fathersandcarershaveaccesstopositiveparentinginformationandsupportservices• Aboriginalhealthpartnershipforumswithstatesandterritorieswillconsidertheincorporationofparentingprogrammesintheirrespectiveactionplans.

Part2,p.21 • SeePart2ingeneral–MaternalHealthandParentingMaternalhealth

M&SEWBFr Outcome2.3

• Supportpregnantwomen,particularlythosewithsubstanceabusedisorders,tohelpstopsmokingandalcoholconsumptiontopreventFASDandincreasethebirthweightofinfants.

• Broadenantenatalcaretoincludesupportforperinataldepressionscreeningandinterventionstrategiestoreducematernalstress.NATSIHP/IP

Strategy2A,pp.21-22

• AboriginalandTorresStraitIslandermothershaveaccesstoculturallyappropriatehealthpromotionprogrammesbeforeandduringpregnancy.• Newmothersandfathershaveaccesstopreconceptionandantenatalhealthpromotionprogrammes(e.g.targetingsmokingandtheuseofalcoholandotherdrugsin

pregnancy).Strategy2B,p.24

• AboriginalandTorresStraitIslandermothersandfathershaveaccesstoaffordable,culturallyappropriateandhigh-qualityantenatalandpostnatalservices.• Mothers,fathersandcarershaveaccesstoantenatalandpostnatalservicesthataddresswellbeing,perinataldepression,maternalstress,smoking,alcoholandotherdrugs,and

nutrition(consistentwiththeNationalAntenatalCareGuidelines),andprovidesupportforbreastfeeding,routinescreeningandantenatalcare.• Supportintegratedservicesmodelsthroughearlychildhoodcommunityhubs.

SeePart2ingeneral–MaternalHealthandParentingChildsexualabuse

RoyalCommissionCSA

Rec6.1,p.4 TheAustralianGovernmentshouldestablishamechanismtooverseethedevelopmentandimplementationofanationalstrategytopreventchildsexualabuse…Rec6.3,p.5 Thedesignandimplementationoftheseinitiativesshouldconsider:tailoringandtargetinginitiativestoreach,engageandprovideaccesstoallcommunities,includingchildren,

AboriginalandTorresStraitIslandercommunities,…andregionalandremotecommunities

PRIMARYPREVENTIONANDEARLYDETECTION

Frontlinegeneral

NationalMHStrategy

Objective4.1.2,p.14 • FacilitateaccesstoAboriginalandTorresStraitIslanderMHfirst-aidtrainingforthefront-lineworkforceofagenciesworkinginrural,regionalandremoteareas.

MH&SEWBFr Outcome3.3,p.38 • MHandrelatedproblemsaredetectedatearlystagesandtheirprogressionprevented• IncreaseMHliteracyandtraumasensitivityinfront-lineservices,particularlythosethatworkwithAboriginalandTorresStraitIslanderchildrenandyoungpeople.

Schools MH&SEWBFr Outcome2.4,p.35 • AdapttrainingresourcesandinclusionstrategiesforAboriginalandTorresStraitIslanderstudentsandfamiliesinmainstreamprogramssuchasKidsMatterandMindMatters.• Adaptend-to-endschoolbasedMH&SEWBprogramsforAboriginalandTorresStraitIslanderchildrenthatincludeafocuson:

o CulturallyandageappropriateAODusepreventionand/orreduction.o CulturallyandageappropriateSP.o Helpseekingbehaviourandde-stigmatisationofMHproblems.o Strengtheningprideinidentityandculture.o Reducingbullyinganditsmentalhealthimpacts.o Reducingyoungpeople’scontactwiththecriminaljusticesystem.o Addressingtheimpactofracismandbuildingresiliencetoracism.

ChildrenOOHC

NTRC Rec35.1,p.55 • FurtherresearchbeundertakenintheNorthernTerritorytounderstandthecharacteristicsandneedsofchildrenandyoungpeoplewhohavebeeninbothoutofhomecareanddetention,toidentifythesizeandcharacteristicsofthecrossoverissue,tomeasuretheprevalenceoftrauma-relatedmentalhealthissueswithinthisgroup,andtoidentifythetypeofneedandservicerequirementsforthisgroup.

RoyalCommissionCSA

Rec12.20,p.40 • Eachstateandterritorygovernment,inconsultationwithappropriateAboriginalandTorresStraitIslanderorganisationsandcommunityrepresentatives,shoulddevelopandimplementplansto:(a)fullyimplementtheAboriginalandTorresStraitIslanderChildPlacementPrinciple(b)improvecommunityandchildprotectionsectorunderstandingoftheintentandscopeoftheprinciple(c)developoutcomemeasuresthatallowquantificationandreportingontheextentofthefullapplicationoftheprinciple,andevaluationofitsimpactonchildsafetyandthe

reunificationofAboriginalandTorresStraitIslanderchildrenwiththeirfamilies

Page 16: NATSILMH Health in Culture Policy Concordance Health in Cultur… · (a) The Fifth National Mental Health and Suicide Prevention Plan • Recognises the National Strategic Framework

NationalAboriginalandTorresStraitIslanderLeadershipinMentalHealth2018

16

(d)investincommunitycapacitybuildingasarecognisedpartofkinshipcare,inadditiontosupportingindividualcarers,inrecognitionoftheroleofAboriginalandTorresStraitIslandercommunitiesinbringingupchildren.

Police NTRC Rec25.1(5),p.40 • AllNorthernTerritoryPolicereceivetraininginyouthjusticewhichcontainscomponentsaboutchildhoodandadolescentbraindevelopment,theimpactofcognitiveandintellectualdisabilitiesincludingFASDandtheeffectsoftrauma,includingintergenerationaltrauma.

Youthjusticeofficers

NTRC Rec20.1,p.36 • Theselectioncriteriaforayouthjusticeofficerbeamendedtoincludedemonstratedexperienceworkingwithvulnerableyoungpeopleincludinganunderstandingofchildandadolescentdevelopment,issueswithdruguse,poverty,culturalidentity,MHanddisability.

20.3,p.37 • Youthjusticeofficersparticipateininductiontrainingbeforecommencingworkinyouthdetentioncentreswhichincludesatleastthefollowing:…o traumainformedpracticeo culturalawarenesso drugandalcoholawarenesso MHissues

RoyalCommissionCSA

Rec15.5,p.46 Respondingtochildren’sdifferentneeds• StateandterritorygovernmentsshouldconsiderfurtherstrategiesthatprovidefortheculturalsafetyofAboriginalandTorresStraitIslanderchildreninyouthdetentionincluding:• a.recruitinganddevelopingAboriginalandTorresStraitIslanderstafftoworkatalllevelsoftheyouthjusticesystem,includinginkeyrolesincomplainthandlingsystems• c.ensuringthatallyouthdetentionfacilitieshaveculturallyappropriatepoliciesandproceduresthatfacilitateconnectionwithfamily,communityandculture,andreflectan

understandingof,andrespectfor,culturalpracticesindifferentclangroups• d.employing,trainingandprofessionallydevelopingculturallycompetentstaffwhounderstandtheparticularneedsandexperiencesofAboriginalandTorresStraitIslander

children,includingthespecificbarriersthatAboriginalandTorresStraitIslanderchildrenfaceindisclosingsexualabuse.Mentalhealthliteracy/stigma

5NMHSPP/IP Action18,p.40 • ActiontoreduceMHproblemstigmaanddiscrimination…Thiswill:accountforthespecificexperienceofAboriginalandTorresStraitIslanderpeopleM&SEWBFr Outcome3.3,p.38 • EnsurecommunitiesandfamilieshaveabetterunderstandingoftheimportanceandroleofMHservicesandtheimpactofmentalillnessincludingbyencouragingnaturalhelpers

andhelp-seekingbehaviour.• WorkinpartnershipwithACCHSstodevelopaculturallyappropriatetargetedcommunicationsstrategy,includingmentalhealthpromotionmaterials,foradaptationby

communitiestoraisementalhealthliteracyandde-stigmatisementalhealthconditions.NATSIHP/IP Strategy1C,p.13

• Whole-of-lifecyclehealthinterventionsareaccessibleandhaveastrongfocusonpreventionandearlyinterventiontopreventmentalhealthconditionsandillness,chronichealth

conditionsandinjuriesfromoccurring,includingdisability• Increasingfocusonpreventionandearlyinterventionstrategies,improvedpatientjourneysandcontinuityofserviceshasreducedriskofchronicconditions,mentalillnessand

injuryoccurringandensuredclinicallycompetent,qualityandaccessiblecarehasbeenprovided.• Preventionandearlyinterventionprogrammes(includingprogrammesthatfocusonchronicdiseases,e.g.includingdiabetes,cancer,hearthealth oral,earandeyehealth;mental

healthconditionsandillness suicidepreventiontobaccoandalcoholanddruguse)havebeendeveloped,supportedandimplemented.Strategy1D,p.17

• SupportforAboriginalandTorresStraitIslanderpeoplestoengagewithhealthpreventionprogrammeshasbeenprovided---• Existinglocal,regional,stateandterritoryactivityhasbeenreviewedtoassesshealthliteracyandacoordinatedstrategytoaddresshealthliteracyimplemented.

ROLEOFMAINSTREAMINPROMOTIONANDPREVENTION

RoleofmainstreamAOD

NationalDrugStrategy

Outcome1.2,p.5 • MainstreamAODservicesaresupportedtodeliverprogramstoaddressharmfulAODuseinAboriginalandTorresStraitIslandercommunities,familiesandindividuals.

RoleofmainstreamMHservices

NationalStandards-MHServicesImplementationGuidelinesforPublicMentalHealthServicesandPrivateHospitals

Developmentofactivities(Criterion5.1)

• p.22.Itisimportanttounderstandtheneedsofourculturallyandsociallydiversepopulation.Anymentalhealthpromotionandpreventioninitiativesneedtobedesignedforculturallyandsociallydiversepopulationgroups;StrategiesforAboriginalandTorresStraitIslanderpopulationsshouldbeinformedbytheNationalStrategicFrameworkforAboriginalandTorresStraitIslanderHealth(2003–2013)[nowNATSIHP?]andbasedonestablishedpartnershipswithAboriginalandTorresStraitIslanderstakeholders.

Appropriateactivities(Criterion5.2)

• p.23.TheMHSshouldconsiderthefollowingstepswhenaddressingthisstandard:o establishandmaintainpartnershipswithcarers,consumersandrelevantstakeholders,toshareandcombineresourceso establishandmaintainmechanismsforconsumerandcarerstoparticipateinthedevelopment,implementationandevaluationofpromotionandpreventionactivitieso developaplanthatincludesgoals,objectives,actionsandevaluationstrategies.

• WithinAboriginalandTorresStraitIslanderpopulationsandsettings,relevantcommunity,consumerandorganisationstakeholdersmustbeincludedinthedevelopingimplementationplans.ThesemustberesponsivetoAboriginalandTorresStraitIslanderdiversityandreflectalocal,strengths-basedapproach,withculturallyadaptedtrainingforearlyidentificationandresourcesandsupportforprimarycareandfirstcontactproviders.

Collaborativepartnerships(Criterion5.3)

• p.23.Collaborativepartnershipsshouldbedevelopedwitharangeofinternalandexternalstakeholders• Thesepartnershipsmeanresourcescanbesharedtopromoteandpreventmentalhealthissues• p.24.Eachservicemustdemonstratepartnershipswhichfosterpromotionandpreventionactivitiesandshowcollaborationatallstagesofdevelopmentandimplementation.

Examplesofsectorsandsettingsinclude:…AboriginalandTorresStraitIslandergroups• p.25.Strategiestopromoteawarenessoftherelationshipbetweenmentalandphysicalhealthshouldbeculturallyappropriate

Accountability(Criterion5.5)

• p.26.TheMHSshouldensurethatthepositionsidentifiedtoprogressmentalhealthpromotionandpreventioninAboriginalandTorresStraitIslandersettingsaregivensufficientinformationabout,andlinksto,AboriginalandTorresStraitIslanderpopulations.

Page 17: NATSILMH Health in Culture Policy Concordance Health in Cultur… · (a) The Fifth National Mental Health and Suicide Prevention Plan • Recognises the National Strategic Framework

NationalAboriginalandTorresStraitIslanderLeadershipinMentalHealth2018

17

Workforce(Criterion5.6)

• p26.Workforcedevelopmentonmentalhealthpromotionandpreventionincludes…attentiontoneedsofIndigenouspeople,familiesandcommunities,andmechanismsforconsultationwithIndigenousstakeholders.

SERVICEDELIVERY

INTEGRATIONOFSERVICES

Integratedservices

5NMHSPP PriorityArea5,p.36 • ImprovingphysicalhealthofpeoplewithMH(withactions)andreducingearlymortalityMH&SEWBFr Outcome4.1.p.39 • Integrateclinicalandnon-clinicalserviceswhoworkwithchildrenandyoungpeopleincludingchildandadolescentmentalhealthservicesandheadspacetobettersupporttheir

needsandreducesuicide.Outcome4.1,p.39 • IntegrateMHandotherrelatedareasservicesdeliveredbyACCHSandotherhealthproviders,includingculturalhealers.Outcome4.3,p.29 • Coordinateandintegratementalhealth,socialandemotionalwellbeing,substancemisuse,suicidepreventionandsocialhealthservicesandprogramstoensureclientsexperience

seamlesstransitionsbetweenthem.DrugStrategy Outcome1.4,p.6 • Cross-sectoraleffortissupportedandenhancedtoensureanintegratedapproach.

NatStandards-MHServices

Standard9,p.20

• TheMHScollaborateswithanddevelopspartnershipswithininitsownorganisationandexternallywithotherserviceproviderstofacilitatecoordinatedandintegratedservicesforconsumersandcarers.

Criterion9.5,p.33 Implementationguidelinesforprivateofficebasedmentalhealthpractices-TheMHSworksincollaborationwithotherrelatedserviceproviders.Examplesoflinkageandpartnershipagreementsinclude:AboriginalandTorresStraitIslandergroups

NATSISPS(SP) Outcome3.2,p.35 • Integratedservices,includingtargetedandindicatedservicesforfamiliesandindividuals,areavailableinAboriginalandTorresStraitIslanderhealingcentresorothercommunitycentres

• (i)Developanddisseminatemodelsforservicesthatcombinespecifictargetedandindicatedservicesincentresprovidingintegratedwellbeingservices• (ii)Strengthenthefocusonearlyinterventionandsuicidepreventionwithinintegratedservices• (iii)Buildinter-sectoralandprofessionallinkstosupportintegratedservices

Outcome4.3,p.38

• Thereareagreementstosupportcollaborativeapproachestojointcasemanagementtoensurecontinuityofservicesandsupportsforhigherriskclients• (i)Pilotandevaluatespecificmultidisciplinaryapproachestoserviceprovisionforvulnerableindividualsandfamilies• (ii)Investigatefeasibilityofspecificmemorandaofunderstandingtoenablejointapproachestocasemanagement• (iii)ClarifyagencyresponsibilitiesforinteragencycoordinationofcareforhighriskAboriginalandTorresStraitIslanderclientsandfamilies

RoyalCommissionCSA

Rec9.7,p.31 • PHNs,withintheirroletocommissionjoineduplocalprimarycareservices,shouldsupportsexualassaultservicestoworkcollaborativelywithkeyservicessuchasdisability-specificservices,AboriginalandTorresStraitIslanderservices,CALDservices,youthjustice,agedcareandchildandyouthservicestobettermeettheneedsofvictimsandsurvivors.

Referralpathways

5NMHSPP Action10,p.33 • ReferralpathwaysbetweenGPs,ACCHS,SEWBservices,AODservices,andMH/physicalhealthservicesAction11,ATSIMHSPSTOR3

• identifyinnovativestrategies,suchastheuseofcarenavigatorsandsinglecareplans,toimproveserviceintegration,supportcontinuityofcareacrosshealthservicesettingsandconnectAboriginalandTorresStraitIslanderwithcommunity-basedsocialsupport(non-health)services

MH&SEWBFr Outcome1.3,p.31 • Joinupassessmentprocessesandreferralpathways…Outcome4.3,p.41

• EffectiveclienttransitionsacrosstheMHsystem• Coordinateandintegratementalhealth,socialandemotionalwellbeing,substancemisuse,suicidepreventionandsocialhealthservicesandprogramstoensureclientsexperience

seamlesstransitionsbetweenthem• PHNsworkinpartnershipwithACCHSsonaregionalorothergeographicalbasisto:identifyandmaprelevantservicesandagencies;anddevelop,promoteandregularlyreview

culturallyandclinicallyappropriatepathwaysbetweenthem–inparticular,forthetreatmentoftraumaandemotionalandbehaviouraldifficultiesinchildren.NATSIHP/IP Strategy1D,p.16 • Improvedregionalplanningandcoordinationofhealthcareservicesacrosssectorsandproviders

• Formalmechanisms(e.g.partnerships)forcooperationbetweengovernments,ACCHOs,PHNs,privatesectorandotherserviceproviderstoimprovepatientjourneys• ExistingaccreditationarrangementstopromoteimprovedpatientjourneysforAboriginalandTorresStraitIslanderinsecondaryandtertiarycarehavebeenimplemented,

monitoredandreviewed.Co-locatedServices

5NMHSPP Action11,ATSIMHSPSTOR2

• Provideadviceonmodelsforco-locatedorflexibleservicearrangementsthatpromoteSEWBinc.factors,includingaperson’sconnectiontocountry,spirituality,ancestry,kinshipandcommunity

MH&SEWBFr Outcome1.3,p.31 • Improveserviceequityforruralandremotecommunitiesandforunder-servicedpopulations,includingthroughplace-basedmodelsofcareOutcome5.2,p.43 • Supportpeoplewithmentalillness,theirfamiliesandcarerstoliveincommunitiesincludingthroughcommunitymentalhealthsupportprograms.

Telehealth NATSIHP/IP Strategy1E,p.17 • Standardsfortheuseoftele-healthstrategieshavebeendeveloped.MyHealthe-records

5NMHSPP Action11,ATSIMHSPSTOR8

• ProvideadviceonculturallyappropriatedigitalservicedeliveryandstrategiestoassistAboriginalandTorresStraitIslanderpeoplestoregisterforMyHealthRecordandtounderstandthebenefitsofshareddata.

Action10,p.33 • Sharingpatientinformationtosupportintegration.MH&SEWBFr Outcome1.3,p.19 • FacilitatecontinuityofcareandinformationsharingbetweenservicesthroughtheuseoftheMyHealthRecord.

Outcome4.3,p.41

• Effectiveclienttransitionsacrossthementalhealthsystem(Strategy)

Page 18: NATSILMH Health in Culture Policy Concordance Health in Cultur… · (a) The Fifth National Mental Health and Suicide Prevention Plan • Recognises the National Strategic Framework

NationalAboriginalandTorresStraitIslanderLeadershipinMentalHealth2018

18

• Facilitaterobustsystemsofcommunicationbetweenmentalhealthservicesandprograms,includingmovingtowardsshareduseofdigitalrecords,utilisingtheMyHealthRecordasappropriate.

NATSIHP/IP Strategy1E,p.17 • Healthsectorstaffhaveongoingaccesstoelectronicinformationandreferralsources.E-mentalHealthstrategy

p.17 • TheE-MentalHealthSupportServicewillplayakeyroleinthedevelopmentandexpansionofthee-mentalhealthsector.Itwillhavearangeofresponsibilities,includingbutnotlimitedto:cliniciansupport,includingpromotionofe-mentalhealthservicestohealthprofessionals,andworkforcetrainingincludingsupportforIndigenousmentalhealthworkers

NatStandards-MHServices

Criteria4.4,p.19 • Implementationguidelines–Publicmentalhealthservicesandprivatehospitals-Theconsumers’healthrecordshouldincludedetailsoftheuseofliaisonstafforotherrelatedserviceproviders.

ROLEOFACCHS/‘SPECIALISEDAREASOFPRACTICE’

ACCHSpreferredproviders

MH&SEWBFr Outcome1.3,p.31 • GivepreferencetofundingACCHSstodelivermentalhealth,suicidepreventionandotherprimaryhealthprogramsandserviceswherefeasible.DrugStrategy PriorityArea1,p.5 • BuildcapacityandcapabilityoftheAODservicesystem,particularlyAboriginalandTorresStraitIslandercommunity-controlledservicesanditsworkforce,aspartofacross-sectoral

approachwiththemainstreamAODservicestoaddressharmfulAODuse.MH&SEWBTeamsinACCHS/expandedprimaryMHcarerole

NATSIHP/IP Strategy1A,p.10

• ACCHOsaresupportedtoprovidehigh-quality,comprehensiveandaccountableservicesthatarelocallyresponsivetoidentifiedAboriginalandTorresStraitIslanderhealthneeds.• Healthneeds(includingmentalhealthandrelatedneeds),workforcecapabilityandcapacityofservicestoaddressthem,havebeensystematicallyassessed:

o Methodologytomaphealthneeds,workforcecapabilityandservicecapacityhasbeendeveloped.Focuswillbetargetedtoareaswithpoorhealthoutcomesandinadequateservices.Systematicassessmentofhealthoutcomes/needs,workforcecapabilityandservicecapacityundertakentoinformthedevelopmentofthecoreservicesmodel,futureworkforcerequirementsandinvestmentandcapacitybuildingpriorities.

o NationalContinuousQualityImprovementFrameworkforAboriginalandTorresStraitIslanderPrimaryHealthCarehasbeenimplementedtosupportthehealthsectortouseclinicaldataforhealthplanningtoimprovehealthpracticeandservicedelivery.

• Fundingmethodologiesthatrespondtoidentifiedhealthandservicecapabilityneeds,andfosterlocalautonomyandpartnerships,havebeendeveloped,implementedandreviewed.

• CoreservicesframeworkforcomprehensiveprimaryhealthcareandaccesstospecialistmedicalcarehasbeendefinedandconsideredbytheMinisterasamatterofpriority. Thismodelwillbeinfluencedby,andwilldirectlyinfluence,theAboriginalandTorresStraitIslanderHealthWorkforceStrategicFramework.

Strategy1C,p.14 • Healthassessments,includingmentalhealth,aremaximisedacrossthelifecycletopromoteearlydetection,managementandclinicalcare.5NMHSPP/IP Action11,

ATSIMHSPSTOR6• ProvideadviceonworkforcedevelopmentinitiativesthatcangrowandsupportanAboriginalandTorresStraitIslanderMHworkforce,incorporateAboriginalandTorresStrait

IslanderHealthworkforcestaffintomultidisciplinaryteams….MH&SEWBFr Outcome1.1,p.28 • GiveprioritysupporttothefurtherdevelopmentofsocialandemotionalwellbeingteamswithinACCHSs[seealsoAppendix3].

Outcome2.2,p.33 • Increasefamily-centricandculturally-safeservicesforfamiliesandcommunities.Outcome3.3,p.38

• SupportACCHSs,GPsandfrontlineservicestodetectpeopleatriskofMHproblemsandmakeappropriatereferrals.• Developasuiteofculturallyadapted,validatedMH&SEWBscreeningtoolsforuseacrossthelifecoursebyACCHSandGPs

Outcome4.1,p.39 • IntegrateMHandotherrelatedareasservicesdeliveredbyACCHSandotherhealthproviders,includingculturalhealers.• ExploreculturallyappropriatelowintensitytreatmentpathwaysthatcanbedeliveredbyACCHS.Complementthesetreatmentoptionsthroughculturallyappropriateself-help

optionsdeliveredthroughthedigitalmentalhealthgateway.Outcome4.2 • EstablishSEWBteamsinAboriginalandTorresStraitIslanderprimaryhealthcareservices(includingACCHS)linkedtoAboriginalandTorresStraitIslanderspecialistMHservices

IAS CultureandCapabilityProgrammep45

• CapableIndigenousorganisationswithstrongleadershipthatareconnectedtotheircommunitiescanfacilitatedeliveryofhighqualityservicesandcommunitydevelopmentinitiativestoIndigenousAustralians.

NATSISPS(SP) Outcome3.2p33 • Integratedservices,includingtargetedandindicatedservicesforfamiliesandindividuals,areavailableinAboriginalandTorresStraitIslanderhealingcentresorothercommunitycentres

Traditionalhealers/specialisedareasofpractice

MH&SEWBFr Outcome1.1,p.29 • Recognisetraditionalhealers,EldersandotherculturalhealersasanessentialpartoftheoverallSEWBandMHareasworkforce.Outcome3.1,p.36

• Accesstotraditionalandcontemporaryhealingpracticeso DevelopculturallyappropriatetreatmentpathwayswithinaSEWBframework.o Supportaccesstotraditionalandcontemporaryhealingpracticesandhealers.o SupporttraditionalandcontemporaryhealingpracticeslikethatoftheNgangkari,culturalhealersandEldersalongsideothermentalhealthandrelatedservices.

Outcome4.1,p.39 • IntegrateMHandotherrelatedareasservicesdeliveredbyACCHSandotherhealthproviders,includingculturalhealers.Outcome5.1

• Ensureaccess[ofpeoplewithseverementalillness]toculturallyandclinicallyappropriatetreatments,includingwithElders,traditionalhealers,culturalhealersandinterpreters.• Developculturallyadaptedassessmentandtreatmentinformationoptionsforthosewithseverementalillnessandtheirfamiliesandcarers.

5NMHSPP Action12.2p34 • increasingknowledgeofSEWBconcepts,improvingtheculturalcompetence…ofmainstreamprovidersandimproveaccesstoculturalhealersGDD Theme1,p.4 • AboriginalandTorresStraitIslanderconceptsofSEWB,MHandhealingshouldberecognisedacrossallpartsoftheAustralianmentalhealthsystem,andinsomecircumstances

supportspecialisedareasofpractice,• Acrosstheirlifespan,AboriginalandTorresStraitIslanderpeoplewithwellbeingormentalhealthproblemsmusthaveaccesstoculturalhealersandhealingmethods.

DrugStrategy Outcome3.2,p.6 • CommunityleadersandElderstakeresponsibilityandaleadingrole,inpartnershipwithgovernment,todesign,deliverandevaluatealcohol,tobaccoandotherdrugsprograms.

Page 19: NATSILMH Health in Culture Policy Concordance Health in Cultur… · (a) The Fifth National Mental Health and Suicide Prevention Plan • Recognises the National Strategic Framework

NationalAboriginalandTorresStraitIslanderLeadershipinMentalHealth2018

19

NATSIHP/IP Strategy6D,p.40 • LocalEldersandseniorcommunitymemberschampionculturallyappropriatehealthandwellbeingchoices• Localeldersandseniorcommunitymembersarerecognisedandvaluedasexpertswhocanhelpimprovelocalhealthandwellbeingoutcomes.• WorkforcestrategygivesconsiderationtohowthehealthsectorcanworkcollaborativelywithtraditionalhealersandutilisetheCommunityDevelopmentProgrammeworkforce.

CulturalRF Domain3,p.14 • Culturalknowledge,expertiseandskillsofAboriginalandTorresStraitIslanderhealthprofessionalsarereflectedinhealthservicemodelsandpractice• Organisationidentifiesandremuneratesculturalprofessionals(culturalbrokers,traditionalhealers,etc.)toassistinunderstandinghealthbeliefsandpracticesofAboriginaland

TorresStraitIslanderpeopleNatStandards-MHWorkforce

Standard3-Meetingdiverseneeds,p.14

• Thementalhealthpractitioner:(11)Liaisesandworkscollaborativelywithculturallyandlinguisticallyappropriatecarepartnerssuchasreligiousministers,spiritualleaders,traditionalhealers,localcommunity-basedorganisations,AboriginalandTorresStraitIslanderhealthandMHworkers,healthconsumeradvocates,interpreters,bilingualcounsellorsandotherresourceswhereappropriate

HealingCSA RoyalCommissionCSA

Rec9.2,p.30 • TheAustralianGovernmentandstateandterritorygovernmentsshouldfundAboriginalandTorresStraitIslanderhealingapproachesasanongoing,integralpartofadvocacyandsupportandtherapeutictreatmentservicesystemresponsesforvictimsandsurvivorsofchildsexualabuse.Theseapproachesshouldbeevaluatedinaccordancewithculturallyappropriatemethodologies,tocontributetoevidenceofbestpractice.

HealingFoundation

MH&SEWBFr Outcome2.1,p.33 • ContinuesupportfortheNationalAboriginalandTorresStraitIslanderHealingFoundation(Exampleaction).

LOWINTENSITYSERVICES

GPs MH&SEWBFr Outcome3.3,p.38

• SupportACCHSs,GPsandfrontlineservicestodetectpeopleatriskofMHproblemsandmakeappropriatereferrals.• Developasuiteofculturallyadapted,validatedMH&SEWBscreeningtoolsforuseacrossthelifecoursebyACCHSandGPs

Outcome4.1,p39 • SupportGPsinundertakingassessmentstoensureAboriginalandTorresStraitIslanderpeopleareappropriatelyreferredtoservicesusingMHTreatmentPlans.• EnsureaccesstoGP-prescribedMHmedications.

Focusedpsychstrategies

PHNGuidelines

PsychologicaltherapiesprovidedbyMHpractitionerstounderservicedgroups,p.1

• In2016-17PHNsareexpectedto:o undertakecomprehensiveregionalmentalhealthplanningandidentifypsychologicaltherapyservicegaps;o ensureservicecontinuityforexistingclients(whereclinicallyappropriatetoneeds)inthefirstyear,notingthatthismayinvolvecontinuationofexistingarrangements(e.g.

AccesstoAlliedPsychologicalServices;ATAPS)tominimisedisruptionstoservicesinthefirstyear;o collectdataonprovisionofpsychologicaltherapyservicesforunderservicedgroups;o promoteawarenesswithincommissioningarrangementsoftargetedrecipients,referralpathwaysandserviceparameters;o considerwaystoachievemorecostefficientandtargetedservicedelivery,includingwhereappropriatereferralofindividualstolowintensityservices;ando ensurereferralpathwaysareinplacetoenableandsupportpatientstoseamlesslytransitionbetweenservicesastheirneedschange.

• LongertermPHNswillbeexpectedto:o commissionpsychologicaltherapyservicesforpeopleinunderservicedgroupstoaddressidentifiedgapsandreviewaccessbythesegroups;o ensuremostefficientuseofresourcesandhighlevelofservicequality;o developandimplementefficientandtimelyservicepathways;o integratecommissionedserviceswithotherinterventionlevelswithinasteppedcareapproach;o supportgeneralpractitioners(GPs)intheircriticalroleinensuringpeopletobereferredtotherightcareattherighttime;ando ensurereferralpathwaysareinplacetoenableandsupportpatientstoseamlesslytransitionbetweenservicesastheirneedschange.

MH&SEWBFramework

Outcome4.2(4) • ExpandaccesstoFocusedPsychologicalStrategiesandMHprofessionalsthroughthepooledmentalhealthfundingavailabletoPHNs,andthroughsupportingaccesstoMBS-subsidisedservices.

Lowintensityservices

PHNGuidelines

Lowintensityservices,p.1

• In2016-17PHNsareexpectedto:o definetargetpopulationgroupsforlowintensitymentalhealthservicesintheirregionalmentalhealthandsuicidepreventionplanning;o commencethedevelopmentofappropriatelowintensitymentalhealthservicemodelsfortheirregion;ando commenceeducatingconsumersandprovidersonlowintensityservices,includingtargetedrecipients,referralpathwaysandserviceparameters.

• LongertermPHNswillbeexpectedto:o commissionlowintensitymentalhealthservicestoimprovethetargetingofpsychologicalinterventionstomostappropriatelysupportpeoplewith,oratriskof,mildmental

illnessaspartofasteppedcareapproachtomentalhealthservicedelivery;ando helptopromotetheDigitalMentalHealthGateway.

MH&SEWBFr Outcome4.1,p.39

• ExploreculturallyappropriatelowintensitytreatmentpathwaysthatcanbedeliveredbyACCHSs.Complementthesetreatmentoptionsthroughculturallyappropriateself-helpoptionsdeliveredthroughthedigitalmentalhealthgateway.

DigitalMHandhelplines

5NMHSPP Action2.6,p.21 • DigitalmentalhealthAction32,p.47 • NationalDigitalMentalHealthFramework

MH&SEWBFR Outcome4.1,p.39 • ExploreculturallyappropriatelowintensitytreatmentpathwaysthatcanbedeliveredbyACCHS.Complementthesetreatmentoptionsthroughculturallyappropriateself-helpoptionsdeliveredthroughthedigitalmentalhealthgateway.

CulturalRF Domain2,p.13 • Technology(e.g.audio-visualandsocialmedia)andelectronichealthtoolsutilisedtodeliverhealthinformationatthetime,intheplace,andinmultipleformatsandlanguagesto

Page 20: NATSILMH Health in Culture Policy Concordance Health in Cultur… · (a) The Fifth National Mental Health and Suicide Prevention Plan • Recognises the National Strategic Framework

NationalAboriginalandTorresStraitIslanderLeadershipinMentalHealth2018

20

meetconsumerneeds

MAINSTREAMMHSERVICES

Counteringsystemicracism

NATSIHP/IP • VisionStrategy1B,p.12

• Systemicracismanddiscriminationisbetterunderstood,addressedandprevented• Mainstreamhealthservicesaresupportedtoprovideclinicallycompetent,culturallysafe,accessible,accountableandresponsiveservicestoAboriginalandTorresStraitIslander

peopleinahealthsystemthatisfreeofracismandinequality• Systemleversandaccountabilitymechanismsestablishedforaddressingracismanddiscriminationhavebeendevelopedandtheirimplementationpromoted.

CulturalRF

Domain1,p.12 • OrganisationanditsleadershiprecogniseandacknowledgethatracismanddiscriminationarekeysocialdeterminantsofhealthforAboriginalandTorresStraitIslanderpeople• Policiesandprocessesforidentifyingandreportingracismanddiscriminationinhealthservicesareinplaceandpromotedtoconsumersandhealthstaff• Structuresandmechanismssupportpromptactionbyorganisationswhenracismanddiscriminationisreported,andregularfeedbackonorganisations’strategiestoaddress

racismanddiscriminationisprovidedtoconsumersandhealthstaffGDD Theme1,p.4 • Acrosstheirlifespan,AboriginalandTorresStraitIslanderpeopleshouldhaveaccesstoaffordable,appropriateandculturallysafeandcompetentmentalhealthandsuicide

preventionprograms,servicesandprofessionalswithoutdirectorindirectdiscriminationGovernanceinclusiveofAboriginalandTorresStraitIslanderpeople

NationalStandards–MHServices

Criterion4.2 • ImplementationGuidelines–PublicMentalHealthServicesandPrivateHospitals,p.18-TheMHSshouldhavedocumentedevidencetoshow:howtheservice’srelevantcommitteesandworkinggroupsconsultwithandrepresentAboriginalandTorresStraitIslandercommunities

• ImplementationguidelinesforNon-governmentCommunityServices,p.34-Responsesshouldaddressattitudinal,physical,andproceduralbarriers.Evidencethatthiscriterionismetcouldinclude:boardmembershipandstaffingreflectingcommunitydiversity

Physicalsafety

NationalStandards–MHServices

Standard2,p.9 • TheactivitiesandenvironmentoftheMHSaresafeforconsumers,carers,families,visitors,staffanditscommunity

Mainstreamservicesrespondtocommunityneeds

NSQHSStandards Action1.2,p.6 • Thegoverningbodyensuresthattheorganisation’ssafetyandqualityprioritiesaddressthespecifichealthneedsofAboriginalandTorresStraitIslanderpeopleAction1..4,p.6 • Thehealthserviceorganisationimplementsandmonitorsstrategiestomeettheorganisation’ssafetyandqualityprioritiesforAboriginalandTorresStraitIslanderpeople

NationalStandards–MHServices

Criterion4.2 • ImplementationGuidelines–PublicMentalHealthServicesandPrivateHospitals,p.18• TheMHSshouldhavedocumentedevidencetoshow:

o theprovisionoftrainingtoallstaff,includingmanagement,onthediversityofneedswithinitscatchmentandonculturallycompetentservicedeliveryo howtheservice’srelevantcommitteesandworkinggroupsconsultwithandrepresentAboriginalandTorresStraitIslandercommunitieso howandwhentheMHSengagesinterpreters.

• Policies,proceduresandworkpracticesthatrecognise,andareresponsiveto,theneedsoftheMHScommunityinclude…identifyingthesocialandculturalcustomsandvaluesofAboriginalandTorresStraitIslanderpeopleinthecommunity

• ImplementationGuidelinesforNon-governmentCommunityServices,p.34• Responsesshouldaddressattitudinal,physical,andproceduralbarriers.Evidencethatthiscriterionismetcouldinclude:

o respectforandresponsivenesstodiversityinservicedeliveryprinciplesandvaluesstatementso documentingthatstaffhavebeentrainedincrossculturalawarenesso documentingtheuseofinterpreterswithconsumersandcarerswhoarenotproficientinEnglishorwhoaredeafo boardmembershipandstaffingreflectingcommunitydiversityo specialistpositionsintheorganisation,forexampleculturallyandlinguisticallydiverseandAboriginalandTorresStraitIslanderliaisonstaff

• ImplementationGuidelinesforPrivateOffice-basedMentalHealthPractices,p.15• TheMHSshouldhavedocumentedevidencetoshow:

o howconsultationandrepresentationofAboriginalandTorresStraitIslandercommunitiesaresoughtwithintheservice’srelevantcommitteesandworkinggroupso howandwhentheMHSengagesinterpreters.

• Policies,proceduresandworkpracticesthatrecogniseandareresponsivetotheneedsoftheMHScommunityinclude:thesocialandculturalcustomsandvaluesofAboriginalandTorresStraitIslanderpeopleidentifiedwithinitscommunity

Consumerfocusedservices

NationalStandards–MHServices

Standard6,p,14 • ConsumershavetherighttocomprehensiveandintegratedMHcarethatmeetstheirindividualneedsandachievesthebestpossibleoutcomeintermsoftheirrecovery.

Criterion6.7,p.14 • ImplementationGuidelinesforPrivateOffice-basedMentalHealthPracticesp.23-Eachconsumerparticipatesfullyinthedevelopmentoftheindividualtreatment,careandrecoveryplan...ForAboriginalandTorresStraitIslanderpeopleinvolvementofcommunityandfamilymaybeessentialinthedevelopmentofsuchplans.

Accessible NationalStandards–MHServices

Criterion10.2.1,p.22 • TheMHSisaccessibletotheindividualandmeetstheneedsofitscommunityinatimelymanner.Criterion10.2.1

• ImplementationGuidelinesforNon-governmentCommunityServices,Serviceprovidersshouldpayparticularattentiontothediversityofitsindividuals:[inc.]AboriginalandTorresStraitIslanderpeople

Page 21: NATSILMH Health in Culture Policy Concordance Health in Cultur… · (a) The Fifth National Mental Health and Suicide Prevention Plan • Recognises the National Strategic Framework

NationalAboriginalandTorresStraitIslanderLeadershipinMentalHealth2018

21

Culturalsafetyandcompetenceasclinicalgovernancestandards

NSQHSStandards Action1.33p.12 • ThehealthserviceorganisationdemonstratesawelcomingenvironmentthatrecognisestheimportanceoftheculturalbeliefsandpracticesofAboriginalandTorresStraitIslanderpeople

NSQHSStandards–AboriginalandTorresStraitislanderUserGuide

KeyTask(KT)1.2,p.3 • Thegoverningbodyensuresthattheorganisation’ssafetyandqualityprioritiesaddressthespecifichealthneedsofAboriginalandTorresStraitIslanderpeopleKT1.4,p.3 • Thehealthserviceorganisationimplementsandmonitorsstrategiestomeettheorganisation’ssafetyandqualityprioritiesforAboriginalandTorresStraitIslanderpeopleKT1.21,p.3 • ThehealthserviceorganisationhasstrategiestoimprovetheculturalawarenessandculturalcompetencyoftheworkforcetomeettheneedsofitsAboriginalandTorresStrait

IslanderpatientsKT1.33,p.3 • ThehealthserviceorganisationdemonstratesawelcomingenvironmentthatrecognisestheimportanceofculturalbeliefsandpracticesofAboriginalandTorresStraitIslander

peopleCulturalsafetyinservicedelivery

5NMHSPP/IP Action11,ATSIMHSPSTOR7

• ProvideadviceonmodelsofservicedeliverythatembedculturalcapabilityintoallaspectsofclinicalcareandimplementtheCulturalRespectFrameworkinMHservices

Strategy10,p.14 • OperationalisingtheCulturalRespectFramework…MH&SEWBFr • CulturalsafetyisamajorfocusNATSIHP/IP Strategy1B,p.12 • Indicatorsformeasuringculturalsafety,suchasdischargefromhospitalswithoutmedicaladvice,andeliminationofthedifferentialsinaccesstobestpracticeclinicalcarefor

AboriginalandTorresStraitIslanderpatientsirrespectiveofgeographyandsocioeconomicstatuswillbeconsideredinthepreparationofthedatadevelopmentplan• Guidanceontheprovisionofclinicallycompetentandculturallysafeservices(includingMH)hasbeenprovidedandimplemented.

CulturalRespectFramework

Domain1,p.12 • Organisationalleadershipactivelymodelsculturalsafetyandresponsivenessbystaffatalllevelsandacrosstheorganisation• Formalorganisationalcommitmenttoimprovingculturalsafetyandresponsivenessisvisibleinallaspectsofcorebusiness,includingvisionandmissionstatements,organisational

principlesandvalues,andcontinuousimprovementactivities• Executive-levelresponsibilityforimplementingandmonitoringculturalsafetyandresponsivenessacrosshealthorganisationsandsystemsagainsthealthoutcomes• Recognitionforleadersofculturalsafetyandresponsiveness,highlightingtheiractivityandsharingofbest-practiceinitiativesacrosstheorganisation• Recogniseandcelebratehistoricaleventsofsignificanceandimportantannualevents(e.g.ClosetheGap,MaboDay,etc.)asanormalpartofbusiness• Organisationalpolicytosupportculturallysafeandresponsivepracticeinhealthservicesandsystems,includingparticularsupportfortrainingandprofessionaldevelopment

towardsculturalcapabilities• Procurementpoliciesbindassessmentofproviders,andprovisionofprocuredservices,toculturalsafetystandards• Datacollectioncapacityandmandatedperformanceindicatorstoensureculturalsafetytargetsarebeingachievedandservicedeliveryisimproving• Resourcesandmaterialsprovidedtoinformallstaff,aswellasAboriginalandTorresStraitIslanderpeople,abouttheculturalsafetyandresponsivenessefforts• AdequatefundinginvestmentandresourcingforAboriginalandTorresStraitIslanderculturalsafetyinitiativesandrelatedserviceimprovementsacrossalllevelsofthe

organisationDomain2,p.13

• OrganisationalcommitmentrecognisingdiversityofAboriginalandTorresStraitIslandercommunitiesandconsumers• AllhealthprofessionalshavetheopportunitytoparticipateinAboriginalandTorresStraitIslanderculturaleventstofostergreaterunderstandingofsocialandculturalissuesto

informholisticpractice• OrganisationalresourcescommittedtoregularlyinformingthecommunityaboutculturalsafetyandresponsivenessprogressandinnovationsCulturallysafeandresponsive

environmentsaredeveloped(e.g.specificliterature,artworks,flags,postersanddecor)andphysicalenvironmentdesignedwithconsiderationforAboriginalandTorresStraitIslanderconsumers

Domain3,p.14 • Budgetandresourcestosupportadequateculturalsafetyandresponsivenesstrainingofhealthstaffatalllevels(clinicalandnon-clinical)andacrossalldisciplines,includingongoingprofessionaldevelopment,capacityforself-reflectionandmonitoringofhealthstaffskills

• Healthprofessionalscanidentifytheneedfor,andactivelyseek,advice,assistanceandinputfromAboriginalandTorresstraitIslanderstaffwhoareavailabletoinformculturallyresponsiveserviceprovision

• PartnershipsestablishedwithACCHOstocollaborateandsharebestpracticeinsupportinghealthprofessionalstoprovideculturallysafeandresponsivehealthservicestocommunities

Domain6,p.17

• Organisationsconductinitialandongoingorganisationalassessmentsofculturalsafetyandresponsivenessrelatedactivities,andareencouragedtointegrateculturalandlinguisticresponsivenessrelatedmeasuresintotheirinternalaudits,performanceimprovementprograms,patientsatisfactionassessments,andoutcomesbasedevaluations

NationalStandardsMHworkforce

Standard3 • Thesocial,cultural,linguistic,spiritualandgenderdiversityofpeople,familiesandcarersareactivelyandrespectfullyrespondedtobymentalhealthpractitioners,incorporatingthosedifferencesintotheirpractice.

Culturalcompetence-languagebarriers

CulturalRespectFramework

Domain2,p.13 • Mechanismsandprocessestorespondto,andsupport,thelinguisticdiversityofAboriginalandTorresstraitIslanderconsumers• AboriginalandTorresStraitIslandercultureandlanguagesareconsideredindecision-makingabouthealthcareneeds—includingtheuseofinterpreterandsupportservices—atall

pointsofcontactthroughouttheconsumerjourney,particularlywheninformedconsentisrequired• Healthstaffhaveaccesstoresourcesandtrainingtoguideandsupportculturallysafecommunicationwithhealthconsumers(e.g.interpreters,liaisonofficers,traditionalhealers,

translatedresourcesandhealthinformationpackages)• Communicationpathwaysareestablishedtoshareexamplesofbestpracticehealthliteracyandimprovedcommunicationthroughouthealthservices,settingsandsectors• WorkingwithlocalAboriginalandTorresstraitIslanderpeopleandorganisations,aswellasinterpreter/translationservices,tosupportcommunicationwithAboriginalandTorres

straitIslanderconsumerstoprovidemoreeffectiveandqualityhealthcare,whileimprovingaccessandpathwaysofcarebetweenorganisationsandmainstreamservices

Page 22: NATSILMH Health in Culture Policy Concordance Health in Cultur… · (a) The Fifth National Mental Health and Suicide Prevention Plan • Recognises the National Strategic Framework

NationalAboriginalandTorresStraitIslanderLeadershipinMentalHealth2018

22

MH&SEWBFr Outcome3.3,p.38 • Supportaccesstoculturalliaisonofficersandlanguageinterpreters(Seealso4.2.6/4.3.4)NationalStandards-MHWorkforce

Standard3,p.14 • TheMHpractitioner:10.Communicateseffectivelywiththepersonand,whererelevant,withfamilymembersand/orcarersthroughtheassistanceofAboriginalandTorresstraitIslanderhealthand/orMHprofessionals,interpreterservicesandbilingualcounsellors11.Liaisesandworkscollaborativelywithculturallyandlinguisticallyappropriatecarepartnerssuchasreligiousministers,spiritualleaders,traditionalhealers,localcommunity-basedorganisations,AboriginalandTorresstraitIslanderhealthandMHworkers,healthconsumeradvocates,interpreters,bilingualcounsellorsandotherresourceswhereappropriate

Standard4 • TheMHpractitioner:UsesculturallysensitivelanguageandpreferredterminologyinlinewithcurrentpolicydirectivesNationalStandards–MHServices

Criterion4.2 • ImplementationGuidelines–PublicMentalHealthServicesandPrivateHospitals,p.18TheMHSshouldhavedocumentedevidencetoshow:howandwhentheMHSengagesinterpreters.

• ImplementationGuidelinesforNon-governmentCommunityServices,p.34.Responsesshouldaddressattitudinal,physical,andproceduralbarriers.Evidencethatthiscriterionismetcouldinclude:documentingtheuseofinterpreterswithconsumersandcarerswhoarenotproficientinEnglishorwhoaredeaf

• ImplementationGuidelinesforPrivateOffice-basedMentalHealthPractices.p.15TheMHSshouldhavedocumentedevidencetoshow:howandwhentheMHSengagesinterpreters.

Criterion4.4 • TheMHShasdemonstratedknowledgeofandengagementwithotherserviceprovidersororganisationswithdiversityexpertise/programsrelevanttotheuniqueneedsofitscommunity.

• ImplementationGuidelines–PublicMentalHealthServicesandPrivateHospitals,p.19.TheMHSneedstodemonstratethatithaspoliciesandproceduresthatallowaccesstoprofessionalservices—suchasinterpreters,AboriginalandTorresstraitIslanderhealthworkers,(etc)…TheMHSneedstoshowhowandwhenitwillengageinterpretersorbilingualworkerstofacilitateculturallyappropriateassessment,diagnosisandtreatment.

• ImplementationGuidelinesforPrivateOffice-basedMentalHealthPractices.p.16.Theuseofinterpretersorbilingualworkersneedstobecoordinatedinconsultationwiththeconsumerandcarertoensureitisculturallysensitive.

• ImplementationguidelinesforNon-governmentCommunityServicesp.35.Staffshouldknowhowtoaccessspecialistservicessuchasinterpreters(includingAuslaninterpreters),and…AboriginalandTorresstraitIslanderhealthworkers.

Hearingloss NationalMHServiceStandards

Criterion4.4 • ImplementationguidelinesforNon-governmentCommunityServices,p.35.Staffshouldknowhowtoaccessspecialistservicessuchasinterpreters(includingAuslaninterpreters),and…AboriginalandTorresStraitIslanderhealthworkers.

Criterion4.2,p34 • Responsesshouldaddressattitudinal,physical,andproceduralbarriers.Evidencethatthiscriterionismetcouldinclude:documentingtheuseofinterpreterswithconsumersandcarerswhoarenotproficientinEnglishorwhoaredeaf

Culturalcompetence-general

5MHSPP/IP Action12.2,p.34 • increasingknowledgeofSEWBconcepts,improvingtheculturalcompetence…ofmainstreamproviders MH&SEWBFr Outcome1.1,p.29 • RequireculturalcompetenceofgeneralpractitionersandothermedicalpractitionersinordertoworkeffectivelywithAboriginalandTorresStraitIslanderpeoplewithMH

problemsandmentalillness.Outcome4.2,p.40 • Culturallyandclinicallyappropriatespecialistmentalhealthcareisavailableaccordingtoneed

• IncorporateculturalcompetencyintheprofessionalstandardsandresponsibilitiesofmentalhealthprofessionswithinaSEWBframework.NATSIHP/IP Strategy1B,p.12 • Mainstreamhealthservicesaresupportedtoprovideclinicallycompetent,culturallysafe,accessible,accountableandresponsiveservicestoAboriginalandTorresStraitIslander

peoplesinahealthsystemthatisfreeofracismandinequality.• Guidanceontheprovisionofclinicallycompetentandculturallysafeservices(includingMH)hasbeenprovidedandimplemented.

CulturalRF Domain3,p.14 • Budgetandresourcestosupportadequateculturalsafetyandresponsivenesstrainingofhealthstaffatalllevels(clinicalandnon-clinical)andacrossalldisciplines,includingongoingprofessionaldevelopment,capacityforself-reflectionandmonitoringofhealthstaffskills

Domain4p15 • Designanddeliveryoforganisationalperformancemeasurementandevaluationofservicesincludingorganisationalself-assessmentsofculturalcompetencyactivitiesinvolvesAboriginalandTorresstraitIslanderhealthconsumers

• AboriginalandTorresstraitIslanderconsumersareengagedinperformancemeasurementandevaluationofhealthservicesthroughaccessible,culturallyresponsiveandsafeprocesses

NationalStandards-MHWorkforce

Standard4,p.14

• ByworkingwithAboriginalandTorresStraitIslanderpeoples,familiesandcommunities,MHpractitionersactivelyandrespectfullyreducebarrierstoaccess,provideculturallysecuresystemsofcare,andimproveSEWB.

• TheMHpractitioner:o DevelopsanunderstandingofAboriginalandTorresStraitIslanderhistory,andparticularlytheimpactofcolonisationonpresentdaygrief,lossandtraumaandits

complexityo Communicatesinaculturallysensitiveandrespectfulway,beingawareofpotentialmistrustofgovernmentandotherserviceprovidersasaresultofpasthistoryo Implementsculturallyspecificpracticesasdescribedinrelevantnational,stateandlocalguidelines,policiesandframeworksthatpertaintoworkingwithAboriginaland

TorresStraitIslanderRespectfullycollectsandrecordsinformationidentifyingAboriginalandTorresStraitIslanderstatusinlinewithcurrentpolicydirectiveso WorksincollaborationwithAboriginalandTorresStraitIslanderculturaladvisorswhereappropriateregardingappropriatecareandengagesmeaningfullytodevelop

culturallyappropriatecareincollaborationwiththesesupportnetworkso SeekstounderstandandworkwithinlocalculturalprotocolsandkinshipstructuresofAboriginalandTorresStraitIslandercommunitieso RespectfullyfollowsIndigenousprotocolsincommunitycontexts,suchastheprocessofvouchinginwhichoneorsomeofthecommunitymembersattesttotheperson

wishingtoenterthecommunity

Page 23: NATSILMH Health in Culture Policy Concordance Health in Cultur… · (a) The Fifth National Mental Health and Suicide Prevention Plan • Recognises the National Strategic Framework

NationalAboriginalandTorresStraitIslanderLeadershipinMentalHealth2018

23

NatStandards-MHservices

Standard4,p.12 • 4.1-TheMHSidentifiesthediversegroups…(inc.)AboriginalandTorresStraitIslanderpeople...thataccesstheservice.• 4.2-TheMHSwheneverpossibleutilisesavailableandreliabledataonidentifieddiversegroupstodocumentandregularlyreviewtheneedsofitscommunityandcommunicates

thisinformationtostaff.• 4.3-Planningandserviceimplementationensuresdifferencesandvaluesofitscommunityarerecognisedandincorporatedasrequired.• 4.4-TheMHShasdemonstratedknowledgeofandengagementwithotherserviceprovidersororganisationswithdiversityexpertise/programsrelevanttotheuniqueneedsofits

community.• 4.5-Staffaretrainedtoaccessinformationandresourcestoprovideservicesthatareappropriatetothediverseneedsofitsconsumers.

NatStandards-MHservices

Criterion4.3 AboriginalandTorresStraitIslander.20.• TheMHSneedstodemonstratethatstaffcanaccessculturalcompetencytraininginMH,andprovidestatisticsonthepercentageofstaffwhoannuallyattendthistraining.• TheMHS,whereavailableandappropriate,shouldintegratetheuseof…AboriginalandTorresStraitIslanderliaisonstaffintoservicedelivery.• TheMHSshouldappointculturalguidesappropriatetotheircommunitiesandwhoareaccessibletoallstaffmembers.• Evidenceincludes

o evidenceofpartnershipswiththeAboriginalandTorresStraitIslandercommunityo servicelevelagreementswithotherproviderssuchasAboriginalandTorresStraitIslandermedicalservices,divisionsofgeneralpracticeorRoyalFlyingDoctorServiceo developmentofmeasuresforculturalcompetencyofstaffo externalmonitoringofnon-discriminatorypracticebycarersandconsumersandAboriginalandTorresStraitIslandercommunitygroups.

• ImplementationGuidelinesforPrivateOffice-basedMentalHealthPractices.p17.TheMHSneedstodemonstratethatstaffareabletoaccessculturalcompetencytraininginMH

andprovidedocumentationshowingthepercentageofstaffwhoannuallyattendthistraining.TheMHS,whenitisappropriate,shouldintegratetheuseofavailableculturallyandlinguisticallydiverseAboriginalandTorresStraitIslanderliaisonstaffintoservicedelivery.

Proactivelyaddressesracismetc

NatStandards-MHservices

Standard4.6,p.12

• TheMHSaddressesissuesassociatedwithprejudice,biasanddiscriminationinregardstoitsownstafftoensurenon-discriminatorypracticesandequitableaccesstoservices.

Traumainformedcare

5NMHSPP Action12.4.p.34 TrainingallstaffdeliveringMHservicestoAboriginalandTorresstraitIslanderpeoples,particularlythoseinforensicsettings,intrauma-informedcare…

SERVICERESPONSETOSEVEREMENTALILLNESS

Rights NatStandards–MHServices

Standard1,p.7 • Therightsandresponsibilitiesofpeopleaffectedbymentalhealthproblemsand/ormentalillnessareupheldbytheMHSandaredocumented,prominentlydisplayed,appliedandpromotedthroughoutallphasesofcare.

MH&SEWBFr Outcome5.1,p.42

• ThatthehumanrightsofAboriginalandTorresStraitIslanderpeoplelivingwithseverementalillnessarerespected• AboriginalandTorresstraitIslanderpeoplelivingwithseverementalillnessareentitledtoprotectionsaspeoplewithmentalillnessasprovidedbythe1991UnitedNations’

PrinciplesfortheProtectionofPersonswithMentalIllnessandfortheImprovementofMentalHealthCare;the2006UnitedNationsConventionontheRightsofPersonswithDisabilities;andequalprotectionunderthe2012MentalHealthStatementofRightsandResponsibilitiesofAustralia’sNationalMentalHealthStrategy.

MentalHealthStrategy

• SeeMentalHealthStatementofRightsandResponsibilities

Entryprocedures

NatStandards–MHServices

Criterion10.3.1,p.54

• ImplementationGuidelines–PublicMentalHealthServicesandPrivateHospitals,p.54TheentryprocesstotheMHSmeetstheneedsofitscommunityandfacilitatestimelinessofentryandongoingassessment...TheMHSshouldhaveadocumentedentrypolicyandprocedurewhichincludesbutisnotlimitedto:ensuringtheneedsofAboriginalandTorresStraitIslanderpersons…areaddressedintheentryprocess&theuseofinterpreters

Treatment MH&SEWBFr Outcome5.1p425.1

• Ensureaccesstoculturallyandclinicallyappropriatetreatments,includingwithElders,traditionalhealers,culturalhealersandinterpreters.• Developculturallyadaptedassessmentandtreatmentinformationoptionsforthosewithseverementalillnessandtheirfamiliesandcarers.

NatStandards-MHServices

Standard10.5,p.26 • TheMHSprovidesaccesstoarangeofevidencebasedtreatmentsandfacilitatesaccesstorehabilitationandsupportprogramswhichaddressthespecificneedsofconsumersandpromotestheirrecovery

Criterion10.5.2,p.26

• TreatmentandservicesprovidedbytheMHSareresponsivetothechangingneedsofconsumersduringtheirepisodesofcarethataddressacuteneeds,promoterehabilitationandsupportrecovery.

• ImplementationGuidelines–PublicMentalHealthServicesandPrivateHospitals,p.61.TreatmentoptionsneedtoaddressAboriginalandTorresStraitIslanderpersons…Inruralandremotesettingspractitionersmustensureprocessesforfrequentmonitoring(throughprimarycareorwellbeingservices)toidentifyandrespondtoAboriginalandTorresStraitIslanderconsumerneeds.

• ImplementationguidelinesforNon-governmentCommunityServices,p.79.ServiceoptionsneedtoaddressAboriginalandTorresStraitIslanderpersons,Evidencethatthiscriterionismetcouldinclude:havingspecialistpositionsintheorganisation,forexample…AboriginalandTorresStraitIslanderliaisonstaff

Supportedaccomm.

NatStandards–MHServices

Criterion10.5.16 • ImplementationGuidelines–PublicMentalHealthServicesandPrivateHospitals,p.66.MHservicesoperatinginareaswithsignificantAboriginalandTorresStraitIslanderpopulationsshouldensurethatsupportedandtransitionalaccommodationoptionsappropriatetoIndigenousconsumersareavailable.Thisincludesflexibleoptionsinregionalcentresclosetospecialistandtertiaryservices,whichareconnectedwithin-communityoptions.

Page 24: NATSILMH Health in Culture Policy Concordance Health in Cultur… · (a) The Fifth National Mental Health and Suicide Prevention Plan • Recognises the National Strategic Framework

NationalAboriginalandTorresStraitIslanderLeadershipinMentalHealth2018

24

MH&SEWBFr Outcome5.1p.42 • EnsuretheSEWBofAboriginalandTorresStraitIslanderpeoplewithseverementalillnessissupported,includingwithinpsychiatrichospitalsandinsupportedaccommodationfacilities.

Continuityofcare

NatStandards–MHServices

Criterion10.5.9 • ImplementationGuidelines–PublicMentalHealthServicesandPrivateHospitals,p64.BecauseoftheburdenofsocialadversityandcomorbidityinsomeAboriginalandTorresStraitIslandercommunities,diverseagenciesandorganisationsareinvolvedinongoingcare.TheMHSshouldensurecoordinationandcommunicationacrosstheservicesandsectors.

Exitprocedures

NatStandards–MHServices

Criterion2.11 • ImplementationGuidelines–PublicMentalHealthServicesandPrivateHospitals,p.12.Thereshouldbearegularriskassessmentofconsumers...Consumersareatgreatestriskintimesoftransitionbetweensettingsortransferofcare…JointriskassessmentsbetweentheMHS,non-governmentorganisations,localcommunitiesandprimaryhealthservicesorAboriginalandTorresStraitIslandermedicalservicesareoftenappropriatewhenresponsibilityforcareisbeingtransferredorjointlymanaged.

Criterion10.6

• ImplementationGuidelines–PublicMentalHealthServicesandPrivateHospitals,p.68.Theintentofthiscriterionistoensurethatmentalhealthservices(MHS)havepolicyandproceduresonhowtoassistconsumerswhentheyexittheserviceandthatconsumersareprovidedwithsufficientinformationonhowtore-entertheserviceif/and/orwhenrequired…Theconsumer’sexitfrom,follow-upandre-entrytotheserviceisthejointresponsibilityoftheprivatementalhealthservice,theprivatepsychiatristandthegeneralpractitioner...Inruralandremotesettingsthisresponsibilitydemandsinvolvementofthementalhealthservice,theprimarycareserviceorAboriginalandTorresStraitIslandercommunitycontrolledorganisation,andotherrelevantproviders.Thismayincludegeneralpractitioners.

SelfmanagmtMHconditions

NatStandards–MHServices

Criterion10.5.13 • TheMHSmustensurethataccesstoappropriateprogramsisavailableandthatthisisinsettingswhereconsumersarenotisolated.ThisisparticularlyrelevantforruralandremoteAboriginalandTorresStraitIslanderpopulations.Thismayrequirethatcarersarepresentorabletovisit,oradditionalresourcesmayberequiredforAboriginalandTorresStraitIslanderconsumerstomaintaincommunitycontact.

Recovery&rehab.

RecoveryFr Capability2Bp.49 • Recovery-orientedpracticeandservicedeliverywithAboriginalandTorresStraitIslanderpeoplemustrecognisetheresilience,strengthsandcreativityofAboriginalandTorresStraitIslanderpeople,understandIndigenousculturalperspectives,acknowledgecollectiveexperiencesofracismanddisempowerment,andunderstandthelegacyofcolonisationandpoliciesthatseparatedpeoplefromtheirfamilies,culture,languageandland.More-seepp49&33

MH&SEWBFr Outcome5.2p31

• AboriginalandTorresStraitIslanderpeopleinrecoveryareabletoaccesssupportservicesinanequitableway,accordingtoneed,withinSEWBframework.Strategies:o Assistyoungpeopleupwithmentalillnesstomeettheireducationaland/orvocationalgoalsandmaintainfriendshipnetworks.o Supportadultsinrecoverytomaintainemploymentandfamilyresponsibilities.o SupportculturallyappropriaterehabilitationforAboriginalandTorresStraitIslanderpeoplewithseverementalillness.o EnsurerecoveryisfacilitatedwithinaSEWBframework.o Supportpeoplewithmentalillness,theirfamiliesandcarerstoliveincommunitiesincludingthroughcommunitymentalhealthsupportprograms.

NatStandards-MHservices

Standard10,p.21

• TheMHSincorporatesrecoveryprinciplesintoservicedelivery,cultureandpracticeprovidingconsumerswithaccessandreferraltoarangeofprogramsthatwillsupportsustainablerecovery.

Criterion10.1.3

• ImplementationGuidelines–PublicMentalHealthServicesandPrivateHospitals,p.47.ItisimportantthatpractitionersworkinginAboriginalandTorresStraitIslandersettingsknowhowtoaccessappropriateinformationandidentifyconsumers’strengthsandabilities

Criterion10.1.4

• (Asabove)p.48.Autonomyshouldbeunderstoodinasocialandculturalcontext,particularlyforIndigenousconsumersandcarers.ServicesandpractitionersshouldhaveaccesstotrainingresourceswhichexploreautonomyincontextsappropriatetoAboriginalandTorresStraitIslanderpeopleandsuggestwaystosupportthisinlocalpractice

Criterion10.1.5 • (Asabove)p.48.ExamplesofstrategiesthattheMHScanusetopromotetherightsofindividualswithmentalillnesstosocialinclusionandcitizenshipinclude:ensuringpractitionersknowabout,andcanengagewith,relevantwork,recreationalandfamily-focusedagenciesandactivitiesinAboriginalandTorresStraitIslandersettings,includingbothconventionalandtraditionalactivitiesandpractices.

Criterion10.1.9 • (Asabove)p.50.TheMHSshouldbeawareofcommunityservicesthatmaysupportconsumers.Thesecouldinclude:AboriginalandTorresStraitIslanderservicesgroupsChildren&youngpeople

MH&SEWBFr Outcome1.3,p.31 • Childrenandyoungpeoplewithoratriskofmentalillness(prioritygroup).Outcome4.1,p.39

• Integrateclinicalandnon-clinicalserviceswhoworkwithchildrenandyoungpeopleincludingchildandadolescentmentalhealthservicesandheadspacetobettersupporttheirneedsandreducesuicide.

Outcome5.2,p.43 • Assistyoungpeopleupwithmentalillnesstomeettheireducationaland/orvocationalgoalsandmaintainfriendshipnetworks.PHNGuidelines

ChildandYouthMHServices,p.1

• In2016-17PHNsareexpectedto:o maintainservicedeliverywithinheadspacecentres,inlinewiththeexistingheadspaceservicedeliverymodel;o improvetheintegrationofheadspacecentreswithbroaderprimarymentalhealthcareservices;physicalhealthservices;drugandalcoholservices;andsocialandvocational

supportservices;o commencethedevelopmentanddeliveryofevidence-basedearlyinterventionservicesforyoungpeoplewith,oratriskof,severementalillness;o supportservicecontinuityforchildrenandyoungpeopleformerlyprovidedunderATAPSandothermentalhealthprograms;o liaisewithrelevantlocalorganisationsinthecontextoffutureregionalplanning,includingthosedeliveringFamilyMentalHealthSupportServices(FMHSS),earlychildhood

services,schoolsandtertiaryandvocationalproviders;ando whererelevant,supporttransitionarrangementsassociatedwithservicesformerlyfundedundertheEarlyPsychosisYouthServicesprogram.

• Longerterm,PHNswillbeexpectedto:o supportthebroaderrolloutofevidence-basedearlyinterventionservicesforchildrenandyoungpeoplewith,oratriskof,severementalillness;o promoteresourcesforclinicalandnon-clinicalprofessionalsavailableunderthenewchildmentalhealthworkforceinitiative;o promotelocalpartnershipsbetweenprimarymentalhealthcareservicesandtheeducationsector;and

Page 25: NATSILMH Health in Culture Policy Concordance Health in Cultur… · (a) The Fifth National Mental Health and Suicide Prevention Plan • Recognises the National Strategic Framework

NationalAboriginalandTorresStraitIslanderLeadershipinMentalHealth2018

25

o workwithLHNs,CAMHS,AMHS,FMHSSsandotherregionalorganisationstoensureappropriatepathwaysforreferralandsupportareavailableforchildrenandyoungpeoplewithoratriskofmentalillnessinthecontextofimplementationofregionalmentalhealthandsuicidepreventionplans.

NDIS/psychosocialdisability

5NMHSPP Action6 • PsychosocialsupportthroughtheNDIS/thosenotqualifyforNDISNATSIHP/IP Strategy1C,p.14 • AboriginalandTorresStraitIslanderwithadisabilityandtheirfamiliesandcarershaveaccesstocommunity-baseddisabilityandrespitecareservices.

• Deliverablesby2018:ImplementationoftheNDISMH&SEWBFr Outcome1.3,p.31 • Peoplewithseverementalillness,includingbytheNDIS(prioritygroup). Outcome5.3,p.44 • AboriginalandTorresStraitIslanderlivingwithpsychosocialdisabilityareabletoaccesstheNDISandothersupportservicesinanequitableway,accordingtoneed,andwithina

SEWBframework• EnsurethattheNDIShasAboriginalandTorresStraitIslanderpeopleasaprioritygroupandthatprovidersarecapableofworkinginaculturallycompetentmannerandwithina

SEWBframework.Whereappropriateservicesdonotexist,supportAboriginalandTorresStraitIslanderbusinessestoprovidetheservices.• DeterminehowtheSEWBofpeoplewithapsychosocialdisabilitycanbesupported.

Carers MH&SEWBFr Outcome2.4,p.35 • SupporttheMH&SEWBofvulnerablechildrenincludingthosewithdisabilitiesandthoseincarerroles.Outcome5.1,p.42 • Developculturallyadaptedassessmentandtreatmentinformationoptionsforthosewithseverementalillnessandtheirfamiliesandcarers.Outcome5.2,p.43 • Supportpeoplewithmentalillness,theirfamiliesandcarerstoliveincommunitiesincludingthroughcommunitymentalhealthsupportprograms.Outcome5.3,p.44 • EnsurethatcarerrespiteandothersupportprogramshaveAboriginalandTorresStraitIslandercarersasaprioritygroupandthattheyhavereachintocommunities.

NationalStandards–MHServices

Standard7,p.16 • TheMHSrecognises,respects,valuesandsupportstheimportanceofcarerstothewellbeing,treatment,andrecoveryofpeoplewithamentalillness.Criterion7.1 • ImplementationGuidelines–PublicMentalHealthServicesandPrivateHospitals,p.31Identificationofcarers

• ImplementationGuidelinesforPrivateOfficebasedMentalHealthPractices,pp.26-27.o ConsiderationoftheroleoftheextendedfamilyandofthegreatercommunitymustalsobetakenintoaccountwhenworkingwithAboriginalandTorresStraitIslander

people…o CultureandthesocialbehavioursinfluenceAboriginalandTorresStraitIslanderpeoples’decisionsaboutwhenandwhytheyseekservices.Thisincludesacceptanceor

rejectionoftreatmentandthelikelihoodofadherencetotreatmentandfollow-up,thelikelysuccessofpreventionandhealthpromotionstrategies,theconsumer’sassessmentofthequalityofcareandtheirviewsaboutthehealthserviceanditsstaff.HelpfromAboriginalhealthworkersandcultural‘guides’isvitalinestablishingmeaningfulcontactwithfamiliesinruralandremotecommunities.

o AmongAboriginalandTorresStraitIslandercarerscanincludeindividualmembersofafamilywhomaynotnecessarilybebloodrelativesandskingroupsandcanembraceentirecommunities.Adifferentdefinitionof‘carer’applies.Identificationofcarerscanthereforebedifficultandflexibilityinrecordingcarerinformationhastobeapplied.

Criterion7.2,p.16 • TheMHSimplementsandmaintainsongoingengagementwithcarersaspartnersinthedeliveryofcareassoonaspossibleinallepisodesofcare.Criterion7.5,p.16 • TheMHSconsiderstheneedsofcarersinrelationtoAboriginalandTorresStraitIslanderpeopleCriterion7.14 • ImplementationGuidelines–PublicMentalHealthServicesandPrivateHospitals,p.35.InvolvingAboriginalandTorresStraitIslandercarersinthedeliveryofmentalMHhelpsa

servicelearnaboutwhatAboriginalpeoplevalueandhowstaffandcarerscanworkwiththesevaluestoachievebetterservicesforclients.ExamplesofhowtoensureAboriginalandTorresStraitIslanderpeopleareinvolvedascarersinclude:o providingfinancialandotherpracticalassistancetoattendo holdingmeetingso ensuringparticipationininterviewpanelso reviewingdraftpolicieso providinginputatorientationprogramso participatinginserviceplanningdayso participatinginanonymousreviewsofcomplaints.

• ItmaybenecessarytoactivelyreachouttocommunitiestoinvolveAboriginalandTorresStraitIslandercarerswholiveinruralandremoteAustralia.Thisengagementwithruralandremotecommunitieswillultimatelybeproductive.

• ImplementationGuidelinesforPrivateOfficebasedMentalHealthPractices,p.28.TheorganisationanddeliveryofMHSmustoccurwithinaframeworkthatsensitivelyunitesATSIculturalrights,viewsandvaluesandthescienceofhumanservices.KnowledgeofwhatAboriginalandTorresStraitIslanderpeoplevalueandhowMHSstaffandcarerscanworkwiththesevaluestoachievebetterservicesforclientswillbehelpedbyhavingAboriginalandTorresStraitIslandercarersparticipate.

RoleofPHNs PHNGuidelines

PrimaryMHCareServicesforpeoplewithseverementalillnessSevereMentalIllness,p.1

• In2016-17PHNsareexpectedto:o commencethedevelopmentanddeliveryofservicesforyoungpeoplewith,atoratriskof,severementalillness;o commissionmentalhealthnursingservicestosupportclinicalcarecoordinationforpeoplewithseverementalillness,ensuringservicecontinuitytoexistingMHNIPclientsand

developingnewservicesinthoseareaswithallocatedgrowth;o encourageGPsandotherregionalproviderstoaddressthephysicalhealthinequitiesofindividualswithseverementalillnesswithintheregion;o promotethebetterintegrationofprimarycareserviceswithcommunitybasedprivatepsychiatryservicesandstatementalhealthservicesforpeoplewithseveremental

illnessinthecontextofthedevelopmentofregionalMentalHealthandSuicidePreventionPlans;ando ensurereferralpathwaysareinplacetoenableandsupportpatientstoseamlesslytransitionbetweenservicesastheirneedschange.Inaddition,asmallnumberoflead

PHNshavebeeninvitedtotrialmodelsofinnovativefundingtosupportclinicalcarepackagesforindividualswithsevereandcomplexmentalillness.

Page 26: NATSILMH Health in Culture Policy Concordance Health in Cultur… · (a) The Fifth National Mental Health and Suicide Prevention Plan • Recognises the National Strategic Framework

NationalAboriginalandTorresStraitIslanderLeadershipinMentalHealth2018

26

• LongertermPHNswillbeexpectedto:o informedbythelessonsfromPHNleadsites,developandcommissionclinicalmentalhealthservicestosupporttheneedsofpeoplewithsevereandcomplexmentalillness

whoarebestmanagedinprimaryhealthcare;o promotetheuseofasinglemultiagencycareplanforpeoplewithsevereandcomplexmentalillness,tohelplinkprovidersacrossmultipleservicesinvolvedinanindividual’s

careandtopromoteamedicalhomeapproach;o engagewiththeprivatementalhealthcaresectortoensurelinksareinplacewithprivatehospitalsandpsychologicalservicestosupportcarecoordination;ando ensurereferralpathwaysareinplacetoenableandsupportpatientstoseamlesslytransitionbetweenservicesastheirneedschange.

PART2:SUICIDEPREVENTION(somerepetitionfromabove)

SYSTEMARCHITECTURE

Nationalapproach

NATSISPS Outcome4.1,p.38

• Multi-sectoralcoordinationofSPisestablishedandsustainedacrosslevelsandsectorsofgovernmentinjurisdictions,regionsandcommunitiesIdentifypriorityareasforhorizontalandverticalalignmentofSPactivityatCommonwealthandstatelevels

• (ii)Developajointactionplanacrosslevelsandsectorsofgovernmentforthe[NATSISPS]• (iii)Developstrategiesforalignmentbetweenkeypolicyframeworksrelatingtoalcohol,MH,ClosingtheGap,AboriginalandTorresStraitIslanderearlychildhoodandAboriginal

andTorresStraitIslandereducationNATSIHP/IP Strategy1D,p.16 • AustGovtMH&SEWB,AOD,andSPstrategieshavebeencoordinated.5NMHSPP/IP Action4(imp)p.11 • SuicidePreventionSubcommittee(i.e.Actionii)willleadthedevelopmentoftheNationalSPImplementationStrategy.Thiswillincludeafocuson…“11elements”(below).

Action11,ATSIMHSPSTOR1

• ToadviseonanationallyagreedapproachtosuicidepreventionforAboriginalandTorresStraitIslanderpeoplesforinclusioninthenewNationalSPImplementationStrategy

CulturalRF Domain5,p.16 • Jointhealthandnon-healthpolicies,programsandservicesatcommunity,stateandnationallevelstoaddressthebroadersocialdeterminantsimpactingonhealthNationalSurveillance

NATSISPS Outcome1.4 • Highlevelsofsuicideandself-harmincommunitiesareidentifiedandmonitoredtofacilitateaplannedresponse.• (i)Standardisedmethodsforassessmentandrecordingofsuicidalbehaviourandself-harmarereviewedforadoptionbyprimaryhealthcareandspecialistmentalhealthservices• (ii)Primaryhealthcareandcommunityservicesimplementprotocolsformentalhealthassessmentandrecordingdataonself-harm

5NMHSPP p.24,11elementsnewNationalSPImplementationStrategy

• Surveillance

ATSISPEPCRP Rec. • RealtimesuicidedataRegionalfocus/PHNs

NATSISPS Outcome4.2,p.38 • ThereisdevelopmentofgovernanceandinfrastructuretoandcapacityforplanningtosupportregionalandlocalcoordinationofSuicideprevention• (i)InvestigatefeasibilityofapproachestoregionalcoordinationofSPincluding,butnotlimitedto,rolesofkeygovernmentagenciesandpartners• (ii)IdentifymodelsforgovernancetosupportinteragencyapproachestocoordinatedSP• (iii)Developdata,informationandresourcestosupportregionallevelplanningandcoordinationofstrategies• (iv)Examinemodelsforpoolingoffundstosupportcoordinatedapproachestoprevention

NATSIHP/IP Strategy1D,p16 • Improvedregionalplanningandcoordinationofhealthcareservicesacrosssectorsandproviders.5NMHSPP Action10,p.33 • RegionalplanstoconnectculturallyinformedAboriginalandTorresStraitIslanderSPandpostventionserviceslocallyMH&SEWBFr Outcome4.3,p.41 • CoordinateandintegrateMH&SEWBsubstancemisuse,SPandsocialhealthservicesandprogramstoensureclientsexperienceseamlesstransitionsbetweenthemPHNGuidelines RegionalApproach

toSuicidePreventionp.1

• In2016-17PHNsareexpectedto:o undertakeplanningofcommunity-basedsuicidepreventionactivity,throughamoreintegratedandsystems-basedapproachinpartnershipwithLocalHospitalNetworks

(LHNs)andotherlocalorganisations;o commencecommissioningofcommunity-basedsuicidepreventionactivitieswithinthecontextofthisplan;ando undertakeplanningandcommissioningofcommunity-basedsuicidepreventionactivitiesforAboriginalandTorresStraitIslanderpeoplethatareintegratedwithdrugand

alcoholservices,mentalhealthservicesandsocialandemotionalwellbeingservices.• LongertermPHNswillbeexpectedto:

o ensurethereisagreementwithintheregion,includingwithLHNs,abouttheneedtosupportperson-centredfollow-upcaretoindividualswhohaveself-harmedorattemptedsuicide,andthatthereisnoambiguityintheresponsibilityforprovisionofthiscare;

o continuecommissioningofcommunity-basedsuicidepreventionactivities,includingforAboriginalandTorresStraitIslanderpeople;ando buildthecapacityofprimarycareservicestosupportpeopleatriskofsuicide.

Empoweringcommunitiestorespondtosuicide

NATSISPS Outcome1.1,p.28 • Communitieshavethecapacitytoinitiate,plan,leadandsustainstrategiestopromotecommunityawarenessandtodevelopandimplementcommunitysuicidepreventionplans(ii)Developinformationandresourceguidesforcoordinatingcommunityactiontopreventsuicide

Outcome1.5,p.28 • Communitiesareassistedtoplanandimplementacomprehensiveresponsetosuicideandself-harmthatincludesbothshort–termandlong-termearlyinterventionandpreventionactivity.

Page 27: NATSILMH Health in Culture Policy Concordance Health in Cultur… · (a) The Fifth National Mental Health and Suicide Prevention Plan • Recognises the National Strategic Framework

NationalAboriginalandTorresStraitIslanderLeadershipinMentalHealth2018

27

ATSISPEPSTW p.3(Table) • Communityempowerment,development,ownership*• Community-specificresponses*

Lifespan-9SystemsApproachStrategies

• Engagingthecommunityandprovidingopportunitiestobepartofthechange

Integratedservices

• Seealsointegrationinthecontextofmentalhealthservicesabove5NMHSPP/IP Action4 • Toadviseonimprovingrelationshipsbetweenprovidersincludingemergencyservices(SuicidePreventionSubcommitteepriorityfocus)NATSISPS Outcome3.2 • Buildinter-sectoralandprofessionallinkstosupportintegratedservices

• Integratedservices,includingtargetedandindicatedservicesforfamiliesandindividuals,areavailableinAboriginalandTorresStraitIslanderhealingcentresorothercommunitycentres

• Developanddisseminatemodelsforservicesthatcombinespecifictargetedandindicatedservicesincentresprovidingintegratedwellbeingservices• Strengthenthefocusonearlyinterventionandsuicidepreventionwithinintegratedservices• Buildinter-sectoralandprofessionallinkstosupportintegratedservices

Outcome4.2 • Coordinatedsuicidepreventionstrategiesaresupportedbyimprovedcommunitysectorcapacity,basedonpartnershipsbetweenservices,agenciesandcommunities• Thereisdevelopmentofgovernanceandinfrastructuretoandcapacityforplanningtosupportregionalandlocalcoordinationofsuicideprevention• Identifymodelsforgovernancetosupportinteragencyapproachestocoordinatedsuicideprevention• Examinemodelsforpoolingoffundstosupportcoordinatedapproachestoprevention

Outcome4.3

• Thereareagreementstosupportcollaborativeapproachestojointcasemanagementtoensurecontinuityofservicesandsupportsforhigherriskclients• Pilotandevaluatespecificmultidisciplinaryapproachestoserviceprovisionforvulnerableindividualsandfamilies• Investigatefeasibilityofspecificmemorandaofunderstandingtoenablejointapproachestocasemanagement• ClarifyagencyresponsibilitiesforinteragencycoordinationofcareforhighriskAboriginalandTorresStraitIslanderclientsandfamilies

ATSISPEPSTW p.3 • Cross-agencycollaborationWorkforce MH&SEWBFr Outcome4.2,p.40 • Culturallyandclinicallyappropriatespecialistmentalhealthcareisavailableaccordingtoneed

• EnsuretherequiredmixandlevelofspecialistMHservicesandworkers,paraprofessionalsandprofessionalsrequiredtomeettheMHneedsoftheAboriginalandTorresStraitIslanderpeople,includingspecialistSPservicesforpeopleatriskofsuicide

NATSISPS Outcome4.4,p.38 • (ii)Establishpartnershipsbetweengovernmentsandthecommunitysectortodevelopandtrainthepreventionworkforceacrosshealth,educationandcommunityservicesPartnershipwithACCHSs

NATSISPS Outcome3.4,p.35 • TherearelinksandpartnershipsbetweenmainstreamspecialistmentalhealthandwellbeingservicesandAboriginalandTorresStraitIslanderwellbeingservicesandcommunityorganisations

• (i)IdentifyopportunitiesforcomplementaryserviceprovisionarrangementsandreferrallinkagesbetweenmainstreamservicesandAboriginalandTorresStraitIslandercommunityservicestocoordinatetheprovisionoftargetedpreventiveservices

• (ii)DeveloplocalpartnershipsbetweenexistingservicessuchasheadspacecentresandATSIcommunitySEWBservicesOutcome4.4,p.38 • CoordinatedSPstrategiesaresupportedbyimprovedcommunitysectorcapacity,basedonpartnershipsbetweenservices,agenciesandcommunities

• (i)BuildthecapacityofAboriginalandTorresStraitIslanderorganisationstosustainpartnershipswithgovtsandotherorganisationsATSISPEPSTW p.3(Table) • PartnershipswithcommunityorganisationsandACCHS*

ACCHSspreferredproviders

MH&SEWBFr Outcome1.3,p.31 • GivepreferencetofundingACCHSstodeliverMH,SPandotherprimaryhealthprogramsandserviceswherefeasible.

Research NATSISPS Outcome4.4,p.38 • (iii)Developoptionsforpreventionresearchpartnershipsbetweenthecommunitysector,non-governmentorganisationsandresearchandtrainingsectorstobuildcapacityinsuicideprevention

PROMOTIONANDPRIMORDIALPREVENTION–INC.ELEMENTSOFSYSTEMSAPPROACH

Buildoncommunitystrengths/addresschallenges

NATSISPS Outcome1.1p.26 • Communitieshavethecapacitytoinitiate,plan,leadandsustainstrategiestopromotecommunityawarenessandtodevelopandimplementcommunitySPplans.ATSISPEPSTW p.3(Table) • Communityempowerment,development,ownership*

• Community-specificresponses*• Addressingcommunitychallenges,poverty,socialdeterminantsofhealth*• InvolvementofElders*

MH&SEWBFr Outcome2.1,p.32 • AboriginalandTorresStraitIslandercommunitiesandculturesarestrongandsupportMH&SEWB• Empowercommunitiestoidentifyandaddresschallenges.• Communitygovernancethroughcommunitycontrolledservicestodeliverhealthprogramsandservices.• Encouragepracticaloutcomes,suchasemploymentofcommunitymembers,schoolattendanceandeducationalattainment.

IAS • SafetyandWellbeingProgramme• Jobs,LandandEconomyProgramme

Page 28: NATSILMH Health in Culture Policy Concordance Health in Cultur… · (a) The Fifth National Mental Health and Suicide Prevention Plan • Recognises the National Strategic Framework

NationalAboriginalandTorresStraitIslanderLeadershipinMentalHealth2018

28

• RemoteAustraliaStrategiesProgrammeCulturalRF Domain5,p.16 • Jointhealthandnon-healthpolicies,programsandservicesatcommunity,stateandnationallevelstoaddressthebroadersocialdeterminantsimpactingonhealth

AODusereduction

ATSISPEPSTW p.3(Table) • Alcohol/drugusereduction*NATSISPS Outcome3.5,p.33 • ThereareintegratedandcollaborativeapproachesacrosssectorsrespondingtoAboriginalandTorresStraitIslanderwhoareathighrisk,suchaspeopleexperiencingmental

illness,substancemisuse,incarceration,domesticviolence,etc.MH&SEWBFr Outcome2.1.6,

p.32• Supportcommunitiesthatwishtorestrictalcoholsupplyanduseamongtheirmembers.

Outcome2.1.8,p.33

• Encouragealcoholreductionstrategies,includingmainstreampolicyanalysisofpotentialpricingleversandtaxationoptions.

Outcome2.4.2,p.35

• Adaptend-to-endschoolbasedMH&SEWBprogramsforAboriginalandTorresStraitIslanderchildrenthatincludeafocuson:Culturallyandageappropriatealcoholanddrugusepreventionand/orreduction.

DrugStrategy

PriorityArea2,p.5

• Increaseaccesstoafullrangeofculturallyresponsiveandappropriateprograms,includingpreventionandinterventionsaimedatthelocalneedsofindividuals,familiesandcommunitiestoaddressharmfulAODuse.

Outcome2.1,p.6 • CulturallyappropriateAboriginalandTorresStraitIslanderprogramsandservicesaresupportedthataddresspreventionprograms,theimpactofalcohol,tobaccoandotherdrugsonindividualsandfamilies,andwithintheircommunities.

Buildonculturalstrengths

NATSISPS Outcome2.1,p.31 • Thereareculturallyappropriatecommunityactivitiestoengageyouth,buildculturalstrengths,leadership,lifeskillsandsocialcompetencies• (i)Developcriteriaforsupportofculturalprograms• (ii)Reviewevidenceforeffectivenessofculture-basedinitiativesandevaluateculturalstrengthsprograms

ATSISPEPSTW p.3(Table) • InvolvementofElders*• Culturalframework*• Culturalelements–buildingidentity,SEWB,healing*• Culturebeingtaughtinschools• Connectingtoculture/country/Elders*

M&SEWBFr Outcome2.12.1.3,p.32

• AboriginalandTorresStraitIslandercommunitiesandculturesarestrongandsupportMH&SEWB.• Strengthencommunitycohesion,andrestoreandhealconnectionstocultureandcountryincludingthroughreclamationandrevitalization

Outcome2.4.6,p.35

• Adaptend-to-endschoolbasedMH&SEWBprogramsforAboriginalandTorresStraitIslanderchildrenthatincludeafocuson:Strengtheningprideinidentityandculture.

CulturalRF Domain2,p.13 • Positivehealthmessagesandprogramsthatrespondtothediversity,strengthsandknowledgeofAboriginalandTorresStraitIslandersocial,cultural,linguistic,gender,religiousandspiritualbackgrounds

IAS CultureandCapabilityProgramme,p.45

• TheobjectivesoftheCultureandCapabilityProgrammeareto:Supporttheexpression,engagementandconservationofIndigenousculture.

Buildonfamilystrengths/addresschallenges

NATSISPS Outcome1.5,p.28 • (i)IdentifyappropriateearlyinterventionprogramsthathavebeenadaptedforAboriginalandTorresStraitIslanderfamiliesOutcome2.3,p.31

• Long-term,sustainablepreventionstrategiesthatbuildresilienceandpromotesocialandemotionalwellbeingarespecificallydevelopedforAboriginalandTorresStraitIslanderfamiliesandchildren

• (i)Developculturallyappropriatestrategiesforfamilyengagementinwellbeingprogramsinmultiplesettings• (ii)MakeparentingprogramsadaptedforAboriginalandTorresStraitIslanderpeoplesmoreavailableinuniversalandtargetedmodestostrengthenparentingskillsandtoimprove

behavioural,developmentalandmentalhealthoutcomesamongchildren• (iii)DevelopfamilyfocusedinterventionsforAboriginalandTorresStraitIslanderparentsandchildreninpartnershipwithchildcarecentresandschools• (iv)DisseminateinformationonmodelsofeffectiveearlyinterventionandpreventionforAboriginalandTorresStraitIslanderfamilies,parentsandchildren

MH&SEWBFr Outcome2.2

• AboriginalandTorresStraitIslanderfamiliesarestrongandsupported• Increasefamily-centricandculturally-safeservicesforfamiliesandcommunities.• SupporttheroleofmenandEldersinfamilylifeandtheraisingofchildreninaculturally-informedway.• Supportsingleparentfamiliesandextendedfamilyandkinsupportnetworks• Supportfamilyre-unificationformembersoftheStolenGenerations,prisoners,childrenremovedfromtheirfamiliesintoout-of-homecare,andyoungpeopleinjuvenile

detention.Outcome3.1,p.36 • SupportprogramsformembersoftheStolenGenerationsandtheirfamilies.

Men’sstrengths

NATSISPS Outcome2.2,p.31 • Lifepromotionandresilience-buildingstrategiesaredeveloped;accesstowellbeingservicesamongAboriginalandTorresStraitIslandermalesisimproved,• (iii)Developstrategiestopromotethestrengthsofelders,fathersandothermenaspositiverolemodelsabletocontributetothewellbeingofcommunity,familiesandyouth

Beststarttolife/school

NATSISPS Outcome2.1,p.31 • Thereareculturallyappropriatecommunityactivitiestoengageyouth,buildculturalstrengths,leadership,lifeskillsandsocialcompetencies• (iii)Developschoolandcommunity-basedlifeskillsprogramsforadolescents• (iv)Promoteleadershipthroughyouthforumsandactivitiestorecogniseachievementsofyoungpeople

Page 29: NATSILMH Health in Culture Policy Concordance Health in Cultur… · (a) The Fifth National Mental Health and Suicide Prevention Plan • Recognises the National Strategic Framework

NationalAboriginalandTorresStraitIslanderLeadershipinMentalHealth2018

29

andadolescence

• (v)DevelopmodelsoftrainingandskillsdevelopmentforpeersasnaturalhelpersOutcome2.3,p.31 • (v)Identifyschool-basedstrategiestocounterbullying,racialdiscriminationandlateralviolence

MH&SEWBFr Outcome2.3/2.4

• SeeingeneralOutcomes2.3/2.4• Supportchildrenandyoungpeople’sstrongconnectiontocultureandsenseofbelongingincommunities,familiesandfriendshipnetworksasawaytosupporttheirresilienceand

tohelpprotectagainstsuicide.NATSIHP/IP

Part4 • 4A.Youngpeoplehaveavoiceinthedevelopmentandimplementationofprogrammesandpoliciesthatareaffectingthem.• 4B.Youngpeoplearesupportedtoberesilientandmakeinformedandhealthychoicesaboutliving,includingbeingproudofidentityandculture.• 4D.Youngpeoplehavegoodeducationandgoodemploymentprospects.

ATSISPEPSTW p.3(Table) • School-basedpeersupportandmentalhealthliteracyprograms• Programstoengage/divert,includingsport*

Lifespan-9SystemsApproachStrategies

• Promotinghelp-seeking,mentalhealthandresilienceinschools

IAS • ChildrenandSchoolingProgramme

PRIMARYANDSELECTIVEPREVENTION–INC.ELEMENTSOFSYSTEMSAPPROACH

Communitycontrolandempowermt.

NATSISPS Outcome1.1,p.28 • Communitieshavethecapacitytoinitiate,plan,leadandsustainstrategiestopromotecommunityawarenessandtodevelopandimplementcommunitySPplans.• (i)Identifycommunitiesandregions(byexpressionofinterest)toworkshopmodelsforcommunityaction• (ii)Developinformationandresourceguidesforcoordinatingcommunityactiontopreventsuicide• (iii)Reviewanddisseminateinformationonbestpracticemodelsforcommunitysuicideprevention• (iv)Developspecificstrategiesregardingaccesstomethodsandmeansofsuicideinthecommunity

ATSISPEPSTW p.3(Table) • Communityempowerment,development,ownership*• Community-specificresponses*• InvolvementofElders*

GDD Theme4,p.5

• AboriginalandTorresStraitIslanderpeopleshouldbetrained,employed,empoweredandvaluedtoleadacrossallpartsoftheAustralianmentalhealthsystemthatarededicatedtoimprovingAboriginalandTorresStraitIslanderwellbeingandmentalhealthandtoreducingsuicide,andinallpartsofthatsystemusedbyAboriginalandTorresStraitIslanderpeoples

Employcommunitymembers

ATSISPEPSTW p.3(Table) • Employmentofcommunitymembers/peerworkforce*GDD Theme4,p.5 • AboriginalandTorresStraitIslanderpeopleshouldbetrained,employed,empoweredandvaluedtoworkatalllevelsandacrossallpartsoftheAustralianmentalhealthsystem

andamongtheprofessionsthatworkinthatsystem.Meansrestriction

NATSISPS Outcome1.1,p.28 • (iv)Developspecificstrategiesregardingaccesstomethodsandmeansofsuicideinthecommunity5NMHSPP p.24,11elements

newNationalSPStrategy

• Meansrestriction

ATSISPEPSTW p.3(Table) • ReducingaccesstolethalmeansofsuicideLifespan-9SystemsApproachStrategies

• Improvingsafetyandreducingaccesstomeansofsuicide

SPliteracy/stigmareduction

ATSISPEPSTW p.3(Table) • Awarenessraisingprogramsaboutsuiciderisk/useofDVDswithnoassumptionofliteracy*Lifespan-9SystemsApproachStrategies

• Trainingthecommunitytorecogniseandrespondtosuicidality

5NMHSPP p.24-11elementsnewNationalSPStrategy

• Stigmareduction—promotetheuseofMHservices

MH&SEWBFr Outcome2.4,p.23 • Adaptend-to-endschoolbasedMH&SEWBprogramsforAboriginalandTorresStraitIslanderchildrenthatincludeafocuson:Helpseekingbehaviourandde-stigmatisationofmentalhealthproblems.

Gatekeepersandcommunityresources

NATSIHP/IP Strategy1C,p.13 • Preventionandearlyinterventionprogrammes(includingprogrammesthatfocusonchronicdiseases,e.g.includingdiabetes,cancer,hearthealth oral,earandeyehealth;mentalhealthconditionsandillnesssuicidepreventiontobaccoandalcoholanddruguse)havebeendeveloped,supportedandimplemented.

NATSISPS Outcome1.3p.28 • Thereisaccesstocommunity-basedprogramstoimprovesuicideawarenessamong“gatekeepers”and“naturalhelpers”incommunitiesaffectedbyself-harmandsuicide.Outcome1.2p.28 • MaterialsandresourcesareavailablethatareappropriatefortheneedsofAboriginalandTorresStraitIslanderpeoplesindiversecommunitysettings.

• (i)Identifyresourcegapsandneeds• (ii)ReviewandextendAboriginalandTorresStraitIslanderlanguagetrainingprogramsformentalhealthandsocialandemotionalwellbeing(iii)Produceresourcematerialsin

diverseformatsforusebyAboriginalandTorresStraitIslanderpeopleindifferentcommunitycontexts,includingthosewithAboriginalandTorresStraitIslanderlanguages

Page 30: NATSILMH Health in Culture Policy Concordance Health in Cultur… · (a) The Fifth National Mental Health and Suicide Prevention Plan • Recognises the National Strategic Framework

NationalAboriginalandTorresStraitIslanderLeadershipinMentalHealth2018

30

5NMHSPP p.24-11elementsnewNationalSPStrategy

• Trainingandeducation–maintaincomprehensivetrainingprogramsforidentifiedgatekeepers• Awareness–establishpublicinformationcampaignstosupporttheunderstandingthatsuicidesarepreventable

ATSISPEPSTW p.3(Table) • Gatekeepertraining–Indigenous-specific*Peertopeermentoring

ATSISPEPSTW p.3(Table) • Peer-to-peermentoring,andeducationandleadershiponsuicideprevention*• Employmentofcommunitymembers/peerworkforce*• School-basedpeersupportandmentalhealthliteracyprograms

GPs/PHC NATSISPS Outcome2.4,p.32 • (iii)Examinestrategiestoimprovethepreventivecapacityofprimaryhealthcare,includingGPservices,routinedeliveryofmentalhealthassessments,counselling,etcATSISPEPSTW p.3(Table) • Trainingoffrontlinestaff/GPsindetectingdepressionandsuicideriskLifespan-9SystemsApproachStrategies

• Equippingprimarycaretoidentifyandsupportpeopleindistress

Helplines NATSISPS Outcome2.4 • ReviewandremodelKidsHelplineandLifelinecounsellingservicestoprovideappropriateservicesforAboriginalandTorresStraitIslanderpeopleineachstateandterritoryTrainingoffrontlinestaff

ATSISPEPSTW p.3(Table) • Trainingoffrontlinestaff/GPsindetectingdepressionandsuicideriskLifespan-9SystemsApproachStrategies

• Improvingthecompetencyandconfidenceoffrontlineworkerstodealworkerstodealwithsuicidalcrisis

ExitinghospitalEDs

NATSISPS Outcome3.1,p.35 • (iii)DevelopstrategiestoimproveAboriginalandTorresStraitIslanderidentification,assessmentofsuiciderisk,psychosocialassessmentandculturallyinformeddischargeprotocolsforhospitalemergencydepartments

ExitingMHservices

NatStandards–MHServices

Criterion2.11 • GuidanceforImplementation–PublicMentalHealthServicesandPrivatehospitalsp.12.Thereshouldbearegularriskassessmentofconsumers...Consumersareatgreatestriskintimesoftransitionbetweensettingsortransferofcare…JointriskassessmentsbetweentheMHS,non-governmentorganisations,localcommunitiesandprimaryhealthservicesorAboriginalandTorresStraitIslandermedicalservicesareoftenappropriatewhenresponsibilityforcareisbeingtransferredorjointlymanaged.

Exitingincarceration

NTRC Rec24.1,p.40

• Anintegrated,evidence-basedthroughcareservicebeestablishedforchildrenandyoungpeopleindetentiontodeliver:adequateplanningforreleaseincluding,asappropriate,safeandstableaccommodation,accesstophysicalandMHsupport,accesstosubstanceabuseprograms,assistancewitheducationand/oremployment

Familiesandchildrenatrisk

NATSISPS Outcome3.5,p.36 • ThereareintegratedandcollaborativeapproachesacrosssectorsrespondingtoAboriginalandTorresStraitIslanderpeoplewhoareathighrisk,suchaspeopleexperiencingmentalillness,substancemisuse,incarceration,domesticviolence,etc

Outcome3.6,p.36 • Thereiscapacitytoidentifychildrenwithearlyoremergingriskofconduct,behaviouralanddevelopmentalproblemsandoptionsforreferralofchildrenandfamiliesatmoderateandhighrisk,includingfamilieswithcomplexmultipleneeds,toculturallyadaptedtherapeuticprograms.

• (i)Providetrainingforchildhealthandearlyeducationstafftoassistthemineffectivelyidentifyingandrespondingtobehaviouralandearlymentalhealthproblemsatchildcare,preschoolandschool

• (ii)Engageat-riskparentstoprovideparentingandfamilysupportviaaccesstohealth,earlyeducationandchildcareservicesaswellaschildprotectionservices• (iii)TrialandimplementculturallyadaptedtherapeuticfamilyinterventionsforAboriginalandTorresStraitIslanderparentsandchildren• (iv)Developstrategiestoidentifyandreduceriskassociatedwithchildprotectioninterventions,includingchildremoval,fostercareandkinshipcareandpracticesofchild

placementv• (v)Improveidentificationoffoetalalcoholsyndromedisorderandotherdevelopmentalimpairmentsinchildren• (vi)Developinformationandresourcestoassisthealthandsocialandemotionalwellbeingpractitionerstorespondtofamilysuicidalbehaviourandfamilymentalillness

Outcome1.5,p.28 • (ii)Buildpartnershipswithschools,communitycouncilsandotheragenciestodeliverearlyinterventionandpreventionprogramsforparents,childrenandat-riskyouthATSISPEPSTW p.3(Table) • School-basedpeersupportandmentalhealthliteracyprograms

• Programstoengage/divert,includingsport*Lifespan-9SystemsApproachStrategies

• Promotinghelp-seeking,mentalhealthandresilienceinschools

MH&SEWBFr Outcome4.1,p.27 • Integrateclinicalandnon-clinicalserviceswhoworkwithchildrenandyoungpeopleincludingchildandadolescentmentalhealthservicesandheadspacetobettersupporttheirneedsandreducesuicide.

NATSISPS

Outcome2.3,p.31

• Identifyschool-basedstrategiestocounterbullying,racialdiscriminationandlateralviolence

Outcome2.4,p.23

• RequireevidencebasedapproachesonMHandwellbeingbeadoptedinearlychildhoodworkerandteachertrainingandcontinuingprofessionaldevelopment.• Adaptend-to-endschoolbasedMH&SEWBprogramsforAboriginalandTorresStraitIslanderchildrenthatincludeafocuson:Culturallyandageappropriatesuicideprevention.

Males NATSISPS Outcome2.2,p.31

• Lifepromotionandresilience-buildingstrategiesaredeveloped;accesstowellbeingservicesamongAboriginalandTorresStraitIslandermalesisimproved• (i)Developstrategies,includinginformationandmentalhealthpromotionstrategies,topromoteuseofgeneralhealthandwellbeingservicesandspecialistservicesbymen• (ii)Identifyanddisseminategoodpracticesformen’sself-helpgroups• (iii)Developstrategiestopromotethestrengthsofelders,fathersandothermenaspositiverolemodelsabletocontributetothewellbeingofcommunity,familiesandyouth

Page 31: NATSILMH Health in Culture Policy Concordance Health in Cultur… · (a) The Fifth National Mental Health and Suicide Prevention Plan • Recognises the National Strategic Framework

NationalAboriginalandTorresStraitIslanderLeadershipinMentalHealth2018

31

Justiceissues NATSISPS Outcome3.5,p.36

• ThereareintegratedandcollaborativeapproachesacrosssectorsrespondingtoAboriginalandTorresStraitIslanderwhoareathighrisk,suchaspeopleexperiencingmentalillness,substancemisuse,incarceration,domesticviolence,etc.

• (i)Developpartnershipprogramstobuildlinksbetweenresidential/custodialsettingsandcommunitysupport(suchastransitionfromprisontocommunityorfromalcoholrehabilitationtocommunityreintegration)

• (ii)ProvidespecificSPandassessmenttrainingforstaffinhighrisksettingswhoworkwithAboriginalandTorresStraitIslanderclients• (iii)Identifyalternativestocommunityreintegrationwherereturntocommunityisnotdesirable

Substancemisuse

NATSISPS Outcome3.5,p.36 • ThereareintegratedandcollaborativeapproachesacrosssectorsrespondingtoAboriginalandTorresStraitIslanderwhoareathighrisk,suchaspeopleexperiencingmentalillness,substancemisuse,incarceration,domesticviolence,etc.

Mediaprotocols

5NMHSPP p.2411elementsnewNationalSPStrategy

• Mediaprotocols

ATSISPEPSTW p.3(Table) • ResponsiblesuicidereportingbythemediaLifespan-9SystemsApproachStrategies

• Encouragingsafeandpurposefulmediareporting

Mentalhealth NATSISPS Outcome3.5p36 • ThereareintegratedandcollaborativeapproachesacrosssectorsrespondingtoAboriginalandTorresStraitIslanderwhoareathighrisk,suchaspeopleexperiencingmentalillness,substancemisuse,incarceration,domesticviolence,etc

NATSIHP/IP Strategy1Cp13 • Whole-of-lifecyclehealthinterventionsareaccessibleandhaveastrongfocusonpreventionandearlyinterventiontopreventmentalhealthconditionsandillness,chronichealthconditionsandinjuriesfromoccurring,includingdisability,

SERVICES&INDICATEDRESPONSESINC.SYSTEMSAPPROACH

Integratedservices

• Seealsointegrationinrelationtomentalhealthservices-above5NMHSPP/IP Action4,Suicide

PreventionSubcommitteepriorityfocus

• Toadviseonimprovingrelationshipsbetweenproviders,includingemergencyservices

NATSISPS Outcome3.2,p.35 • Integratedservices,includingtargetedandindicatedservicesforfamiliesandindividuals,areavailableinAboriginalandTorresStraitIslanderhealingcentresorothercommunitycentres

• (i)Developanddisseminatemodelsforservicesthatcombinespecifictargetedandindicatedservicesincentresprovidingintegratedwellbeingservices• (ii)Strengthenthefocusonearlyinterventionandsuicidepreventionwithinintegratedservices• (iii)Buildinter-sectoralandprofessionallinkstosupportintegratedservices• • (iv)Developandevaluatemodelsforinterdisciplinarypracticeinmentalhealthandearlyintervention• (v)InvestigateinnovativemodelsforpartnershipsbetweenspecialistMHandwellbeingservices(egheadspace)andAboriginalandTorresStraitIslanderwellbeingservicesand

communityorganisationsOutcome4.4,p.38Outcome4.2,p.38

• Coordinatedsuicidepreventionstrategiesaresupportedbyimprovedcommunitysectorcapacity,basedonpartnershipsbetweenservices,agenciesandcommunities

• Thereisdevelopmentofgovernanceandinfrastructuretoandcapacityforplanningtosupportregionalandlocalcoordinationofsuicideprevention• (i)Identifymodelsforgovernancetosupportinteragencyapproachestocoordinatedsuicideprevention• (iv)Examinemodelsforpoolingoffundstosupportcoordinatedapproachestoprevention

Outcome4.3,p.38

• Thereareagreementstosupportcollaborativeapproachestojointcasemanagementtoensurecontinuityofservicesandsupportsforhigherriskclients• (i)Pilotandevaluatespecificmultidisciplinaryapproachestoserviceprovisionforvulnerableindividualsandfamilies• (ii)Investigatefeasibilityofspecificmemorandaofunderstandingtoenablejointapproachestocasemanagement• (iii)ClarifyagencyresponsibilitiesforinteragencycoordinationofcareforhighriskAboriginalandTorresStraitIslanderclientsandfamilies

ATSISPEPSTW p.3(Table) • Cross-agencycollaboration• Clearreferralpathways*

5NMHSPP/IP p.24,11elementsnewNationalSPStrategy

• Oversightandcoordination–utiliseinstitutesoragenciestopromoteandcoordinateresearch,trainingandservicedeliveryinresponsetosuicidalbehaviours

PartnershipwithACCHSs

MH&SEWBFr Outcome1.3 • EffectivepartnershipsbetweenPHNs/ACCHS(Strategy)NATSISPS Outcome3.4,p.35 • TherearelinksandpartnershipsbetweenmainstreamspecialistmentalhealthandwellbeingservicesandAboriginalandTorresStraitIslanderwellbeingservicesandcommunity

organisations

Page 32: NATSILMH Health in Culture Policy Concordance Health in Cultur… · (a) The Fifth National Mental Health and Suicide Prevention Plan • Recognises the National Strategic Framework

NationalAboriginalandTorresStraitIslanderLeadershipinMentalHealth2018

32

• (i)IdentifyopportunitiesforcomplementaryserviceprovisionarrangementsandreferrallinkagesbetweenmainstreamservicesandAboriginalandTorresStraitIslandercommunityservicestocoordinatetheprovisionoftargetedpreventiveservices

• (ii)DeveloplocalpartnershipsbetweenexistingservicessuchasheadspacecentresandAboriginalandTorresStraitIslandercommunitySEWBservicesOutcome4.4,p.38 • CoordinatedSPstrategiesaresupportedbyimprovedcommunitysectorcapacity,basedonpartnershipsbetweenservices,agenciesandcommunities

• (i)BuildthecapacityofAboriginalandTorresStraitIslanderorganisationstosustainpartnershipswithgovtsandotherorganisationsATSISPEPSTW p.3(Table) • PartnershipswithcommunityorganisationsandACCHS*

ACCHSspreferredproviders

MH&SEWBFr Outcome1.3,p.19 • GivepreferencetofundingACCHSstodeliverMH,SPandotherprimaryhealthprogramsandserviceswherefeasible.NATSISPS Outcome3.2,p.35 • Integratedservices,includingtargetedandindicatedservicesforfamiliesandindividuals,areavailableinAboriginalandTorresStraitIslanderhealingcentresorothercommunity

centresOutcome4.4,p.38 • Coordinatedsuicidepreventionstrategiesaresupportedbyimprovedcommunitysectorcapacity,basedonpartnershipsbetweenservices,agenciesandcommunities

AboriginalandTorresStraitIslanderpeopleemployedinmainstreamservices

NATSISPS Outcome3.3 • Targetedandindicatedservices,includingemergencyservices,areculturallyappropriate.TheyaredeliveredbyAboriginalandTorresStraitIslanderpersonnelandengageAboriginalandTorresStraitIslanderclientsandfamilies

• EmployAboriginalandTorresStraitIslanderpersonnelinoutreach,follow-upandengagementroles

Timeprotocols/availability

ATSISPEPSTW p.3(Table) • 24/7availability*• Timeprotocols*(seealsoATAPSGuidelinesforATSOSPServices)• Awarenessofcriticalriskperiodsandresponsivenessatthosetimes*

Culturalsafetyinmainstreamservices

NATSISPS Outcome3.3 • Targetedandindicatedservices,includingemergencyservices,areculturallyappropriate.• DevelopAboriginalandTorresStraitIslanderI-specificprotocolsandtrainingfortargetedandindicatedservices• Expandavailabilityofappropriateculturalawarenesstrainingformainstreamservices

5NMHSPP/IP p.24,11elementsnewNationalSPStrategy

• Accesstoservices–promoteincreasedaccesstocomprehensiveservicesforthosevulnerabletosuicidalbehavioursandremovebarrierstocare

Action4,p.25 • Governmentswill,throughtheSuicidePreventionSubcommitteeofMHDAPC,developaNationalSuicidePreventionImplementationStrategythatoperationalisesthe11elementsabove,takingintoaccountexistingstrategies,plansandactivities,withapriorityfocuson:andfocuson…improvingculturalsafetyacrossallservicesettings

ATSISPEPSTW p.3(Table) • Culturalcompetenceofstaff/mandatorytrainingrequirements(Clinicalelement)5NMHSPP Action4,Suicide

PreventionSubcommitteepriorityfocus

• Improvingculturalsafetyacrossallservicesettings

Treatments NATSISPS Outcome3.1p.35 • ThereisaccesstoeffectivetargetedandspecialistservicesbyAboriginalandTorresStraitIslanderpeoplewhoareatriskofsuicideorself-harm• (i)MapserviceutilisationandbarriersforAboriginalandTorresStraitIslanderpeopleseekingtoaccesstargetedandindicatedservicesinregionsandcommunities• (ii)Identifybarrierstoaccessandutilisationanddevelopstrategiestoimproveaccesstoreferralnetworks,AboriginalandTorresStraitIslanderinformation,liaison,flexibilityand

responsiveness5NMHSPP/IP p.24,11elements

newNationalSPStrategy

• Treatment–improvethequalityofclinicalcareandevidencebasedclinicalinterventionsespeciallyforindividualswhopresenttohospitalfollowingasuicideattempt

ATSISPEPSTW p.3(Table) • Highqualityandculturallyappropriatetreatments*Lifespan-9SystemsApproachStrategies

• Usingevidencebasedtreatmentforsuicidality

Followupcare 5NMHSPP/IP Action4,SuicidePreventionSubcommitteepriorityfocus/

• Providingconsistentandtimelyfollowupcareforpeoplewhohaveattemptedsuicideoratriskofsuicide

ATSISPEPSTW p.3(Table) • Continuingcare/assertiveoutreachpostemergencydepartmentafterasuicideattempt*5NMHSPP/IP p.24,11elements

newNationalSPStrategy

• Treatment–improvethequalityofclinicalcareandevidencebasedclinicalinterventionsespeciallyforindividualswhopresenttohospitalfollowingasuicideattempt

Lifespan-9SystemsApproachStrategies

• Improvingemergencyandfollowupcareforsuicidalcrisis

Page 33: NATSILMH Health in Culture Policy Concordance Health in Cultur… · (a) The Fifth National Mental Health and Suicide Prevention Plan • Recognises the National Strategic Framework

NationalAboriginalandTorresStraitIslanderLeadershipinMentalHealth2018

33

Postvention NATSISPS Outcome1.6,p.29 • Mentalhealthservicesandcommunityorganisationsareabletoprovideappropriatepostventionresponsestosupportindividualsandfamiliesaffectedbysuicide.• (i)DevelopprotocolsforcommunicationbetweenspecialistmentalhealthservicesandAboriginalandTorresStraitIslanderfamiliesregardinginterventionneedsandsupport

followingbereavement• (ii)Buildcapacityofcommunitymembersandcommunity-basedpersonneltoleadpostventionresponsestobereavement• (iii)Developinnovativestrategiesforbereavementsupportincludingpracticalassistancewithhousing,finances,workandchildren’sneeds,psychologicalsupportandcounselling• (iv)DevelopculturallyappropriatebestpracticetherapeuticoptionsforrespondingtotraumaticbereavementandcomplicatedgriefamongAboriginalandTorresStraitIslander

people• (v)SupportdevelopmentofpartnershipsbetweencommunitiesandNGOstosupportemergencyresponseindiversesettings• (vi)Emergencyresponseshouldbeconsistentwithbestpractice(basedonsystematicreviewofresearchonsuicidebereavementfirstresponsesandemergenciessuchas

VictorianbushfiresandQueenslandfloods)ATSISPEPSTW p.3(Table) • CrisisresponseteamsafterasuicidePostvention*

• SeealsoRecommendationsoftheATSISPEPCriticalResponseProjectReport5NMHSPP/IP Action4,Suicide

PreventionSubcommitteepriorityfocus

• Providingtimelyfollowupsupportforpeopleaffectedbysuicide

5NMHSPP/IP p.24,11elementsnewNationalSPStrategy

• Crisisintervention–ensurethatcommunitieshavethecapacitytorespondtocriseswithappropriateinterventions• Postvention–improveresponsetoandcaringforthoseaffectedbysuicideandsuicideattempts

Datacollections

5NMHSPP Action4,SuicidePreventionSubcommitteepriorityfocus

• improveddatacollections-evidence-baseon‘whatworks’

ATSISPEPSTW p.3(Table) • DatacollectionsEvaluation ATSISPEPSTW p.3(Table) • Indicatorsforevaluation

• Disseminationoflearnings