PTSD Among Aboriginal and Torres Strait Islander People in Custody in Australia: Prevalence and Correlates.

Mental disorder and trauma experiences are highly prevalent among individuals in custody; however, the impact of posttraumatic stress disorder (PTSD) on functioning is rarely considered. Indigenous Australians are incarcerated at 13 times the rate of nonindigenous Australians and report high levels of trauma exposure and psychological distress. In analysis of the largest systematic study of mental disorder among indigenous Australians in custody (N = 396), we found that the 12-month prevalence of PTSD was high in both men (12.1%) and women (32.3%). Having PTSD was also associated with high rates of co-occurring mental disorders (anxiety 31.2%, depression 32.8%, psychosis 24.6%, and substance use, 75.4%), lifetime suicidal ideation (50.1%), and suicide attempts (34.4%). Individuals with PTSD, compared to those without, were more likely to experience other mental disorders, OR = 2.42, 95% CI [1.12, 5.80], p = .022; lifetime suicide thoughts, OR = 2.43, 95% CI [1.34, 4.39], p = .001, and attempts, OR = 2.56, 95% CI [1.33, 4.83], p = .002; and high rates of intoxication at the time of arrest. Despite this, most (58.9%) had not accessed any form of mental health care prior to incarceration. These findings highlight the need to identify and manage PTSD in community and custodial populations.

Way Forward: an Indigenous approach to well-being.

OBJECTIVE: Aboriginal and Torres Strait Islander individuals are overrepresented in mental health services in the state of Queensland (QLD), Australia; indicating greater prevalence and less preventative management of mental illness. This paper describes a project to enhance the model of care to improve mental health, alcohol and other drug outcomes for Aboriginal and Torres Strait Islander Community members in two metropolitan Hospital and Health Services, in Brisbane, Australia. METHODS: Individual and focus group consultations were conducted with stakeholders, to determine key themes. RESULTS: The consultative phase of the project revealed three priority areas for action: governance and supervision arrangements for the workforce in the area of Indigenous mental health, alcohol and other drugs; the cultural capability of non-Indigenous clinicians; and consumer access to services. CONCLUSIONS: The Way Forward project is a broad workforce redesign approach to address these three key areas. This approach is designed to acknowledge the strengths among the Indigenous Aboriginal and Torres Strait Islander workforce and to utilise their specialised cultural knowledge. This strategy will also include working in relationships with key Community-controlled health and other organisations. The approach will be reviewed and evaluated.

Enhancing research quality through cultural competence: a case study in Queensland prisons.

OBJECTIVE: To describe the processes undertaken to maximise cultural competence in a complex research project and illustrate how this enhanced the quality of the research and impact of the research outcomes. METHODS: An epidemiological survey of the mental health of Indigenous people in custody in Queensland was conducted using culturally informed research processes. RESULTS: The research process that enhanced cultural competence is described. The research outcomes were positive in terms of participant and community experiences, participation rates, publications and other research outputs, capacity building and translation of research findings. CONCLUSIONS: This paper describes in practical terms how to conduct culturally informed research and how this approach enhanced the scientific rigour of a complex Indigenous health research project. Indigenous health research should be conducted using a culturally competent method.

Prevalence of mental illness among Aboriginal and Torres Strait Islander people in Queensland prisons.

OBJECTIVE: To estimate the prevalence of mental disorder in a representative sample of Aboriginal and Torres Strait Islander people in Queensland prisons. DESIGN, SETTING AND PARTICIPANTS: Cross-sectional assessment of mental health using the Composite International Diagnostic Interview (CIDI) and clinical interviews, conducted by Indigenous mental health clinicians who undertook specific training for this purpose, with support from forensic psychiatrists when indicated. We assessed adults who self-identified as Indigenous and were incarcerated in six of the nine major correctional centres across Queensland (housing 75% of all Indigenous men and 90% of all Indigenous women in Queensland prisons) between May and June 2008. MAIN OUTCOME MEASURES: Diagnoses of anxiety, depressive and substance misuse disorders using the CIDI; diagnosis of psychotic illness determined through psychiatrist interviews supplemented by a diagnostic panel. RESULTS: We interviewed 25% of all Indigenous men (347/1381; mean age, 31.5 years) and 62% of all Indigenous women (72/116; mean age, 29.2 years) incarcerated at the time of our study. The recruitment fraction was 71% for men and 81% for women. Among the 396 individuals who completed both the interview and the CIDI, the 12-month prevalence of mental disorder was 73% among men and 86% among women. This comprised anxiety disorders (men, 20%; women, 51%); depressive disorders (men, 11%; women, 29%); psychotic disorders (men, 8%; women, 23%) and substance misuse disorders (men, 66%; women, 69%). CONCLUSIONS: The prevalence of mental disorder among Indigenous adults in Queensland custody is very high compared with community estimates. There remains an urgent need to develop and resource culturally capable mental health services for Indigenous Australians in custody.

The insidious problem inside: mental health problems of Aboriginal and Torres Strait Islander People in custody.

OBJECTIVE: Despite recognition of the extremely high rates of mental illness among custodial populations and the fact that Indigenous people represent around one-quarter of Australia's custodial population, little is known about the mental health of Aboriginal and Torres Strait Islander people in custody. Mental health is an important component of social and emotional wellbeing for Indigenous people and this paper considers current evidence regarding the mental health status of Indigenous Australians in custody. METHOD: A systematic review was undertaken of the quantitative literature relating to the mental health problems of Indigenous people in custody in Australia. RESULTS: Despite high incarceration rates for Indigenous people and evidence that both mental health problems and rates of mental illness are extremely high in this group, studies in this area are few and limited in scope. CONCLUSION: The first step toward addressing the marked social and mental health problems for Indigenous people in custody is to systematically identify the nature and extent of these problems.