PhD Candidate: Gregory Goodluck
Faculty: Education, Health and Sciences
School: Health Sciences
University: Charles Darwin University
1. Field of research code
2. Thesis Title
Cross Cultural Co-Contributions to Holistic Community Mental Health Work.
3. Description of the issues to be addressed
This study aims to see how better mental health outcomes can be delivered to Indigenous and non-indigenous communities as a result of cross-cultural dialogue.
The purpose of this study is to contribute to the investigation of the cultivation of social and intellectual space in which to develop holistic mental health services for the pluralistic and multicultural society we all share today.
The key area of interest to this research proposal is the development of holistic cross-cultural mental health work. This study will explore ways to develop the best, most effective, practices cross-culturally without being prescriptive, paternalistic, assimilationist, simplistic or exploitative. The impetus for this study arose from the experiences and questions drawn from the researchers’ direct participation in mental health service planning, training and delivery.
Candidate’s Background and Credentials
The candidate-researcher is an accredited Social Worker and Conditionally Registered Psychologist (NT) who has worked in mainstream Community Mental Health Services, Non Government Organisations (NGOs) and private practice. He is currently employed as a Counselling Psychologist in an NGO, in private practice as a Medicare registered Mental Health Social Worker and an Employee Assistance Program (EAP) contract Psychologist in a Remote Community (Groote Eylandte). He has a life-long history of contact with Indigenous people, developed and delivered Vocational and Educational Training (VET) sector training, under the Australian Quality Training Framework (AQTF), in Community Mental Health Work for Indigenous people from NT remote communities through a Registered Training Organisation (RTO). The candidate-researcher was born in Darwin and has lived the Northern Territory for at total of more than 15 years including experience working with indigenous communities and as a trauma counselor with refugees.
Theoretical Problem: To seek and explore what can be shared between cultures for the improvement of the mental health of all communities. This entails finding out what hybrid or new knowledges, understandings and practices are arising and/or can arise to assist both indigenous and non-indigenous communities with community mental health service provision. Central to this task is developing and maintaining guidelines for sharing holistic cross-cultural mental health knowledge respectfully and to best effect.
Aims of the Research:
The purpose of this study is to explore the development of culturally safe and efficacious practices and protocols for community mental health inclusive of the folk wisdom, strengths and world views of the communities accessing mental health services.
This will include investigation of possibilities for developing accessible, holistic community mental health services that include indigenous spirituality and cultural ways, along with established mainstream complimentary healing systems complimentary to the official bio-psycho-social model of mental health work. The precise direction of the later aspects of research will depend on initial findings of grounded research into the wishes of the indigenous communities involved.
The National Health and Medical Research Council’s Values and Ethics: Guidelines for Ethical Conduct in Aboriginal and Torres Strait Islander Health Research (2003) emphasises the importance of Reciprocity, Respect, Equality, Responsibility, Survival and Protection…[and] Spirit and Integrity, when conducting research with Aboriginal communities. A central aim of this research is to uphold, via its methods, all these empowering and egalitarian values in the context of seeking understandings of intrinsic and shared knowledge of healing practices for cross cultural community mental health work.
Mental Health Services Problems
World-wide, Mental Health Services are struggling to adequately address a growing epidemic in mental health problems. The promises of new medications of the 1950’s and the Community Mental Health Movement begun in 1960’s have failed to cure mental illnesses (Gaynor 2003; Morris 2006; Senate Select Committee 2006). A Darwin Psychiatrist recently wrote: "Modern psychiatry is in a state of intellectual collapse…each of the major theories in psychiatry is so flawed as to be beyond salvation.” (McLaren, 2007).
Many sources site a gross failure of Australian mental health systems to adequately stem the increasing prevalence of mental illness in all segments of Australian society (Morris 2006; Senate Select Committee 2006). Some argue that the reason’s for mental health services failures relate to inadequate funding, closure of hospital beds and a lack of resources for community mental health programs (Rosen 2006; McGorry 2005). There is a case for more holistic approaches to Mental Health providing better outcomes (Barker, 2003).
A holistic approach
While scientific advances in biological concomitants of mental health and illnesses are important, subjective experiences within social contexts are at least as important to Mental Health Work outcomes. To those who suffer mental illness the subjective quality of their experiences are of central importance. Of value are mental health systems responding to underlying personal, social and cultural contexts as well as bio-medical factors, rather than a homogenising biological focus. Furthermore to provide a complete, objective, realistic and effective paradigm to understanding health (including mental health) the subjective factor of spirituality should be included (Peach 2003).
Cross-Cultural Mental Health and Holism
The recently emerging fields of Cross-Cultural Psychology (University of Melbourne), Trans-cultural Mental Health (Queensland Trans-cultural Mental Health Service), Multicultural Mental Health (MCMAP SA) and Ethno-Psychiatry (http://www.ethnopsychiatrie.net/English.htm) include the Cultural dimension to form a Bio-Psycho-Social-Cultural model of mental health work. Conventionally a person’s spirituality is conceptually subsumed under the heading of the Cultural. Elsewhere the Cultural is subordinated to the concept of the Social which is in turn often submerged under Psychological which often then gets reduced to the Biological and the Physical. Examples of this reductionism can be found in the language of Medicare regarding allied health workers providing mental health work, for example limiting Social Work services to the category of providing Psychological Strategies.
The Better Access program of the medical benefits scheme funded by the Coalition of Australian Governments (COAG) has made access to mental health Social Workers and Occupational Therapists possible under Medicare. However, the services the Social Workers and Occupational Therapists can provide are "Focused Psychological Strategies” with an individual, not a social, perspective. The Australian Federal Government Department of Health and Aging (DHA, 2007) states:
A range of acceptable strategies has been approved for use by allied health professionals utilizing the Focused Psychological Strategies items. These are: 1. Psycho-education …2. Cognitive-Behavioural Therapy… 3. Relaxation strategies … 4. Skills training…5. Interpersonal Therapy… There is flexibility to include narrative therapy for Aboriginal and Torres Strait Islander people.
The fact that Social Work Interventions are supported by Medical Benefits Scheme, including Narrative therapy for Aboriginal and Torres Strait Islander people is a remarkable recent development heralding further paradigm shift possibilities towards holistic approaches within Cross-Cultural Mental Health Work.
National Mental Health Practice Standards
The national Mental Health Practice Standards require mental health workers to, recognize the 'lived' experience,…[and] rights… of clients and carers, [and].. be sensitive to, and modify approaches in keeping with, social, cultural, linguistic, spiritual, gender and age differences. (Australian Government National Mental Health Education and Training Advisory Group, 2002). This makes it clear that the mental health services own code of practice upholds the importance of 1) people’s ‘lived’ experience, 2) human rights, 3) sensitivity to diversity including spirituality.
Indigenous World view
The traditional Aboriginal way is not to divide the world up into parts pieces (Goodluck, 1980). Theirs is a holistic approach to health rather than an analytical; Dudgeon et. al, 2002). Instead the world is understood through stories using a different form of reasoning called narrative reasoning with its own narrative logic, rather than analytical logic (Goodluck, 1980). Viewing the world from a holistic framework and avoiding reductionism, some Aboriginal Health services (e.g. Nunkuwarrin Yunti, SA; Danila Dilba, NT).prefer to use the term "Social and Emotional Wellbeing” when dealing with what might otherwise be named as mental health issues.
The Aboriginal Social and Emotional Health and Wellbeing Service in Adelaide, Nunkuwarrin Yunti now offers a nationally AQTF accredited training in Narrative Practices for Aboriginal People which many Indigenous communities are favouring (White, 2006). The field of Narrative Therapy arising out of Adelaide (e.g. White & Epstein, 1990; White 1990; 1995) is internationally recognized as an appropriate strengths based approach to counseling and community work.
It is important for good outcomes to empower Indigenous groups to define their own goals, processes and outcomes. The National Aboriginal Community Controlled Health Organisation’s (NACCHO, 2006) position on mental health is:
Culture and Mental Health
The differential of cultural understandings between a mental health practitioner and someone in receipt of their service can be wildly separate even if they share a common ancestry and broad social norms and beliefs. Variations within societies are broad, for example the educated mental health worker may have a different culture from the uneducated client. The highly educated client may have a different culture from the narrowly educated practitioner, for example. A highly educated person in one culture may be viewed as grossly ignorant by members of another culture and vice versa.
There are opportunities for studying the clash of world views, the misunderstandings and debilitating disenfranchisements that occur when a dominant culture claims intellectual primacy over another, relegating its content to mere "primitive” vestiges of bygone eras, which ideology of imperialist paternalism, when internalized by the oppressed culture seriously contributes to the social and emotional degradation and mental illness of the community because it undermines their core psychological structures, their culture, laws and social mores (Trudgeon, 2000).
There may be opportunities to explore the viability of applying holistic, indigenous-derived Western consciousness taxonomies, explorations and healing methods of Westerners like the Integral studies of Ken Wilber (1998; 2000), the Core Shamanics of Michael Harner (1997; 1999) the Human Potential movement of Jean Houston PhD and Robert Masters PhD, (1972; 2007) and Process Psychology (Moss, 1996; Roy, 2000) (to name just a few) for psychological wellbeing and psycho-cultural health and integration of indigenous and non-indigenous individuals and communities.
Michael Harner (1980) says:
Over tens of thousands of years, our ancient ancestors all over the world discovered how to maximize human abilities of mind and spirit for healing and problem-solving. The remarkable system of methods they developed is today known as "shamanism," a term that comes from a Siberian tribal word for its practitioners: "shaman" (pronounced SHAH-mahn). Shamans are a type of medicine man or woman especially distinguished by the use of journeys to hidden worlds otherwise mainly known through myth, dream, and near-death experiences.
Spirituality and Mental Health
The Physician and Psychiatrist Dr. Carl Gustav Jung (1933; 1938; 1939). took pains to point out that psyche means soul in the Greek and that the work of psychotherapy or (mental health work), is to integrate or individuate (reverse the division of) the elements of the psyche or soul. This can fit with an indigenous world view which seeks to fit the individual within the landscape of their soul, in the context of the physical environment, community and cultural and spiritual understanding (Dudgeon et al, 2000; Reid, 1983).
Many post Jungians such as James Hillman (1992; 1997; 2004), Thomas Moore(1994), David Tacey (1995; Roll, 1998) and the Jung inspired Celtic aficionados, Caitlan and John Matthews (2004) provide maps and pathways for wellbeing via Archetypal Psychology and Mythical imagination utilizing story and creative visualisation. The Dulwich Centre in South Australia has taken Narrative Therapy to the world by recognizing the power of story in the psyches of people to create or undermine mental, emotional and social health and wellbeing (e.g. White, 1992; 1995).
The irony is that large sections of Western society seek more spirituality and while Western society overlays what professes to be a secular, demystified form of culture and treatment on peoples for whom spirituality and culture have been central to their lives. Perhaps Indigenous communities can assist disenchanted Westerners towards that which clergyman Thomas Moore(1996) called the re-enchantment of everyday life and help us to decode what his mentor, Psychologist James Hillman (1997) called the soul’s code. Western theoretical constructions can assist with holistic understandings of the mythic processes within cross-cultural psychotherapy and mental health work.
New Transcultural Fusions Emerging
There is fruitful intellectual ground emerging in the dynamic tension between scientific reductionism and expansive, unifying holism, for example in the work of contemporary integral thinkers (Wilber 1998; 2000). Western notions of holistic mental health are developing out of the need in our society to gather in the missing bits of our culture and how we construct our view of the world and evaluate experience. Reclaiming Social, Cultural and Spiritual dimensions to the human experience is a key to the better understanding and treatment of mental illnesses. However, this practice of putting the bits together, paradoxically sits within a reductionistic paradigm while attempting holism. It is bitsy, not holistic, dealing with parts in isolation and clumsily put together. This is a necessary step in developing an appreciation of true holism (Wilber, 2000).
Furthermore and somewhat Ironically, the practice of gathering in the lost bits of our humanity is analogous to the Indigenous practices of soul retrieval (Harner 1980; 1999) which the Ngangkari (Traditional Healers) of Central Australia employed by Ngaanyatjarra Pitjantjatjara Yankunytjatjara (NPY) Women's Council Aboriginal Corporation do for mental health clients (NPY, 2003; Alice Springs News, 2004). They go and look for pieces of the departed soul and return them to the person who is said to have had a greatly improved physical, mental and emotional state as a result (NPY, 2003). Michael Harner (1997; 1999) says we (non-indigenous) should sit at the feet of the indigenous healers for the sake of our own people. There is much to be learned from the strengths within Indigenous societies despite the problems that exist. A strengths perspective (Saleeby, 2006) can ensure that we can consult and engage without exploiting or oppressing communities further.
Using a Narrative Therapy and community work practices approach to consultation (White & Epston, 1990; White, 1990) can ensure respectful sharing and acknowledgement of strengths and resources within communities. This approach can bring about real mutual benefits in an era of mutual obligation rhetoric. Acknowledging and utilising capacity within communities by facilitating process that draw on inherent strengths can benefit communities by increasing collective self esteem and faith, in their own capacities and insight and access to resources – including their own internal community resources, external and combined resources. Carrying out research in this way upholds the values of Reciprocity, Respect, Equality, Responsibility, Survival and Protection, and Spirit and Integrity called for in the NMHRC Guidelines for Ethical Conduct in Aboriginal and Torres Strait Islander Health Research (2003).
Social Work Perspectives
Social work is the study of the interface between the individual’s lived experience and the systems in which they live and interact (Lee, 2001; Poulter, 2005a). The science of social work is particularly useful to this research because it is holistic, reflexive using praxis and responding to what is occurring in communities from a social justice ethical framework. Social work provides useful approaches to the research problems because social justice is central to social work. Social work is useful in the context of this research because it provides theoretical and practical frameworks for addressing social disadvantage. Two key perspectives are the strengths perspective (Saleeby, 2006) and the empowerment approach (Lee, 2001).
A strengths perspective and an empowerment approach are important to positive mental health outcomes in communities and to this research, as the communities we are dealing with typically experience chronic compound disadvantage on many levels. The research program aims for the result to be strengthening and empowering communities to stand in their strengths and access their power and therefore the positive mental health outcomes linked to empowerment and utilizing strengths, such as enhanced self esteem and self efficacy.
Social work is particularly useful to holistic approaches because it combines the social context with the individual’s experience. compatible with a strengths perspective (Saleeby, 2006), narrative therapy (White, 1990) refines the strengths perspective in the area of interviewing and consulting with subjects. The eclectic reflective-pluralism or heuristic paradigm of Poulter (2005a; 2005b; 2006) encourages appropriate application of a plurality of practice models within given situations according to the unique characteristics of persons, situations and problems, reflexively tested in situ for goodness of fit. Within a social work framework, a reflexive model that works with communities using praxis (Freire, 1971) to hypothesis test as you go, adopts the attitude of, What do you need? Try this. How do you like this? Does this do it for you? If not what else might work? This approach is compatible with the action-research (Davvyd & Levin, 1998; Sherman & Torbert, 2000) model currently popular in community work to develop test and adjust community work programs interventions.
The most important thing is to help communities without disempowering them, but still being effective. There are ways to do research and service provision without undermining or disempowering a person or a people which frequently happens to Aboriginal persons (Goodluck J., Personal Communication, June 15th, 2006). That kind of disempowerment is an example of the widespread problem of institutionalized cultural imperialism and cultural hegemony found in all societies built on the mechanics of oppression as explained by Freire (1971; 1973; 1975; 1994).
The holistic outlook of social work allows a plurality of responses to a pluralistic society, promoting strengths and empowerment. An approach summarized by Poulter (2005a, 44)
Heuristic social work practice is not simply eclecticism. It might more appropriately be termed as ‘reflective pluralism’ as it is necessarily reflective, consciously using a plurality of frameworks and is change oriented…. It is not simply a focus on individual change and growth but a focus also on the individual’s potential to contribute to change systems impacting on them.
Holistic Bio-Psycho-Socio-Cultural-Spiritual Mental Health Work
A task of this research is to develop a holistic model inclusive of the bio psycho social cultural and spiritual factors involved in mental health and illness. Within a holistic cross-cultural framework for mental health services some of the issues to be explored are: