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1.18 Social and emotional wellbeing

Why is it important?

Social and emotional wellbeing is a holistic concept based on connections to country, culture, community, family, spirit and physical and mental health. For Aboriginal and Torres Strait Islander peoples, health is not just the physical wellbeing of the individual but the 'social, emotional and cultural wellbeing of the whole community' (SHRG 2004). Social and economic disadvantage is interconnected with historical loss of land (which was the economic and spiritual base for Aboriginal and Torres Strait Islander communities); damage to traditional social and political structures and languages; child removals; incarceration rates and inter-generational trauma (NPHP 2006). Experience of discrimination also leads to psychological distress and has a negative impact on health (Paradies et al. 2008). Indigenous Australians experience higher levels of morbidity and mortality from mental illness, psychological distress, assault, self-harm and suicide than other Australians.

Findings

The Health Survey and Social Survey collect information on a range of social issues relevant to the social and emotional wellbeing of Indigenous Australians. These surveys show that Indigenous Australians retain strong links to their traditional culture. In 2012–13, 63% of Indigenous Australians aged 18 years and over reported they identified with a clan or language group, 73% recognised an area as homelands/ traditional country and 86% felt accepted by other Aboriginal and Torres Strait Islander people. Family and community attachments are important factors in the lives of Indigenous Australians (see measure 1.13). In 2008, 89% of Indigenous Australians reported that they could get support from outside the household in time of crisis and approximately 89% reported that they had been involved in social activities in the last three months. In 2012–13, approximately 54% of Indigenous Australians aged 15 years and over reported that they and/or a relative had been removed from their natural family. Those who were removed from their family were more likely to have high levels of psychological distress (35%) than those never affected by family removals (26%).

Based on analysis of the 2008 Social Survey and the Household Income and Labour Dynamics in Australia Survey (AIHW 2014o), 53% of Indigenous Australians reported that they had 'been a happy person' all or most of the time in the previous four weeks compared with 61% of non-Indigenous Australians. Conversely, 51% of Indigenous Australians reported that they had 'felt so down in the dumps' nothing could cheer them up at least some of the time over the same period compared with 37% of non-Indigenous Australians. However, despite these reported lower levels of wellbeing, on a scale of life satisfaction ranging from 0 (completely dissatisfied) to 10 (completely satisfied) a higher proportion of Indigenous (41%) than non-Indigenous (32%) Australians reported a value of 9 or 10 (AIHW 2014o).

Having a health condition is associated with lower levels of emotional wellbeing (Kahneman et al. 2010). When Indigenous (and non-Indigenous) people reported that their health had improved, they also tended to report a rise in happiness and life satisfaction. Indigenous Australians who were employed tended to report higher levels of wellbeing than those who were unemployed or not in the labour force (AIHW 2014o). There was a weaker link between income and positive wellbeing for Indigenous Australians in remote areas compared with non-remote areas.

Psychological distress

Based on the 2012–13 Health Survey, most (70%) Indigenous adults had low/ moderate levels of psychological stress and 30% had high/very high levels. There was a statistically significant 3 percentage point increase in those reporting high/ very high levels of psychological distress since 2004–05. After adjusting for differences in the age structure of the two populations, the Indigenous rate of high/very high psychological distress was 2.7 times the rate for non-Indigenous adults. Indigenous women (36%) were significantly more likely than Indigenous men (24%) to report high/very high levels of psychological distress. Indigenous Australians living in non-remote areas were more likely to report high/very high distress levels (32%) compared with those in remote areas (24%). Those who reported excellent/very good health were less likely (24%) than those who reported fair/poor health (48%) to have high levels of psychological distress. High/ very high psychological distress levels were associated with lower income, lower educational attainment and unemployment.

Life stressors

In 2012–13, Aboriginal and Torres Strait Islander peoples reported high levels of stressors in their lives, with 73% of those aged 15 years and over reporting that they, their family or close friends had experienced at least one stressor in the previous 12 months. The most common stressors reported were the death of a family member or close friend (37%), serious illness (23%), inability to get a job (23%), mental illness (16%), or alcohol- related problems (14%). The proportion of the Indigenous population reporting at least one stressor was 1.4 times the non-Indigenous rate. People living in non-remote areas tended to experience a greater number of stressors on average (4) than those living in remote areas (3). Those living in non-remote areas were also more likely to have reported serious illness or disability, mental illness and/or involuntary loss of a job. Those living in remote areas experienced stressors such as the death of a family member or close friend and overcrowding more often than those living in non-remote areas. Research has shown that parental stress caused by factors such as unemployment and financial problems is associated with emotional or behavioural difficulties in children and decreased utilisation of health services for the child's needs (Ou et al. 2010; Strazdins et al. 2010).

Depression and racism

In 2012–13, 16% of Indigenous Australians reported they felt they had been treated badly in the last 12 months because they were Aboriginal and/or Torres Strait Islander. Rates of psychological distress were higher for this group (47%) than for those who reported that they had not been treated badly (27%). Research in the NT has found a significant association between interpersonal racism and depression among Aboriginal and Torres Strait Islander peoples after adjusting for sociodemographic factors. Lack of control, stress, negative social connections and reactions to racism such as feeling ashamed or powerless were each identified in the relationship between racism and depression (Paradies et al. 2012). A study of 755 Aboriginal Victorians also found an association between reported racism and psychological distress (Kelaher et al. 2014).

Social and emotional wellbeing of children

The Longitudinal Study of Indigenous Children (LSIC) included a module on Strengths and Difficulties. In Wave 4, Indigenous boys had higher average behavioural and emotional difficulties scores (13) than girls (11.4) (LSIC 2013). These difficulty scores were higher than scores obtained from studies of the general population (ranging from 9 to 9.9 for boys and from 7.5 to 7.7 girls) (Hawes et al. 2004; Mellor 2005). Caution should be used in comparing these studies as they covered different geographies and ages. In Wave 3 of LSIC, 23% of children had scores putting them in the high-risk category for developing clinically significant behavioural problems (LSIC 2012). The 2001–02 Western Australia Aboriginal Child Health Survey (WAACHS) reported that 26% of Indigenous children aged 4 to 11 years were at high risk of clinically significant behaviour problems compared with 17% of non-Indigenous children (De Maio et al. 2005). Another study (NSW Health 2005) found that 23% of Indigenous children aged 5 to 15 years in NSW were at a high risk of emotional or behavioural difficulties. In Wave 4 of LSIC, the main risk factors found to have the greatest impact on the surveyed children's social and emotional difficulties scores, were a close family member having been arrested, been in jail or had problems with the police; the children being cared for by someone else for at least a week as opposed to remaining constantly with their regular carers; and children being scared by other people's behaviour. These intra-family factors were more significant than many commonly assumed social factors, such as illness, housing problems and money worries (LSIC 2013).

Mental health conditions

Mental health related conditions accounted for 3% of deaths among Indigenous Australians over the period 2008–12 in NSW, Qld, WA, SA and the NT combined. Of these deaths 54% were for organic mental disorders (injury or non-psychiatric illness affecting the brain), and 31% were for mental and behavioural disorders due to psychoactive substance use. After adjusting for differences in the age structure of the two populations Indigenous Australians died from mental health related conditions at 1.2 times the non-Indigenous rate.

In the period July 2011 to June 2013, mental health related conditions were the principal reason for 8% of hospitalisations (excluding dialysis) for Indigenous Australians. Indigenous men were hospitalised for mental health related conditions at 2.3 times the rate of non-Indigenous males, and Indigenous females at 1.7 times the rate for non-Indigenous females. Since 2004–05, there has been a 40% increase in hospitalisations for mental health related conditions among Indigenous Australians in the six jurisdictions with adequate data for trend reporting (NSW, Vic, Qld, WA, SA and the NT combined). Rates among non-Indigenous Australians remained static over this period, resulting in a 144% increase in the difference between Indigenous and non-Indigenous rates. The most common reasons for mental health related hospitalisation were mental and behavioural disorders due to psychoactive substance use (37% of episodes), schizophrenia (23%), mood disorders (15%), and neurotic, stress-related disorders (15%). Indigenous hospitalisation rates for mental health related issues were highest in the 25–54 year age groups. Rates were lowest in inner regional (22 per 1,000 population) and very remote areas (23 per 1,000 population) and were highest in remote areas (37 per 1,000 population). Rates varied between jurisdictions. The highest rates were for SA (48 per 1,000) and the lowest for Tasmania (11 per 1,000).

GP survey data collected from April 2008 to March 2013 suggest that 11% of all problems managed by GPs among Indigenous patients were mental health related problems. After adjusting for differences in the age structures of the two populations, Indigenous Australians had mental health problems managed by GPs at 1.3 times the rate for other Australians. Depression was the most frequently reported mental health related problem managed by GPs among Indigenous Australians, followed by anxiety, and then use of tobacco, alcohol and other drugs. Depression and anxiety were the leading mental health related problems managed for other Australians.

Suicide

For the period 2008–2012, among Indigenous Australians in the jurisdictions with adequate data quality (NSW, Qld, WA, SA and the NT combined), there were 561 suicides. This accounted for approximately 5% of deaths among Indigenous Australians at a rate of 19.3 per 100,000 population. Among Indigenous Australians, 73% of suicides were among males. After adjusting for differences in the age profile of the two populations, the Indigenous suicide rate was around twice the rate for non-Indigenous Australians. Among Indigenous Australians aged 15–19 years, the suicide rate was 5 times the non-Indigenous rate. An ABS analysis of suicide data for the 10 years from 2001 to 2010 found that an average of 100 Indigenous Australians ended their lives through suicide each year over the period (ABS 2012c). During 2008–2012, approximately 88% of Indigenous suicides occurred before 45 years of age. This pattern is different among non-Indigenous Australians, with 50% of suicides occurring at less than 45 years of age. After the age of 50, Indigenous suicide rates drop below the suicide rates for non-Indigenous Australians. There has been no significant change in suicide death rates among Indigenous Australians between 1998 and 2012 in NSW, Qld, WA, SA and the NT combined. Research in the NT has shown that Indigenous suicide rates increased significantly between 1981 and 2002 and particularly from the mid-1990s while the non-Indigenous suicide rate remained relatively stable over this period (Measey et al. 2006). More recent data from the NT shows no significant change between 2001 and 2012.

In 2012–13 there were 2,536 hospitalisations among Indigenous Australians for non-fatal intentional self-harm, this represented 3% of Indigenous hospitalisations over this period (SCRGSP 2014a). Rates were higher for Indigenous females (437 per 100,000 population) compared with males (318 per 100,000) and were higher in remote areas (426 per 100,000 population) compared with other areas (389 per 100,000 in major cities and 346 per 100,000 population in regional areas). After adjusting for differences in population age structures, Indigenous Australians were hospitalised for self-harm at 2.7 times the rate of non-Indigenous Australians.

In 2001–02, as part of the WAACHS, young people aged 12–17 years were asked about suicidal thoughts and suicide attempts. Suicidal thoughts were reported by around 1 in 6 (16%) of these young people in the 12 months prior to the survey. A higher proportion of Aboriginal girls reported they had seriously thought about ending their own life than Aboriginal boys (20% compared with 12%). Of those who had suicidal thoughts in the 12 months prior to the survey, 39% reported they had attempted suicide in the same period. The proportion of Aboriginal children who reported suicidal thoughts was significantly higher among those who smoked regularly, used cannabis, drank to excess in the six months prior to the survey, were exposed to some form of family violence, or who had a friend who had attempted suicide.

Implications

The policy responses to social and emotional wellbeing need to be multidimensional and involve a wide range of stakeholders including families and communities, the health sector, housing, education, employment and economic development, family services, crime prevention and justice, and Aboriginal Community Controlled Health Organisations. Strategies that build on the strengths, resilience and endurance within Aboriginal and Torres Strait Islander communities and recognise the important historical and cultural diversity within communities are recommended (SHRG 2004). Recent suicide prevention studies have identified the need to focus on protective factors, such as community connectedness, strengthening the individual and rebuilding family, as well as culturally based programmes that include traditional elements (Tighe et al. 2012; Dudgeon et al. 2012).

The Aboriginal and Torres Strait Islander Healing Foundation is building the evidence base on the value of healing programmes that connect people with cultural traditions to address social and emotional wellbeing. The Foundation is also building a trauma- informed workforce, developing skills such as conflict mediation, suicide prevention, mental health, first aid and lateral violence prevention (Training and Education Volume 2 Healing Foundation 2014). The Foundation has invested $4 million in workforce and community development projects across almost 50 communities, to increase capacity to understand, cope with and respond to people experiencing trauma, loss and grief. The Healing Foundation activities report showed that 94% of participants had improved social and emotional wellbeing, 73% increased their capacity to manage the impacts of trauma, and 60% increased their access to support services following healing activities (Healing Foundation 2014).

The Indigenous Advancement Strategy—Safety and Wellbeing programme provides funding for strategies known to enhance community safety and support Indigenous wellbeing. In 2014–15 this included funding of $39.7m for social and emotional wellbeing services and workforce support. Work to renew the Social and Emotional Wellbeing Framework is also underway. Suicide prevention investment for Indigenous Australians is also provided by the Australian Government:

  • Approximately $4.9m committed under the National Suicide Prevention Programme to specific services for Aboriginal and Torres Strait Islander Australians.
  • $1.2m committed under the Taking Action to Tackle Suicide package for specific suicide prevention activity targeting Aboriginal and Torres Strait Islander peoples.

The Alive and Kicking Goals (AKG) programme is an innovative and award winning suicide prevention programme targeting youth at risk in regional (West Kimberly) WA. The programme is the first of its kind that is evidenced-based, wholly owned and led by young Aboriginal women and men. AKG aims to save young lives through building positive help-seeking attitudes; culturally secure peer education and support network.

Figure 1.18-1 Proportion of people reporting high/very high levels of psychological distress, by Indigenous status and age group, persons aged 18 years and over, 2012–13
chart showing people reporting high levels of psychological distress

Figure 1.18-1 shows the proportion of Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians aged 18 years and over who reported high or very high levels of psychological distress. Data is presented for the following age groups: 18-24 years; 25-34 years; 35-44 years; 45-54 years; 55 years and over; and the total age-standardised proportion. After adjusting for differences in the age structure of the two populations, the Indigenous rate of high/very high psychological distress was 2.7 times the rate for non-Indigenous adults.

Note: totals are age-standardised

Source: ABS analysis of the 2012–13 AATSIHS

Figure 1.18-2 Happiness and sadness, by labour force status, Indigenous Australians aged 15 and over, 2008
chart showing Happiness and sadness

Figure 1.18-2 shows Indigenous Australians who were employed tended to report higher levels of wellbeing than those who were unemployed or not in the labour force

Source: Adapted from the AIHW Indigenous Observatory (AIHW 2014o)

Figure 1.18-3 Relationship between high/very high levels of psychological distress and social factors, Indigenous Australians, 2012–13
high/very high levels of psychological distress and social factors

Figure 1.18-3 shows high/very high psychological distress levels were associated with lower income, lower educational attainment and unemployment.

Source: ABS analysis of the 2012–13 AATSIHS

Figure 1.18-4 Mortality from suicide rates per 100,000, by Indigenous status, sex and age group, NSW, Qld, WA, SA and the NT, 2008–12
chart showing mortality from suicide rates

Figure 1.18-4 shows suicide-related mortality rates (per 100,000 population) among Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians in NSW, Qld, WA, SA and NT for the period 2008–2012. Data is presented for the following age groups: 15-24 years; 25-34 years; 35-44 years; 45-54 years; 55-64 years; 65-74 years; 75 years and over; and the total age-standardised proportion. The rate ratio for each age group is also shown. After adjusting for differences in the age profile of the two populations, the Indigenous suicide rate was around twice the rate for non-Indigenous Australians. Among Indigenous Australians aged 15–19 years, the suicide rate was 5 times the non-Indigenous rate.

Source: AIHW and ABS analysis of National Mortality Database

Figure 1.18-5 Proportion of people reporting selected stressors, by remoteness area, Indigenous persons aged 15 years and over, 2012–13
chart showing proportion of people reporting selected stressors

Figure 1.18-5 shows the proportion of Aboriginal and Torres Strait Islander peoples aged 15 years and over reporting selected stressors. Data is presented separately for non-remote and remote areas. People living in non-remote areas tended to experience a greater number of stressors on average (4) than those living in remote areas (3).

Source: ABS analysis of the 2012–13 AATSIHS

Figure 1.18-6 Age-standardised hospitalisation rates for mental health related conditions, by Indigenous status, 1998–99 to 2012–13
chart showing age-standardised hospitalisation rates

Figure 1.18-6 shows age-standardised hospitalisation rates for mental health-related conditions (rate per 1,000). Data is presented for Aboriginal and Torres Strait Islander peoples in Queensland, WA, SA and NT from 1998-99 to 2012–13; Aboriginal and Torres Strait Islander peoples in NSW, Victoria, Queensland, WA, SA and NT from 2004-05 to 2012–13; non-Indigenous Australians in Queensland, WA, SA and NT from 1998-99 to 2012–13; and non-Indigenous Australians in NSW, Victoria, Queensland, WA, SA and NT from 2004-05 to 2012–13. Since 2004–05, there has been a 40% increase in hospitalisations for mental health related conditions among Indigenous Australians in the six jurisdictions with adequate data for trend reporting (NSW, Vic, Qld, WA, SA and the NT combined). Rates among non-Indigenous Australians remained static over this period, resulting in a 144% increase in the difference between Indigenous and non-Indigenous rates.

Source: AIHW analysis of National Hospital Morbidity Database

Figure 1.18-7 Age-specific hospitalisation rates for mental health related conditions, by Indigenous status, July 2011–June 2013
chart showing age-specific hospitalisation rates

Figure 1.18-7 shows hospitalisation rates for a principal diagnosis of mental health-related conditions among Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians for the period July 2011 to June 2013. Data is presented for the following age groups: 0-4 years; 5-14 years; 15-24 years; 25-34 years; 35-44 years; 45-54 years; 55-64 years; and 65 years and over. Indigenous hospitalisation rates for mental health related issues were highest in the 25–54 year age groups.

Source: AIHW analysis of National Hospital Morbidity Database