Mental health nursing and its practice with Aboriginal and Torres Strait Islander peoples in public mental health services : a multi-sited ethnography

Since the 1990s, significant problems with the public mental health services provided to Aboriginal and Torres Strait Islander peoples have been identified. Mental health professionals have been found to have had little understanding of Aboriginal and Torres Strait Islander culture, and this has often resulted in inappropriate treatment and care. The purpose of this multi-sited ethnography was to undertake an ethnographic analysis of the culture of mental health nursing in relation to its practice with Aboriginal and Torres Strait Islander users of public mental health services. Data collection, conducted between February 2014 and October 2016, involved interviews, observational fieldwork and document analysis. Observational fieldwork included participant observation at two Australia College of Mental Health Nurses conferences and nonparticipant observation in two public mental health services: (i) a regional mental health service; and (ii) an inner city mental health service. In-depth interviews were conducted with seventeen mental health nurses from across the country. Document analysis was undertaken of relevant documents, including historical documents related to the speciality. Mental health nurses practising in public mental health services described how the ideology of biomedical psychiatry dominated treatment and care. This dominance constricted mental health nursing practices to those that complemented biomedical interventions, stifling the development of culturally appropriate care for Aboriginal and Torres Strait Islander service users. While local and national attempts to improve mental health services for Aboriginal and Torres Strait Islander peoples focused on raising individual cultural awareness, the institutional culture in services was dominated by interventions which ignored culture and its implications or care and treatment. The research found that many mental health nurses were unclear about what form specialist practice would take in addressing social and emotional wellbeing for Aboriginal and Torres Strait Islander service users. The speciality of mental health nursing had not developed a clear knowledge base to support practice and the approaches to nursing care were disunited. Practice was constructed from individual nurse's belief and ideas and shaped by their experience of working in mental health services. Mental health nurses positioned the Aboriginal and Torres Strait Islander service user as Other both to themselves, and to non-Indigenous service users. Cultural difference and the legacy of colonisation, including its impact on the health of Aboriginal and Torres Strait Islander peoples, contributed to these beliefs of alterity. Despite an emphasis on difference, mental health nurses did not relate this to Indigenous ways of understanding ill-health using the concept of social and emotional wellbeing. While cultural differences were recognised, what they meant for the nurses or their nursing practice was interpreted in diverse ways. In these circumstances, approaches towards care for Aboriginal and Torres Strait Islander peoples varied considerably between mental health nurses.