Decolonial Research Practices in Mental Health: An Australian based perspective towards diversity inclusive research
Tegan Stettaford, University of Newcastle
The mental health of individuals has become solidified as an undoubtably important aspect of achieving positive quality of life—or so might be the perspective of those from westernised and individualistic cultures. Decolonial perspectives challenge this mainstream thinking to reconsider normative views of domains such as mental health and reinvent this as applicable to minority populations. Decolonial perspectives and practices in mental health require a multimodal and holistic approach to overcome existing barriers. This is essential to achieve steps towards human rights via the improvement of care. Decolonial perspectives will be explored in Indigenous populations of Australia and other global cultures, with consideration to the biomedical model, policy, and reimagined expertise.
When considering decolonial perspectives in mental health research, it is imperative to consider the Aboriginal and Torres Strait Islander Peoples of Australia. Australia’s colonial history is plagued by immeasurable wrongdoings that were inflicted onto the Indigenous Peoples of this land; from abuse, to slavery and the stolen generation, the collective trauma experienced by this population has resulted in their way of life reaching the brink of extinction (Cunneen & Libesman, 2000; Krieg, 2009). Historical attempts to eradicate culture and spirituality via assimilation into western civilisation has had many profound implications for these communities. One of the many domains impacted for Indigenous Australians is mental health, stemming from generational trauma. Unfortunately, attempts to amend these adversities have followed that of our WEIRD (Western, Educated, Industrial, Rich, and Democratic) practices. Consequently, the collectivist nature of Indigenous Australians lives have been impacted (Miller, 2018). The statistics reiterate this bleak story; a 32% increase in Indigenous suicide rates occurred between 1998 and 2015, depicting the unsuccessful reparations of trauma and ineffective mental health care for this population (Coe, 2021).
One of the key components inhibiting the decolonialisation of mental health is the popularity of the biomedical model. This model focuses on the blatant presence of illness, ‘boxing’ people into categories of well or unwell. This compartmentalist approach fragments the individual lives, bodies and spirits of people, which opposes the world views of Indigenous Australians (Garvey, 2008). This approach is detrimental to the effectiveness of care received as it is not consistent with the world-view of Indigenous People and thus is ineffective. There has been recent progress in realising the inapplicability of this method for Indigenous Australians, with a current push to implement a holistic approach, such as SEWB – Indigenous Social and Emotional Wellbeing (Brockman & Dudgeon, 2020). SEWB recognises that many mental illnesses cannot be understood without understanding the circumstances of oppression that foster them (Coe, 2021). Further, adjustment to service practice that incorporates a collaborative approach; involving the ‘family’ effort of health professionals, the individual and their loved ones, pushes back against western medical norms (Fay, 2018). There has been increasing recognition that some psychological disorders (e.g. distress) are products of the ongoing processes of colonialism, and are often healthy or legitimate responses to social structures (Coe, 2021). Moving away from the biomedical model is one step towards a decolonial approach to mental health with the integration of biomedical-opposing approaches into policy allowing for a strengthened response.
Australia’s decolonial history has demonstrated the ability for policy to harm the livelihood of Indigenous Australians exhibited by historical assimilation policies. With more recent recognition of the disparities between Indigenous and non-Indigenous mental health outcomes, government policies have begun to recognise this concern (Booth & Carroll, 2005). A recent study has considered the application of holistic and appropriate mental health approaches within such policies (Coe, 2021). Of the four relevant policy documents examined, the SEWB approach was represented as being a critical approach to decolonial mental health for Indigenous Australians advocating for the integration of this method into current mental health services. Unfortunately, the continued reliance on biomedical health services (e.g., GPs) to be the site in which mental health care occurs, sees a continued influence of western culture (Bacchi, 2009). Further, it is acknowledged that policy is not always translated into practice. There is a need to actively implement policy into services before seeing positive effects. Despite barriers of foregoing the continued western influence, the integration of SEWB into policy to inform practice is a step forward in the right direction for the decolonisation of mental health and well-being.
Decolonial processes around mental health are taking place outside of Australia, including Uganda, Chile, and Africa. These countries often find themselves grappling with similar barriers, such as over reliance on the biomedical model but considerations must be taken in the uniquity of their individual cultures and historical circumstances (Jara & Pisani, 2020). A study based in Africa emphasised the need to interrogate power dynamics, being the role of the physician versus the role of the client, to ensure a decolonial process of mental health care (Horn, 2020). A reconsideration of who knows best and who holds expertise is central to this process. An example was depicted in this study, whereby input was sought from feminists in the region around gender concerns, sexual health and abuse which were causing mental turmoil to the community. These experts were found to be key in decolonising the traditional, western practices of psychology via a culture relevant perspective (Horn, 2020). This example promotes the concept that education and traditional expertise is not always the appropriate way to help Indigenous people improve mental health outcomes. Co-development and integration of voices from those with lived experience are essential to gaining mental well-being.
There are many barriers in the road to decolonising mental health care and well-being practices with Indigenous Peoples. Deconstructing the westernised biomedical model, enforcing relevant and appropriate health care policies and integrating the voices of those most knowledgeable encompass the start of a holistic approach to decolonial mental health care. Further progress is needed to persevere in these areas to overcome the multitudes of barriers that see western ideals dominate practice. Conclusively, the creation of a holistic, multimodal and culturally inclusive decolonial mental health care system will provide Indigenous Peoples inclusion back into their culture and into positive health outcomes.