Challenges to relapse prevention: Psychiatric care of Indigenous in-patients

Abstract Relapse is one of the major contributing factors to the high burden of disability of mental illness. Strategies for relapse prevention are needed. Aboriginal and Torres Strait Islander people continue to be over-represented in mental health care nationwide. Partnerships between Aboriginal Mental Health Workers (AMHWs) and non-Indigenous health professionals can assist in provision of culturally appropriate in-patient care and promotion of self-management and relapse prevention strategies. The Australian Integrated Mental Health Initiative in the Northern Territory (AIMhiNT) aims to improve outcomes for Indigenous people with mental illness. This article reviews the quality of care provided in the Top End in-patient setting, and the involvement of AMHWs in the care of Indigenous people who are hospitalised for mental illness. Findings from a series of clinical file audits (1995, 2001 and 2004) at Royal Darwin Hospital in-patient unit are presented. The files were audited for assessment and care planning activities. The audits reveal that significant improvements in in-patient care between 1995 and 2001 were not sustained in 2004. Recording of social history, and appointment of a case manager, were less likely to occur in 2004 compared with 2001, for both non-Indigenous and Indigenous clients. AMHWs were involved in the care of only 55% of Indigenous clients. Busy in-patient units are at risk of focusing on acute care to the detriment of relapse prevention activities and culturally appropriate care. There is a need to develop models of practice that support relapse prevention for in-patient clients. Key strategies will include improved communication with clients, development of self-management skills, and enhanced partnerships with Indigenous service providers.