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Relapse prevention in remote indigenous mental health

Nagel, Tricia (2008). Relapse prevention in remote indigenous mental health. PhD Thesis, Charles Darwin University.

Document type: Thesis
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Author Nagel, Tricia
Title Relapse prevention in remote indigenous mental health
Institution Charles Darwin University
Publication Date 2008
Thesis Type PhD
Subjects 1199 - Other Medical and Health Sciences
1701 - Psychology
Abstract This study was designed to provide important new information about relapse prevention in Indigenous1 people with chronic mental illness. A key cause of the burden of disease of mental illness is the high frequency of relapse of common mental disorders. National and international best practice guidelines recommend a range of biological and psychological strategies to prevent recurrence of mental illness. There is good evidence that many of these relapse prevention strategies improve outcomes, but there has been a paucity of clinical research into Indigenous-specific interventions. The study was conducted in two remote Indigenous communities in the Top End of the Northern Territory (NT). It targeted Indigenous clients, carers, and Aboriginal Mental Health Workers (AMHWs) and sought to answer two questions as follows: ‘can a culturally appropriate brief intervention be developed which incorporates local Indigenous perspectives of mental health and mental illness?’ and ‘does the brief intervention improve client mental health outcomes compared with treatment as usual’? Assessment, psychoeducation, and care-planning resources were developed with local AMHWs in the two communities. These were gathered into a focused brief intervention. The study then implemented a randomised trial of the intervention compared with ‘treatment as usual’. Clients were randomised to an ‘early treatment’ group, which received the intervention at baseline, and a ‘late treatment’ group, which received the intervention six months later. Client outcomes were assessed six monthly for eighteen months. Participants showed significant reductions in emotional distress and substance use and significant improvements in self-management. The results confirm that promotion of selfmanagement through psychoeducation and goal-setting is an effective relapse prevention strategy. The study contributes important new information about cross-cultural perspectives of mental health, and provides a strategy to deliver treatment in the remote setting that is brief and effective.


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