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The nature of the tensions and disjunctures between aboriginal understandings of and responses to mental health and illness and the current mental health system Smye, Victoria L.

Abstract

Aboriginal peoples continue to be affected by the mental health policies, structures, and social organization of the dominant culture which tends to exclude them. This study explored the nature o f the tensions and disjunctures between Aboriginal understandings of and responses to mental health and illness and the current mental health system. Using an ethnographic design informed by postcolonial and critical perspectives, in-depth individual interviews were conducted with Aboriginal people working in mental health and related fields; policy makers, both Aboriginal and non-Aboriginal; and nurses. A focus group interview was also conducted with health care providers (N=31). The 1998 Mental Health Plan and several documents of reform were also critiqued. Incorporating aspects of postcolonial theories, this study illustrates how dominant culture ideologies, mental health institutional policies, and everyday practices intersect to shape the tensions and disjunctures. Using the interview data and policy critiques, I describe how mental health institutions and policies support the embeddedness of an assimilation ethos - revealed as paternalistic care, ethnocentrism, and the notion of [im]partial policy decision-making. Aboriginal perspectives are largely excluded vis à vis the intersection of the dominance of the biomedical model (i.e., psychiatry) and the ongoing jurisdictional debate regarding who is responsible for Aboriginal mental health. Dominant cultural frameworks and a lack of clarity about who provides what are interwoven and reproduced in the everyday world of mental health service delivery, being marked by acts of omission, colonial ambivalence, and the normalization of Aboriginal suffering. Nevertheless, where normalization occurs, there are powerful points of Aboriginal collective resistance and healing. The study concludes by arguing for the development of critical consciousness to challenge sustaining ideologies, institutional discourses, and predominating practices that exclude Aboriginality. The concept of cultural safety, positioned with in postcolonial perspectives, is discussed as a means of fostering critical consciousness. By examining historically mediated relations of power, longstanding patterns of paternalism, ethnocentrism and assumptions about Aboriginality from a cultural safety lens, there is the potential to shift knowledge and attitudes in nursing and more broadly, in health care. Locating Aboriginal mental health and mental health care within its wider historical, social, political and economic context can help nurses to more fully contribute to social justice in the area of Aboriginal mental health.

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