Enhancing First Nations Health Through Culturally Appropriate Research and Implementation

Trigger warning: This article discusses mental health and includes mentions of suicide, which may be triggering for some readers. If you or someone you know is struggling with thoughts of suicide, please seek help immediately by contacting a crisis helpline or healthcare professional.

For First Nations Australians, good health is more than the absence of disease or illness; it is a holistic concept that involves many aspects of well-being, for both the individual and the community. Dr Leda Barnett, a registered psychologist and Research Fellow at The Hopkins Centre at Griffith University uses this holistic health concept as the guiding framework for her important work in research and psychological interventions to enhance First Nations health. Featured in Aunty Lauraine Barlow’s painting ‘Journeys of Healing’, the holistic health concept Dr Barnett uses features Social (Queen Green Ant), Intellectual (Owl), Physical (Tree), Emotional (Tears) and Spiritual (Stars) aspects of health. Each aspect of health influences the others.

’Journeys of Healing’, painted by Aunty Lauraine Barlow from Yarrabah, used with permission*

The image should not be reproduced without acknowledging the artist

Dr Barnett is committed to positively impacting First Nations health. As a psychologist and researcher, with expertise in addressing social and emotional health, her focus is on the prevention of suicide. To do this, Dr Barnett strongly believes in making health services more empathetic, meaningful, and impactful to all First Nations communities – and using culturally appropriate research methods, combined with tailored innovative implementation approaches.

The Hopkins Centre focusses on ‘Research for Rehabilitation and Resilience’ and supports the goals of Dr Barnett’s suicide prevention research work.

Dr Barnett divides her time between her community-based psychology clinic and conducting research as a Research Fellow at The Hopkins Centre (THC). THC is part of the Menzies Health Institute at Griffith University, and it has a base at Gold Coast Health and Knowledge Precinct (GCHKP) as part of the Inclusive Futures initiative. THC is renowned for research methods that bring patients, clinicians, and researchers together to develop practical solutions that promote improvements in recovery and resilience.

“My research and my work in the prevention of deaths by suicide and developing emotional resilience and wellbeing fits into The Hopkins Centre’s resilience agenda,” Dr Barnett explained. “I am interested in all aspects of mental health, disability, rehabilitation and wellbeing for First Australians”. 

Dr Barnett is currently Co-Vice Chair for the Australian Indigenous Psychologists Association (AIPA) and in 2020 completed her PhD titled ‘First Australian Holistic Health: Development of a Multi-Dimensional Model of Suicidal Ideation and Suicide-Related Behaviour’, working with the First Nations community in Mackay.

Reducing deaths by suicide and suicidal behaviour among First Nations is a public health priority, and Dr Barnett’s research calls for a change in approach.

Australian Institute of Health and Welfare (AIHW) data from 2016–2020 show that the rate of suicide of First Nations Australians is almost twice the rate of non-Indigenous Australians. Dr Barnett’s research found that despite the prevalence of First Australian deaths by suicide, there is a lack of services developed and delivered by First Australians and limited evidence for the effectiveness of mainstream interventional mental health programs amongst First Nations communities.

There are also challenges of underutilisation of existing health services in the First Nations communities, which can be attributed in part to the lack of adequate cultural training of non-Indigenous health workers.

Dr Barnett’s research into suicidality highlighted how First Australian experiences can be better integrated into mainstream health interventions. Her recommendations included that firstly, interventions for First Australians need to be founded in time-intensive community consultation to advise on what the community needs. Secondly, a more culturally sensitive implementation approach is required, again involving the community in how interventions are delivered.

“There needs to be a change to the power dynamic when it comes to First Nations health. There is an opportunity to give more power to communities, for each First Nation community to develop First Nations interventions for their own community that feature their unique culture and worldview, to tackle community issues each community identify as problematic,” Dr Barnett said.

“For example, I think it’s best demonstrated in the drive for more First Nations health professionals, because the First Nations lived experience is what best informs First Nations health interventions.

“We know what our issues are. We know what our strengths are. More opportunities to engage with our strengths to address our health issues will generate more long-lasting results.”

Dr Barnett’s research reveals opportunities for positive changes in the development of First Nations health interventions, including culturally appropriate and more empathetic methods.

Dr Barnett explained that there are many examples of health programs based on overseas models rolled out Australia-wide without customisation to First Nations’ perspectives and experiences.

“If it is not informed by First Nations people, and doesn’t include some degree of ownership, then it’s not going to make significant improvements.”

“There are some non-Indigenous researchers that are doing really good work with Indigenous communities, which is great. What features in their work is a relationship built on trust, mutual respect, and willingness to spend time with and listen to First Nations communities.”

Dr Barnett also said there is the opportunity for Indigenous health workers to be allowed the freedom to work in a way that best suits the individual and the community, which can be challenging in the current system.

“Putting the patient’s health needs ahead of the system’s needs can often be challenging, however, it is essential for positively impacting the delivery of First Nations healthcare.”

Innovative and culturally informed changes to First Nations healthcare delivery positively impacts all Australians.

Innovative and culturally informed changes to First Nations healthcare delivery have the potential to positively impact all Australians. By addressing the unique health challenges faced by Indigenous communities, such as mental health issues, these changes can lead to improvements in healthcare for all Australians. Moreover, initiatives like the research undertaken by Dr Barnett can provide education and awareness on important issues that are relevant to all Australians. Overall, by working collaboratively and taking a culturally sensitive approach to healthcare delivery, we can create a more equitable and effective healthcare system that benefits all Australians.

First Nations visibility and community consultation is important to drive the spirit of connectivity in Lumina Gold Coast.

The Hopkins Centre at Griffith University where Dr Barnett leads her research is situated in the Gold Coast Health and Knowledge Precinct. Within the Precinct is the Lumina development – an emerging health and innovation community where organisations and individuals can co-locate with health and life sciences leaders such as Griffith and GCUH.

Lumina is pioneering new ways for those driven by research and innovation to take new ideas to the community, and positively influence policy and systems. There are benefits of co-location, for example, the proximity of the Hopkins Centre to health tech innovation hubs such as Cohort Innovation Space.

First Nations community consultation and visibility are an essential part of Lumina’s growth.

“First Nations visibility and presence in the Precinct are important. By increasing visibility, we can create opportunities for dialogue, understanding, and empathy between non-Indigenous and Indigenous peoples,” Dr Barnett said. “There is so much to be gained from listening to First Nations voices. There are so many strengths that people do not see. We know what our strengths are, and we want opportunities to share and really engage with these strengths to better First Nations communities’ health, and the health of all Australians.”

ACKNOWLEDGEMENT OF COUNTRY We acknowledge and pay respects to the people of the Yugambeh language region of the Gold Coast and all their descendants both past and present. We also acknowledge the many Aboriginal people from other regions as well as Torres Strait and South Sea Islander people who now live in the local area and have made an important contribution to the community.

*Aunty Lauraine Barlow (2006), a First Australian Community Elder and Researcher from the Cairns region conceptualized her understanding of health within her cultural context in the painting ‘Journeys of Healing’.