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Aboriginal and Torres Strait Islander Health Performance Framework - Summary report

Mental health and social and emotional wellbeing

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The broad disease group that is the leading cause of disease burden for Aboriginal and Torres Strait Islander people is mental and substance use disorders, including depressive disorders, bipolar disorder, anxiety disorders, schizophrenia and alcohol and drug use disorders.

Most of the disease burden from mental and substance use disorders is non-fatal – that is, it is due to years spent living with illness.

Maintaining high levels of social and emotional wellbeing is now a focus of the National Agreement on Closing the Gap, with a target for significant and sustained reduction in suicide of Aboriginal and Torres Strait Islander people towards zero – see Target 14 in the Closing the Gap Information Repository.

The National Aboriginal and Torres Strait Islander Health Plan 2021-2031, released in December 2021, provides a strong overarching policy framework to ensure the formal partnership and shared decision making between the Australian Government and Indigenous communities. The Health Plan covers a range of health services including mental health, and social and emotional wellbeing.

The National Strategic Framework for Aboriginal and Torres Strait Islander Peoples’ Mental Health and Social and Emotional Wellbeing (Commonwealth of Australia 2017a) and the Fifth National Mental Health and Suicide Prevention Plan (Commonwealth of Australia 2017b) are important components of the national response to Aboriginal and Torres Strait Islander health.

While intentional self-harm and suicidal behaviour are classified as injuries for burden of disease analysis, in the HPF they are reported under measure 1.18 Social and emotional wellbeing. Some information on intentional self-harm and deaths by suicide is presented in this section and in the following section on injury.

Almost 1 in 3 Indigenous adults (31%) had high to very high levels of psychological distress in 2018–19 (age-standardised), a similar proportion to 2014–15. In comparison, 13% of non-Indigenous adults had high levels of psychological distress. Those who had been removed from families or had relatives removed from families had a higher proportion with high or very high levels of psychological distress (38%) compared to those who were not removed from their families (26%).

In 2014–15, 68% of Indigenous Australians aged 15 and above (303,300) reported that in the previous year they had experienced one or more specified personal stressors – that is, events with the potential to adversely affect their health or wellbeing, such as serious illness or the death of a family member or friend (see Table 4.2 for most common personal stressors).

Table 4.2: Most common personal stressors, Indigenous Australians aged 15 and over, by remoteness area, 2014–15

Sources of stress

Number Non-remote 

Per cent Non-remote

Number Remote

Per cent Remote

Death of a family member or close friend

89,100

26%

33,400

35%

Not able to get a job

63,500

18%

18,200

19%

Serious illness

45,100

13%

8,600

8.9%

Mental illness

40,200

12%

5,500

5.7%

Overcrowding at home

20,100

5.8%

9,000

9.3%

Alcohol-related problems

20,500

5.9%

8,600

8.9%

Note: Proportion of all Indigenous Australians aged 15 and over, more than one response could be given.

Source: Measure 1.18, Table D1.18.4 – AIHW and ABS analysis of National Aboriginal and Torres Strait Islander Social Survey 2014–15.

COVID-19 and mental health of Indigenous Australians

The COVID-19 pandemic is a high risk to Indigenous Australians’ physical and social and emotional wellbeing (Victorian Government et al. 2020). Specific concerns have included: lack of accessible, culturally appropriate and culturally safe mental health services; challenges faced by the Indigenous Australian allied health workforce, including those living with high-risk individuals; inequalities within the health system that may affect access to care, particularly in the move to digital and telehealth; and loss of remote community services including fly in fly out mental health care.

The impact of lockdowns was particularly acute for Indigenous Australians who are deeply interconnected with family and community members, and where caring responsibilities may have been disrupted. There were heightened effects on those in, or with connections to, remote communities, where isolation was greater and freedom of movement more restricted; those who cannot access waterways, songlines and country; and those who cannot attend to cultural and sorry business. Research on the impacts of COVID-19 and the associated restrictions on Stolen Generations survivors found they had an increased and heightened sense of isolation and loneliness, significant disconnection from family, community, culture and country, and declines in their mental health and wellbeing (Aboriginal and Torres Strait Islander Healing Foundation 2021).

Intentional self-harm and suicide

Between July 2017 and June 2019, 5,829 Aboriginal and Torres Strait Islander people were hospitalised due to intentional self-harm (0.9% of all hospitalisations of Indigenous Australians, excluding dialysis). This corresponds to a rate of 3.5 hospitalisations per 1,000 population for Indigenous Australians.

After adjusting for differences between the age structures of the two populations, Indigenous Australians were hospitalised for intentional self-harm at nearly 3 times the rate of non-Indigenous Australians (3.6 and 1.2 per 1,000 population, respectively). The greatest absolute difference in rates between Indigenous and non-Indigenous Australians were among those in the age groups of 15–24 (rate difference of 3.5), 25–34 (3.8) and 35–45 (4.8) (Figure 4.8).

Figure 4.8: Rate of hospitalisations due to intentional self-harm, by Indigenous status and age, July 2017 to June 2019

The first line chart shows that the rate of hospitalizations from intentional self-harm was highest in the 34–44 age group for Indigenous males and highest in the 15–24 age group for non-Indigenous males.The second line chart shows that the highest rate was in the 15–24 age group for both Indigenous females and non-Indigenous females. Rates were consistently higher for Indigenous Australians than for non-Indigenous Australians.

 Source: Measure 1.18, Table D1.18.27 – AIHW analysis of National Hospital Morbidity Database.

In 2015–2019, 847 Indigenous Australians died from intentional self-harm (suicide), a rate of 24 suicide deaths per 100,000 population. Suicide accounted for approximately 5.5% of total deaths among Indigenous Australians. The age-standardised suicide rate for Indigenous Australians increased by 30% over the decade from 2010 to 2019, with the rate also increasing for non-Indigenous Australians (by 24%) (data from NSW, Qld, WA, SA and NT combined) (Figure 4.9). This corresponded to a significant widening (by 40%) of the gap between Indigenous and non-Indigenous Australians.

Figure 4.9: Suicide rates, by Indigenous status (age-standardised), 2010–2019

This line chart shows that the age-standardised suicide rate for both Indigenous and non-Australians increased between 2010 and 2019. The rates for Indigenous Australians were higher than for non-Indigenous Australians in all years, and the gap widened.

Note: Data from NSW, Qld, WA, SA and NT combined.

Source: Measure 1.18, Table D1.18.26 – AIHW National Mortality Database.

The death rate due to suicide was highest for Indigenous males aged 30–34 (78 per 100,000) and for Indigenous females aged 15–19 (28 per 100,000) in 2015–2019 (data from NSW, Qld, WA, SA and NT combined). Among non-Indigenous Australians, the suicide death rate was highest for males aged 45–49 (31 per 100,000) and females aged 45–49 and 50–54 (both 9.7 per 100,000) (Figure 4.10). The overall rate of deaths from suicide for Indigenous Australians was 2 times the rate of non-Indigenous Australians.

Figure 4.10: Suicide rates, by age group and sex, 2015–2019

This consists of two line charts shows age-specific suicide rates by Indigenous status – one chart for males and one for females. It shows that, for males, the rate of suicide was highest in the 30–34 age group for Indigenous males and in the 45–49 age groups for non-Indigenous males. Rates were higher for Indigenous than non-Indigenous males in most age groups except for those aged 55 and over. For females, the rate of suicide was highest in the 15–19 and 20–24 age groups for Indigenous females and in the 45–49 and 50–54 age groups (10 per 100,000) for non-Indigenous females. Rates were higher for Indigenous than non-Indigenous females in most age groups, except those aged 50 and over. This consists of two line charts shows age-specific suicide rates by Indigenous status – one chart for males and one for females. It shows that, for males, the rate of suicide was highest in the 30–34 age group for Indigenous males and in the 45–49 age groups for non-Indigenous males. Rates were higher for Indigenous than non-Indigenous males in most age groups except for those aged 55 and over. For females, the rate of suicide was highest in the 15–19 and 20–24 age groups for Indigenous females and in the 45–49 and 50–54 age groups (10 per 100,000) for non-Indigenous females. Rates were higher for Indigenous than non-Indigenous females in most age groups, except those aged 50 and over.

Note: Data from NSW, Qld, WA, SA and NT combined.

Source: Measure 1.18, Table D1.18.22 – AIHW and ABS National Mortality Database.

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