Approach to treatment of mental illness and substance dependence in remote Indigenous communities: Results of a mixed methods studyajr_1060 174
Objective: To develop and evaluate a culturally adapted
brief intervention for Indigenous people with chronic
Design: A mixed methods design in which an exploratory
phase of qualitative research was followed by a
nested randomised controlled trial.
Setting: Psycho-education resources and a brief intervention,
motivational care planning (MCP), were developed
and tested in collaboration with aboriginal mental
health workers in three remote communities in northern
Participants: A total of 49 patients with mental illness
and 37 carers were recruited to a randomised controlled
trial that compared MCP (n = 24) with a clinical control
condition (treatment as usual, n = 25).
Intervention: The early treatment group received MCP
at baseline and the late treatment group received
delayed treatment at six months.
Main outcome measures: The primary outcome was
mental health problem severity as measured by the
health of the nation outcome scales. Secondary
measures of well-being (Kessler 10), life skills, selfmanagement
and substance dependence were chosen.
Outcome assessments were performed at baseline,
six-month, 12-month and 18-month follow up.
Results: Random effects regression analyses showed
significant advantage for the treatment condition in
terms of well-being with changes in health of the nation
outcome scales (P < 0.001) and Kessler 10 (P = 0.001),
which were sustained over time. There was also significant
advantage for treatment for alcohol dependence
(P = 0.05), with response also evident in cannabis
dependence (P = 0.064) and with changes in substance
dependence sustained over time.
Conclusions: These results suggest that MCP is an
effective treatment for Indigenous people with mental
illness and provide insight into the experience of mental
illness in remote communities.