(Formerly “Assessing the capacity of South Australian Aboriginal community-controlled health services to deliver comprehensive primary health care to address the burden of grief and loss: A participatory mixed-method health service research project)
Professor Margaret Cargo
Social Epidemiology and Evaluation Research Group, University of South Australia
Aboriginal Health Council of South Australia
Beyond Blue National Priority Driven Research Program
Project completion year
- The findings of the Rising Spirits Community Resilience Project have implications for South Australian state and federal government policy makers, and for government, private, not-for-profit and community controlled service providers in the field of Aboriginal mental health and social and emotional wellbeing (SEWB).
- Many Aboriginal people are in a perpetual state of bereavement due to the high prevalence of premature and preventable deaths. Furthermore, the high prevalence of death results in Aboriginal people constantly facing the heavy burden of emotional, organisational, financial and legal demands which currently characterise funeral preparations and their aftermaths.
- Aboriginal people are best able to identify the kinds of supports that people in their communities need while in grief, and who is needing of that support and when.
- The Aboriginal community controlled health sector from the small one-person or family-based programs, to the larger Aboriginal Community Controlled Health Services (ACCHS) provides invaluable bereavement support. They stretch limited resources to address local need when they can.
- ACCHS largely provide culturally safe ‘wrap around’ support to their Aboriginal clients who are in bereavement. This is despite being under-staffed and under-resourced.
- ACCHS operate within a Primary Health Care framework of health promotion and prevention, equity, access, and inter-sectorial collaboration, and the Aboriginal holistic definition of health which assumes that optimum physical health can only be maintained if social, emotional and spiritual health is also maintained the Aboriginal community controlled health services.
- Of the 39 activities/programs investigated, only three provide bereavement-specific support.
- Initiatives with high Aboriginal engagement were developed and delivered in consultation with Aboriginal communities and employ Aboriginal and/or culturally sensitive non-Aboriginal practitioners.
- The short term nature, priorities and vagaries of funding cycles seem impervious to Aboriginal client needs and the quality of the programs. Their constantly fluctuating targets impact negatively on long term program outcomes, the morale of committed workers and the confidence and trust of the Aboriginal clients.
- Aboriginal cultural ways of grieving are considered healthier but have been forgotten by many. Healthy ways include getting together with family and friends to yarn or just being silently present as a comfort, providing food and sustenance, possibly sitting together around a fire.
- Support groups for men, women, Elders or youth are extremely important particularly when they offer social support, tea/coffee, the opportunity for yarning, and creative outlets (i.e., art, craft, music, sewing).
- Information dissemination to Aboriginal communities is crucial about: locally accessible and trustworthy funeral funds and insurance, planning a funeral; Power of Attorney and living wills; supporting youth.
- During bereavement, family comfort and support is the most important to people. After the funeral, additional supports have been helpful and include counselling with a trusted counsellor; subtle monitoring of the wellbeing of the bereaved by the local trusted health services staff.
- Aboriginal Health Workers in government services often ‘pick up’ those who are not travelling well even when this is outside the scope of their regular work.
- Mainstream services require a greater number of culturally competent staff.
- No region or community has existing infrastructure and staffing that meets Aboriginal people’s grief and loss needs.
- Community resources are stretched to limit, particularly in regions where there is no infrastructure and no services. Many Elders, in these regions, in particular feel burnt out and consumed with hopelessness.
- Within mainstream services there is a clear need to strengthen the awareness, and knowledge of impacts and of available supports for Aboriginal people’s grief and loss needs.
- Aboriginal communities have expressed interest and demonstrated the capacity to be involved in community programs but are in need of infrastructure support for these activities to operate efficiently and to be effective.
Download the final report and appendices.
View the Rising Spirits Grief and Loss website, www.aboriginalgriefandloss.ahcsa.org.au, which provides resources and support on grief and loss for the South Australian Aboriginal community and service providers.