Harmful use of alcohol and other drugs and its relationship with the mental health and wellbeing of First Nations people: a review of the key issues, policy and practice approaches
Abstract
The harmful use of alcohol and other drugs (AOD) is interconnected with mental ill-health: both are acknowledged as significant impediments to the social and emotional wellbeing (SEWB) of Aboriginal and Torres Strait Islander (First Nations) communities, and both stem from inequality, racism and the ongoing impact of colonisation. Young people, justice-involved people and those experiencing homelessness are identified as high-risk groups for both AOD harm and for mental ill-health (AOD-MH).
Despite this:
- the co-occurrence of AOD harms and mental ill-health has not been adequately considered in research, policy, or practice; and
- AOD and mental-health research, policy and responses have remained siloed.
These disconnects hinder integrated policy responses, leading to fragmented systems and to challenges for those seeking support. To address this, this paper has synthesised the limited research on AOD-MH in First Nations communities with studies of AOD-related harms and studies of mental health, wellbeing and SEWB.
The paper confirmed that:
- high rates of AOD-MH occur among those experiencing AOD-related harm and also among those with symptoms of mental ill-health and psychological distress
- siloing of AOD and mental-health policy persists in interventions for AOD-MH, and this can create barriers for people seeking treatment and support
- policy responses show a continuing disconnect between recognising that AOD and mental health are intertwined, and strategies to specifically address both.
Existing and potential interventions for AOD-MH were reviewed (including prevention; the continuum of stepped-care treatment options (where service intensity is matched to client need); and workforce support) and several promising programs are described.
Finally, the paper considers frameworks for addressing AOD-MH. Its findings confirm the importance of high-quality (evidence-based and best-practice) service structures and services. In particular, the importance of integrated responses; community ownership; culture; family; trauma; and the relationship between those dealing with AOD-MH and their service providers. The review concludes that further developments in research, policy and practice for AOD-MH are needed and that, to ensure success, this work must be community-led; have culture at the centre; be adequately funded; and integrate research and practice between the two fields.
