The central role of Aboriginal families in motivational counselling: family support and family 'humbug'

Objective: This mixed methods study aimed to develop and test a brief pictorial motivational intervention for Indigenous people with mental illness, which can be delivered in remote settings. For the purpose of this paper 'Indigenous' refers to Australia’s Aboriginal and Torres Strait Islander peoples and acknowledges their rich diversity of culture.\ud \ud Methods: This study was conducted in remote Indigenous communities in Northern Australia. An ethnographic approach was used to gather remote Aboriginal Mental Health Worker (AMHW) perspectives of wellbeing through key informant interviews and participant observation. The perspectives were integrated into a brief intervention. The intervention was tested in a randomised controlled trial with Indigenous clients and carers and showed improved outcomes. Concurrent qualitative data related to strengths, stressors, goals for change and reasons for change were collected and thematically analysed. This paper reports on the findings of the analysis of the qualitative data. The findings of the randomised controlled trial have been reported in an earlier paper.\ud \ud Results: Clients rated 'family' as one of the main worries, the main strengths and the main reasons for making lifestyle changes. Dealing with family worry or 'humbug' was a common goal, while seeking support from family to make life style changes was a common step. AMHWs reported high rates of mental illness, domestic violence, self harm behaviour and substance misuse in the client homes.\ud \ud Conclusions: Family were a source of strength and support as well as stress and worry for Indigenous clients with mental illness. Clients identified a number of goals and steps toward life style change that focused on family support and dealing with family conflict and 'humbug'.\ud \ud Implications: Client-centred approaches which acknowledge and promote understanding of the role of family in treatment are needed. Family conflict is a key precipitant and perpetuating factor for illness, while family support is a key protective factor. More understanding of successful engagement with families will be pivotal to successful psychological treatment in this setting