Indigenous Model of Mental Health Care: RCT based on a trans-diagnostic CBT program co-designed with the Community

Background

Although it is generally acknowledged that mental disorders are a major health burden amongst Australia’s Aboriginal and Torres Strait peoples (the term Indigenous Australians will respectfully be used going forwards), population-based prevalence rates of mental disorders have not been available. Mental illness is associated with increased burden of chronic co-morbid physical conditions and a 2.5-fold increase in mortality. A report that mental disorders account for 16% of disease burden in Indigenous people is likely a substantial under estimation. Although Mental disorders are epidemic in Indigenous communities, and most of this illness is undiagnosed and untreated the efficacy of treatment of mental disorders in Indigenous Australians has rarely been assessed in controlled experimental studies.

Aims

Primary objective

To evaluate the effectiveness of IMMHC for 6 months in Indigenous participants with depression.

Secondary objectives

To evaluate;

Sustainability of improvements BDI-II scores over a longer time period of 12 months
Changes in co-morbid mental health conditions (any anxiety disorder and/or substance use disorder)
Changes in quality of life
Changes in subsequent health care use and associated costs
Qualitative interviews on what works and why it works 6. Costs involved in providing this new model of care

To answer the primary research question: Is a model of mental health care developed by the Indigenous Community and based on cognitive behavioural therapy (Indigenous Model of Mental Health Care, IMMHC) more effective than Treatment As Usual (TAU) in Indigenous patients diagnosed with depression?

Project plan

We plan to conduct, in an integrated Indigenous primary care setting, a randomised controlled trial of psychological treatment in Indigenous subjects with depressive disorders (20% of the cohort). The treatment program will be co-designed in close collaboration with the local Indigenous community, catering for social, emotional, spiritual and cultural wellbeing. This project will incorporate an innovative treatment model that will support evidence-based outcomes and will be adaptable and scalable beyond the research project. It will improve mental health in Indigenous populations and reduce the gap in Indigenous health disparities.