Indigenous Model of Mental Health Care

This will be delivered by qualified psychologists, who will be trained in the treatment package. The psychologists will receive weekly supervision and fidelity will be assessed by video-taping a random selection (n=20) of sessions. Treatment will consist of both individual and group psychotherapy, as described below. Individual sessions will comprise of tailored, trans-diagnostic CBT; group sessions (co-facilitated with an Indigenous Health Worker; IHW) will involve a focus on skills practice, including yarning about successes and difficulties in application, and obtaining peer support and reinforcement in this area. Individual Treatment: The first one or two sessions will involve the assessment of cognitive and behavioural factors maintaining the disorder. As the SCID-I study has demonstrated that these assessments are typically lengthy, these treatment sessions will be up to 90-minutes. The treating psychologist will then develop a tailored treatment plan, in consultation with a senior clinical psychologist and the participant. Changes in symptomatology may warrant adjustments or changes to the treatment plan. Up to 12 sessions of individual treatments will be provided by qualified psychologists using a combination of face-to-face delivery for primary treatment and telephone delivery to facilitate skills practice. Group Treatment: The efficacy of CBT relies on the use of ‘homework’ or skills practice to maintain treatment effects. We believe that skills practice will be difficult for many Indigenous participants so we will use group sessions for practice (in addition to telephone contacts as above). As such, a ‘Yarning Skills Group’ is planned as an adjunct to individual sessions. The purpose of this group is to build on skills learnt in individual sessions, allow peer support in a positive supportive environment, and focus on personal and group strengths. Group treatment aims to be therapeutic, strengths-based, and culturally friendly by: using both a psychologist, spiritual healers and Indigenous Health Workers as group facilitators; exploring successes in applying skills and learnings obtained from individual sessions; and allowing peers to support each other through learning new behaviours. Consistent with another evidence-based therapy that has adapted CBT for complex presentations using both individual and group CBT, a different psychologist will be used for individual and group sessions. Participants will be offered up to 3 group sessions:, after week 5, after week 8, and after week 10/12 of the intervention. Groups of 10-12 participants will be offered combined treatment in group settings. The study will now also facilitate the conduct of a remote telehealth model of participant recruitment, screening and participation utilising available video-consultation technology. Participants with access to video-consultation resources in their homes will be able to participate at home; those without such resources will have the option to utilise a telehealth service setup in a private room located at the participating Aboriginal Medical Services. Intervention Schedule: Week 1: Overall assessment this includes clinical history and history enough information for a clinical formulation Week 2: Feedback to the client, Psychoeducation about CBT. Commencement of Behavioural Activation and/or Relaxation Strategies. These are incorporated into in-between session practice. Week 3-5: Review of Practice and techniques, commencement of identifying links between thoughts, beliefs, emotions and behaviours. Week 5-8: Challenging thoughts, beliefs and behaviours (‘traps’) that are unhelpful and impact on negative emotions that are linked to depression and anxiety. During this process the client will become increasingly skilled at in identifying these traps and modifying these him or herself. Behavioural activation and relaxation is continues both in session and in between sessions. Week 9-10/12: Consolation of cognitive and behavioural techniques, Relapse management planning.