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2012
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doi:10.1093/cdj/bss030

Re-thinking mental health

for indigenous Australian
communities: communities
as context for mental health
Bernard Guerin* and Pauline Guerin

Abstract Contributing to developing and supporting sustainable mental health

and social well being for Indigenous Australians living in remote
communities is complex, with much diversity within and between
communities and individuals. Drawing from a brief literature review
and our fieldwork in small, remote Indigenous communities in
Australia from 2006 to 2011, we explore the contexts for what
seems to work, and critically re-think the concept of mental health.
Much of the conceptualizing around Indigenous mental health focuses
on the processes of service provision and too much attention has
been paid to indigenizing aspects of mental health and illness rather
than to exploring the historical, cultural, social, economic, and other
life contexts relevant to mental health – especially with regard to the
community as a determinant of mental health. We emphasize that
mental health policy and practice needs to be informed by deep
understanding of contexts, not just epidemiological evidence, and
must therefore involve community development.

Introduction
The life experiences that are generally labelled as ‘mental illness’ are wide-
spread, often debilitating, and can affect anyone. While mental illness is
usually attributed to an individual’s way of behaving or thinking, over
the past decades our understanding of mental illness has polarized: some

*Address for correspondence: Bernard Guerin, School of Psychology, University of South Australia,
St. Bernard’s Road, Magill 5153, Adelaide 5001, South Australia; email: bernard.guerin@unisa.edu.au

Community Development Journal Vol 47 No 4 October 2012 pp. 555–570 555

556 Bernard Guerin and Pauline Guerin

have moved closer to explanations based on individually contained neuro-

chemical imbalances (e.g. Charney and Nestler, 2009), and others to broader
contextual analyses of behaviours and thinking (see, e.g. Friedli, 2009). With
the latter, thinking has moved from early, familial contexts as the causes of
current issues (Freud, 1905), to a broader analysis of external events and
processes that provide the context for the ‘mental illness’ behaviours and
thinking (Billig, 1997; Fisher and Baum, 2010). However, such external con-
texts still often focus on relationships with friends, immediate family, and
strangers – and the conflicts that ensue from these – and this is the basis
for many interventions for mental illness.
The increased awareness of contextual factors is welcome and the various
fields of mental health research and policy have clearly advanced. However,
the re-thinking of mental health and illness in social context often remains
limited and bound by a western view of relationships and their conflicts. In
particular, for our research, the contextual analyses of mental health and
illness falls especially short when working with people from Indigenous
communities because they generally prioritize community relationships
over stranger or friend relationships. Therefore, interventions must incorp-
orate community development perspectives, and we consider in this article
how western conceptualizations of mental health and illness can be prob-
lematic in contexts such as in remote Indigenous communities in Australia,
identifying three main concerns:

(i) Social and familial communities are contextually significantly im-

portant for people generally, but this is especially the case for In-
digenous peoples, for whom western-style social relationships
may not be dominant. The western mental health treatment
system may have a closer fit with people who are primarily
engaged in instrumental western relationships over people who
may have stronger social and familial relationships.
(ii) Failure to explore communities as contextual loci for mental
health and illness has resulted in a tendency to ‘indigenize’ (i.e.
essentialize) causes in the Indigenous context in Australia.
(iii) Dominant western models for mental illness treatments often
focus solely on individuals and their immediate relationships
and fail to take account of the importance of extended commu-
nity relationships.

Community perspectives are indispensable particularly when exploring In-

digenous mental health and illness. While ‘community’ can be understood
in many ways (Guerin and Guerin, 2008a,b), in this paper we refer to the
‘social’ community relevant to many remote Indigenous peoples that
includes the historical, political, economic, religious, spiritual, familial,
 Re-thinking mental health for indigenous Australian communities 557

and educational elements. We describe broadly how the research literature

has approached Indigenous mental health and illness, provide some exam-
ples of an extended role for community in Indigenous mental health, de-
scribe some ways that ‘mental illness’ itself needs to be redefined if
community is taken into account, and finally show how mental illness treat-
ments and policy can incorporate a consideration of communities. These
understandings of the importance of extended community relations and
the structural causes of community disadvantage and marginalization
underpin our emphasis on the need to develop suitable community devel-
opment tools and approaches.
We have worked in several remote Australian Indigenous communities
over a number of years, and have most recently been exploring specifically
how people living in such communities understand mental health and well-
being. The examples we provide are mostly about how the people from
these communities have reported and discussed the issues with us
(policy, bureaucracy, etc.) through ethnographic and participant observa-
tion. To protect and respect community protocols and confidentiality, we
will not provide specific details however, and will not indicate which com-
munities are being discussed. There is debate also in Australia and inter-
nationally about the use of reference terms for people and communities.
Most communities prefer to use their own local names, such as Anangu,
Walpiri, Koori etc., but to further protect confidentiality we use ‘Indigen-
ous’ throughout this paper to refer to the people with whom we have
worked.

Where are the communities in mental health literature?

Despite a very large literature relating to Indigenous Australians’ mental
health and well-being, we found very little dealing directly with our con-
cerns in relation to the complex contexts (cf. Purdie, Dudgeon and
Walker, 2010). While transcultural and cross-cultural psychiatry provide
useful overviews and general concepts, our guiding framework is that the
specific community contexts are important and not generalizable (Kir-
mayer, 1997). For example, the work by Waldram (2004) is significant for
some North American Aboriginal peoples but is not necessarily applicable
for Indigenous Australian communities. Contextual details need to emerge
from the specific communities and people themselves.
It is worth presenting briefly what we found in the large literature,
however, since it illustrates some of the areas that researchers have
focused on in lieu of describing details of the specific community contexts.
Community influence is diffuse and complex with long histories, so cannot
easily be seen or recognized as determinants of individual behaviours and
558 Bernard Guerin and Pauline Guerin

thinking, but it is critical, nonetheless. However, the ‘causes’ of mental

illness often have been attributed wrongly elsewhere. Friedli (2009, p. 9)
writes:
Individual psychological resources, for example, confidence, self-efficacy,
optimism and connectedness are embedded within social structures: our
position in relation to others at work, at home, and in public spaces.
Because social position influences emotion, cognition and behaviour, it is
an ongoing challenge to separate out contextual effects that may be
‘masquerading as individual attributes or the effects of individual
characteristics’.

Broadly speaking, we identified four main themes in the literature relating

to specifically Indigenous Australians’ mental health, all of which dodge
the issue of community involvement on the whole. The role of community
as a determinant of mental health and well-being is hidden in each of these
four literature areas and needs further exploration to foreground it within
specific communities so that community development can be seen to con-
tribute directly to improving mental health.

Processes in service provision

There is a sizeable and growing literature about models for processes in
service provision for Australian Indigenous mental illness (Powell, 2000;
Henderson et al., 2002; Westerman, 2004, 2010; Bishop et al., 2006). Such
studies have investigated how the processes around mental illness treatment
can be made more acceptable or appropriate, rather than changing the treat-
ments themselves. These can include, for example, cultural awareness, com-
petence, or safety models to improve service provision, protocols for
community engagement, or to reduce discriminative practice. While
service provision models depend on community contexts, these are not
often investigated and rigid or stereotyped ideas about communities are
often used (Taylor and Guerin, 2010). For example, protocols have often
been written in the literature as rigid ‘rules’ that must be followed. For
example, until very recently, guidelines for working with Aboriginal Aus-
tralians would dictate that making direct eye contact with Aboriginal
people would be seen as disrespectful and challenging. For example, an
Oxfam Australia (2007, p. 8) guide for Aboriginal and Torres Strait Islander
cultural protocols advises ‘lowering your eyes and avoiding eye contact
with older people or authority figures; not pointing when giving directions;
avoiding body contact such as friendly touching or jostling or touching the
upper torso or arm; shaking hands only if initiated by the other party’.
While it is important to know that this may be the case with some people
in some communities, such protocols tend to over-generalize, and more
 Re-thinking mental health for indigenous Australian communities 559

recent guidelines are incorporating diversity in their recommendations, for

example, New South Wales Department of Community Services (2008, p. 1):
‘As a general rule avoid too much direct eye contact. Aboriginal people
easily and commonly read body language and direct eye contact may be in-
appropriate. Remember though, this will vary and you need to rely on local
knowledge’.
Service provision models and recommendations are therefore important
when working with Indigenous clients but by themselves these models do
not engage with a critical understanding of how mental health and well-
being are conceptualized nor do they attempt to influence the actual treat-
ments for mental illness.

Characteristics of indigeneity
A second major topic found in the Indigenous Australian mental health lit-
erature focuses on ‘indigeneity’ in mental health (Cawte, 1996; Spencer,
2000; Janca and Bullen, 2003; Vicary and Westerman, 2004; Ypinazar et al.,
2007). That is, in many cases, the specific causes, consequences, necessary
treatments, or presentation of mental illness is said to be something essential
to Indigenous Australians – something about them that is different to other
Australians. This might be a type of mental ‘disorder’ or syndrome that
is said to be specific only to Indigenous Australians. In some cases, the di-
versity among Indigenous Australians is acknowledged, but in many cases
Indigenous Australians all fall within a single category based on indigene-
ity. This is a predictable outcome when family and community contexts
have not been adequately considered. Considering the role of contexts is
of course difficult and time-consuming, and it is simpler to explain
mental distress through a combination of internal universal and indigenous
elements.
One example of indigeneity attribution is in Eastwell’s (1982) review. He
summarized specific issues for Indigenous Australians as: ‘the absence of a
neurotic repertoire, the classification of the emotions . . . and the question of
voodoo death’ (p. 222). As a second example, Reser (1981) took issue with
such characterizations of Indigenous Australians as having certain person-
alities and cognitive abilities. In particular, the original author Reser is cri-
tiquing imputed ‘rudimentary and concrete’ cognitive abilities and a
propensity for violence and higher rates of personality disorders to Indigen-
ous Australians purely based on indigeneity (e.g. Morice, 1979). Finally, in a
more contemporary example, Vicary and Westerman (2004) reported that a
common response to mental health issues amongst their sample of Indigen-
ous people was, ‘That’s just the way he is’. Other common indigeneity
elements are to attribute ‘shame’ as something specific to Indigenous Aus-
tralians (e.g. Blagg, 1997), rather than their shyness coming from external
560 Bernard Guerin and Pauline Guerin

(colonial) influences, and to suggest different aetiologies of suicide (cf.

summary of Hunter and Milroy, 2006). Or as one Indigenous woman
(with a diagnosed mental illness) said in a research study (Fromene and
Guerin, 2011, p. 4):
Doctors definitely did, because I am indigenous, and they put all us eggs
in one basket. You already have a stigma because you are not well. You are
just a nut like everyone else, ‘Oh, but you are black. So that’s the reason
why you are nuts’.

This is not to say that there are no differences based on indigeneity, but that
this attribution may often be made too quickly without consideration of the
diversity within Indigenous Australians and non-Australians. Our point
here is that indigeneity seems to be resorted to because the community
context has not been properly explored as a source of external determinants.

Specific mental health issues and treatments for Indigenous Australians

The third area in the Indigenous mental health literature involves papers
reporting on specific mental health issues affecting Indigenous Australians
(Brady, 2004; D’Abbs and Brady, 2004; Nagel, 2006; Petchkovsky et al., 2004;
Phillips, 2003). These are commonly alcohol, drugs, petrol sniffing, co-
morbidity, suicide, depression, loss and grief, stolen generations, relapse,
psychosis, dementia, gambling, women, men, and youth. Although the
issues are rarely unique to Indigenous Australians, the implication may
eventuate that these are ‘Indigenous problems’. While the contextual
focus on more specific analyses of specific issues is welcome in this litera-
ture, the discussions may still attribute causes to some form of indigeneity
as discussed above. For example, consider the literature regarding whether
‘Indigenous suicide’ is different to non-Indigenous suicide (Hunter and
Milroy, 2006; Tatz, 2001). More critically, any underlying external commu-
nity causes such as the impact of colonialism, racism, or poverty are often
passed over in favour of ‘psychological’ causes even if not related to indi-
geneity, therefore bypassing community contexts for mental health commu-
nity development solutions.

Spirituality
Finally, spirituality is a common and growing topic in the literature of Indi-
genous mental health and illness. Professionals cannot deal for long with
Indigenous Australian mental illness without considering both spirituality
and the role of ‘being on Country’ (visiting or living on tribal lands, Grieves,
2009; Lock, 2007) as therapeutic or, at least, as an important consideration.
Despite this, there is remarkably little written systematically about Indigen-
ous mental health and spirituality, and much of what is written may be mis-
 Re-thinking mental health for indigenous Australian communities 561

leading. For example, consider that traditional healers have been referred to
as ‘witchdoctors’ or ‘sorcerers’ in an attempt to help laypersons understand
the concept (Cawte, 1996; Reid, 1983). But the term ‘witchdoctor’ may give
the wrong impression of what traditional healers do and who they are. This
would be like calling the local church minister in the suburbs a ‘witchdoc-
tor’. Spirituality and traditional health may therefore be seen as exotic fea-
tures of indigeneity rather than as ordinary and individual properties
rather than community based. The power of these healing techniques
depends on the community and social relationships, not something exotic
that is ‘indigenous’.

The role of community context in Indigenous mental

health
We have suggested that while our review found four burgeoning areas of
research, and these are common in indigenous mental health literatures
elsewhere around the world, they were each focused on individuals and
the status of being ‘indigenous’ people. We now describe three ways we
have found that community context is involved in mental health, which
allows us to use community development as a mental health intervention.

Communities as hidden determinants of mental health

Our brief review of the research literature found that there are several places
in the research where community-as-determinant has been hidden because
finding those determinants is difficult and takes time. Determinants of
mental health have therefore been attributed to individual causes and espe-
cially indigeneity as a cause, and assessment and intervention have fol-
lowed suit. Examples given were:

(i) the diversity of community context and strategies for taking them
into account is removed and written as rigid rules of protocol and
‘cultural awareness’;
(ii) indigeneity is resorted to as an attribution of mental health and
illness because the community context has not been properly
explored as a source of external determinants;
(iii) underlying external social causes such as the impact of colonial-
ism, racism, or poverty are often passed over in favour of ‘psy-
chological’ or indigeneity causes;
(iv) the power of healing techniques depends on community and
social relationships, and the failure to see these external commu-
nity contexts of healing leads to attributions to individuals and to
indigeneity.
562 Bernard Guerin and Pauline Guerin

Community governance as a determinant of mental health and illness

A more direct influence of communities on mental health and illness comes
through how communities are governed, which first involves community
and family relationships, and second, the impact of government bureaucra-
cies on people’s lives.
When we ask people in remote Indigenous communities about mental
health, or more usually about social and spiritual well-being, their
responses are often couched in terms of how families in the communities
are interacting. This is something that is not normally considered in
‘western’ mental health since the mental health system underplays relation-
ships in communities (Guerin and Guerin, 2008a,b). However, it is difficult
to overestimate how much the lives of people in remote communities are
centred around their communities – for both good and ill. From our field-
work it is entirely inappropriate, in our view, to assess the mental health of
someone in a remote Indigenous community without knowing about their
wide family history, current community issues, as well as the historical,
economic, and political concerns for the community. This is often hard to
conceive for those not involved in the communities. There is a need to
remember that a hallmark of ‘westernized’ relationships is a tendency to
become compartmentalized (Bailey, 1971, p. 144; Guerin, 2004) and
people who are important in one area of a person’s life (like work) may
not be prominent in other areas (home). This was not the case for the
communities we studied, and this is likely to be the case for many other
communities.
The other important issue identified in our conversations with people in
remote Indigenous communities relates to governance: the extent to which
‘mental health’ issues are a result of the way government bureaucracies
interact with people, rather than anything individual (due to their ‘person-
ality’) or cultural (due to their ‘indigeneity’). We and our colleagues have
elsewhere called this the ‘Bureaucratic Stress Syndrome’ or BS syndrome
(Guerin, Guerin and Tedmanson, 2011), where the ‘syndrome’ is outside
of the person in the community context. In remote locations there is wide-
spread poverty and few services available, compared with urban settings,
and usually there is limited or no choice of service providers (Guerin and
Guerin, 2008a,b). This can cause a great deal of stress when everyday ser-
vices – water, fuel, health, food, schools, electricity – consistently need at-
tention and require dealing with bureaucracies. For people to make
something happen – the basic idea of self-efficacy – it requires a great
deal of effort in highly regulated and bureaucratized remote Indigenous
communities. Talking with people in the field has convinced us that this
produces a form of helplessness directly related to this bureaucratic stress
 Re-thinking mental health for indigenous Australian communities 563

that would affect anyone adversely. That is, it is not about their indigeniety
per se. Similar chronic bureaucratic stressors are evident, for example, in
refugee communities (Guerin, Guerin, Diiriye and Abdi, 2004; Guerin,
Guerin, Diiriye and Yates, 2004).

Community policy as a determinant of mental health and illness

Related to the ‘BS syndrome’ is what we and our colleagues call the ‘Policy
Dis-Stress Syndrome’ (Tedmanson et al., 2011). While everyone’s lives are
determined by government policies to some extent, our talking and partici-
pating with people in remote communities suggests that far-reaching policy
changes directly affect those living in remote Indigenous communities to a
much greater degree. The problem is more than this, however; policy and its
implementation for Indigenous communities gets changed frequently
(Dillon and Westbury, 2007). We have noted, for example, that on almost
every field trip we have made there has been some turmoil because a gov-
ernment policy has been changed, usually without any warning to the
people affected.
As an example from our field notes, one of the authors visited a commu-
nity in 2008 to find that a major policy change had come without warning
that resulted in employment changes for almost all the residents, for the
worse (see The Anangu Lands Paper Tracker, 2011, for more specific infor-
mation). The details of the policy change and the issues needing to be
addressed by the community are not of importance for this paper, but it
meant that within one day the whole community needed to change their
employment status from a government policy called community develop-
ment employment program (CDEP) to become welfare recipients, with
much stress and frustration for community members and huge financial
and security implications.
This in turn meant that discussions with the community were not pos-
sible because everyone was preoccupied and distressed by what had hap-
pened and were working hard to adapt to this imposed policy change. A
colleague visited shortly thereafter and when, in a few weeks, we compared
notes, it turned out that on her visit the policy change had been partially
reversed and the whole community was again in turmoil about having to
take another action. Our point is that these sorts of changes are not uncom-
mon, and during our time of working with people from these particular
communities, we have seen major community disruptions due to govern-
ment policy changes on nearly every field trip over many years.
Overall, most people in such communities cannot simply ‘get on with life’
in a policy environment that is constantly changing, not determined by
themselves, and when each policy change has marked effects on everyday
life. Rapid and radical policy changes are key contributors to mental
564 Bernard Guerin and Pauline Guerin

health issues in remote Indigenous Australian communities, and all the

determinants mentioned may be key factors in fostering ‘learned helpless-
ness’ and what becomes defined as depressive illness. For mental health pro-
fessionals working in these communities, a lack of knowledge about these
continual policy changes would, understandably, lead to thinking that the
‘problem’ lies within the individual – i.e. they are depressed or anxious and
require personal intervention of some sort, when the intervention more ap-
propriately may be to intervene on the government policy changes to find
stable ways to improve the poverty, lack of appropriate service provision,
and other contextual elements.

Community context in mental health interventions: the role of community

development
We have argued that consideration of the community contexts by working
with people in communities is essential to any intervention for mental
health outcomes. However, this does not mean working with more commu-
nity or family members within a Western therapeutic approach. To change
mental health outcomes in remote Indigenous communities, we must
promote:

(i) community development initiatives to empower the whole com-

munity in its relationships and dealings with professionals and
governments so people can better manage their own ‘mental
health’ issues;
(ii) measures that will reduce the amount of bureaucracy in everyday
life;
(iii) initiatives to stabilize the policies within which impact on people
in daily life; and
(iv) more thorough and systematic documentation and research into
community contexts – economic, social, cultural, and historic –
and how these engender the ‘mental health’ issues Indigenous
Australians experience.

Community development, therefore, has multiple pathways for producing

positive changes in mental health outcomes, and we are only now begin-
ning to explore how these might help people within the communities that
they live. Including people in service provision processes is one step, but
we must look to community processes as well – not just how we treat indi-
viduals. Arranging new community activities, commonly done through arts
and performances, is another new avenue to explore more thoroughly
(Guerin et al., 2011).
While some psychologists and psychiatrists agree on some social deter-
minants of mental health, they then may relegate these forms of change
 Re-thinking mental health for indigenous Australian communities 565

to social workers or see other change agents as ‘social issues’ rather than
‘mental health’ issues. Our argument is that this is not superfluous to
‘real’ mental health interventions such as talking therapies and cognitive
behavioural therapies. Rather it is necessary when working with remote In-
digenous communities to situate ‘treatments’ within diverse community
contexts (Guerin and Guerin, 2008a,b). Therefore, community development
must be an integral strategy for tackling mental health and illness in disad-
vantaged and marginalized communities. As an example, a recent research
project of ours involved spending many hours repeatedly talking with a
small number of Indigenous Australians who had been diagnosed with
Borderline Personality Disorder (BPD) by psychiatrists (Fromene and
Guerin, 2011). Through talking about the minute contextual details of
their lives, the nine key symptoms of BPD identified by the standard Diag-
nostic and Statistical Manual IV (DSM-IV) were each able to be better con-
textualized as related to historical poverty and the impact of government
policies on families. Our evidence suggests that these contextual factors
were implicated in causing symptoms of confusion for the participants par-
ticularly in relation to their sense of identity and to family structure over
many years and generations. Additionally, ubiquitous racism and discrim-
ination experienced by our respondents led to a loss of opportunities in life.
We therefore concluded that rather than having a ‘Borderline Personality’
they have had ‘Borderline Socializing Environments’ largely brought about
by the contexts of colonization (Fromene and Guerin, 2011).
The future of mental health research and interventions for remote Indi-
genous communities, and others too, requires thorough contextual and
social analyses rather than focusing on causes of mental distress as a
means of enabling their eventual reduction. There should be less effort
spent on making generalizations divorced from understandings of
people’s social lives. Thorough exploration of the community, contexts for
peoples’ behaviours and thoughts should be undertaken before making
attributions of source and developing associated interventions to deal
with mental health issues.

Changing the scope of mental health and illness

conceptions for all
In this paper, we have avoided western diagnostic mental illness concep-
tions, such as depression, psychoses, personality disorders, etc. We have
argued instead that for some remote Indigenous Australian people and
their communities, the community itself and its wider contexts form the
background to what are often labelled as ‘mental illnesses’. We suspect
566 Bernard Guerin and Pauline Guerin

that this will be found to be the case in many other disadvantaged and mar-
ginalized communities.
The final question to address is whether ‘mental’ health issues are really
something uniquely ‘psychological’ or whether they are a reflection of ex-
ternal conflicts and problems in life which should be recorded, observed,
and taken into account when dealing with manifested problems? We
have argued here that behaviour of Indigenous Australians (and, indeed,
people more generally) is partly a function of social, historical, and political
impacts on their ways of life over many decades (Hunter, 2002). Problems in
mental health services occur because of using overly abstract and general-
izable ways of speaking about mental health. In the words of Hunter (2007,
p. 88): ‘Summarizing mental health status, then, is fraught with the twin
dangers of generalisation and decontextualization—context is critical’. Gen-
eralizations are useful in making knowledge seem applicable to many
people but the contexts are removed in formulating generalizations and
thus generalized knowledge is limited when dealing with specific people.
However, if ‘context is vital’ (Garvey, 2000, p. 33), we cannot assume that
context relevant to non-Indigenous people will apply to Indigenous people
or vice-versa. The real issue therefore becomes one of how far the aetiology of
behaviours that are seen in ‘mental illness’ pertains to the context in which a person
is immersed rather than something purely about an individual separate from it.
This is the nub, we believe, of a major divide in the mental health literature,
and Indigenous and multicultural mental health issues have been discur-
sive domains for these discussions because the determinants of mental
health seem different (Guerin, Guerin, Diiriye and Abdi, 2004; Guerin,
Guerin, Diiriye and Yates, 2004; Guerin, Elmi and Guerin, 2006). Psycholo-
gists and psychiatrists have traditionally put causes ‘inside’ a person, as
either a personality or ‘mental’ disorder or else as internal brain processes.
The mainstream literatures on Indigenous Australians’ mental health have
continued this by placing the causes onto (supposedly) context-free con-
cepts of indigeneity or the protocols and procedures for dealing with ‘Indi-
genous issues’ identified in our brief literature review above. The question
is important because as we have tried to show, the locus of treatment will
shift from talking to people or providing medications, to working alongside
them in families and communities, and to identify the wider contexts for
thoughts and behaviours in order to change them. In stark form, it is not
that interventions should try to alleviate poverty or racism in order to
make the personal or individual ‘mental illness’ easier to deal with in a
western method; rather, the context of living in poverty or racism is the
‘mental illness’ that needs curing.
We recommend therefore that all specific community contexts – historical,
cultural, economic – be better documented in order to understand and influ-
 Re-thinking mental health for indigenous Australian communities 567

ence ‘mental illness’, not just the ones we have referred to in our own field
work (e.g. Tew, 2005). This should result in policies driven not just by an
‘evidence-base’, but by a ‘contextual evidence-base’. The interventions,
therefore, must also be community development-oriented rather than indi-
vidually oriented, if mental health is to be improved in communities such
as those that we have worked with, and perhaps others too.

Acknowledgements
We thank the people in the communities and the service providers who gra-
ciously agreed to be involved in these projects, and also Deirdre Tedmanson
and Yvonne Clark for useful conversations about this article.

Bernard Guerin is with the University of South Australia, Adelaide, SA, Australia Pauline
Guerin is with Flinders University of South Australia. Bernard Guerin is Professor of Psych-
ology at the University of South Australia, Adelaide.

Pauline Guerin is jointly employed by the School of Nursing and Midwifery at Flinders Uni-
versity of South Australia and is the Psychology Program Coordinator, Pennsylvania State
University, Brandywine Campus, Media, PA.

Funding
This work was supported by grants from the Australian Research Council
(ARC DP0877901) and the Australian Institute of Aboriginal and Torres
Strait Islander Studies (AIATSIS G07/7290).

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