Background: Recognising the inherent complexities associated with co-occurring alcohol and other drug (AOD) and mental health conditions (‘dual diagnosis’ or ‘comorbidity’), the National Comorbidity Project was introduced by the Commonwealth in 2000, which saw the union of the National Drug Strategy and the National Mental Health Strategy for the first time. The subsequent National Drug Strategy: Australia’s Integrated Framework 2004-2009 was heavily grounded in the promotion of dual capacity i.e. the ability for both AOD and mental health services to respond to those presenting with a dual diagnosis. A ‘No Wrong Door’ philosophy, referring to the provision of appropriate treatment services to presenting clients regardless of where they enter the treatment system, became the ‘push’ from the government as they introduced the National Comorbidity Initiative in 2007.
Despite the significant over-representation of Indigenous Australians within our mental health and drug harms data, there is an obvious absence of a dialogue that includes Australia’s Indigenous population in the NCI. The NCI pays no attention to the need for the AOD and mental health workforces to ensure ‘culturally appropriate’ service provision to Indigenous service users.
This study investigates the Australian states and territories own policy responses to Dual Diagnosis Capability, specifically as they relate to Indigenous service users. The study seeks to determine the extent to which these policies are culturally proficient.
Methods: A systematic review was undertaken of the Australian state and territories that have dual diagnosis policies. In the absence of a national guideline for measuring cultural competence, the state and territory policies were examined and assessed through the lens of the Cultural Competence Continuum and a grading tool was designed specifically for this study modelled on the Dual Diagnosis Capability in Addiction Treatment (DDCAT) tool and the Victorian Aboriginal Child Care Agency (VACCA) Aboriginal Cultural Competence Matrix. The Bridgman and Davis’ Policy Cycle was used as the ‘lens of good policy’.
Results: Five Australian states’ and territories’ dual diagnosis documents were evaluated, the results showing very low levels of cultural proficiency. It is apparent that when viewed at a national level, there is little strength in Australia’s dual diagnosis policies from the perspective of how appropriately they reflect the needs of Indigenous Australians with a dual diagnosis.
Conclusions: ‘Culturally competent’ service delivery requires particular characteristics as outlined in the Cultural Competence Continuum in order for policy-makers and services to start a process of shifting on this continuum. The results of the study demonstrate that the Australian policies examined do not have these characteristics. In their current form, these policies are not culturally proficient; rather, they are demonstrating attributes of cultural destructiveness, aversion, blindness, and overall cultural incompetence. Until Australian policy sets a directive for standards, not just guidelines, then it will remain difficult to measure true cultural competence in any organisation or larger service system. And arguably, the continued poor health status of Australia’s Indigenous population will ensue.
A gateway to Melbourne's research publications