Mental health

About this topic

For many Aboriginal and Torres Strait Islander (First Nations) people, good mental health is indicated by feeling a sense of belonging, having strong cultural identity, maintaining positive interpersonal relationships, and feeling that life has purpose and value (Dudgeon & Walker 2015; Dudgeon et al. 2014). Conversely, poor mental health can be affected by major stressors such as removal from family, incarceration, death of a close friend or family member, discrimination and unemployment, as well as stressors from everyday life (PM&C 2017; Gee et al. 2014).

The legacies of colonisation and the ongoing trauma experienced by First Nations people also affect mental health. Dispossession from land, forced removal of First Nations children from families, and institutionalised racism have enduring effects on social and emotional wellbeing (Dudgeon & Walker 2015).

Connection to mind and emotions

Connection to mind and emotions is one of the 7 domains of social and emotional wellbeing for First Nations people.

Social and emotional wellbeing is a holistic way of looking at relationships between individuals, family, kin and community in the context of land, culture, spirituality and ancestry. Cultural groups and individuals each have their own interpretation of social and emotional wellbeing (Gee et al. 2014).

Factors that support the connection to mind and emotions are education, agency and strong identity. Conversely, mental illness, development or cognitive impairments and other disability, trauma, racism and unemployment can negatively affect the connection to mind and emotions (PM&C 2017).

Good mental health is a positive state of wellbeing in which a person can manage their thoughts and feelings to cope with the normal stressors of life and reach their potential in the context of family, community, culture and broader society. Mental health problems are ‘diminished cognitive, emotional or social abilities but not to the extent that the criteria for a mental illness are met’, such as psychological distress (AIHW & NIAA 2020).

Mental illnesses are diagnosed according to criteria and range from high‑prevalence disorders such as anxiety and depression, through to low‑prevalence disorders such as psychosis, schizophrenia, and bipolar disorder (AIHW & NIAA 2020).

There are cultural differences to be considered by practitioners when identifying and treating mental health conditions in First Nations people. Symptoms such as a weakened spirit and community disconnection may require cultural resolution and healing with culturally appropriate counselling services (Gee et al. 2014). Additionally, expressions and perceptions of mental health conditions such as depression may differ between First Nations people and non-Indigenous Australians (Brown et al. 2012; Vicary & Westerman 2004).

In 2020, all Australian governments and the Coalition of Aboriginal and Torres Strait Islander Peak Organisations worked in partnership to develop the National Agreement on Closing the Gap- external site opens in new window (the National Agreement), built around 4 Priority Reforms. The National Agreement also identifies 19 targets across 17 socioeconomic outcome areas. One of these targets directly relates to mental health, monitored annually by the Productivity Commission.

National Agreement on Closing the Gap: mental health-related targets

Outcome area 14: Aboriginal and Torres Strait Islander people enjoy high levels of social and emotional wellbeing

Target: Significant and sustained reduction in suicide of Aboriginal and Torres Strait Islander people towards zero (from an age-standardised rate of 25.1 per 100,000 people in 2018).
Status: In 2021, the suicide age-standardised rate for Aboriginal and Torres Strait Islander people was 27.1 per 100,000 people (for NSW, Queensland, WA, SA and the NT combined). To measure progress toward this target, a trajectory of a 75% reduction is presented on the Closing the Gap information repository. The 2021 rate is above the trajectory rate of 20.8 per 100,000 people.

Source: Closing the Gap information repository.

Key statistics

Mental health problems and mental illness are distinct from social and emotional wellbeing problems, although they can interact and influence each other (PM&C 2017). Mental illness (mental health conditions) can still affect people who have good social and emotional wellbeing. Mental health problems are ‘diminished cognitive, emotional or social abilities but not to the extent that the criteria for a mental illness are met’, for example psychological distress (PM&C 2017). Mental health conditions are diagnosed according to certain criteria. They range from high prevalence disorders such as anxiety and depression, through to low prevalence disorders such as psychosis, schizophrenia, and bi-polar disorder.

The Indigenous Mental Health and Suicide Prevention Clearinghouse (the Clearinghouse) has used 3 social and emotional wellbeing measures – psychological distress, level of mastery and perceived social support – from the National Aboriginal and Torres Strait Islander Health Survey (NATSIHS) 2018–19 to identify relationships between mental health conditions, drug and alcohol use, unfair treatment and SEWB. For more information about these scales, see the topic page on Social and emotional wellbeing.

Prevalence of mental health conditions

The data presented here is sourced from the NATSIHS 2018–19 and is for persons aged 18 and over. Estimates are calculated using a sample selected from a population rather than all members of that population. See the data tables in the Download data section for notes related to these data.

In 2018–19, over a third of First Nations people (37%) reported having a current mental health condition. The proportion was higher among females (42%) than males (30%) (Figure 1, Table MH.1). Most people who reported ever being diagnosed with a mental health condition also reported having a current condition (190,100 and 178,400, respectively) (Table MH.1).

Almost a quarter of all First Nations people (24%) reported having a current, long-term mental health or behavioural condition (ABS 2019). More than one in 10 individuals reported having long-term diagnosed Anxiety (17%) or Depression (13%) (ABS 2019) (Figure 1; Table MH.2).

People aged 35–44 had the highest proportion of people reporting a current, long-term mental health or behavioural condition (32%), followed by people aged 45–54 (31%) and 25–34 (30%). It was lowest among people aged 0–14 (15%) (ABS 2019) (Table MH.3).

Social and emotional wellbeing and mental health

First Nations people ever diagnosed with a mental health condition were more likely to report High/Very high psychological distress (53%), Low mastery (49%), which is the level of control a person feels over their own life, and Low perceived social support (13%) than people without a diagnosed mental health condition (18%, 23% and 6.2%, respectively). These proportions were similar among people with a current mental health condition (Table MH.4).

Levels of social and emotional wellbeing varied by mental health condition. The proportion of people reporting Low/Moderate psychological distress was greatest among people with Depression (43%) and smallest among people with Behavioural/emotional problems (23%) (Table MH.4).

The proportion of people reporting High mastery and High perceived social support was greatest among people with Anxiety (48% and 49%, respectively). People with Harmful use/dependence on alcohol or drugs had the smallest proportions of High mastery and High perceived social support (35% and 35%, respectively) (Table MH.4).

Social and emotional wellbeing and alcohol and other drugs

The pathways between alcohol consumption and mental health and social and emotional wellbeing are complex. Harmful consumption of alcohol may cause or exacerbate mental health conditions. On the other hand, harmful levels of alcohol may be used to cope with poor mental health, as a form of self-medication (Gray et al. 2018; Nadew 2012; Wilkes et al. 2014).

The data presented here is sourced from the National Aboriginal and Torres Strait Islander Health Survey (NATSIHS) 2018–19 and is for persons aged 18 and over. Estimates are calculated using a sample selected from a population rather than all members of that population. See the data tables in the Download data section for notes related to these data.

First Nations people are more likely to abstain from alcohol than non-Indigenous Australians; however, those who do drink are more likely to do so at dangerous levels (ABS 2019). The Clearinghouse has used the frequency of consuming 3 or more standard drinks in a day as a proxy for the current alcohol guidelines, released in 2020. These guidelines state that healthy adults should not consume more than 10 standard drinks per week, or more than 4 drinks in a day (NHMRC 2020).

Caution should be taken in ascribing the direction of relationships using the Clearinghouse analysis. While the analysis found associations between variables, it cannot determine the direction of the relationships nor the causal factors/variables.

Low/Moderate psychological distress was most likely to be reported by First Nations people consuming 3 or more standard drinks in a day 1 to 2 days a week, 13 to 51 times in a year and people who had Never consumed alcohol (73%, 73% and 71%, respectively). It was least likely to be reported by people consuming 3 or more drinks on 3 or more days a week (Table MH.5). The proportion of people reporting High mastery was greatest for people consuming 3 or more drinks on 1 to 2 days a week (74%) and was smallest for people drinking on 3 or more days in a week (61%) (Table MH.5).

The proportion of people reporting a mental health condition was greatest among people consuming 3 or more drinks in a day 12 or fewer times in a year (42%) or 3 or more days a week (42%) and smallest for people who reported drinking 1 to 2 days a week (28%) (Table MH.6).

High/Very high psychological distress (44%) and Low mastery (44%) were more likely to be reported by First Nations people who used substances for non-medical purposes in the last 12 months than people who did not use substances (27% and 30%, respectively). People who used substances were less likely to report High perceived social support than people who did not (52% compared with 63%) (Table MH.7). Almost half (48%) of people who reported using substances in the previous 12 months also reported having a current diagnosed mental health condition (Table MH.6).

Among people who reported using substances in previous 12 months, people who used Analgesics were most likely to report High/Very high psychological distress (62%), compared with people who used other drug types (Figure 3; Table MH.7).

Unfair treatment and mental health

Experiences of racism and racial discrimination are common for First Nations people in Australia, regardless of gender, age and geographic location. Experiences of racism among First Nations people are associated with negative impacts on mental health and wellbeing outcomes including psychological distress, stress and depression (Truong & Moore 2023).

In 2018-19, among First Nations people who had a diagnosed mental health condition, 34% experienced unfair treatment in the past 12 months, compared with less than 20% who did not have a diagnosed mental health condition (Table MH.8). Twenty-one per cent of people with a diagnosed mental health condition avoided situations due to past unfair treatment compared with 10% without a diagnosed mental health condition (Table MH.8).

Burden of disease from mental and substance use disorders

The following data was sourced from the AIHW Australian burden of disease study.

In 2018, mental and substance use disorders were the leading cause (23%) of total disease burden for First Nations people. Within this disease group, the leading causes of burden were:

23% Anxiety disorders
19% Alcohol use disorders
19% Depressive disorders
9% Drug use disorders (excluding alcohol)
7% Schizophrenia (AIHW 2022) (Figure 4; Table MH.9).

Key terms

An administrative data set is information collected for the purposes of delivering a service or paying the provider of the service.

Burden of disease or disease burden refers to:

Burden of disease is a measure of the impact of different diseases or injuries on a population. It combines the years of healthy life lost due to living with ill health (non-fatal burden) with the years of life lost due to dying prematurely (fatal burden). Fatal and non-fatal burden combined are referred to as total burden, reported as the disability-adjusted life years (DALYs) measure (AIHW 2020).

Disability-adjusted life years (DALY): Measure (in years) of healthy life lost, either through premature death, defined as dying before the expected life span at the age of death (YLL), or, equivalently, through living with ill health due to illness or injury (YLD). It is often used synonymously with ‘health loss’ (AIHW 2022).

Level of mastery was determined using the Pearlin Mastery Scale, which is a set of seven statements used to measure how much a person feels in control over life events and outcomes. Higher levels of mastery can lessen the impact of stress on a person’s physical and mental wellbeing. Respondents were asked to respond to each statement by selecting one of four responses presented on a prompt card, ranging from ‘strongly agree’ to ‘strongly disagree’. Responses to the statements were combined to produce an overall score between seven and 28. The scores were then grouped to describe the level of mastery as low (7–19) or high (20–28). The Pearlin mastery scale was asked of people living in non-remote areas only (ABS 2019).

A mental health or behavioural condition refers to the following:

depression (including feeling depressed)
anxiety
harmful use or dependence on alcohol or drugs
behavioural or emotional problems such as attention deficit hyperactivity disorder (ADHD) and conduct disorders in children and adolescents and adults
other mental health conditions such as organic mental problems, other mood (affective) disorders, other anxiety related problems, and psychological development (ABS 2019).

A current long-term mental health or behavioural condition is an illness or disability which was current at the time of the interview and which had lasted at least six months, or which the person expected to last for six months or more.

The term Mental and substance use disorders is an international administrative classification that includes mental health and behavioural conditions as well as other conditions such as autism spectrum disorder and cognitive impairment.

Perceived social support was determined using a set of six statements from the Multidimensional Scale of Perceived Social Support (MSPSS), which measure a person’s perception of the social support they receive from family and friends. Respondents were asked to respond to each statement by selecting one of seven responses presented on a prompt card, ranging from ‘very strongly disagree’ to ‘very strongly agree’. ‘Don’t know’ and refusal options were available and, if selected, a score was unable to be determined. Responses to the statements were combined to produce a family score, a friends score and an overall score. The family, friends and overall scores were grouped to describe the level of perceived social support from each dimension as low (1–2.9), moderate (3–5) or high (5.1–7). The MSPSS was asked of people living in non-remote areas only (ABS 2019).

Psychological distress refers to how often a person had experienced negative emotional states in the previous four-week period, measured by the Kessler Psychological Distress Scale (K5). The K5 prompts questions such as ‘in the last four weeks, how often did you feel without hope?’. Responses range from ‘all of the time’ to ‘none of the time’. Combined responses produce a score between 1 and 25. The scores were grouped to describe the level of psychological distress as low/moderate (5–11) or high/very high (12–25) (ABS 2019).

Remoteness: Each state and territory is divided into regions based on their relative accessibility to goods and services (such as to general practitioners, hospitals and specialist care) as measured by road distance.

These regions are based on the Accessibility/Remoteness Index of Australia and defined as Remoteness Areas by either the Australian Standard Geographical Classification (ASGC) (before 2011) or the Australian Statistical Geographical Standard (ASGS) (from 2011 onwards) in each Census year. The 5 Remoteness Areas are Major cities, Inner regional, Outer regional, Remote and Very remote.

Where do I go for more information?

This information was compiled from the following data sources: ABS National Aboriginal and Torres Strait Islander Health Survey (NATSIHS) 2018–19 and the Australian Burden of Disease Study 2018. More information about these data sources and data quality is available in Data sources.

Information about alcohol and other drugs was compiled from the following data source: National Aboriginal and Torres Strait Islander Health Survey (NATSIHS) 2018–19. More information is available in Data sources.

Data quality issues

Survey data presented above are from the Aboriginal and Torres Strait Islander Health Survey (NATSIHS). The following factors should be considered when interpreting these estimates.

Data are collected from a self-report survey, and responses may differ from information available from other sources.
Accuracy of responses may be affected by the length of time between events experienced and participation in the survey.
Some people may have provided responses they felt were expected, rather than those that accurately reflect their own situation.
Results of previous surveys have shown a tendency for people to under-report when asked about certain topics, such as substance use.
Survey participants may report more than one mental or behavioural condition. Total mental and behavioural conditions refers to those who reported at least 1 mental or behavioural condition (ABS 2019).

See ABS NATSIHS 2018–19 Methodology for more information.

All estimates in the Australia Burden of Disease Study 2018 were produced using the best possible data that were available within the scope and timeframe of the study.

Data for First Nations people are subject to several limitations of data quality and availability. These include under-identification of First Nations people in administrative data sets, changes in people’s inclination to identify as Aboriginal or Torres Strait Islander, and lack of available data on the prevalence of certain diseases in the First Nations population. For more information about data quality issues, see Australian Burden of Disease Study 2018: methods and supplementary material.

References

ABS (Australian Bureau of Statistics) 2019. National Aboriginal and Torres Strait Islander Health Survey, 2018–19. ABS cat. no. 4715.0. Canberra: ABS.

AIHW (Australian Institute of Health and Welfare) 2018. Impact of alcohol and illicit drug use on the burden of disease and injury in Australia: Australian Burden of Disease Study 2011. Canberra: AIHW.

AIHW 2020. Indigenous health and wellbeing. Canberra: AIHW. Viewed 17 May 2021.

AIHW 2022. Australian Burden of Disease Study: Impact and causes of illness and death in Aboriginal and Torres Strait Islander people 2018. Australian Burden of Disease Study series no. 26. Cat. no. BOD 32. Canberra: AIHW.

AIHW & NIAA (Australian Institute of Health and Welfare & National Indigenous Australians Agency) 2020. Aboriginal and Torres Strait Islander Health Performance Framework. Canberra: AIHW. Viewed 19 May 2021.

Brown A, Scales U, Beever W, Rickards B, Rowley K & O'Dea K 2012. Exploring the expression of depression and distress in aboriginal men in central Australia: a qualitative study. BMC Psychiatry 12:97. doi:10.1186/1471-244X-12-97

Catto M & Thomson N 2008. Review of illicit drug use among Indigenous peoples. Australian Indigenous HealthInfoNet.

Dudgeon P, Cox A, Walker R, Scrin C, Kelly K, Blurton D et al. 2014. Voices of the peoples: The national empowerment project research report 2015. Perth: National Empowerment Project, University of Western Australia.

Dudgeon P & Walker R 2015. Decolonising psychology: discourses, strategies and practice. Journal of Social and Political Psychology 3(1):276–297.

Gee G, Dudgeon P, Schultz C, Hart A & Kelly K 2014. Aboriginal and Torres Strait Islander social and emotional wellbeing. In: Dudgeon P, Milroy H & Walker R (eds). Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice. 2nd edn. Canberra: Australian Government, pp. 55-68.

Gray D, Cartwright K, Stearne A, Saggers S, Wilkes E & Wilson M 2018. Review of the harmful use of alcohol among Aboriginal and Torres Strait Islander people. Perth: Australian Indigenous HealthInfoNet.

Leckning B, Borschmann R, Guthridge S, Silburn SR, Hirvonen T, Robinson GW 2023. Suicides in Aboriginal and non-Aboriginal people following hospital admission for suicidal ideation and self-harm: A retrospective cohort data linkage study from the Northern Territory. Australian and New Zealand Journal of Psychiatry, 57(3):391-400.

Nadew GT 2012. Exposure to traumatic events, prevalence of posttraumatic stress disorder and alcohol abuse in Aboriginal communities. Rural and Remote Health 12:1667.

NHMRC (National Health and Medical Research Council) 2008. Australian alcohol guidelines for low-risk drinking 2007. Canberra: NHMRC.

NHMRC 2009. Australian Guidelines to Reduce Health Risks from Drinking Alcohol. Canberra: NHMRC.

NHMRC 2020. Australian Guidelines to Reduce Health Risks From Drinking Alcohol. (ed., Department of Health). Department of Health: National Health and Medical Research Council.

PM&C (Department of Prime Minister and Cabinet) 2017. National Strategic Framework for Aboriginal and Torres Strait Islander Peoples’ Mental Health and Social and Emotional Wellbeing. Canberra: Australian Government.

Robinson G, Silburn S & Leckning B 2011. Suicide of Children and Youth in the NT 2006–2010: Public release report for the Child Deaths Review and Prevention Committee. Darwin: Menzies SHR.

SCRGSP (Steering Committee for the Review of Government Service Provision) 2014. Report on Government Services 2014. Canberra: Productivity Commission.

Truong M and Moore E, 2023. Racism and Indigenous wellbeing, mental health and suicide. Catalogue number IMH 17, Australian Institute of Health and Welfare, Australian Government.

Vicary D & Westerman T 2004. That’s just the way he is’: Some implications of Aboriginal mental health beliefs. Australian e-Journal for the Advancement of Mental Health 3(3):103–112.

Wilkes E, Gray D, Casey W, Stearne A, Dadd L, Dudgeon P et al. 2014. Harmful substance use and mental health. In Dudgeon P, Milroy H & Walker R (eds). Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice, Part 2:125–146.

Data tables

Table number and title	Source	Reference year
Table MH.1: Presence of mental health conditions among First Nations people, by sex, 2018–19	AIHW analysis of ABS NATSIHS	2018–19
Table MH.2: Self-reported long-term mental health or behavioural condition among First Nations people, by sex, 2018–19	ABS NATSIHS, as published in AIHW Aboriginal and Torres Strait Islander Health Performance Framework data tables	2018–19
Table MH.3: Self-reported long-term mental health or behavioural condition among First Nations people, by age, 2018–19	ABS NATSIHS, as published in AIHW Aboriginal and Torres Strait Islander Health Performance Framework data tables	2018–19
Table MH.4: Social and emotional wellbeing among First Nations people, by diagnosed mental health conditions, 2018–19	AIHW analysis of ABS NATSIHS	2018–19
Table MH.5: Social and emotional wellbeing among First Nations people, by frequency of consuming 3 or more drinks in a day in the last 12 months, 2018–19	AIHW analysis of ABS NATSIHS	2018–19
Table MH.6: Presence of mental health conditions among First Nations people by substance and alcohol use, 2018–19	AIHW analysis of ABS NATSIHS	2018–19
Table MH.7: Social and emotional wellbeing among First Nations people, by substance use and type, 2018–19	AIHW analysis of ABS NATSIHS	2018–19
Table MH.8: Unfair treatment among First Nations people, by presence of mental health conditions, 2018–19	AIHW analysis of ABS NATSIHS	2018–19
Table MH.9: Leading causes of Mental health and substance use disorder burden (DALYs) among First Nations people, by type of disorder and sex, 2018	AIHW Australian Burden of Disease study	2018