Social 2013). Varied factors have been found to be

Social & Emotional Wellbeing   Aboriginal and Torres- Strait Islander: Social & Emotional Wellbeing IntroductionAboriginals and Torres- Strait Islanders population has used this term ‘social & emotional wellbeing’ (SEWB) to describe about the societal, emotional, cultural as well as spiritual wellbeing of an individual (Gee, 2014). SEWB emphasize the relation of Aboriginals with land, family, community as well as spirituality that are important to individuals; which affects their wellbeing (Langham, 2017). All the health professionals should meticulously consider SEWB while caring Aboriginals, which is highly sensitive. Australian Medical services puts greater efforts in improving Indigenous health by adopting WHO’s primary health care principles(Marles, 2012). This post discusses about the importance of SEWB rather than mental health activities while implementing Health based programs among Indigenous population.. Difference between SEWB and mental healthSEWB is a complex and multidimensional concept with certain resonance for Aboriginals & Torres- Strait Islanders (Dudgeon, 2014) whereas mental health is mostly used by the non-Indigenous population to describe about the thinking, feeling, coping and ability to participate in daily activities and that mental health involves absence of any mental disorders. Most of the Aboriginals & Torres- Strait Islanders states that the term ‘mental health’ as well as ‘mental illness’ focuses only on problem aspect and fail to involve those factors that encompasses and influence a person’s wellbeing (Bowins, 2016, Sherwood, 2013). Moreover, the holistic view of health in SEWB has pushed the Aboriginals and Islanders to prefer the term ‘social & emotional wellbeing’ rather than mental health. Gee (2014) suggested that though the terms SEWB and mental health & illness are used interchangeably, the later terms should be considered as a part of an individual’s SEWB rather than equating them with SEWB. Additionally, Aboriginals believe that SEWB is ‘a multifaceted aspect of health that not only encompasses mental health, but also the varied health and wellbeing domains such as their link to country, culture, ancestry, spirituality family along with community (Sherwood, 2013). Considering SEWB and mental health as an aspect of cultural constructions can definitely enhance the effect of cultural responsiveness and strengths related approach in-order to manage the emerging issues among individuals. In-regard to Aboriginal & Torres-Strait Islanders, many past events have imposed a serious effect on their SEWB. According to Zubrick (2014), colonization has caused a profound effect on the cultural practices and their implication on SEWB among Aboriginals (Sherwood, 2013). Varied factors have been found to be linked with SEWB as racial discrimination, life stresses, grief, loss of lands (dispossession), societal exclusion, policies and actions including child removals (care with protection orders), unresolved life- trauma, incarceration, societal and economic disadvantages, family violence, unemployment, substance abuse along with physical health issues (Zubrick, 2014). Gee (2014) has also identified many factors that influences SEWB as the link of Aboriginals with country, their spiritual beliefs, ancestral origin, kinship, self determination, cultural continuity as well as governance in community (Parker, 2013). According to Professor Milroy, three themes were found to have affected Aboriginals and Islanders as the denial of humanity; existence as well as identity (Gee, 2014).   Aboriginal Medical Services and its alignment with PHCAboriginal community controlled healthcare services (ACCHS) also called as Aboriginal Medical Services (AMS) has pioneered the current comprehensive primary health care (PHC) in Australia by following the Alma Ata’s Declaration of World Health Organization (Freeman, 2015). In 1970s, ACCHS was developed in response to the poorer access to health care services as well as varied discrimination practices in the usual healthcare provided to the Aboriginals. Its services provided a modified primary health-related care model in-regard to the general health care practice, which was supported and funded by the Medicare services. The first ACCHS service that includes the Central- Australian’s Aboriginal Congress (later termed as Congress) was developed based on the effect of public (local Aboriginal population) meetings for formulating plans to seek collective advocacy as well as for taking action to support the Aboriginal’s rights that includes the right to health. Dwyer (2011) has stated that nearly 150 ACCHS services were found to have served about one- third to half of the Aboriginals. In present days of Australia, the self determination based policies of 1980s and 1990s were modified by a practice that was featured by a paternalistic- interventionism as well as a deficit-model related to the Aboriginals health- and wellbeing (NACCHO, 2011). ACCHS organizations are found to play a greater role in giving the voice for and render control to local Aboriginal and Islander communities (Sherwood, 2013). ACCHS strives to provide PHC as enshrined by the WHO in the Alma-Ata declaration- 1978 based on its definition for PHC as ‘essential health-care that are practically applied, scientifically sound as well as acceptable by society with all the technologies made accessible universally to individuals, families and communities; by their fullest participation and at an affordable cost by the community and Nation’. Many of the principles of ACCHS echoes the WHO’s definition which also stresses mostly that the community should identify their own problems and needs for taking an effective action (Freeman, 2016).The main principle of the National- Aboriginal’s Health Strategy involves ‘not only maintaining physical wellbeing of Aboriginals is important but also the societal, psychologicaland cultural wellbeing of the community is equally important in which the people can achieve full potential so as to bring the total wellbeing of the Aboriginal community (Freeman, 2015). The mentioning of ‘community’ is highly essential aspect of the Aboriginals view of their self and hence strongly connected to health & wellbeing. ACCHS also has a holistic healthcare view which recognizes the need for a multifaceted Indigenous healthcare and focuses mainly on their cultural complexities (Freeman, 2016). As Aboriginal communities in Australia has varied cultural practices and speak distinct languages, local control is must. The first ACCHS services were implemented in 1971 in the inner cities of Sydney, Redfern (Marles, 2012). AMS has expanded too many health-care facilities that renders free medical, psychological, dental, obstetrics and gynecology, pharmacology as well as alcohol services to a larger Aboriginal group. Greater difficulties were encountered by the Indigenous people in accessing the health care because of their uncomfortable feeling in seeking medical care at mainstream hospitals, reluctance, extreme geographical isolation and lack of transportation. It was overcome by the main-stream services of ACCHS by tackling the cultural and language disparities. AIHW (2011) showed that there was a greater discrepancy in life expectancy of Aboriginals and non-Indigenous people with unacceptably higher to be 11.5 yrs in males and 9.7 in females. Additionally, key health indicators (infant mortality, heart disease, mental illness) of Aboriginals was found to be worse which shows that a novel approach to Aboriginals is needed.Moreover, the services provided by ACCHS are restricted by funding; with majority from the Common-wealth/ State & Territory Government (NACCHO, 2011). The 2012 Indigenous Expenditure (Steering) Report shows that for every dollars of money that are spent for non-Indigenous healthcare, only 0.66 dollars were spent for Aboriginal healthcare. ACCHS strives to widen its activities to promote accessibility of Aboriginals to essential basic care. Many Universities have started medical schools to train Indigenous doctors based on the principle ‘stronger focus on the community with equity along with engagement by the medical personnnels’, thereby enhancing the advocacy and leadership skills in Indigenous people.As per WHO and World Bank report, integration of people is vital to promote quality of care (Cotlear, 2011) and hence ACCHS strives to enable comprehensive PHC approach in Aboriginals to achieve Universal health converge by reducing  health inequalities. Community participation is crucial element in a ‘rights-related approach to healthcare’ that includes the politics of solidarity and therefore UHC should be framed in human right terms (Grover. 2014, Freeman, 2016).ACCHS have adopted greater strategies to tackle the accessibility of services (including culturally- competent) (Freeman, 2015). It has addressed the following aspects as: Availability- by providing free transportation to all the service areas; Affordability by providing all services and medicines; Acceptability by designing the space to provide services in culturally respectfulwelcome and employing local Aboriginals and Engagement- by interactions with local community (Baum, 2012).Application of SEWB within ACCHS service    SEWB concerns are found to contribute to higher burden of disease with poorer health status in Aboriginals, while conversely, chronic diseases increases the risk for getting psychological problems (Langham, 2017). ACCHS serves a greater number of services within the social and emotional wellbeing of the Aboriginals so as to improve the overall health of Aboriginals. One among them is the their participation in disease prevention as well as health promotional strategies along with the provision of treatment with rehabilitation services, including medical-related, dental, and mental-health clinics with addiction therapy centers.     These activities of ACCHS include early child-hood with youth-related programs (as ante-natal care with birthing classes, mother & child immunizations, day-care, pre-school readiness-program, with youth-based outreach), health check-ups for adult, healthy life-style and exercise groups, community-based health-care education (sexual health) and mental- health promotions(in young people with communities) (Baum, 2014).The AATSIHS (2012-2013) noted that SEWB of Aboriginals are compromised with higher psychological distress with 2.7 times more as compared to non-Indigenous people (ABS. 2013). Hence, ACCHS adopts the definition of mental health as given by WHO (2016) as a complete state of societal with emotional wellbeing; with which persons will be able to cope with the usual life stresses and can realize their own potentials. ACCHS adopts mental-health strategies among young Aboriginals and communities by teaching psychosocial with behavioral skills, inter-personal skills in daily work and counseling so as to promote health-outcomes.AHMAC (2015) suggested that lower education-status, unemployment and poverty level are found to increase psychological distress in Aboriginals. Therefore, ACCHS strives to meet SEWB which is affected by a complex web of biological, emotional, societal, cultural, environmental as well as economic factors.ConclusionIt is highly crucial to care the Aboriginal and Islander communities by understanding their SEWB rather than terming it as mental health. Evidences suggest that ACCHS indulges itself into the Aboriginal services by adopting all the principles of primary health care as given by the WHO such as providing essential care by prompting accessibility, availability, affordability and acceptability; promoting inter-sectoral coordination, coordination with technologies and promoting community engagement; by considering their SEWB (Freeman, 2015). Most of the ACCHS activities were found to be within their SEWB so as to enable greater acceptance of services among Indigenous people, thereby enhancing their quality-of-life (Langham, 2017). Hence, the health professionals should provide holistic care to the Aboriginals within their SEWB rather than fearing them with term ‘mental health’.        ReferenceAHMAC. (2015). Aboriginal and Torres Strait Islander health performance framework 2014 report: Australian Health Ministers’ Advisory Council. Canberra: Department of the Prime Minister and CabinetAIHW. (2011). The health and welfare of Australia’s Aboriginal and Torres Strait Islander people: an overview 2011: Australian Institute of Health and Welfare. Canberra, ACT: Australian Institute of Health and Welfare.Australian Bureau of Statistics-ABS. (2013). Australian Aboriginal and Torres Strait Islander health survey: first results, Australia, 2012-13: Table 7 data cube. Canberra: Australian Bureau of StatisticsBaum, F et al. (2012). Community development: Improving patient safety by enhancing the use of health services:  Australian Family Physician. 41:424–28 Baum, F et al. (2014). Health promotion in Australian multi-disciplinary primary health care services: Case studies from South Australia and the Northern Territory: Health Promotion International. 29:705–19. Bowins, B. (2016). Mental Illness Defined: Continuums, Regulation, and Defense. Retrieved from, D et al. (2015). Going universal: How 24 developing countries are implementing universal health coverage reforms from the bottom up. Washington, DC: World BankDudgeon, P et al. (2014). Effective strategies to strengthen the mental health and wellbeing of Aboriginal and Torres Strait Islander people. Canberra: Closing the Gap ClearinghouseDwyer, J et al. (2011). Contracting for Indigenous health care: Towards mutual accountability: Australian Journal of Public Administration. 70(1):34–46.Freeman, T et al. (2015). Revisiting the ability of Australian primary health care services to respond to health inequity:  Australian Journal of Primary Health. 22:332–38Freeman, T et al. (2016). Service providers’ views of community participation at six Australian primary healthcare services: Scope for empowerment and challenges to implementation: International Journal of Health Planning and Management. 31:E1–E21. Gee, G et al. (2014). Aboriginal and Torres Strait Islander social and emotional wellbeing. 2nd ed. Canberra: Department of The Prime Minister and Cabinet: 55-68Grover, A. (2014). Right of everyone to the enjoyment of the highest attainable standard of physical and mental health. UN Doc. A/69/299  Langham, E. (2017). Social and Emotional Wellbeing Screening for Aboriginal and Torres Strait Islanders within Primary Health Care: A Series of Missed Opportunities: Front. Public Health. Retrieved from, E. (2012). The Aboriginal Medical Service Redfern: improving access to primary care for over 40 years: Aust Fam Physician. 41(6): 433-436.NACCHO. (2011). National Aboriginal Community Controlled Health Organization: 2010- 2011 Annual Report. Canberra, ACT: Parker, R & Milroy, H. (2014). Aboriginal and Torres Strait Islander mental health: an overview. Retrieved from documents/aboriginal-health/working-together-second-edition/wt-part-1-chapt-2-final.pdf. Sherwood, J.  (2013). Colonization: It’s bad for your health; The context of Aboriginal health: Contemporary Nurse. 46 (1): 28–40. Steering Committee for the Review of Government Service Provision. (2012). Indigenous expenditure report: overview. Canberra, ACT: Productivity Commission.World Health Organization. (2016). Mental health: strengthening our responses. Retrieved from, S.R et al. (2014). Social determinants of social and emotional wellbeing. Retrieved from