9.3.4 Need for Integrated, Flexible, Culturally Appropriate, Community-Based Services

Services and individuals identified small pockets of good practice in service response. Such practice acknowledges and enacts principles of reciprocity, consistency, flexibility, accountability, fairness and cultural/social sensitivity in service delivery. Services that take a preventative approach to addressing complex support needs appear to achieve better outcomes for Indigenous people with mental and cognitive impairment. Therapeutic and person-centered service models enable services to engage and build a rapport with clients while their behavioural, emotional and health needs are assessed. This approach leads to positive outcomes when all relevant services are involved in the development and implementation of case plans. Services that are flexible in their delivery of programs reportedly observe better outcomes for Indigenous people with mental and cognitive disability. This is the case across most areas of service provision. In order to respond flexibly and adaptively, however, individual staff often need to ‘bend the rules’ and act outside official service policies and guidelines. In especially complex cases, measures such as MOUs can enable services to work around service guidelines and eligibility criteria. 

Innovative services are trialing self-determining models where the client is wholly or partly the driving force behind their care plans, increasing their sense of agency and empowerment. Such models are similar to that proposed under the NDIS; it is important that models already successfully operating are preserved and used as an exemplar for practice in the NDIS. Services which involve the family and gain their support feel more equipped to identify and pursue outcomes for Indigenous clients with mental and cognitive disability. In some cases, the family also benefits from several of its members receiving services concurrently. Family mapping helps services understand the structure of the family and identify individual and collective needs. There was a clear need expressed for culturally appropriate rehabilitation services to be located in people’s own communities, staffed with professionals trained in both mental health and wellbeing and cognitive disability principles and practice.