Original Article Approach to treatment of mental illness and substance dependence in remote Indigenous communities: Results of a mixed methods study Tricia Nagel, 1,2,4,5 Gary Robinson, 3 John Condon 2 and Tom Trauer 6 1 Top End Mental Health Services, 2 Menzies School of Health Research, 3 School for Social and Policy Research, Institute of Advanced Studies, Charles Darwin University, Darwin, Northern Territory, 4 School of Medicine, Flinders University, Adelaide, South Australia, 5 School of Medicine and Dentistry, James Cook University, Brisbane, Queensland, and 6 Department of Psychiatry, University of Melbourne, Parkville, Victoria, Australia Abstract Objective: To develop and evaluate a culturally adapted brief intervention for Indigenous people with chronic mental illness. Design: A mixed methods design in which an explor- atory phase of qualitative research was followed by a nested randomised controlled trial. Setting: Psycho-education resources and a brief inter- vention, motivational care planning (MCP), were devel- oped and tested in collaboration with aboriginal mental health workers in three remote communities in northern Australia. Participants: A total of 49 patients with mental illness and 37 carers were recruited to a randomised controlled trial that compared MCP (n = 24) with a clinical control condition (treatment as usual, n = 25). Intervention: The early treatment group received MCP at baseline and the late treatment group received delayed treatment at six months. Main outcome measures: The primary outcome was mental health problem severity as measured by the health of the nation outcome scales. Secondary measures of well-being (Kessler 10), life skills, self- management and substance dependence were chosen. Outcome assessments were performed at baseline, six-month, 12-month and 18-month follow up. Results: Random effects regression analyses showed significant advantage for the treatment condition in terms of well-being with changes in health of the nation outcome scales (P < 0.001) and Kessler 10 (P = 0.001), which were sustained over time. There was also signifi- cant advantage for treatment for alcohol dependence (P = 0.05), with response also evident in cannabis dependence (P = 0.064) and with changes in substance dependence sustained over time. Conclusions: These results suggest that MCP is an effective treatment for Indigenous people with mental illness and provide insight into the experience of mental illness in remote communities. KEY WORDS: co-morbidity, community psychiatry, health service, Indigenous, self-management. Introduction Aboriginal and Torres Strait Islander people are over- represented in inpatient mental health care nationwide and hospitalisations for ‘mental and behavioural disor- ders due to psychoactive substance use’ are three and four times the rate of non-Indigenous women and men, respectively. 1,2 Furthermore, most Indigenous people live in remote and rural areas with limited access to specialist mental health services 3 and marked differences in literacy, lan- guage and worldview. 4,5 In light of these challenges, there is a need to develop culturally adapted psychologi- cal interventions that can be delivered in primary care settings. ‘Brief interventions’ are a collection of techniques that include motivational interviewing 6,7 and regular follow up. A systematic review and meta-analysis of primary care indicated that brief alcohol intervention was effec- tive in reducing alcohol consumption, 8 while a number of recent studies have shown good response to similar strategies in the setting of co-morbid psychosis and sub- stance use. 9–11 Furthermore, another brief therapy, problem-solving therapy, has been described as the most Correspondence: Dr Tricia Nagel, Menzies School of Health Research, Charles Darwin University, Rocklands Drive, Casuarina, Northern Territory, 0810, Australia. Email: tricia.nagel@menzies.edu.au Declaration of interest: None identified. Accepted for publication 18 November 2008. Aust. J. Rural Health (2009) 17, 174–182 © 2009 The Authors Journal compilation © 2009 National Rural Health Alliance Inc. doi: 10.1111/j.1440-1584.2009.01060.x