Breaking the Silence: Shifting the Focus in Perinatal Mental Health Screening for Aboriginal and Torres Strait Islander Parents

Dr Sharon Pittaway
Senior Consultant Associate

"When I was first pregnant, my mother told me not to talk about my mental health with anyone."

This powerful quote set the tone for my presentation to the Victorian Branch of PANDA (Perinatal Anxiety and Depression Australia) last week. As we mark Perinatal Mental Health Week (Nov 17-23), it’s timely to reflect on key findings from our consultations with Aboriginal and Torres Strait Islander parents on their experiences with perinatal mental health screening. The quote above highlights a painful reality: fear and distrust are deeply rooted in many Aboriginal and Torres Strait Islander families’ experiences when discussing mental health. Let’s explore why this is the case and how we can change it.

Fear and distrust: The legacy of child removals

One of the strongest themes that emerged from our consultations was fear—particularly the fear of being judged or misunderstood, and the fear of child removals. For many Aboriginal and Torres Strait Islander parents, this fear is deeply rooted in a long history of forced separations. This fear silences parents at a time when they most need support, making open discussions about mental health feel too risky.

When Aboriginal and Torres Strait Islander parents enter healthcare settings, they carry this historical and cultural context with them. Questions about their mental health can feel loaded, as disclosing struggles with anxiety or depression may be perceived as a trigger for unwarranted child protection interventions. Understanding this context is crucial for healthcare providers seeking to offer meaningful support.

Shifting away from a deficit lens

Another critical issue highlighted in our consultations is the deficit lens through which many healthcare providers view Aboriginal and Torres Strait Islander families. This lens focuses on what parents lack rather than what they bring to the table. Imagine only being seen for your challenges, with no recognition of your strengths or cultural knowledge. It’s disheartening and counterproductive.

To shift away from this deficit-based approach, healthcare providers need to adopt a strengths-based perspective. This involves recognising the resilience, resources, and cultural knowledge Aboriginal and Torres Strait Islander parents have, while also examining personal biases. Ask yourself: Are you focusing more on problems than on the strengths parents bring? Are your own cultural assumptions shaping how you engage with Aboriginal and Torres Strait Islander families?

Building trust, one small step at a time

Trust isn’t built overnight—it’s the result of small, consistent actions. One simple yet powerful way to build trust is to change how you position yourself during a consultation. Instead of sitting across from a pregnant mother, sit beside her. This reduces the perceived power imbalance and creates a more collaborative atmosphere.

Language matters too. Rather than labelling parents as “vulnerable,” use terms like “parents experiencing vulnerability.” This subtle shift focuses on circumstances rather than the person, maintaining dignity and respect.

Embracing culturally safe communication

Our research also highlighted the value of integrating culturally safe communication practices, such as yarning and dadirri, into mental health screenings. Yarning is a relaxed, conversational way of sharing stories, while dadirri involves deep, respectful listening. These approaches align with Indigenous ways of knowing, fostering mutual respect and trust.

Rather than using rigid screening tools, healthcare providers should adopt a more conversational approach. Allow parents to lead discussions, focus on their strengths, and be genuinely curious about their experiences. This not only aligns with Indigenous communication styles but also creates a more supportive environment for discussing mental health.

Moving forward

The key takeaway from my presentation to PANDA was clear: improving perinatal mental health outcomes for Aboriginal and Torres Strait Islander families requires rethinking how screenings are conducted. It’s about more than just asking the right questions—it’s about how, where, and in what context those questions are asked. Shifting from a deficit to a strengths-based approach and prioritising trust can transform the screening experience for Aboriginal and Torres Strait Islanderparents.

As we observe Perinatal Mental Health Week, let’s commit to making these small yet impactful changes in practice. By embracing a strengths-based, culturally safe approach, we can support better mental health outcomes for Aboriginal and Torres Strait Islander families, creating a more inclusive and supportive healthcare environment for all.