Is there a role for prevention in aboriginal mental health?

Primary prevention is consistently identified as a priority in mental health and Aboriginal health planning. In both areas it has proved to be elusive. Aboriginal mental health therefore presents substantial challenges, particularly in remote Australia. In this paper, two brief case histories are used to demonstrate the limits of conventional psychiatric engagement in such settings and explore the dimensions of social disadvantage that compound psychiatric vulnerability. There are difficulties of primary prevention in mental health generally, and access to mental health services for those most at risk, including indigenous Australians, is unacceptably poor. Proceeding to primary prevention in Aboriginal mental health will, of necessity, include rectifying that situation and addressing the social precursors of mental disorders and distress. Such initiatives will require wide and sustained commitment toward long-term goals, with a focus on children and families, and must include effective substance-abuse strategies.