CCE-CE-004

THE COMPETENT CANDIDATE

The competent candidate should be able to:

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Task 1: Take an appropriate history, including mood, social stressors, family support, and suicide risk.

The competent candidate should:

• Build rapport with Jayden, using gentle, open-ended questions to encourage conversation.
• The HEADS framework provides a useful way to explore a young person’s world.
• Elicit key symptoms of depression, such as low mood, anhedonia, sleep/appetite changes, and social withdrawal.
• Assess suicide risk, including:
  • Passive thoughts (e.g., “I don’t care if I wake up tomorrow”) vs. active suicidal ideation.
  • Presence of a plan, intent, or access to means.
  • History of self-harm or previous suicide attempts.
• Explore the impact of the recent suicide in the community, acknowledging grief and trauma responses.
• Assess protective factors, such as family, friends, culture, and future goals.

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Task 2: Explain the likely diagnosis and provide initial emotional support.

The competent candidate should:

• Explain that Jayden’s symptoms suggest depression and that grief after a suicide can make these feelings stronger.
• Use non-stigmatising language, e.g., “It makes sense that you’re struggling—this has been a really tough time.”
• Acknowledge the difficulty of talking about mental health and normalise his experience.
• Explore Jayden’s understanding of mental health, addressing any cultural concerns or stigma.
• Provide immediate reassurance, letting Jayden know:
  • He is not alone and support is available.
  • Depression is treatable, and he can feel better with the right help.
  • You will work together to find a way forward that feels right for him.

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Task 3: Develop an appropriate management plan, including risk management, culturally safe care, and support options.

The competent candidate should:

• Assess urgency: If Jayden is at high suicide risk, ensure immediate safety planning and consider crisis mental health services.
• Involve family and community supports, if appropriate and if Jayden consents.
• Offer referral to an Aboriginal Mental Health Worker, explaining how they can help.
• Discuss therapy options, such as:
  • Cognitive Behavioural Therapy (CBT) or trauma-informed counselling.
  • Aboriginal and Torres Strait Islander social and emotional wellbeing programs.
• Consider antidepressant medication, but only if indicated and after discussing risks/benefits.
• Provide practical coping strategies, e.g., daily routine, reconnecting with supportive people, engaging in cultural activities.
• Schedule follow-up, ensuring continuity of care.

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Task 4: Discuss culturally appropriate mental health services and pathways for further support.

The competent candidate should:

• Offer referral to local Aboriginal health services, ensuring culturally safe care.
• Discuss community supports, such as:
  • Elders or trusted community members.
  • Men’s groups and cultural healing programs.
• Explain how mental health services work, addressing concerns about privacy and stigma.
• Provide resources on suicide prevention (e.g., 13YARN, a helpline for Aboriginal and Torres Strait Islander people).
• Encourage Jayden to stay engaged with care, even if he doesn’t feel ready for therapy now.

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SUMMARY OF A COMPETENT ANSWER

• Builds rapport sensitively, allowing Jayden to open up at his own pace.
• Identifies depression and assesses suicide risk thoroughly.
• Provides emotional support and normalises distress after community trauma.
• Develops a collaborative management plan, ensuring culturally safe and holistic care.
• Offers appropriate mental health referrals, including Aboriginal-specific services.

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PITFALLS

• Rushing the conversation instead of building trust first.
• Using medical jargon instead of simple, culturally appropriate explanations.
• Failing to ask about suicide directly, missing a potential risk.
• Not addressing cultural factors, such as stigma, community connection, and family support.
• Over-medicalising the encounter, instead of recognising grief and social distress.
• Not scheduling follow-up, leaving Jayden unsupported.

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REFERENCES

• RACGP National Guide to Preventive Health for Aboriginal and Torres Strait Islander People
• Suicide prevention helpline for Aboriginal and Torres Strait Islander people (13YARN)
• GP Exams – Depression

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Effective Communication with Aboriginal and Torres Strait Islander (ATSI) Patients

Effective communication with Aboriginal and Torres Strait Islander (ATSI) patients is fundamental to delivering culturally safe, respectful, and effective healthcare. It requires an understanding of cultural values, historical context, and individual patient perspectives.

Key Principles of Communication

1. Build Trust and Rapport

• Many ATSI patients may have had negative experiences with healthcare services due to historical and systemic issues.
• Trust takes time and should be built through respect, listening, and demonstrating genuine care.
• Avoid rushing the conversation—taking time to establish rapport is critical.
• Consider involving Aboriginal Health Workers if the patient feels more comfortable with cultural representation.

2. Use Culturally Appropriate Language

• Avoid medical jargon—use simple, clear explanations.
• Some ATSI patients may use different terms for health conditions (e.g., “sugar sickness” for diabetes).
• Use plain language and check understanding with teach-back methods.

3. Be Aware of Non-Verbal Communication

• Silence is important—many ATSI patients pause before answering as a sign of respect.
• Eye contact can vary—some ATSI patients may avoid direct eye contact as a sign of respect, particularly with elders.
• Body language matters—sit at eye level, keep an open posture, and avoid appearing rushed.

4. Engage in Yarning

• “Yarning” is a conversational style of storytelling used in many Aboriginal communities.
• A less direct approach may be better than asking “yes/no” medical questions.
• Start with informal discussion (e.g., “How’s your family?”) before moving into health concerns.

5. Consider Family and Community Involvement

• Family and kinship are central in many ATSI cultures.
• Some patients may want family members involved in decision-making.
• Always ask who they’d like to be present and respect their choices.

6. Acknowledge Social Determinants of Health

• Recognise barriers such as transport, financial strain, food access, and community stressors.
• Ask about practical challenges in following medical advice.
• Be flexible in healthcare planning, ensuring realistic recommendations that fit the patient’s lifestyle.

7. Understand the Impact of Colonisation and Intergenerational Trauma

• Be sensitive to past experiences of discrimination in the healthcare system.
• Avoid authoritative or paternalistic communication—collaborate with the patient.
• Acknowledge mistrust of institutions and work towards empowering the patient.

8. Respect Cultural and Spiritual Beliefs

• Some ATSI patients may hold traditional healing beliefs alongside Western medicine.
• Respect cultural views on illness, healing, and death.
• Consider involving Aboriginal Liaison Officers or Elders when appropriate.

Practical Tips for Clinicians

✅ Introduce yourself properly and explain your role clearly.
✅ Ask open-ended questions: “Can you tell me what’s been happening?”
✅ Use reflective listening: “It sounds like this has been really tough for you.”
✅ Avoid interrupting—allow pauses and silence.
✅ Ask about support networks and family involvement.
✅ Clarify understanding: “Just to make sure we’re on the same page, can you tell me what you understand about this?”
✅ Work in partnership: “What do you think would work best for you?”

Conclusion

Communicating effectively with ATSI patients requires cultural awareness, respect, and a patient-centred approach. Taking the time to listen, build trust, and acknowledge cultural perspectives leads to better health outcomes and stronger therapeutic relationships.

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MARKING

Each competency area is assessed on a scale from 0 to 3.

☐ Competency NOT demonstrated
☐ Competency NOT CLEARLY demonstrated
☐ Competency SATISFACTORILY demonstrated
☐ Competency FULLY demonstrated

1. Communication and Consultation Skills

1.1 Communicates effectively and respectfully in a culturally appropriate manner.
1.3 Engages the patient in a way that allows them to feel safe and heard.
1.4 Provides clear and empathetic explanations about mental health.

2. Clinical Information Gathering and Interpretation

2.1 Elicits a thorough history, including mood, suicide risk, and cultural considerations.

3. Diagnosis, Decision-Making and Reasoning

3.1 Recognises depression and assesses severity.
3.3 Identifies the need for urgent intervention if suicide risk is high.

4. Clinical Management and Therapeutic Reasoning

4.1 Develops a culturally appropriate mental health care plan.
4.3 Provides structured education on mental health support options.

5. Preventive and Population Health

5.1 Provides culturally appropriate mental health support.
5.3 Addresses social determinants impacting mental health.

6. Professionalism

6.2 Ensures confidentiality while balancing duty of care.

7. General Practice Systems and Regulatory Requirements

7.1 Engages with local Indigenous health services and mental health programs.

9. Managing Uncertainty

9.1 Recognises and responds appropriately to uncertainty in mental health presentations.

10. Identifying and Managing the Patient with Significant Illness

10.1 Identifies suicidal risk and ensures safety.

11. Aboriginal Health Context (AH)

AH1.1 Demonstrates understanding of cultural factors affecting mental health in Aboriginal and Torres Strait Islander communities.
AH1.3 Provides care in collaboration with culturally safe services.

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Competency at Fellowship Level

☐ CLEARLY BELOW STANDARD
☐ BELOW EXPECTED STANDARD
☐ BORDERLINE
☐ AT EXPECTED STANDARD
☐ ABOVE STANDARD