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Similar to our study, researchers in Australia worked with Indigenous peoples to create a framework of well-being priorities, which included relationships, empowerment, and culture are key priorities . There are several examples in Canada of Indigenous-led and Indigenous-driven mental health initiatives that promote Indigenous knowledge, culture and language. For instance, Carrie et al. (2015), conducted a policy review of Nicaraguan health plans at the national and regional level that support the integration of traditional medicine and biomedicine. Enrlich and colleagues (2015) engaged multiple stakeholders across sectors within the health system in Australia to identify a range of collaborative actions and processes to improve the physical health of people with severe mental illness .

This shift promises to produce a new generation of psychologists equipped with a more diverse and nuanced understanding of mental health. As indigenous practices gain popularity, there’s a risk of these traditions Cultural humility resources for professionals being commodified or misused by those who don’t fully understand or respect their cultural context. Indigenous psychological principles also have applications in community development and social work. In educational settings, indigenous psychology can inform learning approaches that are more in tune with students’ cultural backgrounds.

Two pre–post studies of the same intervention with comparison groups measured resilience and did not show statistically significant changes in the intervention group (Sun and Buys, 2013a, 2013b). Psychiatric symptoms and status were assessed in one pre–post study and statistically significant reduction in status only was observed at 6 and 12 weeks (Dickerson et al., 2014). In the third study, stress and coping scores were statistically significantly improved in the intervention group (Tosa et al., 2018). Among three pre–post studies with comparison groups, two studies using the same intervention measured fewer stressful events in the intervention group (Sun and Buys, 2013a, 2013b), but statistical significance was only measured in one of the studies (Sun and Buys, 2013a). Social and emotional well-being measured in two pre–post studies with comparison groups using the same intervention (Sun and Buys, 2013a, 2013b) showed statistically significant improvement in well-being in only one of the studies (Sun and Buys, 2013a). A measure of well-being showed statistically significant improvements immediately post-intervention in one pre–post study (Sabbioni et al., 2018).

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Related, community health workers must navigate a spectrum of diverse traditional cultural, spiritual, or religious beliefs within a single community (Gampa et al., 2017). Further, AI youth reported that the community mental health workers were respectful, knowledgeable, professional, and helpful (Cwik et al., 2016). AI youth who received the intervention had reduced depression symptoms, reduced suicide-related outcomes, and more positive attitudes toward seeking mental health care. Over the past decade, Substance Abuse and Mental Health Services Administration funded programs have demonstrated the significant role Native community mental health workers can provide in suicide prevention (The National Tribal Behavioral Health Agenda, 2016).

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This trauma is not just a memory of the past but a living experience that continues to affect the mental health and wellbeing of Indigenous individuals and communities today. To understand the current state of Indigenous mental health, it is crucial to examine the historical trauma inflicted upon these communities. The mental health of Indigenous peoples is a complex issue deeply intertwined with the historical and ongoing impacts of colonization. It is further conceivable (although not directly evident) that the service evaluation intention of the study, combined with the academic background and largely non-Indigenous composition of the study team may have hampered more effective Indigenous stakeholder engagement. The lack of a designated Indigenous stakeholder and service user voice impeded the examination of the ultimate service implementation success and cultural appropriateness from an Indigenous perspective. Professionals equally highlighted future avenues for and benefits of greater service flexibility regarding referral pathways, session format, funding use, and Indigenous health worker involvement.

Genuinely culturally responsive and anti-colonial mental health care requires shifting resources and power back to Indigenous helpers, languages and communities. Indigenous individuals may hold the belief that the only way to seek support from mainstream mental health services is by presenting at Emergency Departments during times of crisis or precarious situations where they fail to be taken seriously or receive assistance . (3) Tertiary mental health services are the highest level of specialised care, typically provided for individuals with severe and complex mental health conditions that often require long-term management and specialised interventions. These Indigenous-focused studies may have different measures of access depending on how utilisation was defined (e.g., for the general or specific mental healthcare) and usually compare the result with the non-Indigenous population 50, 51, 75. To explore factors that reduce access to specialist mental health services in Australia, Amos et al. adopted an access measure as a utilisation-to-population ratio (e.g., annual mental health bed days per 10,000 capita) within a large geographical unit (i.e., Statistical Area Level 3) .

• The field of indigenous psychology also offers exciting collaborative research opportunities.
• “Taking IFOT to the land has proven a powerful approach, says Fellner, who continues to lead this work with communities.
• Titles and abstracts were excluded if they did not include (1) Indigenous people from Canada, the United States, New Zealand or Australia; (2) a mental health intervention; and (3) mental health outcome(s).
• One possible reason for these gaps could be a lack of standardised accessible data at a fine resolution that helps capturing details of mental health service providers and users, impedances of the accessing process (e.g., travel cost), and relevant locational information .
• When discussing trauma-informed care, the embedding of Indigenous culture and values into treatment and healing was described.

Through the cultural assessment, we learned that six interventions trained community members (Beckstead et al., 2015; Brave Heart et al., 2020; Gray et al., 2010; Tosa et al., 2018; Varcoe et al., 2017, 2021) (where applicable, given some were retrospective or observational), extending the impact of the intervention beyond the study period. First, mental health is also encompassed by and conceptualized through the term ‘social and emotional wellbeing (SEWB)’ in Australia. We have developed an exploratory table (Supplemental Table S8) which should be reviewed cautiously given that future studies should conduct in-depth investigations into the level and duration of Indigenous involvement for example, as well as other yet to be identified factors that may be more meaningful to Indigenous peoples and communities. Trained Indigenous persons living in the community may integrate intervention activities and skills acquired into programming or services.