Historical government policies, such as the forced removal of children, have contributed to deep mistrust of Western services. This mistrust is reinforced by ongoing racism and the continued dominance of Western biomedical models of health and treatment. Indeed, a lack of cultural safety is identified as a key barrier to service engagement.7
Cultural safety is critical to rebuilding trust in health services. This is expected to improve service experiences and engagement which, over time, should contribute to more equitable mental health outcomes. It is particularly important in mental healthcare8 because experiences and expressions of distress can look different across cultures. Without an understanding of how culture shapes experience, there is a risk that care may be inappropriate or fail to meet patient needs.
What can services and practitioners do to support cultural safety?
Our research9,10 identifies several key principles that support the implementation of cultural safety in mental health services.
At the service level, cultural safety must be embedded in governance, leadership and accountability structures. This includes establishing Aboriginal advisory groups with direct access to executive decision-making. Services should also prioritise the recruitment, retention and development of Aboriginal staff across all levels of the organisation.
Service design should be grounded in culturally informed, strengths-based approaches to care. This includes integrating cultural models of care and healing as recognised clinical options, and ensuring services are trauma-informed and family-centred. Accessibility should be prioritised through welcoming and culturally inclusive environments, and flexible models of care such as walk-in appointments and other low-barrier entry points.
For medical practitioners, Ahpra, the AMC and professional colleges expect cultural safety to be embedded in both clinical practice and the health systems in which doctors often play a critical role. Regardless of where you are starting from, cultural safety is a lifelong learning process that requires ongoing self-reflection, self-education, clinical experience, formal training, and a sustained commitment to improvement.
Doctors also have an important role in fostering culturally safe practice by teaching medical students and junior doctors, role-modelling culturally safe care, and providing mentorship throughout specialist training.11 For further guidance, see the latest edition of the Good Medical Practice guide from the Australian Medical Council.
Cultural safety requires system-wide change
Cultural safety is a critical component of efforts to close the gap in health and wellbeing outcomes for Aboriginal and Torres Strait Islander peoples. It requires sustained, fully resourced, system-wide reform.
Key recommendations will be outlined in our forthcoming guidance framework, to be released later this year.
