Australian Indigenous model of mental healthcare based on transdiagnostic cognitive–behavioural therapy co-designed with the Indigenous community: protocol for a randomised controlled trial

Correspondence: Bushra Nasir. Email: [email protected]

The burden of disease attributable to mental health disparities account for as much as 16% in Indigenous Australians¹ (in this manuscript, we respectfully refer to Aboriginal and Torres Strait Islander people as Indigenous Australians), which may be a major underestimation given accurate data on prevalence of mental disorders in Indigenous Australian have not been available. Our previous mental health prevalence study found that the prevalence of current common mental disorders in a cohort of 544 Indigenous Australians was more than four times that of the general Australian population, markedly higher than previous estimates.² Standardised prevalence rates of current, 12-month and lifetime mood disorders were 16.2% (12.2–20.2%), 19.5% (15.1–23.8%) and 32.2 (27.1–37.3%), respectively; 6.4, 3.1 and 2.2 times higher, respectively, than those of the general Australian population.³

Although disproportionate burden of mental disorders among Indigenous people has been attributed to the intergenerational impact of colonisation, others have acknowledged that interventions and services currently available may not be effective or culturally appropriate in supporting the health needs of Indigenous Australians.⁴ Despite this notion, and the high levels of poor mental health,² the efficacy of treatments has rarely been assessed in controlled trials.⁵ An urgent priority exists for the treatment of mental illness, and specifically depression, in this population. Major barriers (cultural, economic and geographic) exist to the utilisation of the limited ambulatory services available. In addition, virtually no robust evidence exists regarding effective and culturally acceptable treatments for mental disorders in Indigenous people.

Addressing the imbalance

There is now considerable literature available on the importance of culturally appropriate healthcare⁶ and guiding principles need to achieve community acceptance and ‘buy in’ from patients.⁷ Treatments and services that have been efficacious in other health conditions, have been those that include Indigenous people in the design and delivery of the service, and recognise and support cultural concepts of health, social and emotional well-being.⁸ To facilitate an inclusive approach to healthcare development, a desirable methodology is the application of community-based participatory research (CBPR) principles and strategies.⁹ CBPR is a partnership approach to research that equitably involves community members, organisational representatives and researchers in all aspects of the research process and in which all partners contribute...