Cultural Safety in Action: Building Trust and Belonging in Indigenous Mental Health Care

The lives of Native Americans, hereafter referred to as Indigenous peoples in North America (United States and Canada) are impacted by historical and contemporary events and practices stemming from colonization, including forced assimilation, interpersonal racism, land dispossession, cultural disruption, and systematic violence. The trauma associated with these events and practices has been linked to increased mental health and substance use challenges for many Indigenous peoples. When seeking help for these challenges, many Indigenous peoples face Western systems of care that are neither culturally competent nor built on the foundation of trust.

Trust is an essential foundation for effective mental health programming in Indigenous contexts. Evidence-based research consistently shows that culturally safe environments, built on respect and reciprocity, are more likely to engage Indigenous clients and support long-term mental wellness outcomes. Programs that prioritize relational accountability with Indigenous communities, including consistent engagement, transparency in decision-making, and inclusion of traditional knowledge holders, tend to foster stronger participation and retention rates among Indigenous clients seeking mental health services¹.

Establishing trust requires long-term commitment from health professionals and service providers. This involves not only integrating cultural practices into programming but also creating space for Indigenous governance and leadership in mental wellness initiatives. For example, involving Indigenous advisory councils or Elders in program design and evaluation has shown to improve community relevance and cultural appropriateness. Such practices center Indigenous worldviews and recognize traditional healing as integral to holistic wellness². Without trust and cultural alignment, even well-funded programs risk low engagement and poor outcomes.

The Importance of Culturally Competent Staffing and Training

A consistent gap in mental health service delivery for Indigenous Peoples is the lack of culturally competent practitioners. Indigenous clients often report feeling misunderstood or dismissed by mainstream providers who lack awareness of historical trauma and Indigenous cultural values. To address this, jurisdictions have increasingly invested in cross-cultural training for mental health staff. Training should include Indigenous histories, the impact of colonization, trauma-informed care, and culturally specific communication strategies³.

However, training alone is insufficient without also hiring Indigenous staff and practitioners. Indigenous representation within the workforce enhances cultural safety and ensures that services reflect the lived reality of Indigenous clients. Programs that employ Indigenous counselors and support workers, especially those with lived experience, have demonstrated increased client trust and satisfaction⁴. Municipal and regional health authorities should prioritize recruitment and retention of Indigenous professionals and support their ongoing development through mentorship and leadership opportunities.

Integrating Traditional Healing Practices with Western Models

Many Indigenous communities advocate for a two-eyed seeing approach, which values the strengths of both Indigenous and Western ways of knowing. Mental health programs that offer access to traditional healing ceremonies, land-based wellness activities, and cultural teachings alongside clinical treatment are better equipped to meet the diverse needs of Indigenous clients⁵. Elders and traditional healers provide spiritual and emotional guidance that complements clinical services, addressing issues of identity, belonging, and intergenerational trauma.

This integrated approach has been particularly effective in programs that serve youth and families. For example, the First Nations Mental Wellness Continuum Framework in Canada emphasizes cultural continuity through land-based programs, language revitalization, and intergenerational knowledge transfer⁶. These components not only promote mental wellness but also strengthen community cohesion. Practitioners should be prepared to advocate for flexible funding models that allow for the inclusion of cultural practices as legitimate mental health interventions.

Community-Based Mental Health Education and Peer Support

Community education plays a critical role in reducing stigma and increasing awareness about mental health issues among Indigenous Peoples. Grassroots initiatives led by community members are more likely to be trusted and accepted. These initiatives often include peer-to-peer education, storytelling, and workshops that address mental health in culturally relevant ways. Programs such as Mental Health First Aid - First Nations, developed in collaboration with Indigenous communities, have shown effectiveness in building community capacity⁷.

Training community members to become wellness champions or peer support workers can be a powerful strategy to normalize mental health conversations and provide early intervention. These individuals often bridge the gap between formal services and community needs, serving as trusted liaisons. Municipal governments and health authorities should consider funding peer-led initiatives and offering micro-grants to community groups for localized mental health programming. These efforts help sustain momentum and ensure that mental wellness becomes embedded in the fabric of community life.

Creating Safe, Confidential, and Accessible Spaces

One of the consistent findings in evidence-based research is that Indigenous clients are more likely to seek help when services are provided in safe, non-judgmental, and confidential environments. Physical space matters. Locations that are culturally welcoming, private, and community-owned are preferred over institutional or unfamiliar settings. Where possible, services should be delivered in community settings such as cultural centers, friendship centers, or Indigenous-run clinics⁸.

Equally important is the emotional safety of clients. Practitioners must approach service delivery with humility, patience, and an openness to learning. Confidentiality must be clearly communicated and upheld, especially in smaller communities where fear of gossip or judgment can deter individuals from seeking help. Creating drop-in options, mobile services, or anonymous support lines can also increase accessibility. When clients feel safe and respected, they are more likely to engage in ongoing care and healing processes.

Recommendations for Municipal Practitioners and Public Administrators

For professionals working in health and mental wellness at the local level, several practical steps can enhance the cultural competence and effectiveness of Indigenous mental health programming. First, develop partnerships with local Indigenous organizations and leadership. These partnerships should be formalized through memorandums of understanding that outline shared goals, roles, and communication protocols. Second, allocate funding specifically for Indigenous-designed and -led mental wellness initiatives. Avoid applying one-size-fits-all models that do not reflect the cultural and historical context of the community.

Third, support capacity building within Indigenous communities by funding training, mentorship, and leadership development for Indigenous mental health professionals and peer supporters. Fourth, ensure that evaluation methods respect Indigenous data sovereignty and incorporate qualitative success indicators defined by the community. Lastly, advocate for policy changes that recognize cultural healing practices as essential components of mental wellness and not as supplemental services. These actions require commitment and collaboration but are essential for delivering equitable, culturally competent care.

Bibliography

1. National Collaborating Centre for Indigenous Health. “Cultural Safety in First Nations, Inuit and Métis Public Health: Environmental Scan of Cultural Competency and Safety in Education, Training and Health Services.” 2013.

2. Gone, Joseph P. “Redressing First Nations Historical Trauma: Theorizing Mechanisms for Indigenous Culture as Mental Health Treatment.” Transcultural Psychiatry 50, no. 5 (2013): 683-706.

3. Kirmayer, Laurence J., et al. “Rethinking Resilience from Indigenous Perspectives.” Canadian Journal of Psychiatry 56, no. 2 (2011): 84-91.

4. Allan, Billie, and Janet Smylie. “First Peoples, Second Class Treatment: The Role of Racism in the Health and Well-Being of Indigenous Peoples in Canada.” Wellesley Institute, 2015.

5. Hart, Michael A., Raven Sinclair, and Judy Pompana. “Indigenous Healing Practices in Child Welfare: A Review of Literature.” First Peoples Child & Family Review 12, no. 1 (2017): 62–75.

6. Health Canada. “First Nations Mental Wellness Continuum Framework.” Ottawa: Government of Canada, 2015.

7. Mental Health Commission of Canada. “Mental Health First Aid - First Nations.” 2016.

8. Wemigwans, Jennifer, and Linda Tuhiwai Smith. “A Digital Bundle: Protecting and Promoting Indigenous Knowledge Online.” University of Regina Press, 2018.