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 intergenerati