Best practice in early psychosis intervention for Australian Indigenous communities
No attempt at cultural adaptation of early psychosis intervention (EPI) for young Indigenous Australians has been published. Our aim was to identify promising elements of best practice relevant to mainstream mental health service (MHS) delivery of EPI to Indigenous communities. A scoping review of the published and unpublished Australian Indigenous health literature was carried out. A validity testing strategy for qualitative research, triangulation, was then used to identify promising service models.
We found that almost no high quality studies evaluating the effectiveness of mainstream MHSs adapted for Indigenous Australians have been published in the scientific literature. Our review identified three examples of a promising mainstream service model with potential for delivering EPI (the Indigenous sub-team), and two elements applicable to best practice EPI in rural and remote services (telepsychiatry and specialist psychiatric outreach assistance).
We conclude that specialist EPI could be delivered by Indigenous sub-teams (rather than specialist EPI teams) embedded in large mainstream MHSs. These teams incorporate culturally safe practice and can be fully integrated with Indigenous primary health care and community services. In rural and remote services, specialist psychiatric outreach assistance and telepsychiatry (at least when this function is embedded in an Indigenous sub-team) appear likely to support best practice EPI.
The development of evidence-based culturally appropriate mainstream MHSs for Indigenous Australians, including ones for EPI, appears improbable without attitudinal changes on the part of both non-Indigenous health professionals and Indigenous academic and political leadership.
