Q&A

Culturally Competent Mental Health Services for Aboriginal People

How can non-Indigenous clinicians provide culturally competent mental health care to Aboriginal clients? Tracy Westerman explains.

Tracy Westerman, a Nyamal woman from the Pilbara region of Western Australia, founded Indigenous Psychological Services in 1998 and is its Managing Director. In 2003 she became the first Aboriginal person in Australia to complete a combined master’s and PhD in clinical psychology, at Curtin University. She was named Western Australia’s Australian of the Year in 2018 and appointed a Member of the Order of Australia (AM) in 2021.

Her work centers on culturally valid assessment, including the Westerman Aboriginal Symptom Checklists for youth and adults. In a 2021 paper, she gave the first empirical validation of culture-bound syndromes among Aboriginal Australians. Her memoir, Jilya, published in 2024, tells the story behind that work.

In this Q&A, Tracey Westerman explains how depression can present differently in Aboriginal clients and how she adapts CBT. She also covers validated assessment tools and what non-Indigenous psychologists can do to build cultural competence.

Differentiating between self harm and sorry cuts in young people is a challenge and how best to approach this.

A 2021 study published in Clinical Psychologist, and titled "The Validation of Culture Bound Syndromes for Aboriginal Australians" was the first empirical research on this topic. You can read the full article here. This will guide you through this formulation. I also cover this in my training workshops. our website has a publications section with links to all published works.

image

CB abstract

Are there key risk factors for suicide in indigenous communities and do these differ from the general population?

Yes, there are considerable differences. The best starting point is this paper I have just published based upon my extensive work in this area.
also go onto the website as there are significant amounts of free content etc., including radio interviews, podcasts etc., that will guide you through it more

www.indigenouspsychservices.com.au

pdf

Whole of Community Suicide Prevention

Is there a standardised mental health symptom inventory that has been validated with adult Aboriginal populations?

Yes, I have validated FOUR. The main ones however are the Westerman Aboriginal Symptom Checklist - Youth and the Westerman Aboriginal Symptom Checklist - Adults. The tests also come with comprehensive clinical and cultural validation guidelines; intensive training to ensure cultural safety of practitioners (including cultural safety testing - I have developed THREE psychometric tests that have demonstrated the ability to determine, measure and improve cultural safety which are also on our website) to address practitioner error in assessment. These are the only tools which have been determined as valid and also address cultural safety in practitioners to minimise practitioner bias in assessment.

How does depression look/present in indigenous communities? Is there a reliable measure to assess this?

Yes, my two tools, the Westerman Aboriginal Symptom Checklist - Youth (WASCY) and the Westerman Aboriginal Symptom Checklist - Adult (WASCA). They can be found on our website (www.indigenouspsychservices.com.au). We are about to publish on a further large scale study. Depression does 'look different' and this follows on from a number of papers that point to these differences: Manson, 1995; James, 1998; Allen, 1998). We have a bit of free content under publications which might assist also. Depression in Aboriginal people is more of an 'acting out' phenomena as a primary symptom (change in behaviour) and appetite doesn't seem to be as impacted (generally)

Are there some guiding principles that white therapists can follow to create safety for Aboriginal clients?

Yes, we actually develop these for organisations and my psychometric tests have these attached to them. However, a good generic article to read is this one. And of course, attend one of my workshops as this is embedded throughout in highly clinical and culturally complex case studies and the dilemmas attached to them. It is the most secret culture in the world. Attached is also my abstract on culture bound syndromes which is about to be published in Clinical Psychologist.

image

CB abstract

pdf

Engaging Australian Aboriginal Youth in Mental Health Services 2010

Can you talk about the link between racism and the mental health of Aboriginal people in Australia?

There are a number of opinion pieces I have written on the topic - probably the main one is this one, however, a few of them cover this issue in different forms including "Funding football programs is not suicide prevention". Paradies work is also highly recommended on this topic

Can you explain cultural related mental illness?

Well Culture-bound syndromes are defined by the Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition (DSM-IV) as recurrent, locality-specific patterns of aberrant behavior and troubling experience that may or may not be linked to a particular DSM-IV diagnostic category. Many of these patterns are indigenously considered to be "illnesses," or afflictions, and most have local names. The most recent DSM-5 updates criteria to reflect cross-cultural variations in presentations, gives more detailed and structured information about cultural concepts of distress, and includes a clinical interview tool to facilitate comprehensive, person-centered assessments. I have recently had the FIRST paper accepted by Clinical Psychologist for publication on this topic. I am attaching the abstract. When the full paper is available it will be on our website under publications

image

CB abstract

Is there a specific therapeutic approach that you prefer to use with Aboriginal clients? Especially for distress tolerance. Does CBT need to be adapted?

Probably the best starting point to this is to have a listen to my podcast in which I focus specifically on the adaptation of some therapies with Aboriginal people. The Westerman Jilya Institute (www.thejilyainstitute.com.au) has been set up to specifically determine treatments of best practice with Aboriginal people. Most of my work is based on significant cultural and clinical instinct and testing of different techniques with Aboriginal people. I am predominantly CBT oriented and I generally adapt to focus on visual spatial medium. We also use a lot of invivo, narrating high risk situations so that it is more concrete and experiential rather than abstract. We are hoping that we can not only dedicate significant work into clinical trials with at risk Aboriginal people but also be able to train practitioners who are genuinely struggling with a lack of evidence based practice. Sadly I haven't published on therapeutic interventions yet (hopefully that is coming!), but have published this article on Engagement

pdf

Engaging Australian Aboriginal Youth in Mental Health Services 2010

As a non indigenous psychologist, what can I do to be culturally sensitive and support Aboriginal people? Should I aim to refer to Indigenous psychologists where possible?

Obviously Indigenous Psychologists have an advantage as culturally empathy is generally easier. We understand the different worldview; there are many things that do not require explanation. HOWEVER, the concept is that anyone should be able to become 'culturally competent' and I have done a significant amount of work around this because, frankly there is no Indigenous content (empirically tested, not just cultural 'awareness as an 'option' or elective' I mean embedded) that is embedded in psychology degrees in Australia. It is really about being guided by the research that is out there; being curious and most importantly undertake cultural supervision, A good starting point its to better understand your skills - we have a number of online cultural safety tests which generate an individual cultural supervision plan for you on our website. www.indigenouspsychservices.com.au
There is a lot of free content that will also help

ACT for Perfectionism and People Pleasing

This six-week practical course takes you step-by-step through the effective treatment of unhelpful perfectionism and unhealthy people-pleasing (“fawning”), using ACT in combination with other essential skills, such as assertiveness and setting boundaries.

Early Registration | Save $200Savings end in 1d 21h 37m 18s

View Course

DBT Intensive for Adolescents and Families

DBT Intensive for Adolescents and Families provides a complete implementation pathway for hospitals, community mental health services, residential programs, and youth treatment facilities seeking high-fidelity adolescent DBT delivery. This intensive for established clinical teams combines step-by-step foundational training with 12 months of expert consultation.