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Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care
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Viewpoint: Evidence and practice in Indigenous mental health.

Ernest Hunter1

  • 1The Cairns Institute, James Cook University, Smithfield, QLD, Australia.

The Australian and New Zealand Journal of Psychiatry
|May 7, 2026
PubMed
Summary

A decade after initial commentary, updated schizophrenia guidelines still inadequately address Aboriginal and Torres Strait Islander populations, advocating only for universal cultural safety.

Keywords:
Aboriginal and Torres Strait IslanderIndigenouspsychosisschizophreniasocial determinants

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Area of Science:

  • Psychiatry
  • Clinical Practice Guidelines
  • Indigenous Health

Background:

  • A previous commentary in 2016 addressed Indigenous content in RANZCP schizophrenia guidelines.
  • Updated guidelines (Suetani et al., 2026) incorporate the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.
  • Consideration for Aboriginal and Torres Strait Islander populations remains minimal, grouped with Māori in a 'special populations' section.

Purpose of the Study:

  • To reflect on the evolution of considerations for Indigenous Australians in clinical practice guidelines for schizophrenia over the past decade.
  • To evaluate the impact of the new GRADE framework on addressing the mental health needs of Aboriginal and Torres Strait Islander peoples.
  • To assess changes in the recognition of social determinants impacting Indigenous mental health vulnerability within these guidelines.

Main Methods:

  • Comparative analysis of clinical practice guidelines for schizophrenia treatment from a decade ago and the present.
  • Review of the content pertaining to Aboriginal and Torres Strait Islander populations within both guideline versions.
  • Reflection on the author's previous commentary and current observations regarding Indigenous mental health in psychiatric guidelines.

Main Results:

  • The updated guidelines, despite employing the GRADE approach, offer limited advancements in addressing the specific needs of Aboriginal and Torres Strait Islander populations.
  • Indigenous Australians and Māori are relegated to a brief 'special populations' section.
  • The primary recommendation for these groups is a general call for 'universal cultural safety in mental health systems'.

Conclusions:

  • The updated guidelines show little substantive change in their approach to Indigenous mental health compared to a decade prior.
  • The integration of the GRADE framework has not translated into more specific or effective recommendations for Aboriginal and Torres Strait Islander peoples.
  • There is a continued need for guidelines to more comprehensively address the social determinants of mental health and provide tailored strategies for Indigenous populations.