Aboriginal Consensus on Principles, Priorities and Actions for Culturally Safe Mental Health Services: A Delphi Study

Culturally unsafe mental health services contribute to persistent inequities for Aboriginal and Torres Strait Islander peoples, yet existing cultural safety frameworks lack clear, prioritised, community-endorsed implementation guidance. This study aimed to establish Aboriginal consensus on cultural safety principles, implementation priorities and practical actions for culturally safe mental health services. A three-round modified Delphi study was conducted with 37 Aboriginal participants from Western Australia with expertise in mental health, social and emotional wellbeing and lived experience. In Round 1, participants completed an online survey rating the importance of cultural safety principles and identifying those requiring urgent action. In Rounds 2 and 3, facilitated yarning sessions reviewed findings, refined principles, grouped them into implementation domains, and identified priority actions. Aboriginal Participatory Action Research ensured Aboriginal leadership and governance throughout. All principles achieved strong consensus for importance. The most urgent priorities were trustworthiness, Aboriginal governance, trauma-informed care, addressing racism and strengthening the Aboriginal workforce. Participants organised the refined principles into six implementation domains, with Leadership and Governance identified as foundational to reform. Trustworthiness was reframed as an aspirational outcome requiring structural change. This study provides a community-endorsed, prioritised framework for translating cultural safety principles into mental health service practice and policy.