Songline and Country practices

1. Introduction

Version followed: the Aboriginal and Torres Strait Islander social and emotional wellbeing (SEWB) model of Gee, Dudgeon, Schultz, Hart and Kelly as reproduced in the National Strategic Framework for Aboriginal and Torres Strait Islander Peoples' Mental Health and Social and Emotional Wellbeing 2017–2023 (the framework's diagram dates the model 2013; the authors' chapter appears in Working Together, 2nd edition, 2014), used alongside the DSM-5-TR Cultural Formulation Interview. [source: https://www.niaa.gov.au/sites/default/files/documents/publications/mhsewb-framework_0.pdf] [source: https://thekids.org.au/our-research/Indigenous-health/working-together-second-edition]

What this is, plainly. "Songline and Country practices" is not a therapy and not something a psychotherapist does. Songlines are Aboriginal knowledge and Law held by custodians. AIATSIS describes them as ancient and continuing routes across the continent that link people, places and practice, trace the journeys of ancestral beings, and are sung by Elders to carry the stories of Country; it reports that only the right people can speak for Country and that authority over a songline is formally passed by Elders to successors they choose. [source: https://aiatsis.gov.au/explore/marlaloo-songline] The National Museum of Australia's Songlines: Tracking the Seven Sisters project was directed by a curatorium of community-nominated senior knowledge holders from Martu Country and the APY and Ngaanyatjarra Lands, with partners including the NPY Women's Council; the Museum states that these were knowledge holders, not an advisory group. [source: https://nma.gov.au/exhibitions/songlines/about] "Country" practices (being on Country, caring for Country, ranger and land-management work, cultural camps, returning to homelands) are led by Traditional Owners, communities, Aboriginal Community Controlled Health Services (ACCHSs) and ranger and land organisations. [source: https://www.indigenoushpf.gov.au/Measures/2-14-first-nations-people-with-access-to-their-tra]

Core idea of how change happens, as Aboriginal and Torres Strait Islander authors and the national framework put it. Wellbeing is holistic and relational: it arises from connections to body, mind and emotions, family and kinship, community, culture, Country, and spirituality and ancestors, all shaped by social, historical and political determinants. Disrupting these connections (dispossession, child removal, racism) sustains ill health; restoring and strengthening them, under Aboriginal and Torres Strait Islander leadership, supports healing. The framework states that land is central to wellbeing. [source: https://www.niaa.gov.au/sites/default/files/documents/publications/mhsewb-framework_0.pdf] Working Together describes Country as a deep spiritual and bodily connection, land as a place to heal and restore purpose (citing Helen Milroy), and identity as resting on descent, connection to Country, upbringing and community recognition. [source: https://embrace.thekids.org.au/siteassets/working-together-aboriginal-and-wellbeing-2014.pdf]

The psychotherapist's role. Your work is SEWB-informed, culturally safe psychotherapy: assessing and formulating with the SEWB domains and the Cultural Formulation Interview, supporting the client's own connection to Country and culture through community pathways, collaborating with and referring to ACCHSs, Aboriginal mental health workers, Elders and traditional healers (for example ngangkari) when the client wishes, and addressing trauma, racism and safety. Songlines, ceremony and Law are never content you teach, ask the client to disclose, or reproduce. [synthesis, based on the framework's action areas] Spiritual concepts in this guide (Dreaming, ancestral beings, spirit) are described as communities and their institutions hold them.

2. Framework

The SEWB model is a framework, not a manualised treatment; it has no fixed session count. The national framework sets a stepped-care structure (promote wellness; build resilience in people at risk; care for mild to moderate illness; care for severe illness), each with cultural and clinical elements. [source: https://www.niaa.gov.au/sites/default/files/documents/publications/mhsewb-framework_0.pdf] The phases below are a clinical sequence derived from that framework and the Cultural Formulation Interview. [synthesis]

The model (as the national framework presents it). Seven overlapping domains, each with risk and protective factors:

Body: physical health, feeling strong; protective factors include culturally safe health services.
Mind and emotions: managing thoughts and feelings; risks include trauma and racism; protective factors include a strong identity and agency.
Family and kinship: central to how societies function; risks include family violence and children in out-of-home care.
Community: connecting and working together; risks include lateral violence and isolation; protective factors include community-controlled services.
Culture: continuity with the past, underpins identity; risks include services that are not culturally safe and languages under threat.
Country: underpins identity and belonging; risks include restricted access to Country; protective factors include time on Country.
Spirituality and ancestors: purpose and meaning; protective factors include access to cultural events and ceremonies. Around these sit social, historical and political determinants; needs change across the life course, and understandings of SEWB vary between groups and individuals. [source: https://www.niaa.gov.au/sites/default/files/documents/publications/mhsewb-framework_0.pdf] The authors' fuller description of each domain in their own chapter is [uncertain: not verified].

Phase 0. Preparing yourself and your service (before clients). Goal: cultural capability and local relationships. Learn whose Country you practise on; build links with the local ACCHS, SEWB or Aboriginal mental health team, Link-Up and Stolen Generations services and, where they exist, healer programs. Move on when you know at least where to refer and whom to consult. [synthesis] The framework asks for a culturally competent workforce and for traditional healers and Elders to be recognised as part of it. [source: https://www.niaa.gov.au/sites/default/files/documents/publications/mhsewb-framework_0.pdf]

Phase 1. Engagement and cultural assessment (about sessions 1–3). Goal: safety, relationship, the client's own account. Tools: yarning and deep listening, the core Cultural Formulation Interview and relevant modules, SEWB domain mapping, explanatory model, risk assessment. Move on when the client has told the problem in their own terms and you have a shared picture of their connections and disconnections. [synthesis]

Phase 2. Shared formulation and plan (about sessions 2–4). Goal: a formulation across the seven domains and determinants, agreed with the client (and family if they wish), naming which supports are cultural (Elders, healers, on-Country programs) and which are clinical. Move on when the client endorses the plan and any referrals have their consent. [synthesis]

Phase 3. Working alongside (ongoing; weekly to fortnightly, flexible, in person, by phone or outreach). Goal: psychological work on the client's goals while cultural and community supports run in parallel under their own authority; regular check-ins on how the two fit. Move on when goals are met or the client chooses to lead with community supports. [synthesis]

Phase 4. Integration, review and transition. Goal: make sense of cultural or on-Country experiences in the client's terms, review outcomes with strengths-based measures, warm handover to community services, and plan for return or follow-up. The framework calls for cultural support during admission and on return to community and for integrated referral and discharge. [source: https://www.niaa.gov.au/sites/default/files/documents/publications/mhsewb-framework_0.pdf]

Severe illness, acute suicide risk or safeguarding concerns override the sequence at any point (see 4.15 and 4.16). [synthesis]

3. Guiding principles

The nine principles in the national framework (paraphrased) [source: https://www.niaa.gov.au/sites/default/files/documents/publications/mhsewb-framework_0.pdf] [source: https://embrace.thekids.org.au/siteassets/working-together-aboriginal-and-wellbeing-2014.pdf]:

Health is holistic, and land is central to wellbeing. Practical meaning: ask about Country, culture and spirit as routinely as about sleep and mood.
Self-determination is central. Practical meaning: the client and their community decide which cultural supports are involved; prefer community-controlled services where the client wants them.
Culturally valid understandings must shape assessment and care. Practical meaning: formulate in the client's terms first; diagnostic categories second.
Trauma and loss since colonisation have intergenerational effects. Practical meaning: take a family history of removal, dispossession and loss as part of standard assessment.
Human rights must be recognised. Practical meaning: minimise coercion; support the client's participation in every decision.
Racism, stigma and disadvantage are ongoing stressors. Practical meaning: name and address racism, including in your own service.
Family and kinship are central. Practical meaning: involve family and kin as the client defines them.
There is no single culture. Practical meaning: never assume a client's connections, language or practices; ask.
There are great strengths, creativity and endurance. Practical meaning: map strengths in every domain, not only deficits.

Further principles from community bodies and institutions:

Cultural authority rests with the right people. Only the right people speak for Country; songline authority is passed by Elders. Practical meaning: you never speak for, teach or interpret a client's Country or Law. [source: https://aiatsis.gov.au/explore/marlaloo-songline]
Cultural strength, best practice, best evidence, Aboriginal and Torres Strait Islander presence, and leadership (the five themes of the Gayaa Dhuwi (Proud Spirit) Declaration). Practical meaning: Aboriginal and Torres Strait Islander people should be present and leading in the care pathway, not consulted at the end. [source: https://www.health.gov.au/resources/publications/gayaa-dhuwi-proud-spirit-declaration-framework-and-implementation-plan]
Cultural safety is judged by clients, families and communities, not by the provider. Practical meaning: ask for feedback on safety and act on it. [source: https://engage.dss.gov.au/wp-content/uploads/2026/01/Gayaa-Dhuwi.pdf]
"Best of both worlds": clinical and cultural care together. Practical meaning: plan both strands and how they connect. [source: https://engage.dss.gov.au/wp-content/uploads/2026/01/Gayaa-Dhuwi.pdf] Ngangkari themselves say the best outcomes come from western-trained doctors and ngangkari working together. [source: https://parliament.nt.gov.au/__data/assets/pdf_file/0008/366452/Sub-No.-37,-NPY-Womens-Council,-Attachment-B,-NPY-Womens-Council-Ngangkari-Project.pdf]
Some knowledge is not yours to hold. Practical meaning: never ask for details of ceremony, songs, sacred sites or restricted knowledge; accept "I can't talk about that" without probing. [synthesis]
Respect cultural protocols about the deceased. AIATSIS and the National Museum warn viewers about images, voices and names of people who have died. Practical meaning: ask how the client wishes deceased relatives to be referred to. [source: https://aiatsis.gov.au/explore/marlaloo-songline] [source: https://nma.gov.au/exhibitions/songlines/about]
Torres Strait Islander peoples have a distinct identity. Practical meaning: respect Ilan Pasin (Island custom) and Islander ways of working; do not apply mainland Aboriginal concepts by default. [source: https://embrace.thekids.org.au/siteassets/working-together-aboriginal-and-wellbeing-2014.pdf]
Check communication. Standard English may not be everyone's first language. Practical meaning: check understanding and offer interpreters. [source: https://embrace.thekids.org.au/siteassets/working-together-aboriginal-and-wellbeing-2014.pdf]

4. Intervention inventory

Every item below is the psychotherapist's own work. None of it involves performing, teaching, imitating or eliciting songlines, ceremony, Law or healing practices; those stay with custodians, Elders and healers. Example language is illustrative unless quoted.

4.1 Cultural self-examination and preparing your practice

Purpose / when: before and throughout work with Aboriginal and Torres Strait Islander clients. The framework asks for a culturally competent workforce and measurable cultural competence standards, and notes that services without cultural safety practices may indirectly discriminate. [source: https://www.niaa.gov.au/sites/default/files/documents/publications/mhsewb-framework_0.pdf]
Steps: (1) Find out whose Country your practice is on and which local Aboriginal and Torres Strait Islander organisations operate there. (2) Identify the local ACCHS, SEWB or Aboriginal mental health workers, Link-Up and Stolen Generations services, interpreters and, where available, healer programs; ask each how they prefer referrals and consultation to happen. (3) Reflect in supervision on your own cultural position, assumptions about "tradition" and "authenticity", and how racism shows up in your service (waiting rooms, forms, missed-appointment policies). (4) Arrange cultural supervision or consultation with an Aboriginal or Torres Strait Islander practitioner where possible. [synthesis]
Example language (illustrative, to a local ACCHS): "I'm a psychologist working on this Country. When one of my clients wants your involvement, how would you like me to make contact, and what should I not do?"
Watch for: treating one consultation as permanent permission; assuming all Aboriginal clients want Aboriginal services (some prefer mainstream for privacy). It is working when you can name local referral pathways and your feedback from Aboriginal colleagues and clients is acted on. [synthesis]

4.2 Yarning and deep listening (engagement stance)

Purpose / when: from first contact. The framework stresses culturally safe engagement; NPY Women's Council reports ngangkari advice that, when someone first raises self-harm, people should listen, sit with them, talk slowly and avoid criticism. [source: https://parliament.nt.gov.au/__data/assets/pdf_file/0008/366452/Sub-No.-37,-NPY-Womens-Council,-Attachment-B,-NPY-Womens-Council-Ngangkari-Project.pdf]
About dadirri: Dadirri is a Ngangiwumirr spiritual practice of deep listening, stillness and connection to Country, brought forward by Dr Miriam-Rose Ungunmerr-Baumann AM; the Miriam Rose Foundation says it "belongs to Country" and is shared as a gift of reconciliation, and it offers its own accredited programs for schools. [source: https://miriamrosefoundation.org.au/dadirri/] A therapist may learn from this teaching through the Foundation's own materials, but should not present themselves as practising or teaching dadirri. Its use in Aboriginal-led trauma-healing work (for example by Judy Atkinson) is reported in the literature [uncertain: not verified].
Steps: (1) Allow time; avoid rapid-fire questions. (2) Start with relationship: who the client's people are, where they are from, if they wish to share. (3) Offer to share something about yourself (where you are from, your role). (4) Let the story come in the client's order; use silence. (5) Summarise back in the client's words and check. (6) Offer to have a support person or family member present. [synthesis]
Example language (illustrative): "We've got the hour, there's no rush. Maybe start wherever feels right; I'd like to hear about you and your mob, not just the problem."
Watch for: your discomfort with silence; interpreting quietness as resistance or flat affect; shame (a significant social emotion for many clients) when attention is too direct. Working when the client brings up family and Country without prompting and returns. [synthesis]

4.3 Core Cultural Formulation Interview (CFI)

Purpose / when: first evaluation, and whenever the problem's meaning, help seeking or the relationship with you is unclear. The CFI clarifies the problem from the perspective of the person and their social network: meaning, sources of help and expectations of services. It is meant for any clinician in any setting, supports clinical understanding and is not the sole basis for diagnosis. [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf] [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-SectionIII.pdf]
Steps: Work through the four APA domains (16 questions): (1) cultural definition of the problem; (2) cultural perceptions of cause, context and support (causes, stressors and supports, role of cultural identity); (3) cultural factors affecting self-coping and past help seeking (including barriers); (4) cultural factors affecting current help seeking (preferences, and the clinician–patient relationship, e.g. perceived racism or language barriers). Use the APA form; clinicians may reproduce it for use with their patients, but modifying or translating it needs APA permission. [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf] For this population, listen within domain 2 for Country, kin and spirit as causes or supports, and within domain 4 for experiences of racism in services. [synthesis] Time: the DSM-5 field trial found it feasible and that later interviews took less time; no duration in minutes is verified [uncertain]. [source: https://experts.umn.edu/en/publications/feasibility-acceptability-and-clinical-utility-of-the-cultural-fo/]
Example language (illustrative): "Sometimes doctors and families understand a problem differently. How would you describe what's been happening, in your own words, and how would your family talk about it?"
Watch for: reading the questions like a form; the client giving the answer they think a clinician wants. Working when the client's own terms for the problem and their preferred supports are written into your notes. [synthesis]

4.4 CFI supplementary modules and Informant Version

Purpose / when: for depth on a subtopic, at the first evaluation, later or repeatedly. Twelve modules exist; most relevant here are Cultural Identity; Spirituality, Religion, and Moral Traditions; Social Network; Coping and Help-Seeking; Explanatory Model; Psychosocial Stressors; Patient–Clinician Relationship; School-Age Children and Adolescents; Older Adults; Caregivers. The Informant Version (17 questions) is for a family member or friend. [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf] [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Informant.pdf]
Steps: (1) Use the core CFI form's cross-references to pick the module. (2) For Cultural Identity, include connection to Country, language group, kinship and community recognition, all of which Working Together lists as bases of identity. [source: https://embrace.thekids.org.au/siteassets/working-together-aboriginal-and-wellbeing-2014.pdf] (3) For Spirituality, ask about meaning and sources of strength, not about the content of Law or ceremony. (4) Use the Informant Version with family or kin the client nominates, with consent. [synthesis]
Example language (illustrative): "What helps you feel strong in who you are? You don't need to tell me anything that isn't mine to know."
Watch for: identity questions landing as tests of "how Aboriginal" someone is, especially for clients removed from family or raised off Country. Identity is not based on skin colour or "blood". [source: https://embrace.thekids.org.au/siteassets/working-together-aboriginal-and-wellbeing-2014.pdf]

4.5 Exploring the explanatory model

Purpose / when: whenever the client's understanding of cause or treatment may differ from yours.
Steps: Cover Kleinman's eight areas in your own words: what the client calls the problem; what caused it; why it began when it did; what it does and how it works; how severe it is and how long it will last; what treatment they think they should have; the main problems it has caused; what they fear most. [source: https://tanenbaum.org/wp-content/uploads/2021/06/HANDOUT-Explanatory-Models-of-Illness.pdf] (Kleinman, Eisenberg and Good 1978, Annals of Internal Medicine 88:251–258 [source: https://www.cambridge.org/core/product/F99D9D36838A8207D377730DEB445F7B/core-reader]) Record family and community views alongside the client's. [synthesis]
Example language (illustrative): "What do you reckon started this? What would your nan or aunties say it is?"
Watch for: explanations involving spirit or Country (for example, NPY Women's Council reports that many Anangu understand some illness as caused by harmful elements in the spiritual world, and depression and anxiety as linked to a weakened spirit). Record these as the client's and community's understanding, without endorsing or dismissing them. [source: https://parliament.nt.gov.au/__data/assets/pdf_file/0008/366452/Sub-No.-37,-NPY-Womens-Council,-Attachment-B,-NPY-Womens-Council-Ngangkari-Project.pdf]

4.6 SEWB domain mapping

Purpose / when: assessment, formulation and review; builds a shared strengths-and-needs picture. [source: https://www.niaa.gov.au/sites/default/files/documents/publications/mhsewb-framework_0.pdf]
Steps: (1) Draw (or invite the client to draw) the seven domains, perhaps as overlapping circles. (2) For each, ask what is strong and what is hurting, using the framework's examples of risk and protective factors as prompts. (3) Add the outer ring of determinants: history (removal, dispossession), social conditions (housing, income, racism), politics. (4) Mark which domains the client wants to strengthen and who could help (family, Elders, ACCHS, rangers, healers, you). (5) Revisit every few sessions. [synthesis built on the framework's model]
Example language (illustrative): "This is a way a lot of mob think about wellbeing: body, mind, family, community, culture, Country and spirit. Where are you feeling strong right now? Where's the hurt?"
Watch for: turning the map into a deficit checklist; assuming every client relates to every domain the same way (the framework says understandings vary). Working when the client uses the map's language themselves and names their own next steps.

4.7 Exploring connection to Country

Purpose / when: within assessment and whenever Country, homelands, land rights, return or displacement come up. The framework names restricted access to Country as a risk and time on Country as protective. [source: https://www.niaa.gov.au/sites/default/files/documents/publications/mhsewb-framework_0.pdf] National survey data (2022–23) show 76% of First Nations adults recognised an area as homelands or traditional Country and 22% lived there; 13% had been removed from family and 45% had relatives who were removed. [source: https://www.indigenoushpf.gov.au/Measures/2-14-first-nations-people-with-access-to-their-tra]
Steps: (1) Ask whether the client has a Country they belong to and whether they can get there. (2) Ask about barriers: distance, money, removal history, family conflict, native title or development affecting the land. (3) Ask what being on, or away from, Country is like for them. (4) Stay with the relational meaning the client gives; do not ask about sacred sites, songlines or ceremony. (5) For clients who do not know their Country (Stolen Generations, adoption, out-of-home care), treat this as a loss to be held, and offer Link-Up or family-tracing services if wanted. [synthesis; Link-Up named in the framework]
Example language (illustrative): "Is there a place you'd call your Country? What's it like for you being away from there?"
Watch for: grief and anger about dispossession (validate, do not rush to fix); shame for clients who have not been able to connect. Working when the client can name what connection would look like for them and who holds the right to help.

4.8 Cultural concepts of distress and normative experience versus illness

Purpose / when: when experiences could be read as symptoms but may be culturally understood (spirit, ancestors, sorcery or payback fears, sensing deceased relatives) or when a client fears being labelled "mad" for describing them.
What the manuals say: DSM-5-TR describes cultural concepts of distress as idioms, explanations or perceived causes, and syndromes, revised in DSM-5-TR to avoid stigmatising language. [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-SectionIII.pdf] Its listed examples (from a secondary source) are ataque de nervios, dhat syndrome, hikikomori, khyâl cap, kufungisisa, maladi dyab, nervios, shenjing shuairuo, susto and taijin kyofusho; none is an Australian Aboriginal concept, and the exact DSM-5-TR list is [uncertain]. [source: https://www.unmc.edu/bhecn/_documents/dsm5tr_bw_6_slides_11_pages.pdf] Dissociative identity disorder criteria allow that identity disruption may be described as possession in some cultures and exclude disturbance that is a normal part of broadly accepted cultural or religious practice; dissociative trance (other specified dissociative disorder) likewise excludes trance that is part of accepted collective practice (DSM-5 wording; DSM-5-TR keeps these points in substance, exact wording [uncertain]). [source: https://pmc.ncbi.nlm.nih.gov/articles/PMC9199574] [source: https://umsystem.pressbooks.pub/aswbprep/?p=1299] ICD-11 6B62 trance disorder and 6B63 possession trance disorder require that the state is involuntary and unwanted and not part of accepted cultural or religious practice. [source: https://www.findacode.com/icd-11/code-1807490186.html] [source: https://pmc.ncbi.nlm.nih.gov/articles/PMC9199574] A DSM-5-TR note on culturally sanctioned beliefs and psychotic symptoms is [uncertain: not verified].
Steps: (1) Ask whether the experience is known and accepted in the client's family and community. (2) Ask how others in the community respond to it and whether it distresses or impairs the client. (3) Look for features beyond the cultural frame: functional decline, disorganisation, experiences the family themselves see as unusual, risk. (4) With consent, consult an Aboriginal mental health worker, cultural consultant or (where the client wishes and a program exists) a ngangkari or Elder about whether it is within normal cultural experience. (5) Hold both possibilities in the formulation; avoid premature diagnosis and avoid missing psychosis, mania or substance-induced states. [synthesis]
Example language (illustrative): "Some people tell me about seeing or hearing family who have passed, and for many it's part of life and not a problem. Is this like that for you and your family, or does it feel different, or worrying?"
Watch for: clients concealing experiences for fear of hospital; families seeing change the client cannot; substance use (NPY Women's Council reports ngangkari view cannabis, alcohol and petrol as distorting thinking and raising self-harm risk, and say some new illnesses cannot be treated traditionally). [source: https://parliament.nt.gov.au/__data/assets/pdf_file/0008/366452/Sub-No.-37,-NPY-Womens-Council,-Attachment-B,-NPY-Womens-Council-Ngangkari-Project.pdf]

4.9 Asking about, and collaborating with, Elders and traditional healers

Purpose / when: whenever the client's explanatory model involves spirit or Country, or the client mentions an Elder or healer. The framework asks services to support traditional and contemporary healing, including Ngangkari, cultural healers and Elders, alongside mental health care; to involve family, Elders and traditional healers in primary care; and to ensure access to Elders, traditional healers and interpreters in severe illness. [source: https://www.niaa.gov.au/sites/default/files/documents/publications/mhsewb-framework_0.pdf] The NPY Women's Council Ngangkari Program (developed 1998; ngangkari employed since 1999) supports Anangu traditional healers of the Ngaanyatjarra, Pitjantjatjara and Yankunytjatjara Lands to practise in communities, clinics and hospitals, and educates health and mental health workers about their role. [source: https://aigi.org.au/resource/example-the-ngangkari-program] [source: https://parliament.nt.gov.au/__data/assets/pdf_file/0008/366452/Sub-No.-37,-NPY-Womens-Council,-Attachment-B,-NPY-Womens-Council-Ngangkari-Project.pdf]
Who holds authority: ngangkari hold cultural authority and healing knowledge passed down through generations [source: https://aigi.org.au/resource/example-the-ngangkari-program]; Elders and Traditional Owners hold authority for their Country; the community organisation (e.g. NPY Women's Council, an ACCHS) governs its program. You do not choose, vet or "prescribe" a healer.
Steps: (1) Ask neutrally whether the client or family has seen, or would like to see, an Elder or healer. (2) If yes, ask how they want that to fit with your work and what you may share. (3) Obtain specific written consent for any information exchange, naming the person or organisation. (4) Make contact only through the community's own pathway (ACCHS, Aboriginal health worker, program coordinator), not by approaching individuals directly unless invited. (5) Ask the healer or Elder, through that pathway, what they would like you to know or do; do not ask about their methods. (6) Agree who does what, and how concerns about risk will be shared. (7) Record the arrangement. [synthesis]
Broader evidence on collaboration (outside Australia): in Nigeria and Ghana, the COSIMPO cluster trial (Gureje et al., The Lancet, 2020) found collaborative shared care between traditional and faith healers and primary care workers reduced psychosis symptoms more than usual care (adjusted PANSS difference about −15) and reduced harmful practices. [source: https://pubannotation.org/docs/sourcedb/PubMed/sourceid/32861306] [source: https://centreforglobalmentalhealth.org/node/839] In a Ghanaian prayer-camp trial (Ofori-Atta et al., Br J Psychiatry 212(1)), adding psychiatric medication to prayer-camp care lowered symptoms, but days in chains were not significantly reduced. [source: https://www.mentalhealthdataprizeafrica.aphrc.org/repository/paper/33405/joining-psychiatric-care-and-faith-healing-in-a-prayer-camp-in-ghana-randomised-trial] These settings differ markedly from Australia; transfer is [synthesis].
Example language (illustrative): "Some people I work with also see an Elder or a ngangkari, and that can sit alongside what we do. Is that something you or your family have done or would want? You decide what, if anything, I share."
Watch for: pressure from family or services either way; confidentiality in small communities; treating the healer as a free add-on rather than a paid, recognised worker. Working when the client experiences the two strands as fitting together rather than competing.

4.10 Referral and warm handover to community-controlled and SEWB services

Purpose / when: when the client wants Aboriginal-led care, cultural healing programs, Stolen Generations support or practical help across domains. The framework asks Primary Health Networks to partner with and prefer ACCHSs, to establish SEWB teams in primary care, to support Stolen Generations programs and Link-Up, and to build integrated referral and discharge processes. [source: https://www.niaa.gov.au/sites/default/files/documents/publications/mhsewb-framework_0.pdf] Gayaa Dhuwi (Proud Spirit) Australia asks for warm referrals so families do not have to retell their stories, and for SEWB navigators between services. [source: https://engage.dss.gov.au/wp-content/uploads/2026/01/Gayaa-Dhuwi.pdf]
Steps: (1) Offer options, including staying with you. (2) With consent, call the receiving service with the client present if possible. (3) Send a short summary agreed with the client. (4) Offer a joint session or continued contact during the transition. (5) Follow up. [synthesis]
Example language (illustrative): "Would it help if we rang them together now, so you don't have to tell it all again?"
Watch for: referral used to offload a "complex" client; long waits leaving the client without care. Working when the client attends and reports feeling known by the new service.

4.11 Supporting the client's own connection to Country and culture

Purpose / when: when the client names reconnecting with Country, language, kin or culture as a goal. Government reporting summarises observational studies linking cultural connection with fewer social and emotional difficulties (Footprints in Time), cultural connection as protective (Mayi Kuwayu), ranger participation with high life satisfaction, caring for Country in central Arnhem Land with better mental health, and cultural camps with belonging and intergenerational healing for Stolen Generations participants; it notes most evidence comes from small observational studies. [source: https://www.indigenoushpf.gov.au/Measures/2-14-first-nations-people-with-access-to-their-tra] Gayaa Dhuwi (Proud Spirit) Australia argues that on-Country healing camps and Elder-led mentoring should be recognised as valid interventions. [source: https://engage.dss.gov.au/wp-content/uploads/2026/01/Gayaa-Dhuwi.pdf]
Steps: (1) Help the client clarify what connection means to them (visiting homelands, contact with kin, language classes, ranger work, cultural camps, Stolen Generations programs). (2) Identify the legitimate community pathway for each (Traditional Owner groups, land councils, ACCHS, Link-Up, local Aboriginal organisations); the client, not you, makes contact or asks family to. (3) Work on practical and psychological barriers: money, travel, family conflict, shame about not knowing language or protocol, fear of rejection. (4) Plan for safety around the visit (relapse risk, grief, sorry business). (5) Debrief afterwards (4.12). [synthesis]
Example language (illustrative): "You've said going home to Country would mean a lot. Who in your family would be the right one to talk to about that? What gets in the way?"
Watch for: you, not the client, setting cultural goals; suggesting non-Aboriginal "nature therapy" as equivalent; directing the client to ceremonies or teachers outside their community's pathways. Working when the client takes steps through their own kin and community.

4.12 Integrating cultural, healing and on-Country experiences

Purpose / when: after a client returns from Country, a cultural camp, sorry business or a healer's visit and wants to talk about it.
Steps: (1) Invite them to share only what they can share. (2) Ask about the meaning for them, what changed, what felt hard. (3) Link insights to their goals and SEWB map. (4) Notice grief, longing or conflict on return to the city or service. (5) Record their account in their words. [synthesis]
Example language (illustrative): "Only tell me what's yours to share. What did being back there mean for you, and what are you bringing back with you?"
Watch for: asking for restricted details; reinterpreting the experience in clinical language the client did not use; post-return low mood. Working when the client describes greater strength or clarity and connects it to daily life.

4.13 Working with family and kin

Purpose / when: throughout. Family and kinship are central in the framework; NPY Women's Council reports that family talking gradually with an anxious person is part of recovery. [source: https://www.niaa.gov.au/sites/default/files/documents/publications/mhsewb-framework_0.pdf] [source: https://parliament.nt.gov.au/__data/assets/pdf_file/0008/366452/Sub-No.-37,-NPY-Womens-Council,-Attachment-B,-NPY-Womens-Council-Ngangkari-Project.pdf]
Steps: (1) Ask who the client counts as family; record kin by the client's terms. (2) With consent, invite nominated family to sessions or use the CFI Informant Version. (3) Ask about kinship responsibilities and any avoidance relationships that affect who can sit together. (4) Agree confidentiality boundaries with everyone present. [synthesis]
Example language (illustrative): "Who are the people you'd want around you in this? Is there anyone it wouldn't be right for you to be in a room with?"
Watch for: obligations that overload the client; family violence (screen privately). Working when family supports the plan and the client feels backed rather than exposed.

4.14 Addressing intergenerational trauma and racism

Purpose / when: whenever removal, dispossession or racism appears in the history or the present. The framework links trauma and loss since colonisation to disrupted cultural wellbeing with intergenerational effects. [source: https://www.niaa.gov.au/sites/default/files/documents/publications/mhsewb-framework_0.pdf] Adults who had not been removed from family reported low or moderate distress more often (74%) than those who had (60%); Mayi Kuwayu analyses suggest everyday racial discrimination may account for up to 47% of the psychological distress gap. [source: https://www.indigenoushpf.gov.au/Measures/2-14-first-nations-people-with-access-to-their-tra] Working Together addresses individual, institutional and internalised racism. [source: https://embrace.thekids.org.au/siteassets/working-together-aboriginal-and-wellbeing-2014.pdf]
Steps: (1) Take a family history of removal and dispossession with care and permission. (2) Name structural causes explicitly, so distress is not located only in the client. (3) Use evidence-based trauma work the client consents to, paced and with cultural supports in place; exposure-based work only with stabilisation, informed consent and the right to stop. (4) Ask directly about racism, including in your own service. [synthesis]
Example language (illustrative): "A lot of what you're carrying started long before you. It makes sense that it shows up like this." / "Has anything in this service felt racist or unsafe? I'd want to know."
Watch for: retraumatisation through repeated story-telling; defensiveness in yourself when racism is named. Working when the client's self-blame eases and they can name protective connections.

4.15 Suicide and self-harm risk, culturally informed

Purpose / when: at every assessment and when risk signals appear. NPY Women's Council reports ngangkari advice to listen and sit with the person, talk slowly, avoid criticism (which can add pressure and risk), and ensure people at risk can reach hospital when they cannot be safely monitored in community. [source: https://parliament.nt.gov.au/__data/assets/pdf_file/0008/366452/Sub-No.-37,-NPY-Womens-Council,-Attachment-B,-NPY-Womens-Council-Ngangkari-Project.pdf] The framework calls for post-discharge follow-up after self-harm or suicide attempts. [source: https://www.niaa.gov.au/sites/default/files/documents/publications/mhsewb-framework_0.pdf]
Steps: Follow current standard risk assessment and safety planning, adding: family and kin as safety supports (with consent); cultural supports and Aboriginal crisis lines the client prefers; lethal-means counselling limited to safe storage and removal; awareness of community clusters after a death; Aboriginal liaison if admission is needed. [synthesis]
Example language (illustrative): "I'm asking because I care what happens to you: have things got so heavy you've thought about ending your life?"
Watch for: shame silencing disclosure; substance use; recent losses and sorry business. Working when the client and family hold a shared safety plan.

4.16 Safeguarding

Purpose / when: whenever there is risk of harm to a child or adult, family violence, or coercion. [synthesis]
Steps: Follow mandatory reporting law and local policy; where safe and consistent with the law, involve Aboriginal child-protection and family services; distinguish cultural practice from abuse by consulting Aboriginal colleagues rather than assuming either way; never let "culture" excuse harm, and never treat ordinary cultural life (kinship care, time on Country) as neglect. [synthesis] The framework notes children in out-of-home care as a risk factor and calls for family reunification support. [source: https://www.niaa.gov.au/sites/default/files/documents/publications/mhsewb-framework_0.pdf]
Example language (illustrative): "I need to be straight with you about what I have to report and why, and I'll tell you each step."
Watch for: the history of child removal shaping fear of services. Working when the client stays engaged through the process.

4.17 Interpreters, Aboriginal mental health workers and cultural brokers

Purpose / when: when language, regional differences or cultural context limit mutual understanding. The framework calls for access to cultural liaison officers and interpreters and recognises natural helpers. [source: https://www.niaa.gov.au/sites/default/files/documents/publications/mhsewb-framework_0.pdf]
Steps: (1) Offer an Aboriginal-language interpreter where relevant. (2) Brief the interpreter or worker beforehand; check for kinship conflicts. (3) Speak to the client, not the interpreter. (4) Debrief afterwards on cultural meaning. [synthesis]
Example language (illustrative): "Would you like someone who speaks your language with us, or an Aboriginal health worker?"
Watch for: using family members as interpreters for sensitive topics; worker overload. Working when misunderstandings drop.

4.18 Strengths-based review and cultural-safety feedback

Purpose / when: every few sessions and at closure. Gayaa Dhuwi (Proud Spirit) Australia asks that cultural safety be verified by client and family feedback, that outcomes include connection to culture and kin, and that culturally validated tools be used, naming the Westerman Aboriginal Symptom Checklist (a licensed instrument; use only with its training and licence). [source: https://engage.dss.gov.au/wp-content/uploads/2026/01/Gayaa-Dhuwi.pdf]
Steps: (1) Revisit the SEWB map. (2) Ask directly how safe and respected the client feels with you. (3) Record changes in connection as well as symptoms. (4) Adjust the plan. [synthesis]
Example language (illustrative): "Is there anything I've done that didn't sit right? What would make this better for you?"
Watch for: politeness masking dissatisfaction; dropout as the only feedback. Working when the client gives you specific feedback and sees it acted on.

5. Handling problems

The sources give principles rather than problem-by-problem guidance; nearly all responses below are [synthesis] unless a source is cited.

Missed sessions or long gaps ("non-adherence"). Often reflects sorry business, family obligations, travel to Country, money or transport, not disengagement. Response: flexible scheduling, phone or outreach contact, no automatic discharge for missed appointments, a check-in message that keeps the door open. Treat it as information about the client's life, not resistance. [synthesis]
Quietness or few words early on. Response: slow down, offer a support person, use yarning, accept short sessions; avoid reading silence as flat affect or resistance (4.2). [synthesis]
Client does not want cultural framing. Some clients prefer mainstream care or find questions about culture intrusive. Response: self-determination applies here too; offer the SEWB lens once, then follow the client's lead; keep asking about racism and family without assuming. [synthesis, principle 2 and 8 of the framework]
Shame about disconnection ("I don't know my Country / language"). Common for people affected by removal. Response: locate the loss in history and policy, not in the client; make clear identity rests on descent, upbringing and community recognition, not on cultural knowledge alone [source: https://embrace.thekids.org.au/siteassets/working-together-aboriginal-and-wellbeing-2014.pdf]; offer Link-Up or Stolen Generations services if wanted. [synthesis]
Client asks you to explain or take part in songlines, Dreaming or ceremony. Response: say plainly that this is not your knowledge or role and that only the right people speak for Country [source: https://aiatsis.gov.au/explore/marlaloo-songline]; help them think about who in their family or community could guide them. [synthesis]
Non-Aboriginal client wants "songline" or "Aboriginal healing" practices. Response: explain that these belong to specific peoples and custodians and are not available as therapy techniques; do not offer imitations; where interest is in listening and reflective practice, point to the Miriam Rose Foundation's own programs for dadirri, offered on its terms. [source: https://miriamrosefoundation.org.au/dadirri/] [synthesis]
Family or community pressure (toward or away from healers or services). Response: meet with family if the client wishes; restate that the client decides; involve an Aboriginal health worker to mediate. [synthesis]
Healer or Elder advice appears to conflict with medical care. Response: do not dismiss either; explore with the client what each means to them; never advise starting, stopping or changing medicines yourself and route medication questions to the prescriber; with consent, invite a joint conversation through the community pathway. NPY Women's Council reports ngangkari themselves value working with western-trained doctors and hospital care for those at risk. [source: https://parliament.nt.gov.au/__data/assets/pdf_file/0008/366452/Sub-No.-37,-NPY-Womens-Council,-Attachment-B,-NPY-Womens-Council-Ngangkari-Project.pdf] [synthesis]
Uncertainty whether an experience is cultural or a symptom of illness. Response: consult (Aboriginal mental health worker, cultural consultant, healer if the client wishes); gather family's view; monitor function and risk; document both readings (4.8). If risk is high, act on safety first while keeping the cultural reading in the record. [synthesis]
Overwhelm during trauma work. Response: pause, ground in present-day connections the client names (family, Country, strengths from the SEWB map), slow pacing, return to stabilisation; make sure cultural and family supports are in place before resuming. [synthesis]
Rupture over racism or a culturally unsafe act (yours or the service's). Response: thank the client for telling you, acknowledge the harm without defending, say what you will change, follow through, and check later; escalate service-level racism. Cultural safety is judged by the client, not by you. [source: https://engage.dss.gov.au/wp-content/uploads/2026/01/Gayaa-Dhuwi.pdf] [synthesis]
Fear of you as part of the system that removed children. Response: name the history openly; be transparent about reporting duties from the start; offer an Aboriginal co-worker. [synthesis]
Confidentiality in small communities. Response: agree with the client who may know what; take care with interpreters and workers who may be kin; meet where the client feels unobserved. [synthesis]
Return-to-Country visit goes badly (rejection, grief, relapse). Response: plan beforehand (4.11); debrief without judgement; hold the grief; revisit pathways with family; watch for risk. [synthesis]
Remote clients and telehealth. Response: agree a local support person and safety plan; coordinate with local clinic, ACCHS and, where they exist, healer programs; allow for connectivity and privacy limits. [synthesis]
Lateral violence or community conflict affecting the client. The framework lists lateral violence as a community-domain risk. [source: https://www.niaa.gov.au/sites/default/files/documents/publications/mhsewb-framework_0.pdf] Response: name it as a consequence of colonisation and stress, not individual failing; support boundaries; involve trusted community supports. [synthesis]
Therapist over-reach or paralysis. Over-reach: adopting cultural roles, using Aboriginal words or concepts as techniques. Paralysis: avoiding the topic of culture for fear of error. Response for both: cultural supervision, consultation, and asking the client. [synthesis]

Sources

Web sources:

Books and papers cited:

Gee G, Dudgeon P, Schultz C, Hart A, Kelly K (2014). Aboriginal and Torres Strait Islander social and emotional wellbeing. In Dudgeon P, Milroy H, Walker R (eds), Working Together: Aboriginal and Torres Strait Islander Mental Health and Wellbeing Principles and Practice, 2nd ed. Canberra: Commonwealth of Australia. (Chapter text itself [uncertain: not verified]; model as reproduced in the national framework.)
Kleinman A, Eisenberg L, Good B (1978). Culture, illness, and care: clinical lessons from anthropologic and cross-cultural research. Annals of Internal Medicine 88:251–258.
Lewis-Fernández R, Aggarwal NK, Lam PC, et al. (2017). Feasibility, acceptability and clinical utility of the Cultural Formulation Interview. British Journal of Psychiatry 210(4):290–297.
Gureje O, Appiah-Poku J, et al. (2020). Collaborative shared care for psychosis (COSIMPO). The Lancet.
Ofori-Atta A, Attafuah J, Jack H, Baning F, Rosenheck R, et al. Joining psychiatric care and faith healing in a prayer camp in Ghana: randomised trial. British Journal of Psychiatry 212(1) (year [uncertain]: 2018 volume, repository lists 2019).

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