Indigenous cultural safety in psychedelic assisted therapy : a qualitative analysis

Abstract

Indigenous Peoples in North America face distinct barriers to accessing mental health care, including psychedelic assisted psychotherapy (PAT). Although PAT has demonstrated efficacy for treatment-resistant mental health disorders, limited diversity in psychedelic research and the importance of set and setting highlight the need for Indigenous cultural safety (ICS), an approach to care that is respectful, culturally responsive, and reduces the incidence of racism and discrimination. However, to date, factors that promote ICS in PAT have not been systematically examined. This qualitative study employed semi-structured interviews to explore experts' perspectives on the key factors that support ICS in PAT. Using a qualitative design informed by postcolonial theory and Two-Eyed Seeing, 10 semi-structured interviews were conducted with experts in Indigenous mental health and psychedelic therapy. Data were analyzed using reflexive thematic analysis within a dual epistemological framework integrating constructivism and critical realism. Four interconnected themes described the conditions required to support ICS in PAT across foundational, conceptual, applied, and structural levels. The themes include: 1) Contextualizing Cultural Safety, 2) Conceptualizing Culturally Aligned Psychedelic Care, 3) Co-creating Culturally Aligned Psychedelic Care, and 4) Systemic Factors Impacting Accessibility. Findings suggest that achieving ICS in PAT requires a broader model of culturally aligned psychedelic care that builds upon the foundational principles of ICS, while remaining sufficiently flexible to address the unique therapeutic context of PAT. The project speaks to the conditions that are required for psychedelic care to become culturally aligned, ethically governed, and genuinely accessible for Indigenous communities. Culturally aligned psychedelic care cannot be achieved through isolated cultural adaptations to existing PAT protocols; it requires changes at the interpersonal, therapeutic, conceptual, and systemic levels. Ultimately, a culturally aligned psychedelic model will be grounded in the foundational safety elements of psychedelic care, while maintaining sufficient flexibility to be adaptable to the needs of diverse Indigenous individuals and communities. These findings provide a foundation for developing culturally aligned psychedelic care and may inform future clinical practice, training, policy, and research conducted in partnership with Indigenous communities.