Importance: Mental health services fail to provide culturally safe care for Aboriginal peoples, contributing to persistent health disparities. Understanding how psychiatric care is organized, alongside lived experiences of care, may identify leverage points for service redesign. Objective: To examine Aboriginal mental health care pathways using integrated qualitative and quantitative analysis. Design, Setting, and Participants: This mixed-methods study was conducted from June 2022 to December 2023 at the Great Southern Mental Health Service in Western Australia. Twenty Aboriginal adults were recruited; the quantitative component included 19 patients with 1108 documented clinical interactions, and 7 participated in in-depth yarning interviews. Novel analytical methods included a community-preserving surrogate network algorithm and transition-matrix trajectory clustering. Main Outcomes and Measures: Centrality metrics identifying key agents in the clinical interaction network; patient trajectory clustering based on clinical action sequences; qualitative themes from yarning interviews using reflexive thematic analysis. Results: A total of 20 Aboriginal adults were recruited; the quantitative analysis included 19 patients (mean SD age, 38.4 15.9 years; 10 women and 9 men) with 1108 documented interactions, with 7 patients (mean SD age, 44.0 17.8 years; 4 women and 3 men) participating in qualitative yarning interviews. The clinical interaction network had a core-periphery structure in which patients often served as the main link between external agents and hospital staff. Aboriginal mental health workers had closeness centrality above the 99th percentile in surrogate networks, indicating a structurally distinctive central position within the network. Trajectory analysis identified 3 care pathways: predominantly internal care, prolonged internal engagement, and complex external referral with repeated readmissions. Qualitative themes emphasized cultural safety, kinship, and ongoing trauma and showed inconsistent Aboriginal mental health worker presence during crises, while integrated analyses highlighted their pivotal yet vulnerable role within fragmented care pathways, underscoring the need for trauma-informed, culturally safe redesign. Conclusions and Relevance: In this mixed-methods study, Aboriginal mental health workers occupied central bridging positions, and patients were intermediaries between disconnected parts of the system. Strengthening culturally grounded roles and redesigning care pathways based on operational information flow may improve care coordination and cultural safety in multisetting mental health systems.
Milroy et al. (Wed,) studied this question.