Decolonizing mental health: the Nova Scotia transcultural mental health program as a model of care

African Nova Scotians, Indigenous peoples, and refugees experience significant disparities in access to culturally appropriate mental health care due to systemic inequities, intergenerational trauma, stigma, and limited availability of culturally competent services. The Nova Scotia Transcultural Mental Health Program (NSTMHP) was established to close gaps in serving these equity-denied groups using a culturally responsive and collaborative model of care in primary healthcare settings. This paper describes the development, implementation, governance, and model of care of the NSTMHP as an approach to advancing equitable, decolonized mental health services. This descriptive program-development paper outlines the collaborative processes used to design and implement the NSTMHP. The program was developed through partnerships involving the Dalhousie University Department of Psychiatry, Nova Scotia Health Mental Health and Addictions Program, culturally specific community organizations, patient advocates, and primary healthcare clinics. A shared-care model was implemented in which culturally competent psychiatrists provided direct and indirect psychiatric consultations within primary care settings. Governance structures, service pathways, implementation processes, educational initiatives, and research activities were reviewed descriptively. No statistical analyses were conducted, as this paper focuses on program design, implementation, and model development. The NSTMHP established a structured governance framework consisting of an advisory council and management team representing healthcare, academic, and community partners. The program developed culturally responsive pathways for psychiatric consultation services for African Nova Scotians, Indigenous peoples, and refugees within community-based primary care clinics. Key outcomes included improved collaboration between psychiatry and primary care, enhanced opportunities for culturally informed education and research, increased integration of mental health services within equity-denied communities and strengthened community partnerships. Important implementation challenges included sustaining funding, recruiting and retaining culturally competent clinicians, addressing social and structural determinants of health, and adapting assessment and treatment approaches to align with diverse cultural perspectives and decolonizing principles. The NSTMHP demonstrates the feasibility and potential value of a collaborative, culturally responsive, and community-informed model for improving access to mental health services among equity-denied populations. The program provides a promising framework for integrating transcultural and decolonizing approaches into mental health systems and may inform the development of similar equity-oriented initiatives in other jurisdictions.