The mental health landscape underwent a significant transformation with the sudden rise of teletherapy services during the COVID-19 pandemic. In particular, rural, remote, and indigenous communities saw a substantial increase in accessibility to teletherapy services. However, these communities present unique cultural challenges, often overlooked in conversations around teletherapy. This article defines indigenous people as per the United Nations and outlines several facts that telehealth practitioners need to understand before trying to be helpful. The article will also outline the importance of cultural competency and safety in rural mental health settings when providing teletherapy services. A Part II article will provide a case study for the reader to evaluate.
Overview of Indigenous Communities
According to a 2020 systematic review of telehealth with indigenous populations worldwide, Indigenous communities form a rich tapestry of diverse cultures and traditions, each preserving its unique identity separate from the dominant societies they are part of. The United Nations, recognizing the broad range of these communities, has yet to provide a strict definition but rather a description of what makes up an Indigenous group. These criteria include the following.
Self-identification as Indigenous
Historical continuity with pre-colonial societies
Strong ties to territories and surrounding natural resources
Distinct social, economic, or political systems
Unique languages and cultures, and
Being a non-dominant group in society.
These communities exist globally, with an estimated 370–500 million individuals residing in over 90 countries, representing a vast spectrum of more than 5,000 distinct cultures. Even though these communities comprise roughly 5% of the world’s population, 15% of the world’s most impoverished individuals are from these groups. This economic disparity often results in higher malnutrition rates and inadequate resource access.
Moreover, Indigenous peoples’ life expectancy is typically 20 years shorter than non-Indigenous populations worldwide. This gap is primarily due to inadequate healthcare, lack of health information, and a higher susceptibility to infectious diseases such as malaria, tuberculosis, HIV, and AIDS. Today’s blog post will explore how telehealth could address these health disparities within Indigenous communities.
The Distinctiveness of Rural Mental Health
Historically, rural communities have been underrepresented and underserved in psychological services, making the advent of teletherapy a significant development in rural mental health. However, the assumption that rural areas are merely smaller versions of urban centers is a fundamental mistake.
Rural communities come with diverse geographies, economic conditions, and cultures, which significantly differ from one another and urban centers. The unique dynamics of rural life, such as weather impacts, social norms, privacy concerns, and community roles, can significantly affect teletherapy services. Therefore, teletherapy professionals must practice cultural humility and ensure a culturally safe therapeutic setting for their rural clients.
The Importance of Cultural Competence and Safety
Cultural competency and safety are integral to effective psychotherapy. They involve understanding and respecting a client’s culture, ethnicity, beliefs, and values and viewing them as assets. This respect empowers clients to be proactive in managing their health.
Cultural humility, a cornerstone of culturally competent practice, involves ongoing self-reflection of one’s views and biases. Practitioners must be willing to acknowledge and explore personal areas of ignorance and weaknesses, as these can hinder the therapeutic relationship.
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