Culturally appropriate psychotherapy and its retention: An example from Far North Queensland (Australia)

Background: Culturally appropriate mental health care is essential in remote Australia. However, while associated with the development of an effective therapeutic alliance, current literature insufficiently reports the retention and psychotherapy outcomes of Indigenous adults. We aimed to describe the characteristics and retention of clients attending the Far North Mental Health and Wellbeing Service (FNS). Methods: We conducted a retrospective cross-sectional study on clients who received one or more psychotherapy consultations between 1st July 2019 and 31st December 2020. Population, entrance, and treatment characteristics were described, with retention compared between the major cultural groups. Entrance characteristics comprised referral pathway and reason for presentation and were investigated as alternative predictors of client retention. Findings: There were 186 non-Indigenous (68.3 % female) and 174 Indigenous (62.6 % female) clients, with a median number of 3.0 consultations (IQR 2.0–5.3). Indigenous status did not significantly predict retention. Referral pathway significantly predicted the number of consultations (Wald X²(6) = 17.67, p = .0071) and immediate discontinuation (Wald X²(6) = 12.94, p = .044), with self-referred clients having the highest retention. Initial presentation reason significantly predicted the number of consultations (Wald X²(5) = 13.83, p = .017), with clients with potential health hazards related to socioeconomic and psychosocial circumstances having the lowest retention. Significantly more Indigenous clients presented for this reason (20.1 % vs 4.3 %). Interpretation: Comparable retention of Indigenous clients suggests cultural appropriateness of the psychotherapy being delivered by the FNS. Services might use the described therapeutic approach as a guide for culturally appropriate care.