Psychedelic medicine and cultural responsiveness: A call for Aboriginal and Torres Strait Islander engagement in Australian clinical trials and practice
December 2024
Bianca Sebben, Jem Stone, Jerome Sarris, Daniel Perkins, Kirt Mallie, Scarlet Barnett, Simon G. D. Ruffell, Vanessa L. Beesley
As psychedelic-assisted therapy advances in Australia, through clinical trials and the reclassification of MDMA and psilocybin, there is a critical imperative to centre Aboriginal and Torres Strait Islander Peoples in its ethical development. Despite holding over 65,000 years of relational knowledge with plant and fungal medicines, these communities have been largely excluded from current research and policy conversations. As a result, most psychedelic protocols remain culturally unsafe, shaped by a Western biomedical paradigm that overlooks Indigenous healing frameworks.
Western Psychiatry vs Indigenous Worldviews
Contemporary clinical trial protocols for psychedelic-assisted therapy are largely structured around individualised care, with preparation, dosing, and integration typically occurring within a therapist-participant dyad. This model reflects the colonial legacy of Western psychiatry, which privileges personal autonomy and individual pathology. In contrast, Indigenous health frameworks, and particularly those of Aboriginal and Torres Strait Islander Peoples, centre collective wellbeing. Here, social, emotional, and cultural health are understood as interdependent, with individual healing intrinsically linked to family, community, country, and culture.
Additionally, from an Indigenous perspective, healing with psychedelic medicine is inseparable from the relationship with the medicine itself (i.e. its spirit, origin, and ecological context). When used outside of sacred space or without energy-clearing practices, psychedelic substances can disrupt the country and harm native flora. However, Western clinical trial and prescriber models rarely account for these relational and environmental dimensions. Aboriginal and Torres Strait Islander Peoples not only hold deep knowledge of these medicines, but also carry the right to respond to activities on their lands, particularly when there is potential for harm.
Barriers to Access and Participation
There are currently three formal pathways for accessing psychedelic medicines in Australia: drug development trials, investigator-initiated trials, and authorised prescriber models. Each pathway relies on Western diagnostic criteria and screening tools that have not been validated for Aboriginal and Torres Strait Islander populations. This creates a structural barrier for individuals whose mental health experiences have not been clinically diagnosed, or may be culturally bound or community-defined.
In parallel, therapist eligibility requirements, such as formal psychology qualifications and registration with regulatory bodies, often exclude Indigenous healers. This is despite their profound expertise in cultivating safe, contained environments for botanical medicine work, and the reality that Indigenous therapists are often uniquely equipped to meet the cultural and relational needs of their communities in ways non-Indigenous practitioners may not be.
Recommendations for Inclusive Practice
To create a truly inclusive and effective psychedelic therapy landscape, the authors propose the following:
Forming Indigenous-led expert reference groups for protocol design
Consulting Traditional Owners to acknowledge and protect cultural knowledge
Diversifying therapist teams to include Indigenous healers
Exploring decentralised, group-based models in naturalistic settings
Ensuring Human Research Ethics Committees (HRECs) and regulators support Indigenous therapist participation and involvement in protocol design
With Australia still in the early stages of designing what psychedelic-assisted therapies will look like in practice, this moment presents a crucial opportunity to prioritise Aboriginal and Torres Strait Islander Peoples’ health equity and cultural wisdom through inclusion at every stage of the evolving process.