Re: Meta-analysis of Australian Indigenous psychiatric treatment,critiqued

We thank Brown (2017) for his thoughtful comments on our review (Leske et al., 2016). In reply, we would like to clarify a few inaccuracies reported in his commentary. Most importantly, our paper was a systematic literature review employing a narrative synthesis, rather than a meta-analysis. We did not as purported by Brown conduct a meta-analysis because of considerable heterogeneity in reported outcomes, nor indeed because of insufficient diagnostic information or too few studies.

Nevertheless, we agree with Brown (2017) that research into the diagnostic practices in Indigenous populations have to date received inadequate attention, specifically with respect to their reliability and validity. In Australia, work is now underway (M Toombs, personal communication, 24 April 2017) to validate the Structured Clinical Interview for DSM-IV (SCID) in Aboriginal and Torres Strait Islander Australians (N = 522). Participants and psychologists in this study have reported that the SCID is culturally acceptable. They do report that culturally competent trained clinicians with considerable experience and knowledge of Indigenous Australians should conduct the interviews.

Brown (2017) argues that our systematic review was premature. This is presumably a judgement based on the fact that only a small number of studies were identified in our search. We argue the contrary. To our knowledge, this is the first review of treatments for diagnosed mental and substance use disorders in Indigenous adults in the four countries included. Identifying minimal research published in this area is an important finding in itself and gives impetus to increase funding and conduct rigorous intervention studies in Indigenous populations. In time, this should facilitate the comprehensive meta-analysis that we could not conduct. Furthermore, our review identified future research priorities including standardisation of outcomes examined and conduct of replication studies for promising interventions.

Finally, while we agree with Brown (2017) that increased quality of treatment and service delivery is a priority, we disagree that research should be placed on hold until this is achieved. Rather, research that assesses and monitors treatment and service quality has been identified as a priority in numerous publications and policy documents, and it directly informs intervention and service development (Department of Health, 2016). We believe the burden of mental and substance use disorders in Indigenous populations will ultimately be reduced through Indigenous communities, consumers, clinicians, service planners, researchers, non-government organisations and governments, all working collaboratively.