Mapping Aboriginal mental health journeys through psychiatric care systems: a mixed-methods study integrating lived experience with network analysis

Background: Mental health service models in Australia often lack cultural safety, limiting their capacity to meet the care needs of Aboriginal and Torres Strait Islander peoples. We examined psychiatric care pathways for Aboriginal patients by integrating clinical interaction network analysis, transition matrix-based trajectory clustering and qualitative insights into patient journeys. Methods: We conducted a convergent mixed-methods study within an Aboriginal Participatory Action Research framework, led by Aboriginal researchers in partnership with community organisations. Quantitative analysis drew on 1,108 interaction instances involving nineteen Aboriginal patients presenting to a regional mental health service. Clinical interaction network modelling identified central agents and organisational structure while transition matrix-based clustering elucidated patterns in patient trajectories. Seven participants contributed to yarning interviews which were thematically analysed to explore lived experiences. Integration of qualitative and quantitative findings provided comprehensive insights into Aboriginal psychiatric care. Findings: Network analysis showed the patient as the most central node, with the Mental Health Nurse, Psychiatric Registrar, Psychiatric Consultant and Aboriginal Mental Health Worker also central. Using a new community-preserving surrogate algorithm, we found that only the AMHW’s closeness exceeded expectations based on degree, underscoring its distinctive bridging role in facilitating information flow. External agents communicated predominately via the patient node indicating reliance on patients as intermediaries. Hospital staff showed a core-periphery structure centred on key clinical roles. Patient trajectory clustering revealed three patterns: (1) internal interventions/follow-up, (2) extended hospital-based transitions and (3) external referral with readmissions. Qualitative analysis showed the AMHW’s essential role in supporting culturally safe care but noted inconsistent availability and ongoing culturally unsafe experiences. Interpretation: Integrating systems modelling with lived experience offer novel insights into Aboriginal psychiatric care. The findings emphasise the AMHW’s bridging role and the imperative to strengthen this workforce and embed cultural safety across services. *Helen Milroy and Blerida Banushi contributed equally to this work.