Indigenous and diaspora healing knowledge in U.S. mental health systems: A systematic review of cultural adaptation, access, and outcomes

Objective: This systematic review examined how Indigenous and diaspora healing knowledge has been adapted, integrated, or engaged within U.S. mental health systems, with particular attention to cultural adaptation, access to care, and reported outcomes. It focused on how mental health services respond to culturally grounded healing practices, community-based support systems, and alternative help-seeking pathways among Native and diaspora populations. The review also considered whether these forms of healing knowledge are meaningfully incorporated into care or remain peripheral to dominant clinical models.
Methods: The review was organized according to PRISMA 2020 principles and drew on literature addressing Indigenous healing, immigrant and refugee mental health service use, culturally adapted psychotherapy, community-based mental health support, and community-linked models of care. Searches were structured around mental health, Indigenous and diaspora populations, traditional healing, cultural adaptation, access, and outcomes. Extracted studies were synthesized thematically because the evidence base was conceptually related but methodologically diverse.
Findings: Four major themes emerged. First, Native mental health scholarship consistently frames healing within sovereignty, land, spirituality, kinship, and community authority. Second, immigrant and diaspora studies show that access is shaped by cost, insurance, language, stigma, trust, migration stress, and reliance on family, faith leaders, and informal networks. Third, culturally adapted interventions can improve engagement and some clinical outcomes, but adaptation is unevenly described and often under-evaluated. Fourth, the strongest models of care are those that move beyond surface cultural competence toward community-led and culturally grounded service design.
Conclusion: U.S. mental health systems need more than standard cultural competence frameworks. They require structurally responsive, community-centered, and culturally grounded approaches that recognize the legitimacy of multiple healing systems and the importance of trust, informal support, and community control in mental health care.