Visions Journal

Culture humility and the cultural foundations 
of mental wellness

Sheila Blackstock, RN, COHN, FNCEI, PhD

Reprinted from the Don't Erase Me: Why culture matters in mental health issue of Visions Journal, 2026, 21 (3), pp. 7-9

Cultural humility is a lifelong practice of self-reflection and self-critique that asks health professionals—and health systems—to recognize and address personal and structural biases, while humbly learning from the people and communities they serve.¹ 

In Canada, national guidance further clarifies that cultural humility and cultural safety exist on a continuum and are essential for equitable care for First Nations, Inuit and Métis Peoples, given the persistence of racism, discrimination and stigma in health systems.²

When practised earnestly, cultural humility improves mental health care because it creates spaces where Indigenous identities, knowledge systems and healing practices are respected and centred—conditions that have direct implications for safety, trust and well being.^{1, 2}

A lifelong learning

Growing up in rural northern BC on a ranger station in wildfire season, we developed a deep respect for the interconnection of the bush to the climate and all living things. In our Gitxsan culture we realized the role of wholistic health (physical, mental, emotional, spiritual and environmental) and well-being; being interconnected with being on the land.

In my youth, I developed a deep understanding of how the land ethos is intricately balanced with my well-being—out in the bush picking huckleberries with my dog; cross-country skiing on packed trails to cross paths with a cow moose and her calf seeking a reprieve from the deep snow. All these things and more brought serenity and balance to me.

These lessons of gathering from the bush are integral to our culture, and there are many more lessons to be learned. Cultural humility is much the same approach to “understanding what you do not understand,” and seeking guidance to learn more. Ultimately, the goal is to create environments where First Nations feel safe and open to share stories.

Indigenous approaches to wellness

This lived experience resonates with Indigenous mental health scholarship in Canada, which shows wellness is relational and land-connected: identity, language, kinship and relationships with the land support resilience, meaning-making and healing.³ In this view, culture is not an add on to care, but a foundational source of wellness that shapes how distress is expressed, how help is sought and which pathways to healing are most effective.³

Accordingly, cultural humility asks clinicians, educators and leaders to approach Indigenous knowledge systems as authoritative, and to co-create care grounded in local teachings. This approach aligns with the First Nations Health Authority’s description of cultural safety as care that addresses power imbalances and results in environments free of racism and discrimination.¹ 

More support for culture as wellness

Canadian policy frameworks reinforce the stance led by Indigenous scholars. The First Nations Mental Wellness Continuum, co-developed with First Nations leadership, defines mental wellness as a balance of the mental, physical, spiritual and emotional. Wellness is then supported by culture, language, Elders, families and Creation.^4,5 The framework’s widely cited pillars—hope, belonging, meaning and purpose—underscore that culture and connection are not extra, but determining of wellness across the lifespan.⁵

For educators and practitioners, this implies that promoting specific activities are mental health interventions in their own right, including:

• Land-based programs
• Language revitalization
• Elders-in-residence models^4,5

Combating Indigenous racism

Research shows how Indigenous  specific racism—from policy to interactions with the healthcare system—undermines mental health and access to services.⁶ The resulting inequities affect everything from help-seeking  to staying in treatment and outcomes, contributing to disproportionate burdens of distress and suicide in some communities.^{3, 6}

BC’s professional guidance emphasizes several core expectations for culturally safe and humility-informed health practices, including:

• Self-reflexive practice
• Anti-racism
• Person-led care⁷

Cultural humility responds by shifting responsibility from “fixing the patient” to transforming systems—confronting prejudice, changing policies and embedding accountability structures that protect the right to culturally safe care.^1,6 

National standards and regulatory guidance are converging around these expectations. The Health Standards Organization has put forward a national Cultural Safety and Humility standard (CAN/HSO 75001) that sets requirements for organizations to co-design, deliver and evaluate culturally safe services with First Nations, Inuit and Métis Peoples.⁸

The requirements also address Indigenous-specific racism across the full care pathway.8 This work complements provincial and professional guidance in BC emphasizing self-reflexive practice, antiracism and person-led care as core to competent nursing and allied health practices.⁷

Humility and reconciliation

Cultural humility also aligns with the Truth and Reconciliation Commission of Canada’s Calls to Action. These calls include expectations for:

• health equity
• cultural competence
• closing gaps in health outcomes⁹

For postsecondary programs and health organizations, this means shifting curricula, quality-improvement metrics and funding to uphold Indigenous self-determination  in health. It also means supporting distinctions-based (tailored) approaches that reflect the unique priorities of First Nations, Inuit and Métis communities.^2,9

From a research perspective, the mechanisms linking culture, humility and mental health can be thought of in three reinforcing domains:

Identity and belonging: When services affirm Indigenous identities, language and land relationships, they support coherence of self (feeling integrated) and collective continuity (feeling like your group endures)—key ingredients of resilience.^3,5

Safety and trust: Humility-informed  practice explicitly recognizes power differentials, addresses bias and fosters relational accountability, thereby improving engagement and therapeutic alliance.^1,8

System transformation: Standards and policies that embed cultural safety shift structures (i.e., governance, workforce, measurement) so that equity and Indigenous leadership are built into how care is designed and evaluated.^4,8  

How we change

For educators and service leaders, several practical steps flow from this evidence. They should:

• co-develop curricula and services with local Nations, Elders and Knowledge Keepers, recognizing them as co-educators and co-researchers^1,4
• build land-based, language-rich  programming into mental health promotion and recovery pathways, including grief and trauma support^3,5
• implement organizational standards that require antiracism training, distinctions-based  approaches and evaluation metrics tied to safety and outcomes^2,8
• ensure accountability through patient-reported experience measures that explicitly assess cultural safety and through governance structures that include Indigenous leadership^{1, 8}

My Gitxsan reflection illustrates why these commitments are not abstract ideals, but clinical and pedagogical necessities. Experiences of harvesting, being on the land and encountering non-human relatives foster calm, meaning and balance—outcomes that the First Nations Mental Wellness Continuum Framework recognizes as integral to mental wellness and that are sustained by culture and relationships.^4,5

Cultural humility provides the ethical and methodological stance to honour those knowledges while transforming health and education systems that have too often dismissed them, thereby advancing mental health and well being for Indigenous Peoples in ways that are safe, relational and just.^1,6 

Footnotes:

1. First Nations Health Authority. (2022, October 21). Cultural safety and humility. fnha.ca/what-we-do/cultural-safety-and-humility
2. Public Health Agency of Canada. (2023, June 20). Common definitions on cultural safety (CPHO Health Professional Forum). canada.ca/en/health-canada/services/publications/health-system-services/chief-public-health-officer-health-professional-forum-common-definitions-cultural-safety
3. Kirmayer, L. J., Dandeneau, S., Marshall, E., Phillips, M. K., & Jessen Williamson, K. (2011). Rethinking resilience from Indigenous perspectives. The Canadian Journal of Psychiatry, 56(2), 84–91. doi.org/10.1177/070674371105600203 
4. Health Canada. (2015). First Nations mental wellness continuum framework. Government of Canada Publications. https://publications.gc.ca/site/eng/9.700117/publication.html
5. Indigenous Services Canada. (2015). First Nations mental wellness continuum framework—Summary report. sac-isc.gc.ca/eng/1576093687903/1576093725971
6. Allan, B., & Smylie, J. (2015). First Peoples, second class treatment: The role of racism in the health and well being of Indigenous peoples in Canada. Wellesley Institute. wellesleyinstitute.com/publications/first-peoples-second-class-treatment
7. British Columbia College of Nurses and Midwives. (2020). Indigenous cultural safety, cultural humility and anti racism: Practice standard (Companion guide).  bccnm.ca/Documents/cultural_safety_humility/ps_companion_guide.pdf 
8. Health Standards Organization. (2025). CAN/HSO 75001:2026 Cultural safety and humility (public review draft). healthstandards.org/public-reviews/cultural-safety-and-humility
9. Truth and Reconciliation Commission of Canada. (2015). Truth and Reconciliation Commission of Canada: Calls to Action. National Centre for Truth and Reconciliation. nctr.ca/about/history-of-the-trc/truth-and-reconciliation-commission-of-canada-calls-to-action