Context: PSPNET is a digital mental health service that provides free and confidential internet-delivered cognitive behavioural therapy (ICBT) designed with and for Canadian public safety personnel (PSP). Recognizing the high prevalence of mental health challenges and barriers to care among PSP, PSPNET aims to offers an alternative accessible, evidence-based mental health care option for PSP to complement other forms of care. Treatment outcomes are promising with large reductions in symptoms of depression, anxiety, and posttraumatic stress at post-treatment. These benefits are consistent across diverse PSP sectors and genders. Yet, there remains a critical need to explore whether and how to improve PSPNET for Indigenous (First Nations, Inuit, and Métis) PSP. This is particularly important as Indigenous Peoples in Canada experience disproportionately high rates of mental health challenges due to the ongoing impacts of colonization, systematic inequities, and related risk factors such as socioeconomic disparities and limited access to culturally responsive care. To help reconcile this inequity, PSPNET is working towards understanding and improving the accessibility, inclusivity, and effectiveness of ICBT among Indigenous PSP through collaborative research. Methods: The PSPNET Advisory Group was founded in 2024 to provide an ethical space, in line with the Canadian Tri-Council Policy Statement, for Indigenous Peoples (e.g., Elders, PSP, researchers, students, community members) to review current and inform future PSPNET services, research, and outreach. Research initiatives led by the group have included a mixed-methods study comparing ICBT qualitative and quantitative results between Indigenous and White PSP to inform possible directions for course adaptations and to improve awareness and accessibility among Indigenous communities. Results: The mixed-methods study included a sub-sample of quantitative (n=351; 8% Indigenous clients) and qualitative data (n=10; 100% Indigenous clients) from the PSPNET therapist-guided ICBT program, called the PSP Wellbeing Course, collected between December 2019 to October 2022. Independent t-tests showed Indigenous clients reported statistically significantly higher anxiety and depression symptoms compared to White clients at pre-treatment but both groups reported clinically improved symptoms at 8-weeks post-enrollment. Indigenous clients showed comparable levels of and improvement in their posttraumatic stress symptoms as White clients. Independent t-tests also showed comparable treatment engagement and satisfaction between Indigenous and White clients. Reflexive thematic analysis (n=10) provided critical directions for adapting course content (e.g., case stories, additional resources) to improve inclusivity while emphasizing the role of outreach in equitable access. Conclusions: Indigenous PSP are interested in and benefit from ICBT but, nevertheless, offer insights that cultural adaptations may further enhance treatment engagement, effectiveness, and satisfaction. Directions underway include continued collaboration with Indigenous Peoples (PSP and non-PSP) to increase equitable access to ICBT among Indigenous communities in Canada. Future directions include implementation of cultural adaptations (e.g., case stories, additional resources) and evaluation of such adaptations on treatment outcomes among Indigenous and non-Indigenous clients. Implications: Collaboration with interested parties is vital for conducting culturally appropriate research and identifying ways to improve equitable access to digital mental health services for underrepresented communities.
