Psych CASC / OSCE · Professional — cultural formulation and Indigenous mental health
Cultural formulation interview with an Aboriginal woman — CASC communication station
MRCPsych/FRANZCP-style CASC: person-centred CFI skills, SEWB awareness, non-racist communication, risk, and collaborative plan with optional Aboriginal Health Worker involvement.
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Target exams
Station brief
Format. Communication station, approximately 7–10 minutes active time after reading. You are the community psychiatry registrar seeing a new referral. [1]
Candidate instructions. Build rapport. Explore cultural identity as she defines it. Elicit her explanatory model of the current problem. Screen for suicide risk. Explore social and emotional wellbeing domains and experiences of racism or service mistrust without forcing disclosure. Offer Aboriginal Health Worker/ACCHO involvement with consent. Avoid stereotypes and checklist ethnography. Agree a collaborative plan. [1][2][3]
Candidate scenario
Your patient is 41, Aboriginal, living in a regional town. GP referral: low mood, poor sleep, withdrawn from netball and family events for two months. No prior psychiatric admissions. She may mention that a previous ED visit felt dismissive. English is fluent. No acute medical issue. An Aboriginal Health Worker is available if she agrees. [3]
Marking domains
- Respectful introduction; ask how she wants to be addressed and who should be involved
- CFI-style curiosity about identity, meaning of illness, stressors, supports, and relationship to services
- Kleinman-style explanatory model questions used conversationally
- Explicit, sensitive suicide risk assessment
- SEWB language available without forcing it
- Racism/mistrust explored without defensiveness
- Offer of Aboriginal Health Worker/ACCHO with consent
- Collaborative plan; teach-back; non-stereotyping language
- Time management and empathy [1][2][3][4][5]
Reveal assessor key
Open. Introduce role; explain purpose: understand what is happening for her and what would help, not only fill a form. Check comfort, privacy, and whether she wants anyone else present. Ask preferred name and cultural identity language she uses for herself. [1][2]
Explore. "What do you call what you have been going through?" "What do you think is causing it?" "What usually helps in your family or community?" "How connected have you felt to family, community, culture, Country?" "Have services felt safe or unsafe before?" [3][4]
Risk. Passive/active ideation, intent, plan, means, protective people, substances, safety tonight. [1]
Supports. Offer Aboriginal Health Worker and ACCHO pathway with consent; do not assume she wants traditional healing or any specific practice. [3][5]
Close. Summarise in her words; shared plan (GP, psychology/counselling options, cultural supports, crisis contacts); check understanding; thank her. [2]
Fails. "In Aboriginal culture people always…" ; skipping risk; arguing that racism is not relevant; forcing spiritual disclosure; using pejorative labels. [5]
References
- [1]Lewis-Fernández R, Aggarwal NK, Lam PC, et al. Feasibility, acceptability and clinical utility of the Cultural Formulation Interview: mixed-methods results from the DSM-5 international field trial Br J Psychiatry, 2017.PMID 28104738
- [2]Krishan Aggarwal N, Chen D, Lewis-Fernández R If You Don't Ask, They Don't Tell: The Cultural Formulation Interview and Patient Perceptions of the Clinical Relationship Am J Psychother, 2022.PMID 35430870
- [3]Dudgeon P, Agung-Igusti R, Derry K, Gibson C Australian aboriginal and Torres Strait Islander social and emotional well-being Am Psychol, 2025.PMID 41379665
- [4]Kleinman A, Eisenberg L, Good B Culture, illness, and care: clinical lessons from anthropologic and cross-cultural research Ann Intern Med, 1978.PMID 626456
- [5]Curtis E, Loring B, Jones R, et al. Refining the definitions of cultural safety, cultural competency and Indigenous health: lessons from Aotearoa New Zealand Int J Equity Health, 2025.PMID 40346663