Objective: To describe and characterise treated psychotic disorders in the Indigenous populations of Cape York and the Torres Strait. Design: Cross‐sectional analysis of patients with a psychotic disorder identified by treating psychiatrists. Setting and participants: Indigenous patients aged ≥ 15 years in Cape York and Torres Strait communities receiving treatment for a psychotic disorder over 3 months in 2010. Main outcome measures: Prevalence of psychosis diagnoses, intellectual disability, and substance use comorbidities. Results: 171 patients were included. The prevalence rate in this population was 1.68%, higher for males (2.60%) than females (0.89%), and twice as high in the Aboriginal (2.05%) than in the Torres Strait Islander (0.95%) population. High rates of alcohol and cannabis use were found. Comorbid intellectual disability was common and more frequent among Aboriginal patients. Conclusions: The burden of psychosis in the Indigenous population of Cape York and the Torres Strait is high. Further research is needed to understand the social determinants of these disorders and to design effective social and clinical measures to alleviate this burden.

Psychotic disorders are common and more so among young adult Aboriginal men, with high rates of comorbid conditions including substance use, intellectual impairment and diabetes. In parallel to this case complexity, there are high rates of coercive treatments. Certain differences by ethnicity and location are described and possible explanations proposed.

Despite over a century of clinical experience, methamphetamine remains a troublesome substance. There remains an urgent need at multiple levels from various sectors to combat this ongoing problem, and psychiatry has an essential role in this endeavour.