Culture Clash: A Discussion of the Provision of Mental Health Services for Maori Consumers in New Zealand (original) (raw)
Related papers
Culture and mental health care in New Zealand: indigenous and non-indigenous people
This chapter sets out to provide an overview of mental health services in New Zealand, with specific attention to the cultural aspect of these services for both indigenous people (Mäori) and migrants. We are ourselves both migrants to New Zealand and approach this chapter as insiders and outsiders to the system, giving us a unique perspective. There are a number of limitations we would like to highlight: We do not claim to speak for all New Zealanders and acknowledge that this chapter is a beginning reference point, not a comprehensive review of all mental health issues. This chapter focuses on adult mental health and excludes in depth discussion of child and youth mental health issues, problem gambling and alcohol and other drugs. We do not claim to be experts in issues related to Mäori, since we are not ourselves Mäori. Throughout the chapter we use the term ‘tangata whai ora’ rather than ‘patient’. We do this to recognise and acknowledge the unique context of the New Zealand consumer’s reality but in doing so also acknowledge that all terms have their politics and limitations. Mäori words and terms used in this chapter are italicised for the benefit of the non-New Zealand reader and a glossary is provided at the end. The chapter begins with an overview of the unique background and contextual issues that have shaped the New Zealand mental health system. It presents demographic information, discusses the significance of the Treaty of Waitangi and the structure of the health system, with particular reference to the health reforms of the 1980s and 90s. It emphasises the importance of the recovery model and the role of consumers in the delivery and development of mental health services. The first section concludes with a summary of the role of the Mental Health Commission. The chapter then continues with a discussion of the unique bi-cultural nature of New Zealand, with particular reference to Mäori and the role of the Treaty of Waitangi. There follows a discussion of key aspects of psychiatric practice in New Zealand and a separate section describing the mental health services that are provided for Mäori. Issues of workforce development are discussed and the chapter concludes with a discussion on migrant and refugee communities and their mental health requirements and service provision.
Mahi a Atua: A Māori approach to mental health
Transcultural Psychiatry, 2019
M aori are the indigenous people of Aotearoa New Zealand. European colonisation had a devastating effect on their communities and their way of life. While there is some evidence of a renaissance of M aori culture in recent years, like other indigenous people across the world, they continue to be massively overrepresented in their country's figures for poor mental and physical health. In this paper, we briefly review the literature on the Movement for Global Mental Health and review the case that has been made for the use of indigenous psychologies in place of approaches based on Western psychiatry and psychology. We present two case histories where an intervention based on an indigenous M aori approach to negotiating emotional conflicts and dealing with mental health problems was used. This approach, called Mahi a Atua, was developed by two of the authors over a number of years. We conclude that indigenous approaches to mental health offer not just an adjunct to, but a real alternative to, the interventions of Western psychiatry. They provide a framework through which individuals and families can negotiate their journeys through mental health crises and difficulties. However, such approaches can also work on a socio-cultural level to promote a positive identity for indigenous communities by celebrating the power of indigenous deities, narratives, and healing practices that were marginalised and suppressed by the forces of colonisation.
International journal of qualitative methods, 2020
This article presents a description of a specific Indigenous research methodology, Kaupapa Māori Research (KMR), followed by a discussion of the potential contribution that KMR and other Indigenous frameworks make toward understanding and addressing widespread mental health inequities affecting the world's Indigenous peoples. The contribution of existing qualitative KMR to the fields of health and mental health in New Zealand is discussed, and innovative approaches employed within these studies will be outlined. This paper describes the utility of KMR methodology which informed the development of qualitative interviews and the adaptation of an analytic framework used to explore the impact of systems on the experiences of Māori (the Indigenous peoples of New Zealand) with bipolar disorder (BD). This paper adds to others published in this journal that describe the value, inherent innovation, and transformative potential of KMR methodologies to inform future qualitative research with Indigenous peoples and to enact systemic change. Transformation is achieved by privileging the voices of Māori describing their experiences of mental health systems; presenting their expert critique to those responsible for the design and delivery of mental health services; and ensuring equal weight is given to exploring the clinical, structural and organizational changes required to achieve health equity. It is proposed that this approach to research praxis is required to ensure that studies do not perpetuate institutional racism, which requires close adherence to Indigenous research priorities and partnership with Indigenous peoples in all steps of the research process.
Taking Account of Culture: The contracting experience of Māori mental health providers
AlterNative: An International Journal of Indigenous Peoples, 2006
The major reforms in the New Zealand health sector during the 1990s resulted in a burgeoning in the numbers of Māori health providers, many of whom worked in the area of mental health. Occurring alongside these health reforms was an increased concern with public accountability and interest in measuring the performance of Crown (New Zealand Government) agencies. During 2001–2004, research was undertaken that sought to understand the mental health contracting experience from the point of view of Māori health providers. The research examined the experience of Māori mental health providers as they contract to deliver Māori mental health services in a health sector dominated by ‘Western’ or mainstream approaches to accountability, contracting, and performance measurement. This article presents one of the key findings from this research: that Māori mental health providers regularly and routinely work outside the scope of their contracts to deliver mental health services that are aligned w...
Maori cultural adaptation of a brief mental health intervention in primary care
Journal of primary health care, 2012
There are no brief psychological mental health interventions designed specifically for Maori in a primary care setting. To adapt an existing cognitive behavioural therapy-based, guided self-management intervention for near-threshold mental health syndromes in primary care, for Maori, and to examine its acceptability and effectiveness. Semi-structured interviews with primary care clinicians and Maori patients were conducted to inform adaptations to the intervention. Clinicians were then trained in intervention delivery. Patients were recruited if they self-identified as Maori, were aged 18-65 years, were experiencing stress or distress and scored ≤35 on the Kessler-10 (K10) measure of global psychological distress. Patient and clinician satisfaction was measured through a questionnaire and semi-structured interviews. Post-intervention, patients' mental health status was measured at two weeks, six weeks and three months. Maori adaptations included increased emphasis on forming a r...
2009
There is increasing concern about the inequalities, overall health outcomes, and mental health of Pacific peoples residing in New Zealand. The New Zealand Mental Health Survey (Te Rau Hinengaro), conducted in 2003/2004, identfied Pacific peoples as having a higher 12-month prevalence of mental disorders than the general population. The burden of mental health amongst Paqfic peoples was identified as high and associated with other socioeconomic correlates. Pacflcpeoples were also more likely not to access professional mental health assistance. The aim of this study was to provide indepth qualitative data that explored Pacflc perceptions and experience of the theory practice, and utilisation of Pacific mental health services in New Zealand This paper documents: (i) the different models of care practiced in the Pacific mental health sector and (ii) the specific components that: (a) make these models uniquely Pacific, and (b) that consumers and families identWed as integral to the recov...
Australasian Psychiatry, 2019
Objective: To update measures of mental disorders and service use in Pacific people living in New Zealand. Method: A narrative review was conducted of available data on the prevalence of mental disorder, psychotropic drug prescribing and service use by Pacific people. Results: The 12-month prevalence of mental disorders in Pacific people was similar to European/Other in 2004. Currently Pacific people report high rates of psychological distress but lower levels of psychiatric disorders. Pacific adults have low rates of drinking but many who drink have a hazardous pattern. While Pacific people previously accessed services less than half the rate of European access, access rates in secondary care are now similar. Pacific people have relatively low rates of psychotropic drug use but these are increasing. Conclusion: There is limited evidence about Pacific people’s mental health in New Zealand. Patterns of psychopathology and service use may be different from other ethnic groups. Protect...