- FINLEY FERNAN L. ORDENIZA
IMPROVEMENT OF MENTAL HEALTH ACCESS FOR SERVICES AND ITS WELLBEING FOR MAORI PEOPLE
Mental Health and wellness promotion is not a fresh concept for Maori people here in New Zealand, but rather it is new on terms of mental health services that focused more on diseases in the past. Maori people got so many practices and one of them are “tapu” and noa, manakitanga”, it is a philosophy and native practice of caring for their family when sick and not well. The treaty of Waitangi 1840 was to provide protection and to enhance the wellbeing of the natives in New Zealand called “tangata whenau”. However the government was trying to deal with different Maori groups to resolve the grievances in the past but then it contributed to as risk factor that affects the mental health/ state of individuals. Nowadays, a distinct view is arising of how the Maori people wanted to view themselves in medium term and the wellness and mental health mean in the perspective of the Treaty, they claim that there was a great improvement on their health except for their mental health as long as the Crown would properly addressed and agrees the socioeconomic, justice and educational issues of the self-determination (tino rangatiratanga) by Maori.
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According to District Health Board report in 2009/10, approximately 120,293 individuals sought for mental health services and 116,645 of these individuals were seen by the District Health Board while 12,256 clients was by the Non-government Organization, and a great increase by 8.1% from 2008/09 on the total counts of individuals seen. Noticeably 54% of those individuals seen were male. Overall the clients identified as having the highest numbers sought mental health services are the Maori people by 22.4%. Demographically speaking according to the report it shows 2.7 times people living on the deprived area seen by the mental health services compare to the least deprived areas.
Working as a Community Support Worker in IHC and dealing with those intellectually and mentally challenged clients inspire and helps me in choosing this topic for my research on how things need to be for the improvement of the mental health access for services and its wellbeing specifically for Maori people in line to the Treaty of Waitangi and analysing vital ethics and power cultural safety principles on healthcare practice.
Mental health as defined by the World Health Organization is a state of wellbeing of an individual realizing his/her own potential, how an individual copes with the normal stresses in life, on how an individual work productively and lastly able to contribute something to his/her own community. In addition to that, World Health Organization emphasizes the meaning of health, wherein for them it was the overall state of a person’s physical, mental, social aspects and not purely the non-existence of disease or illness.
To start with, knowing and understanding the nature and extent of Maori’s mental health should be taken in consideration first to meet their mental health needs and effectively handle Maori’s mental disorders and health problems. Te Rau Hinengaro, a New Zealand Mental Health survey provides vital information and track the trends for the past years till present though this survey report focus more on adult Maoris ranging from 16 years old and over and these result help the authorities track what should be done concerning Maori’s mental health and accessing Mental Health services. On this survey they found vital facts learned that one in every three Maori adults met the criteria for at least one mental disorder on the past 12 months and half of the Maori had been experiencing mental health illness in their lifetime. They also learned that in Maori, developing a single mental health illness was usual. The came out with a conclusion that socioeconomic status of Maori was vital that affects their mental health, and mental health illnesses are most common to Maori people aged 16-44 years old but less common within older age group. Maori women had larger occurrence of having metal health disorder compare to men. Though having higher number affected with mental disorder/illness on Maoris, the number of Maoris who seek health services are lower than non-Maori people.
The topic and issue was all about improvement on the access of mental health services by New Zealanders specifically the tangata whenau or the indigenous people called Maori with proper acknowledgement of Te Tiriti or Waitangi and its respective principles that governs the entire characteristics of mental health service provision. Wherein the Mental Health Commission recognizes the importance of this Treaty as the original outline for relations between the Crown and the Maori people.
As a healthcare service provider, the significance of this issue was it open our minds on the existing problem that Maori people experiencing nowadays, in contrary with the Treaty implications wherein it says in article one that with regards to the public funding and delivery of mental health services, it needs significant consultation with the Maori people and they should by involve in the development of those services. The other thing was in article two about Maoris self-determination that gives Maori people with more chances to establish and implement strategies and services that would enhance mental health services, Maoris wellbeing outcomes and mental health status. And lastly, the article three of these implications that the Crown make sure that the Maori receive the same rights of citizenship and benefits that includes the equal access to mental health services, the equal health and wellbeing outcomes, accessible mainstream mental health services that meets Maoris needs.
According to the result from the analysis of Te Rau Hinengaro 2003/04 27, it illustrates the Maori people generally have higher rates of mental disorders than non-Maori people and higher level of need for mental health services is not currently met. Continuous and consistent effort should be needed to create pathways of care, the environments and workforce to effective for Maori mental health service users and their family. Whanau Ora carries all Maori aspirations about mental health and delivers an approach that establish whanau capability and gives assistance for Maori families to attain their overall health and wellbeing.
For these services to be efficient for the Maori people, they need to meet the comprehensive health and mental needs of the service user in their whanau setting. They should also recognize the contexts of the service user’s being and objectives. Distinguished a Maori world sight in rendering the service and approach appropriately in Maori’s culture, able to point out the barriers to Maori who access mental health services and surge access for Maori to equal access to mental health services.
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At present, the government proposed a change based on the manual created named Blueprint 2, it emphasizes the recovery approach and the initiative to offer access mental health services for Maori people that are moved by mental health issues here in New Zealand. The Government are focusing on the needs of the Maori people with mental health issues notably influence their total health and their capacity to be effective neither at home and work. The government also was conscious in terms of the benefits if early response and recognition to achieve positive result for Maori people and for society. Latest survey shows that New Zealand still one of the highest suicidal rates among the youth in a developed world and disparities in mental health outcomes for Maori and Non-Maori people. This Blueprint 2 according to the government will help achieve better vision and outcome in the future especially for Maori people, as they emphasize that “mental health and wellbeing is everyone’s business”, putting the phase for the future wherein people concerned does their part in protecting and refining mental health and wellbeing. At the government believes that mental health and wellbeing shows a vital role in building a well-effective and useful society. When this proposal would be successfully implemented, heaps of great improvement to Maori’s mental health due to access to services would happen. Some of these are, Maori people suffering from mental health issues doesn’t need to wait for help; they become partners in the process of care; mental health issues will be accepted and treated accordingly on the entire life-course; they would experience good mental health due to hand on hand partnership of the government and the community.
Providing an overview of the ‘best practice’ trends for managing the issue is to recognize and create efficient management Maori’s mental health problems. Though it is known that mental health problems are common to them but unfortunately their needs were not met appropriately especially accessing mental health services here in New Zealand. Determining mental health issues and delivering immediate services to Maori people should be considered as the main concern. Rendering most effective level of mental health service to them, the government should acknowledged sole viewpoint in Maori’s culture. They should determine Maori’s perception on how they deal with mental health problems and how they do it prior on rendering this mental health services to them.
The Ministry of Health here in New Zealand are trying all the best shots in dealing with mental health problems within Maori people and the accessibility of mental health services but not enough to say that the project was a success. There are heaps of things should be done and changes in terms of accessible mental health services and the government should take in consideration to recognize that there is higher occurrence of mental health disorders within Maori people and their needs for having the said treatment was increasingly unmet as well; the government should prioritize Maori people when determining mental health illnesses/disorders and prioritize them when rendering early actions; the government should recognize that there is a difference within Maori people on how they see the health problem as a whole, their knowledge regarding mental health problem and their treatment goals based on their culture and beliefs; ensuring care rendered to them is culturally in a right manner and lastly create a partnership with Maori healthcare providers and treatment should be acceptable to clients culture and their whanau.
In addition, in terms of accepting mental health problems in Maori, mostly they exhibit mental health disorder likely the same way with non-Maori clients but healthcare provider should welcome appearance including much spiritual and physical manifestations of suffering. Majority of health professionals should be conscious with these manifestations to be able to search for expert advice to clear the problem and render proper actions. Having an effective communication between health professionals and clients is a meaningful aspect to be able to distinguish mental health problem/ disorder and so appropriate mental health services will be rendered as early as possible depending on client’s needs. Providing enough time to establishing therapeutic relationship is vital on the entire process. Like for example the GP would introduce himself properly and knowing his/her client well, the GP should dig more deeply the client’s background, culture, about client’s family/ whanau and create good connection. Providing the client all the time and patiently listening to client’s story contribute as well for a successful treatment process. And the other thing was, the GP or healthcare provider should take into account that mental health problems usually go along with substance abuse problems and clients/ individuals may encounter heaps of mental health problems at the same time.
Analysing the ethics and power cultural safety used on healthcare practice the government should recognize different principles for better understanding and as a guide on rendering mental health care services to Maori people.
The first principle was, the cultural safety’s goal was to enhance the New Zealanders wellbeing and relates entire relationships by emphasizing positive health consequences and health improvements, healthcare providers including nurses and GP’s should recognize Maori’s beliefs and customs compared to other non-Maori clients like for instance and this could be according to their age or group, sexuality, sexual preference, profession and social and economic status, ethnic foundation, spiritual belief and disability.
The second principle of cultural safety aims to improve the provision of health and disability services by having a culturally safe healthcare professional workforce in a way like recognizing the power connection between the service provider and the individuals who are using the health services. The healthcare professional acknowledge and works together with other people after undertaking a thorough process of institutional and own analysis and enabling the service users. Individuals should be able to convey degrees of identified hazard or safety. Helping healthcare professionals to comprehend the diversity throughout their own cultural reality and the effect of that to any individuals who varies in some other way from themselves. Concerning social science models that strengthen the art of healthcare practice, wherein understanding that healthcare practice is further than carrying out the duty but rather it is more on responding and relating effectively to individuals with varied needs in such a way that the people who uses the health services can characterize as safe.
The third principle of cultural safety is general in its application by accepting the disparities within healthcare communications that signifies the microcosm of disparities in health that have existed throughout history and inside our nation and more largely on addressing the source and result association of history, politics, socioeconomic status, housing, education, sexuality, personal experiences of individuals using health services. In addition, recognizing the validity of disparity and diversity in people’s attitudes and social structure and recognizing the behaviour and beliefs, guidelines and customs of health and disability service providers can turn as barriers on accessing the services concerning quality development on rendering the service and service user’s rights.
Lastly the fourth principle concerning cultural safety has an attached emphasis on comprehending the effect of the healthcare professional as a carrier of his/her own culture; the history, behaviour and life experiences. Challenging healthcare provider to assess their custom carefully, accepting the power relationship in healthcare is biased toward the health and disability service provider. This principle emphasize on balancing the power connections in healthcare practice so that every client receives an efficient service, prepare healthcare professionals to decide any tension between the cultures of healthcare professional and the service users. Recognizing that those power imbalances can be assessed, bargained and changed to render equitable, efficient and appropriate delivery of service wherein it lowers the risk to the people who may then estranged from the service. This principle highlights that result on understanding of self, the rights of other people and validity of disparities and it should support the healthcare professional with skills in working with different type of people.
- Word Health Organization. Retrieved from http://www.who.int/features/factfiles/mental_health/en/
- Mental Health Commission (June 2012). Retrieved from http://www.hdc.org.nz/media/207642/blueprint%20ii%20how%20things%20need%20to%20be.pdf
- Ministry of Health. 2013. Mental Health and Addiction: Service use 2009/10. Wellington: Ministry of Health. Retrieved from http://www.health.govt.nz/publication/mental-health-and-addiction-service-use-2009-10
- Best Practice Journal. Recognising and managing mental health problems in MÄori. Retrieved from http://www.bpac.org.nz/BPJ/2010/June/mentalhealth.aspx
- “Oakley Browne M, Wells J, Scott K, (eds). Te Rau Hinengaro: The New Zealand Mental Health Survey. Wellington, New Zealand: Ministry of Health; 2006.”
- “Ministry of Health. Te Puawaitanga: Maori mental health national strategic framework. Wellington: Ministry of Health; 2002.”
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