Te Kani Kingi

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Mäori Mental Health and Mäori Mental Health
Outcomes

• Te Kani Kingi
• Te Mata o Te Tau
• Academy for Maori Research and Scholarship
• Massey University

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Mäori Mental Health Status
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Mäori Mental Health Status

• Lack of reliable data in mental health
• Dramatic Increase in admissions since the mid
  1970s
• Higher rates of re-admissions (40 higher)
• Increase in disorders associated with alcohol and
  drug misuse
• Large numbers of Mäori receiving compulsory
  treatment
• Over represented in acute mental health disorders
  (23)
• Escalating rates of suicide, particularly with
  youth.

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Mäori Mental Health Status

• Tend to access services late
• - more acute
• - treatment more intensive/longer
• - draw on more resources
• Actual prevalence rates are even more alarming
• - based on admissions data

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How common were mental disorders among Maori?
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Why are admission rates now so high ?

• Uncertain
• - more Mäori accessing services
• - mis-diagnosis
• - urbanisation and cultural alienation
• - better recording of ethnicity data
• - changes to ethnicity coding
• - less whänau tolerance
• - inadequate primary health care

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OTHER INDICATORS OF POOR MÄORI MENTAL HEALTH

• Educational underachievement
• Poverty
• Unemployment
• Inadequate Housing

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WHAT ARE THE SOLUTIONS ?

• Need to be varied
• treatment, prevention and health promotion
  orientated
• Policies which encourage a high standard of care,
  but which also consider some of the broader
  factors which can impact on mental health

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One Approach

• Development of Mäori Mental Health Services
• - began to evolve from about the mid-1980s
• - considerable growth since the health reforms
• - differ according to a range of variables (type
  of care provided, type of organisation, access to
  resources)
• - typically adopt approaches to care based on
  Mäori philosophies
• - holistic models e.g. Te Whare Tapa Wha

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Range of Benefits

• Providing care within an environment more suited
  to the needs of the individual
• Improved access
• Therapies placed within a more relevant/cultural
  context
• Other cultural needs may be more effectively met
  (e.g. whänau interaction)
• Cultural assessments

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Problems

• Difficult to consider the extent to which these
  type of activities/approaches have contributed to
  health gains
• Health outcome measures may provide some
  cluesbut
• They may not be entirely suitable or appropriate
• In 1997 recommendations for a Mäori specific
  measure of mental health outcome were made

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THE MMHO FRAMEWORK

• Principles Stakeholders Domains of
  Outcome Clinical Endpoints
• Wellness Consumer Taha
  wairua Assessment
• Cultural integrity Clinician/carer Taha
  hinengaro Inpatient Treatment
• Specificity Whänau Taha
  tinana Outpatient Treatment
• Relevance Taha Whänau Community Care
• Applicability Community Support

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KEY CHARATERISTICS OF THE FRAMEWORK

• Consumer focused
• Three questionnaires used to measure outcome
• Targeted at specific clinical endpoints
• Domains based on an existing Mäori health model
  (Te Whare Tapa Wha)
• Compatible with more targeted measures

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THE BIGGEST ISSUE

• How to consider the components of Te Whare Tapa
  Wha within a mental health outcome schedule
• Solution
• Develop another framework !

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Dimensions
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EXAMPLES

• Q1. As a result of the INTERVENTION do you feel
• more valued as a person
• stronger in yourself as a Mäori
• more content within yourself
• healthier from a spiritual point of view
• Q2. As a result of the INTERVENTION are you
• more able to set goals for yourself
• more able to think, feel and act in a positive
  manner
• more able to manage unwelcome thoughts and
  feelings
• more able to understand how to deal with your
  health problem

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EXAMPLES

• Q3. As a result of the INTERVENTION do you feel
• more able to move about without pain or distress
• more committed to having good physical health
• more able to understand how physical health
  improves mental well-being
• physically healthier
• Q4. As a result of the INTERVENTION are you
• more able to communicate with your Whänau
• more confident in your relationships with other
  people
• clearer about the relationship with your Whänau
• more able to participate in your community

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SCORING METHOD
A) Much more More No Change
Less Much less
B) Much more More No Change
Less Much less
C) Much more More No Change
Less Much less
D) Much more More No Change
Less Much less
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Validation Issues

• Major modifications of the instrument are
  anticipated as a result of validation
• Validation methodology developed
• 1st phase completed
• Additional tests required

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Indigenous Perspectives on Health

• Q 4
• As a result of the hip replacement are you now
  able to walk around the block
• A) Much better than before
• B) Better than before
• C) The same as before
• D) Worse than before
• E) Much worse than before

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Cultural Perspectives of Health Outcome
An elderly man who is overweight, breathless on
exercision and prone to gout, may be seen by
himself and his community as healthy because his
whanau relationships are mutually rewarding and
he maintains a sense of harmony with the wider
environment
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Key Points

• Mental illness is now considered to be the number
  one contemporary health threat facing Maori
• Historically these issues were of little concern
  to Maori
• The reasons for this are complex
• Solutions are similarly complex but include the
  development of Maori mental health services

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Key Points

• Maori mental health service often operate in a
  holistic manner and strive for outcomes which are
  similarly broad
• Existing outcome measures are unable to measure
  (completely) the effectiveness of these services
  and their activities
• Hua Oranga is a Maori measure of mental health
  outcome which attempts to measure service
  efficacy as well as the broad range of outcomes
  desired by Maori mental health consumers

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Key Points

• The measure may identify outcome deficits and
  therefore provides opportunities to inform
  clinical treatment options
• The measure is not designed to replace, rather
  complement, existing measures of mental health
  outcome

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Mäori Mental Health and Mäori Mental Health
Outcomes

• Dr Te Kani Kingi
• Te Mata o Te Tau
• Academy for Maori Research and Scholarship
• Massey University