A Maori perspective of health

Predictors of chronic trauma-related symptoms in a community sample of New Zealand motor vehicle accident survivors

This study examined 1,500 New Zealand community-residing adults for involvement in serious motor vehicle accident (MVA) and the development of trauma-related symptomatology. The incidence of MVA was 11 %. More than 50 % of the accident victim sub-sample reported hyperarousal, with exaggerated startle, intrusive recollections, situational avoidance, emotional reactivity, and cognitive avoidance. The high incidence of trauma-related symptoms is noteworthy given 59 % of victims reported sustaining no or mild accident injury, and only 27 % were admitted to hospital for severe injury. Trauma-related symptoms were related to measures of injury severity, psychological and social functioning, and persistent medical problems. Pre- and post-accident factors, that is, experience of additional trauma, experience of stressful life events and post-accident social contact were the most important predictors of trauma-related symptoms severity. This study discusses the importance of examining trauma-related symptoms rather than using categorical diagnostic criteria (i.e., post-traumatic stress disorder, PTSD) as a sole means of characterizing the psychological impact of MVA.

Indigenous mental health 2035: future takers, future makers and transformational potential

OBJECTIVE

The aims were to review progress in Indigenous mental health over the past 25 years and to identify possible directions for the next 25 years.

METHOD

Māori involvement in health and health care was used to illustrate key Indigenous developments since 1984. Challenges in the decades ahead were discussed in the context of demographic transitions, life course epidemiology, global trends, technological innovations and health leadership.

RESULTS

Progress was measured by a range of indicators including Māori-referenced life expectancy, Māori agendas for health, strengthened cultural identity, the dissemination of health knowledge, and Māori participation in the health sector. In contrast to being ready to respond to change (future takers), active planning for the future (future makers) was seen as a better way of achieving Indigenous aspirations. One option for health advancement currently being developed in New Zealand involved an integrated approach premised on intersectoral delivery and a focus on families.

CONCLUSIONS

Indigenous health will be advanced by dedicated approaches to family wellbeing that avoid fragmentation, focus on positive strengths, and lead to positive outcomes for family members and the family as a whole.

Differences in patients' perceptions of Schizophrenia between Māori and New Zealand Europeans

OBJECTIVE

Māori (the Indigenous people of New Zealand) are disproportionately affected by mental illness and experience significantly poorer mental health compared to New Zealand Europeans. It is important to understand cultural differences in patients' ideas about mental illness in treatment settings. The aim of the present study was to investigate differences in illness perceptions between Māori and New Zealand Europeans diagnosed with schizophrenia.

METHOD

A total of 111 users of mental health services (68 Māori, 43 New Zealand European) in the greater Auckland and Northland areas who had been diagnosed with schizophrenia or other psychotic disorder were interviewed using the Brief Illness Perception Questionnaire and the Drug Attitude Inventory. District Health Board staff completed the Global Assessment of Functioning for each patient.

RESULTS

Māori with schizophrenia believed that their illness would continue significantly less time than New Zealand European patients did. Chance or spiritual factors were listed as causes of mental illness by only five Māori patients and no New Zealand European patients. Other illness perceptions, as well as attitudes towards medication, were comparable between groups. Across groups, the top perceived causes were drugs/alcohol, family relationships/abuse, and biological causes.

CONCLUSION

Illness perceptions provide a framework to assess patients' beliefs about their mental illness. Differences between Māori and New Zealand European patients' beliefs about their mental illness may be related to traditional Māori beliefs about mental illness. Knowledge of differences in illness perceptions provides an opportunity to design effective clinical interventions for both Māori and New Zealand Europeans.

Indigenizing mental health services: New Zealand experience

Mental health services in New Zealand have been significantly altered by Māori cultural values. Since 1980, a monocultural approach has given way to the incorporation of Māori language, Māori health perspectives, and Māori psychological frameworks in the assessment, treatment, and care of patients. Māori provider organizations, an expanded Māori health workforce, and Māori leadership have been crucial catalysts for the transformation. The shifts have paralleled similar changes in other sectors, reflecting a broader societal movement within which indigeneity has received greater acknowledgement. The author's bicultural background, psychiatric training, and inclusion in Māori networks were important for promoting the transformation.

Categorical ethnicity and mental health literacy in New Zealand

OBJECTIVE

Public social policies in New Zealand assume that there are fundamental differences between Maori views of health phenomena and non-Maori perceptions. The biomedical model and a Maori model known as Te Whare Tapa Wha are commonly employed to characterise these differences. Using the categorical ethnicity demarcation 'Maori/non-Maori' we investigate this claim with respect to mental health literacy about depression.

DESIGN

Participants were randomly selected from the General and Maori Electoral Rolls and recruited by post (N=205). A vignette methodology was employed and involved the development of a fictional character as a target stimulus who exhibited the minimum DSM-IV-R criteria for a major depressive disorder. Participants responded to items regarding problem recognition, well-being, causal attributions, treatment preferences, and likely prognosis.

RESULTS

The majority of Maori and non-Maori participants correctly identified the problem the vignette character was experiencing and nominated congruent attributions for the causes of the problem. In relation to treatment strategies and likely prognosis, independent of self-assigned ethnicity, participants rated professional treatments above alternative options. Overall the categorical ethnicity distinction 'Maori and non-Maori' produced no systematic variation with regards to individual evaluative responses about a major depressive disorder.

CONCLUSIONS

Contrary to the embedded assumption within New Zealand's public health strategies that there are essential differences between the way Maori and non-Maori view health problems, and that the categorical ethnicity demarcation reliably reflects these differences, we found no evidence for the veracity of this claim using a major depressive disorder as a target for judgements. Alternative explanations are canvassed as to why this assumption about fundamental differences based on categorical ethnicity has gained ascendancy and prominence within the sphere of New Zealand health.

Psychiatrists' recommendations for improving bicultural training and Maori mental health services: a New Zealand survey

OBJECTIVE

In the context of Maori being over-represented as clients, and underrepresented as professionals in New Zealand's mental health system, this study ascertained the beliefs of New Zealand's psychiatrists about issues pertaining to Maori mental health. The overriding objective was to gather recommendations as to how to improve bicultural training and mental health services for Maori.

METHOD

A questionnaire involving closed and open-ended questions was sent to 335 New Zealand psychiatrists.

RESULTS

Of the 247 psychiatrists (74%) responding, 40% believed their training had prepared them to work effectively with Maori. Recommendations for improving training focused on the need for greater understanding of Maori perspectives of well-being. Recommendations for improving mental health services for Maori highlighted the need for more Maori professionals and for Maori-run services. No psychiatrists thought that pakeha clinicians should not work with Maori clients, but the majority (70%) recognised the need to consult with Maori staff when doing so. Twenty-eight psychiatrists (11.3%), all male, New Zealand born, and with 10 or more years clinical experience, believed that Maori were biologically or genetically more predisposed than others to mental illness. Several respondents offered other racist comments.

CONCLUSIONS

The high response rate and the many positive recommendations suggest a high level of constructive interest in these issues among psychiatrists. Comparisons with a simultaneous survey of psychologists are made. It is hoped that the recommendations might inform those responsible for training programs and for providing or purchasing mental health services.

Maori health and the health care reforms

Maori participation in the 1991 health care reforms is considered against the background of their involvement in health reforms since the turn of the century. Throughout this period Maori have consistently sought autonomous health care. Traditional indigenous healers have provided healing for Maori as they have for other indigenous people, such as Aborigines, Pacific Islands people and Canadian Indians. Maori, including western health care professionals, submitted that healers should be included among the health care services personnel providing core health services. They argued this on the basis of their health status and of their rights with respect to the Treaty of Waitangi. The influence of the 1977 WHO resolution, concerning the role of traditional healers in attaining 'Health for All by the Year 2000', is considered in relationship to Maori health initiatives and how the 1991 health care reforms may impact upon them, and the bicultural policy that has guided Maori health developments over the last decade. Evaluating Maori health and the health care reforms in terms of Maori participation, the status of traditional indigenous healers and the future of Maori health initiatives leaves Maori in no doubt that they have some hard work ahead to maintain the position they held prior to the reforms.

Behavioural factors affecting physical health of the New Zealand Maori

A major factor in the aetiology of illness is the behaviour of individuals with regard to certain risks and hazards of the environment. The Maori of New Zealand have been shown to be at greater risk of illness and death than their non-Maori counterparts. It is estimated that a significant proportion of this excess morbidity and mortality can be attributed to at least four behavioural factors: smoking, obesity, alcohol use and accidents. This paper examines the inter-cultural differences in these factors, both from a contemporary and an historical perspective. Some of the reasons for the continuation of these adverse patterns of behaviour are explored, in particular the role of psycho-cultural stress. Some possible mechanisms of effecting behavioural change in modern Maori society are discussed.

Alcohol prevention in New Zealand: working towards a national alcohol policy

This paper outlines some of the efforts that have been taken towards the formation of a national alcohol policy in New Zealand and its relevance for prevention planning in New Zealand. Strategies on the availability, taxation, advertising, and shaping of attitudes towards alcohol are discussed from a public health perspective. Preventive advances in alcohol education and health-related promotions for adolescents are also described. A Maori perspective on health and a women's perspective on alcohol prevention are considered essential factors specific to the formulation of a New Zealand alcohol policy. The implementation of any alcohol policy will depend on the level of support achieved, not only at the national level, but also in the wider community.

Mana, tapu, noa: Maori cultural constructs with medical and psycho-social relevance

This paper discusses three concepts, mana, tapu and noa, that lie at the heart of Maori culture. These concepts are inter-related and concern power and influence, with political (or secular) authority implicit in mana and ritual (or religious) authority determined by tapu and noa. The paper explores their importance for the understanding of the ethnic views on aetiology and management of illness, the mechanisms of social organization and control, and the behaviour of individuals. Although the belief in these concepts exists in only an attenuated form in modern Maori society, their importance becomes obvious to any psychiatrist or physician working with Maori patients.

Progress towards achieving health for all New Zealanders by the year 2000

New Zealand has been faced in recent years with a serious failure to maintain its relative position, in comparison to other OECD countries, in its social, economic and health status indicators. Although health costs so far have been successfully controlled, through a largely capitation funded service, its health organisational problems are typical of developed countries including major problems of equity and efficiency. Despite these problems some important recent initiatives give optimism for future health improvement. These include the spread of the service concept through service development groups and moves towards decentralisation through area health boards. Population-based funding of hospital and area health boards, supplemented with service planning guidelines, has proved to be an important lever for change. Maori health initiatives are beginning to show the way to improving the status of this disadvantaged section of society and perhaps for other New Zealanders as well. Important issues yet to be faced include establishing an effective central organisation for the health services, education and training for leadership and a more central place for the still largely fragmented and isolated primary health care services.