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23 Apr 2003

By Jim Chipp

Last year Porirua City News journalist Jim Chipp was awarded a Rosalynn Carter Mental Health Journalism Fellowship.

Jim elected to examine how Porirua's mental health services take into account the ethnic and cultural differences of their clients.

The following is what he found among Capital and Coast District Health Board's clients.

First to come under scrutiny was Porirua's Maori population.

Maori make up more of the nation's mental health patients than their 15 percent of the population should. And they have some illnesses at two to three times the rate that their pakeha neighbours do, Massey University Professor of Maori research and development Mason Durie says.

Things may get even worse. Diseases such as schizophrenia and bipolar disorder, which usually appear in the teenage years or 20s, are likely to increase with the demographic.
Maori make up 25.5 percent of Porirua's youth, according to Statistics New Zealand, and the proportion is growing rapidly.

So what is being done to forestall the epidemic and to trim the high Maori illness rates?
The framework is prescribed in The Blueprint for Mental Health Services in New Zealand, produced by the Mental Health Commission in 1998.

A Porirua Maori resident appearing with acute mental illness symptoms for the first time is likely to begin their treatment with a couple of weeks in Wellington Hospital's Ward 27, which is part of the mainstream mental health system with no specialised Maori component.

They might then spend some time in a more relaxed environment at a rehabilitation service residence within the Porirua Hospital grounds, before rejoining their family or moving to sheltered housing in the community.

In either case, they would then be under the care of Kenepuru Hospital's Te Whare Marie specialist Maori mental health unit, which provides clinical expertise to outpatients in a cultural setting at the hospital.

From Te Whare Marie has sprung Te Roopu Pookai Taaniwhaniwha, which provides cultural and social support from its Matahauariki Cannons Creek base.

Wellink also provides residential and mobile community support services for patients in the Porirua community.

What is it that makes Maori so susceptible to mental illness?

Partly, just the normal predictors of mental illness for everybody.

Wherever people live with poverty, poor housing or are unemployed, mental illness rates are elevated.

And in Porirua Maori unemployment rates in the danger years of youth are at least double pakeha rates in every demographic, and in most cases triple, according to Statistics New Zealand's 2001 census.

Maori are also eight times more likely to live in overcrowded homes than pakeha ( Statistics New Zealand census 1996).

However, the normal predictors are not the whole story. Harvard University Department of Social Medicine instructor Alex Cohen says mental health issues of indigenous people are neglected all over the world.

Doctor Cohen is also co-director of the University of Melbourne – Harvard Medical School international mental health leadership programme and author of The Mental Health of Indigenous Peoples, a World Health Organisation report.

"They (Maori) are virtually the only indigenous people in the world who were not defeated militarily.

"It's a question of whether that has not shaped their mental health in the long run."

His report says Maori account for 67 percent of all court-ordered psychiatric admissions.

He identifies depression among Maori women as the leading mental health problem, but is surprised the overall suicide rate for Maori is actually lower than the general population.
Professor Durie, who is of Rangitane, Ngati Kauwhata and Ngati Raukawa descent, is a psychiatrist by profession and served on the National Royal Commission on Social Policy, and also on the Mental Health Commission.

Maori don't need to be treated any differently, he says.

"All services for Maori or anybody should be directed, anyway," he says.

"Directed in a way that makes sense to that person.

"What we're talking about is best practice, really, and it goes across all cultures.

"A good treatment programme always recognises the culture and background of the people it deals with."

The Treaty of Waitangi adds another component and imposes further obligations on providers, particularly State ones, Professor Durie says.

"We are looking for what I would call cultural congruence.

"The people doing the diagnosing should be of the same culture."

The issue that comes out of that is workforce development.

The Henry Rongomau Bennett Memorial Scholarships offer financial assistance aiming to double the number of Maori psychiatrists to a total of 10 within three years.

Henry Rongomau Bennett was New Zealand's first Maori psychiatrist.

Secondly, the Te Rua Puawai Scholarship system for people involved in the broad range of mental health disciplines started four years ago.

It aimed to assist 100 students to graduate within five years, and with one year to go looks like exceeding expectations.

Compared with the situation 10 years ago, things have changed beyond recognition, Professor Durie says.

However, while the number of Maori in the mental health services has increased hugely in the past two decades, most are concentrated in what is called cultural services and relatively few are in clinical services such as psychiatrists, nurses, psychologists and service managers.

Reprinted with permission from Capital Community Newspapers Limited.