Monday, 13 June 2005

Mental health and addiction services: the acid test for multi-ethnic society in Aotearoa/NZ

A recent fono (meeting) held at Pataka in Porirua was attended by over sixty Pacific mental health and addiction service providers, funders and planners in the lower North Island provided an opportunity to explore issues and challenges facing the sector.

“Pacific populations are fast growing and youthful,” confirmed Dr Debbie Ryan, Chief Advisor Pacific Health at the Ministry of Health. “The changing demographic of these populations presents both a challenge and an opportunity to address the way we deliver basic services and address the cultural needs of our young people within an evolving environment,” Dr Ryan said.

Pacific and Maori have a much younger age structure and higher fertility rates indicating a forecast for 2051 in which, 57% of Kiwi children will be of Maori or Pacific descent. At the same time the European share of the working population will fall from 78% to 66%.

“These statistics confirm the need to plan for a future which will address the needs of Pacific people and which truly reflects our multi-ethnic society,” declared Dr Ryan.

“Mental health and addiction services need to recognise a complex range of issues which impact on the whole person including culture, mortality rates, family and community as well as socio-economic factors and the accessibility of appropriate services,” Dr Ryan added.

Mental Health and addiction: the issues
Mental Health and Addiction Profile
•Estimated 20-25% will experience a mental illness in their lifetime
•High use of community mental health services
•High rates of referral from justice system – 66% higher than NZ total
•Alcohol and drug use, problem gambling issues will be increasingly important

Source: Te Orau Ora, Ministry of Health 2005

Underpinning the challenge of developing a mental health and addiction service which responds to the needs of Pacific people is an understanding of identity and culture. A number of fono participants thought the biggest challenge was the willingness of decision-makers to move away from monocultural principals of mental health care, toward a recognition of Pacific values and practices which acknowledge families, communities, church, tradition and ancestry, and the fulfilment of mutual obligations.
“In addressing demographic realities it is important that mental health and addiction providers move beyond cultural sensitivity toward a framework of cultural sensibility, which is more than a recognition of language needs,” said Dr Ryan.

Fuimaono Karl Pulotu-Endemann, Director of Health Strategy for Pava, identified the delivery of a culturally competent mental health and addiction service to be about recognising and resourcing ethnic specific services that are consumer focussed. “Fundamental to the development of an effective mental health and addiction service is the need to increase the capability and capacity of a Pacific mental health and addiction workforce,” he said.

Finding solutions
“…Emphasis is placed on individualistic interventions such as the provision of educational materials, when it is well established that information alone does not entice people to change behaviour.
We need an in-depth understanding of the personal values, beliefs, preferences and aspirations that drive behaviours in different social groups.”
British Medical Journal Nov. 2004

In addressing the needs of mental health and addiction providers and service users the Technical Advisory Services (TAS), on behalf of the Central Regional District Health Boards, has established the Regional Pacific People’s Mental Health and Addiction Project, which will provide a forum for strategic planning and policy advice and service development to meet the need of health service users and providers in the lower North Island. The recent fono was a significant step in establishing this regional project.

“The challenge is to learn about the different models of service delivery and frameworks used in the field of mental health and addiction service and appropriately resource those that work for the Pacific peoples communities, said Simon Phillips, Senior Advisor Maori and Pacific People’s Health, Central Region’s TAS.

“Solutions will be part of a comprehensive approach to workforce and service development, including the potential for ethnic-specific PHO services, such as Langimalie, a Tongan PHO in Auckland. It will also mean working with mainstream providers to address the needs of service users and providers, including the need to focus on child health, determinants of health, and behavioural change.” Mr Pulotu-Endemann added.

“Developing a mental health and addiction service which meets the needs of current and future mental health and addiction service users and providers will also inform the delivery of an effective mental health and addiction service for all New Zealanders - one that treats the whole person in the context of cultural imperatives. In effect, this will result in a breakthrough in the assessment, treatment, and recovery protocols and practices in mental health and addiction service delivery for everyone,” concluded Mr Phillips.

ENDS