Search

This article presents a description of a specific Indigenous research methodology, Kaupapa Māori Research (KMR), followed by a discussion of the potential contribution that KMR and other Indigenous frameworks make toward understanding and addressing widespread mental health inequities affecting the world's Indigenous peoples. The contribution of existing qualitative KMR to the fields of health and mental health in New Zealand is discussed, and innovative approaches employed within these studies will be outlined. This paper describes the utility of KMR methodology which informed the development of qualitative interviews and the adaptation of an analytic framework used to explore the impact of systems on the experiences of Māori (the Indigenous peoples of New Zealand) with bipolar disorder (BD). This paper adds to others published in this journal that describe the value, inherent innovation, and transformative potential of KMR methodologies to inform future qualitative research with Indigenous peoples and to enact systemic change. Transformation is achieved by privileging the voices of Māori describing their experiences of mental health systems; presenting their expert critique to those responsible for the design and delivery of mental health services; and ensuring equal weight is given to exploring the clinical, structural and organizational changes required to achieve health equity. It is proposed that this approach to research praxis is required to ensure that studies do not perpetuate institutional racism, which requires close adherence to Indigenous research priorities and partnership with Indigenous peoples in all steps of the research process. [ABSTRACT FROM AUTHOR]

The new RANZCP guidelines for the treatment of schizophrenia and related disorders highlights what we know works. In this paper, we examine why patients so often fail to benefit from this knowledge and why clinical practice falls so far short of the recommended standard. Instead of the continuous improvement that we expect of health care in general, in psychiatry we face an accelerating decline in systems of care. There has been a sustained underinvestment in public mental health care and a shared failure by State and Federal governments to construct and commit to a governance and funding model that can deliver the standard of care that is available in other major non-communicable diseases, and which we know is equally possible for severe mental illness. This paper sets out some of the reasons for the poor quality of care received by many people with schizophrenia and related disorders in Australia, and describes ways that care could be improved. In particular, we recommend an explicit statement of what constitutes an adequate standard of care, for people at all stages of these illnesses. This would help provide transparency about whether the care provided by mental health services achieves these benchmarks, and enable publication of results comparing the performance of different states and regional services. Patients and families, as well as professional, consumer and carer organizations would then be able to see clearly where the deficits are and demand resources and care that match the recommendations. [ABSTRACT FROM AUTHOR]

Objective: In New Zealand and Australia, a renewed emphasis on equity and efficiency in the provision of mental health care has seen outcomes-focused, culturally appropriate clinical practice become essential within mental health services. Ascertaining the degree to which quality improvement and monitoring systems are enhancing professional practice and patient outcomes, however, is hindered by the difficulty of measuring the process of quality care delivery. Method: This paper argues that it is the process of care delivery (i.e. what clinicians do to, and for, patients) that is critical to the effectiveness of treatment and the degree to which treatment either inhibits or promotes an improvement in mental health recovery. Identification of the underlying causes of poor achievement of process factors is likely to positively impact on things such as readmission rates, shared care initiatives, and ultimately patient recovery. Such attention could be the difference between low-quality service provision and a high-quality service provision with positive recovery outcomes for patients. Results: Ascertaining the degree to which quality improvement and monitoring systems are enhancing professional practice and patient outcomes for indigenous people, however, is hindered by the difficulty of measuring such concepts. Australia has indeed embraced 'culturally appropriate' practice in recent years, but this appears to be piecemeal when compared with New Zealand. Certainly, there are inconsistent and variable approaches to cultural practices with indigenous people when comparing the two countries. Conclusions: Using evidence from a bicultural mental health nursing study that developed and validated generic and Maori-specific (indigenous) clinical indicators for mental health nursing standards of practice in New Zealand, it is argued that the process of care delivery is equally as important as outcome measures when ascertaining the effectiveness of nursing care. Second, this paper contends that accurate process measures must be culturally responsive to indigenous and other ethnic groups. [ABSTRACT FROM AUTHOR]

Objective: Suicide is a global health priority. It is important to analyse the effects of investment in mental health services on suicide rates. This paper presents and discusses recent changes in suicide rates and diagnostic mix among clients of the mental health service in Auckland during a time of service growth. Method: Details of suicides among current clients were analysed for the years 1993 to 2006, comparing the periods 1993-1999 and 2000-2006. These periods were compared with the local population and national figures. Results: The local population suicide rate decreased significantly with the rate among clients increasing slightly so the proportion occurring among clients increased (up to 31%). There was an increase in non-psychotic diagnoses. Conclusions: As access to services expands the proportion of suicides that occur in known clients will paradoxically increase. Service expansion may have contributed to the falling population suicide rate in Auckland. [ABSTRACT FROM AUTHOR]

Objectives: The present paper aims to: (i) describe how the Mental Health Commission in New Zealand works and has contributed to the substantial enhancement of mental health resources and services; (ii) determine whether mental health reform policies will ever be implemented properly without an independent monitor with official influence at the highest levels of government; and (iii) demonstrate how variants on this model work in other Western countries and how it can be adapted to the Federated system in Australia.Conclusions: It is recommended that the Australian National Mental Health Plan 2003-2008 should be complemented by a long-standing national mental health commission (or similarly constituted body), which is also able to report independently from and to the government, with direct access to the Prime Minister, Premiers and Australian Health Ministers. Its aims would be to monitor service effectiveness and identify gaps in service provision, training and performance of the work force, management and government. It would be informed by consumer, carer and provider experience, and by reviews of evidence-based research regarding health needs and cost-effective services. It should accurately cost such service gaps, and advise government on a strategy for implementing them. It could also promote and advise formally on enhancing community awareness, decreasing stigma and discrimination and improving workforce recruitment and retention. [ABSTRACT FROM AUTHOR]

Objective: This paper outlines the methods used, and preliminary descriptive data collected, in a study on a cohort of Maori and non-Maori patients admitted to the inpatient psychiatric services in Otago between 1990 and 1992. Method: The notes of 42 Maori and 217 non-Maori first admissions to psychiatric inpatients were reviewed. Information concerning this admission was entered onto a database and analysed. Results: The Maori admission rate was 4 per 1000 compared with 1 per 1000 for non-Maori people. This was higher than expected based on Otago population figures. Rates of family psychiatric history did not differ between Maori and non-Maori. Although Maori were found to have higher rates of social welfare support and were more likely to have no academic qualifications the differences were not significant. The sources of referral for Maori admissions were more likely to be from the law, and Maori were more likely to have had prior psychiatric inpatient treatment. The most common diagnosis for Maori and non-Maori was depressive disorders, and suicidal behaviour was common. Conclusions: Maori are overrepresented among first psychiatric inpatient admissions in Otago. They appear to be a more disadvantaged group with respect to financial support, academic qualifications and other health problems. The most common diagnosis did not differ between Maori and non-Maori cohorts. [ABSTRACT FROM AUTHOR]