Culturally competent, safe and equitable clinical care for Ma¯ori with bipolar disorder in New Zealand: The expert critique of Ma¯ori patients and Wha¯nau

Abstract

Objective: Research designed to increase knowledge about Māori with bipolar disorder is required to understand how health services support wellbeing and respond to identified levels of community need. This paper synthesises the expert critique of Māori patients with bipolar disorder and their whānau regarding the nuances of cultural competence and safety in clinical encounters with the health system. Methods: A qualitative Kaupapa Māori Research methodology was used. A total of 24 semi-structured interviews were completed with Māori patients with bipolar disorder and members of their whānau. Structural, descriptive and pattern coding was completed using an adapted cultural competence framework to organise and analyse the data. Results: Three themes were evident from participants’ critique of clinical components of the health system. Theme 1 established that the efficacy of clinical care for bipolar disorder was dependent on Māori patients and whānau having clear pathways through care, and being able to access timely, consistent care from clinically and culturally competent staff. Theme 2 identified the influence of clinical culture in bipolar disorder services, embedded into care settings, expressed by staff, affecting the safety of clinical care for Māori. Theme 3 focused on the need for bipolar disorder services to prioritise clinical work with whānau, equip staff with skills to facilitate engagement and tailor care with resources to enhance whānau as well as patient wellbeing. Conclusion: The standard of clinical care for Māori with bipolar disorder in New Zealand does not align with practice guidelines, Māori models of health or clinical frameworks designed to inform treatment and address systemic barriers to equity. Research also needs to explore the role of structural and organisational features of the health system on Māori patient and whānau experiences of care.

Staff perceptions of the quality of care delivered in a New Zealand mental health and addiction service: Findings from a qualitative study

“…Importantly, Māori staff comprise only 6% of the total SDHB SMHAS workforce. In Haitana et al (2022a), participants reported that "…all staff, regardless of role or ethnicity needed to be culturally competent to provide effective care in clinical settings" (p.6). More directly, participants in this study reported a lack of knowledge of appropriate care often results in Māori SMHAS users' cultural needs being overlooked, or sometimes ignored.…”

“…However, previous research has found initiatives targeted towards improving individual staff cultural safety, while necessary, are unlikely to be sufficient to improve culturally safe and equitable care within health services (Curtis et al, 2019). It is imperative that there is also an organizational and system-level focus on prioritizing the importance of te ao Māori and hauora Māori, and an emphasis and expectation of the delivery of culturally safe and equitable care (Curtis et al, 2019;Haitana et al, 2022aHaitana et al, , 2022bHaitana et al, , 2023. We are hopeful the establishment of Te Aka Whai Ora (the Māori Health Authority) and the partnership model intended within NZ's health and disability system reforms will serve as an important starting point for this necessary 'topdown' prioritization (Ministry of Health, 2022).…”

“…Our findings are consistent with those of the recent SDHB Mental Health Continuum of Care Review (Synergia, 2021) which indicated a need for SDHB SMHAS to shift away from a dominant Western 'medical model' of health and well-being, and instead utilize more holistic mental health and well-being models. Recent qualitative research exploring effective and culturally appropriate care for Māori SMHAS users, particularly those with bipolar disorder, has shown the importance of incorporating te ao Māori, tikanga Māori (customs/ protocols), and involving whānau (family) in service delivery for Māori SMHAS users (Haitana et al, 2022a(Haitana et al, , 2022b(Haitana et al, , 2023Staps et al, 2019); approaches/elements which the 'medical model' has been described as incongruent with (Bush et al, 2019;Durie, 2011;Graham & Masters-Awatere, 2020;Haitana et al, 2022aHaitana et al, , 2022bStaps et al, 2019). Reports from some participants of an absence of Māori models of care in their workplace, suggests that increased utilization of Māori health models and clinical practice frameworks, such as Kaupapa Māori frameworks (Haitana et al, 2022a), Te Whare Tapa Whā (Durie, 1985), the Meihana model (Pitama et al, 2007), Te Ara Waiora a Tāne (Bush et al, 2019) and Mahi a Atua (Kopua et al, 2020), may be an important step in improving the quality of care for Māori SMHAS users.…”

“If we can just dream…” Māori talk about healthcare for bipolar disorder in New Zealand: A qualitative study privileging Indigenous voices on organisational transformation for health equity

“…The organisation of healthcare requires transformation to achieve health equity outcomes in New Zealand 9, 12 . Clinical and structural changes are also required to address systemic barriers that prevent health equity for Māori, this paper highlights the full extent of organisational change required across the H&DS 1, 25, 26 . The organisation of healthcare, while known to effect the processes and outcomes of care, has been under‐researched, and under‐addressed privileging the needs of majority populations by design, leadership, and models of delivery 4–6 .…”

“…9,12 Clinical and structural changes are also required to address systemic barriers that prevent health equity for Māori, this paper highlights the full extent of organisational change required across the H&DS. 1,25,26 The organisation of healthcare, while known to effect the processes and outcomes of care, has been under-researched, and under-addressed privileging the needs of majority populations by design, leadership, and models of delivery. [4][5][6] The challenge going forward is whether the resourcing for an equitable healthcare organisation will be implemented across the H&DS in partial fulfilment of the long overdue promises of the Crown.…”