Māori, Pacific people and youth not prioritised in mental health support

Māori, Pacific people and young people are not being prioritised when it comes to accessing mental health support, a new report has found, despite evidence clearly demonstrating these groups need a higher level of support.

The Mental Health and Wellbeing Commission has reported that fewer people are able to access kaupapa Māori primary mental health services, and that funding for these services has not kept pace with other mental health investment.

Only 29 percent of Māori who access specialist service use kaupapa Māori services, and young people are increasingly being declined for specialist help after being referred.

The report notes the age-standardised rate of suicide deaths is highest among Māori men aged 25 to 44 years, Maori and Pasifika being more likely to be kept in solitary confinement, and young people increasingly being placed in adult in-patient services, that are potentially unsafe.

Carole Koha has worked in Mental Health and Addictions for the past 35 years. She is currently the chief executive of Te Waka Whaiora, a kaupapa Maori mental health and addictions support service based in Porirua.

"We talk about choice, you talk about who access's what services, Māori don't have a choice. When you come against 20 non-Māori organisations and maybe one Māori organisation within a community they will definitely referred to the non-Māori organisation, because either A) there's no trust or B) we're not funded to deliver clinical services," she said.

There were a whole range of reasons Māori continued to go to non-Māori services and she said it was not that Māori services were not in a position to deliver, they just did not have the funds.

"So by the time they do access services they're in a crisis, but there aren't enough services to meet that particular crisis so the burden becomes a whānau burden, and sometimes within all cultures - not just Māori - whānau are actually the reason why our tangata are where they are."

Hine Moeke-Murray is chief executive of Te Kupenga Net Trust, based in Gisborne, a kaupapa Maori organisation providing peer support and advocacy in mental health and addictions.

She said a huge part of the issue was that many Māori did not meet the criteria for intervention.

"It's no longer intervention, it's no longer prevention we are doing critical response to our whānau because they couldn't get through the doors in the first place."

Without stable funding and strong relationships with clinical services it's very difficult to achieve better outcomes for whānau Māori, she said.

"When we talk about intervention our whānau can come to a community organisation absolutely, if they need further clinical intervention because they may need some specialist care and they don't meet the criteria of that service where to from there? Where to from there? They get bounced back into the community and when something goes wrong it's the community organisation that's blamed."

Services were jumping through hoops to meet the political outcomes the government of the day required, which created huge pressures on services as well, she said.

"If there's no services out there that can meet the needs of our babies, all of our people, then how do we change the system because it is system driven."

Koha said there were pockets of funding going out to Māori services, but not enough to make positive long-term outcomes.

The system was still not meeting the needs of rangatahi, she said.

"We have a rangatahi portion within our contract but we don't have a clinical [portion], so what I've had to do is employ clinicians out of some of our little bit of surplus that we have. We're not contracted to do it but we need to do it because I'm finding that that's a gap."

Minister acknowledges inequitable mental health outcomes

In a statement to RNZ, Minister for Mental Health Matt Doocey acknowledged Māori had inequitable mental health outcomes, particularly in suicide rates.

"That is why when I launched the Suicide Prevention Action Plan, this had multiple specific actions that were for Māori, to acknowledge those inequities.

"I am committed to working with community groups and Health NZ to ensure we are improving outcomes for all New Zealanders, including Māori. That is where the mental health and addiction targets come in. I have been very clear that we are not just celebrating when we reach the targets at a national level. What is most important is getting into the data and ensuring that all groups are reaching the targets. This includes Māori. If there's a region and group not meeting the target, I expect additional focus to be put into that area."

"We have invested additional funding, whether it be through the Innovation Fund or the Suicide Prevention Action Plan, for Māori, and I committed to continuing to work with our community organisations to get more funding out the door where needed.

The commission's report noted seclusion - otherwise known as solitary confinement - was often a traumatising experience and the Ministry of Health reported that Māori in adult in-patient services were 6.6 times more likely to be secluded than non-Māori.

Doocey said seclusion was an issue he had been closely looking at and one he cared strongly about addressing, including for Māori.

"Each individual case is a clinical decision, and I expect that the appropriate processes and assessments are followed.

"The Mental Health Bill currently before Parliament seeks to further reduce the use of seclusion. This includes requiring the person in charge of a service to report annually to the Director-General on the steps taken to eliminate the placement of people under compulsory care in seclusion.

"The Bill as it currently stands will limit the use of seclusion and strengthen safeguards. It also prohibits the use of seclusion for people under the age of 18. I am committed to the goal of getting to zero seclusion overtime."

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