Te Tau Ihu Māori mental health outcomes and tangata whaiora experiences in Te Wahi Oranga (Nelson Acute Mental Health Inpatient Unit) : an exploratory study : a thesis submitted for the degree of Doctor of Philosophy at Te Kura Hinengaro Tangata - School of Psychology, Massey University, Turitea, Palmerston North
There are significant differences between Maori and non-Maori mental health in New Zealand. Maori have higher prevalence of serious mental health disorders than non-Maori, yet in comparison to non-Maori, Maori are less likely to access health services; are less likely to be referred to specialist mental health services by General Practitioners (GPs) and more likely through law and welfare agencies; are more likely to be involuntarily admitted; have higher admission (and readmission) rates, are more likely to be diagnosed with psychotic disorders on admission; and have higher suicide and mortality rates.
The aim of this research was to explore outcomes for Maori in Te Tau Ihu (Nelson/Marlborough), New Zealand and understand Maori tangata whaiora (service users/patients) experiences from admissions through to discharge from a mental health acute inpatient unit in Te Tau Ihu. First, five years of inpatient data was collated to identify whether there were similarities between Te Tau Ihu Maori and Maori nationally in terms of admission rates, readmission rates, seclusion practices, length of stay and diagnostic data. Second, using a narrative inquiry approach embedded within a Kaupapa Maori framework, 13 tangatawhaiora were interviewed.
This research has found that there are some similarities between Maori in Te Tau Ihu and Maori nationally in terms of the higher number of admissions and first time re-admissions, higher rates of psychotic disorders and seclusion. However, Te Tau Ihu Maori compare more favourably in terms of lower two or more subsequent re-admissions, and there is minimal difference between Maori male and female admission rates.
In terms of tangata whaiora experiences, there are consistencies with other studies around concerns with medication, stigma and discrimination, lack of respect, boredom, fear and safety, and relationships with staff. There are also new learnings in terms of the complex relationship with medication, the importance of food and music as a relationship enabler, the strength of having Maori staff on the unit and a call for more therapeutic interaction.
The findings endorse the need for more comprehensive care planning based on Te Whare Tapa Wha (mental, physical, family, spiritual dimensions) to better support tangata whaiora.