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Start date: 2020Subject: search.filters.subject.420313 Mental health services

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    The CAMHS referral process : the perspectives of school counsellors on the front line of youth mental health in Aotearoa New Zealand : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Psychology at Massey University, Manawatū, Aotearoa New Zealand
    (Massey University, 2025) Holland, Ashley
    School counsellors are fundamental to supporting the mental health of young people in Aotearoa New Zealand. They are crucial in not only providing primary care services but also for facilitating the referral to Child and Adolescent Mental Health Services (CAMHS) when counselling alone is not sufficient. Mental health in Aotearoa New Zealand is increasing in both prevalence and severity, rangatahi mirroring this nationwide trend. There are significant stressors influencing all key stakeholders involved with supporting rangatahi mental health, with strains on public mental health services such as CAMHS. There is a disparity between CAMHS nationwide, in both service and delivery processes. As school counsellors are responsible for many of the referrals made to CAMHS, this research study gathered perspectives from school counsellors to shed light on the current state of the referral process. Method: Participants completed a mixed methods designed online survey, and the responses were analysed using both descriptive statistical analysis and reflexive thematic analysis. Results: School Counsellors identified key areas of strengths, weaknesses and changes needed within the CAMHS service. A list of beneficial next steps for CAMHS was generated. Conclusion: There is a considerable need for a more responsive CAMHS referral process in Aotearoa New Zealand, catering for the increasing complexity and demand of rangatahi mental health. There are both strengths and weaknesses of the current CAMHS referral process, and with collaboration and cooperation with school counsellors they will be able to implement changes which will improve this process, benefiting vulnerable rangatahi.
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    Mental health conceptualisations and perspectives on mental health services of Black Sub-Saharan African migrants and refugees in Aotearoa New Zealand : a doctoral thesis submitted in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, Manawatu Campus, New Zealand
    (Massey University, 2025-08-22) Musakwa, Michelle
    The number of African migrants and refugees is increasing in Aotearoa-New Zealand (A-NZ). However, there is still limited understanding regarding the mental health experiences of Black Sub-Saharan Africans. Without adequate knowledge of the experiences of this population, it is difficult for mental health professionals to provide culturally appropriate services. As such, it is prudent to develop an understanding of the way this population conceptualises, experiences, and manages mental health and mental distress. This study explores how Black Sub-Saharan Africans in A-NZ conceptualise and manage mental health and their perspectives on mental health services in A-NZ. A qualitative approach was employed, with data collected through nine semi-structured individual interviews and two focus groups (each with four Black Sub-Saharan African women). Individual interview data were analysed using Interpretative Phenomenological Analysis, highlighting the role of identity in mental health conceptualisation and the intergenerational and gender differences that exist. Focus group data were analysed through Reflexive Thematic Analysis and key themes identified included barriers to accessing services and participants’ preferences regarding mental health services. Overall, this study found that culture and identity play a critical role in how Black Sub-Saharan Africans perceive mental health. These factors also influence people's experiences with mental health services. Understanding the cultural nuances of Black Sub-Saharans in A-NZ can help mental health clinicians develop an ethos of engagement that promotes better quality of care.
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    Exploring the barriers and facilitators of accessing and utilising mental healthcare for adults with childhood trauma : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Psychology at Massey University, by Distance, Aotearoa/New Zealand
    (Massey University, 2025) Brocas, Caitlin
    Childhood trauma is a prolific and pervasive issue, with New Zealand reporting a concerning number of child maltreatment cases each year. Extensive research has highlighted the myriad of negative physiological, neurological, and psychological impacts associated with experiencing trauma in childhood. Despite this, mental healthcare service usage in New Zealand remains relatively low, with the most recent data estimating only 2.9% of the population access some form of mental healthcare annually (Te Whatu Ora, 2023). To understand this, disconnect, the current study aimed to explore the lived experiences of adults with childhood trauma and identify the barriers and facilitators that impact accessing and utilising mental healthcare. Employing Interpretive Phenomenological Analysis, semi-structured interviews were conducted with four adult participants to provide an in-depth understanding of their experiences accessing care. Analysis revealed six overarching themes: Constraints of Living in a Small Town, The Cost of Care, Confronting Internal Barriers, reaching a Breaking Point and A Need for A System that Cares. From these themes, six primary barriers were identified: Limited Resources, Incompatibility in the Therapeutic Relationship, Lack of Anonymity, Stigma, Lack of Trust and Financial Constraints. Three key facilitators also emerged: Crisis as a Motivator, Support and Positive Healthcare Relationships. Additionally, participants identified several systematic changes that would facilitate future access and utilisation of care. This thesis addresses critical gaps in existing literature and contributes to our understanding of the challenges and supports that impact to mental healthcare for adults with childhood trauma in New Zealand.
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    In search of healing narratives amongst warriors : exploring the lived experience of New Zealand Defence Force service members seeking mental health support : a thesis presented in partial fulfilment of the requirements of the degree of Doctor of Clinical Psychology, Massey University, Palmerston North, New Zealand
    (Massey University, 2024) Grimm, Carsten James
    Narratives of war and of warriors exist throughout recorded human history and society’s support for soldiers in distress reflects the cultural paradigm of the period. Contemporary approaches to supporting military mental health focus on barriers to care and psychotherapy outcomes; however, little is known about the user experiences of personnel as they navigate military healthcare systems. This research project explored the narrative accounts of 21 active duty New Zealand Defence Force (NZDF) personnel who had accessed mental health support in order to understand their experiences of accessing care. Participants described their mental health recovery using a better-than-before narrative structure aligned with the hero’s journey, which involved challenges crossing the help seeking threshold and concluded with positive personal transformation. Stories of holistic recovery adopted Māori well-being heuristics to narrate the interconnection of relationships and health behaviours that supported participant healing. Participant accounts of seeking support also reflected paradoxical narratives, as the NZDF mental health system both helped and hindered personnel during their period of distress. Many of the cultural aspects of the NZDF were described as strengths but also as barriers that prevented personnel from connecting to care that was effective and meaningful to them. Narratives in this research contribute important perspectives on military mental healthcare that both celebrate the NZDF mental health system and offer opportunities to develop practices that better support personnel to navigate the many values conflicts and dilemmas they experience during their military service.
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    Te Ao Māori screening tool for whai ora Māori engaged with secondary community mental health and addictions services in Whanganui, Aotearoa/New Zealand : a literature review and clinical project presented in fulfilment of the requirements for the degree of Master of Health Science in Nursing at Massey University, Wellington, New Zealand
    (Massey University, 2022) Potaka-Osborne, Cheyenne
    Background: Māori will predominantly not be offered or have Māori Services or Māori models of care as a first option when seeking input from health services, despite continuing to experience inequity, ongoing health disparities and poor health outcomes across Aotearoa. Current health strategies continue to explicitly highlight the importance of holistic and cultural approaches in terms of models of care, assessment and treatment interventions within the mental health and addiction sector, however, services do not reflect Kaupapa Māori approaches that are by Māori for Māori with Māori, unless they are being provided by an iwi-led organisation. Aim: Part one - completed 2020: The aim of the integrated literature review is to examine national and international literature, to understand the limitations of current mental health and addiction assessments and screening tools, and identify the best available evidence and contemporary strategy and policy in Aotearoa to underpin the development of a cultural screening tool. Part two – Completed 2021/2022: The overall aim of the project is to Co-design and produce an integrated cultural screening tool for tangata whai ora and whānau whānau that is appropriate for the Aotearoa context. The screening tool will identify current cultural needs of tangata whai ora, and uphold Te Tiriti obligations, and is based on the best available evidence. Methodology: An integrative literature review was completed to identify the current constraints of mental health and addiction assessments and screening tools in terms of cultural inclusiveness. A co-design methodology with a Te Ao Māori lens was then utilised to co-design a cultural screening tool for use with Māori, which supports with identifying where tangata whai ora are currently sitting in terms of their cultural needs including beliefs, values and practices. This was completed in partnership with Whanganui District Health Board (WDHB) Māori Health Services, ensuring that local Māori tikanga was utilised and developing a draft cultural screening tool for Māori, by Māori, with Māori. Results: The main themes identified through the integrative literature review were, the importance of lived experience and co-design, biomedical and paternalistic approach to MHAS Services, and perceptions and disproportionate insights and micro and macro needs within MHAS. In Aotearoa the implications of this is that the biomedical model does not primarily allow a person’s cultural needs or social determinants to be a determining factor when considering treatment options. Evidence indicates that current assessment and screening tools in Aotearoa do not consistently reflect a cultural, recovery or partnership approach in terms of cultural inclusivity and Te Tiriti. There is a clear need for our MHAS to consider utilising the concept of integrated models of care in terms of service provision and the development of assessment frameworks and screening tools, especially in terms of the integration of Māori models, cultural frameworks and social determinants of care. As part of the aim of this work, a draft Te Ao Māori screening tool and an education plan has been successfully developed for trial, evaluation and implementation within Community Mental Health and Addictions (CMHAS) by the leadership team and Māori Health Services at WDHB. Conclusion: It is well evidenced that Māori experience significantly worse health outcomes in almost all areas of health care, compared to non-Māori, and Māori are predominantly not offered kaupapa Māori health services or Māori models of care when engaging with health services. Inequities to Māori accessing health care continue to present as complex in nature and are made up of multiple factors. This research has highlighted that in Aotearoa health care services, there is a clear gap due to the lack of Te Ao Māori assessment and screening tools to identify the current cultural needs of tangata whai ora. There needs to be a greater focus on the cultural needs of tangata whai ora and whanau if we are to improve equity, health outcomes for Māori, and see a reduction of inequities for groups at increased risk of preventable and chronic mental health and addiction issues. This research has been successful in developing a co-designed cultural screening tool and clinician’s education sessions for implementation and evaluation with the CMHAS environment to reduce current health inequities experienced by Māori. If we are to improve health outcomes for Māori, then health services need to acknowledge that cultural identity, beliefs, values, and connection are the foundation of tangata whai ora and whānau wellbeing.
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    "I could cope so much better if I could just get a good night's sleep" : maternal sleep and mental health from early pregnancy to three years post birth : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Public Health at Massey University, Wellington, New Zealand
    (Massey University, 2020) Ladyman, Clare Iona
    Healthy sleep is vital to health and wellbeing at all life stages. But for many women, achieving restorative and satisfying sleep consistently throughout pregnancy is challenging. Because vulnerability to experiencing depressive symptoms increases with poor sleep and poor sleep influences the development and trajectory of depressive symptoms, sleep is an important and modifiable factor in the prevention and treatment of depression. Pregnancy is also considered a key teachable life stage as mothers wish to be healthy in order to protect their unborn baby. Yet research investigating non-pharmacological sleep education interventions for preventing perinatal depression is scarce. This thesis comprises three studies that investigate the relationship between maternal sleep health and depression. It presents findings from a scoped review examining sleep health throughout pregnancy; a longitudinal analysis of depression trajectories from late pregnancy to three years post-birth and the association of different sleep dimensions to trajectory group membership; and, the development, implementation and efficacy of a sleep education pilot intervention designed to promote sleep health and reduce the likelihood of depressive symptoms throughout pregnancy. Findings from the scoped review showed that while sleep in pregnancy is highly variable from one woman to the next, significant changes to sleep throughout pregnancy were not indicated for women who were considered physically and mentally healthy. However, the results of the longitudinal analysis revealed that for a sub-group of women, poor sleep was significantly associated with clinically elevated and persistent depressive symptoms throughout the perinatal period and into their child’s preschool years, with the probability of experiencing depressive symptoms especially pronounced for Māori women. The Sleep HAPi pilot study found recruiting and retaining previously depressed women into a longitudinal perinatal sleep education study achievable and the study design highly acceptable to participants. Similar to the results of the scoped review, self-reported sleep duration, quality, timing, continuity and daytime sleepiness remained stable throughout pregnancy, and at intervention end none of the women in this study were experiencing clinically elevated depressive symptoms. Sleep HAPi women were compared to a control group from a previous study with no sleep education component; Sleep HAPi mothers had significantly better sleep initiation and experienced fewer depressive symptoms at intervention completion, though results require confirmation in a larger randomised control group study. Collectively, the findings from these studies highlight the strong relationship between sleep and maternal mental health. Sleep education interventions, such as Sleep HAPi, show promise for minimising depressive symptoms, and optimising sleep for pregnant women. These findings have important health care practice and policy implications and the potential to improve outcomes for mothers, children, families and society.