Provision at the interface : the Māori mental health contracting experience : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Māori Health at Massey University, Turitea Campus, Palmerston North, New Zealand
New Zealand's mental health performance and monitoring framework is a complex and evolving one. Its initial development occurred at a time when it was taken for granted that mainstream understandings of health and mainstream systems of service delivery would not only be appropriate for all New Zealanders, but would also service the needs of all New Zealanders. Latterly however there has been an acknowledgment that a wholly different understanding of health and health care has existed in this country; the worldview understood and shared by tangata whenua. This thesis uses a theoretical framework devised specifically for this research to investigate the experience of Maori mental health providers as they contract to provide mental health services for the Crown; to ascertain whether Maori mental health providers deliver outside of their contracts; and to examine the role multiple accountabilities play in contracting. The theoretical framework, the "Maori research paradigm net" is inclusive of both the kaupapa Maori and Maori centred approaches, moving beyond the traditional dichotomy that frames Maori health research and allowing the researcher the freedom to select and use the best and most appropriate research tools from both traditional social science research practices, and from Maori culture and tikanga, to answer the research question posed. The thesis concludes that Maori mental health providers deliver mental health services at the interface between two philosophical viewpoints or worldviews: that of the Maori community in which they are located and to whom they provide services; and that of the funder, from whom they obtain resources to enable them to deliver services. As a consequence of working at the interface, Maori providers regularly and routinely work outside the scope of their contracts to deliver mental health services which are aligned with those values and norms enshrined in Maori culture. To adequately acknowledge and validate the beneficial extra-contractual provision which occurs as a result of delivering mental health services at the interface, and prevent less desirable provision, a more responsive contracting environment and a performance measurement framework, which integrates both worldviews and which takes account of the multiple accountabilities that Maori providers manage, is required.