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

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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.
Māori Masters Thesis