I have worked in mental health for 28 years. Over that time we have arguably made little progress addressing inequities, in particular with Māori. Māori are still up to three times more likely than others to experience mental health issues.
And yet our approaches are underpinned by an assumption that everyone starts off from the same point. We assume that the health sector is a level playing field, but the data shows remarkable disparity. We need to address this with one mind. If we get it right for Māori we can get it right for other groups. Everyone knows about the inequities and now it is time for action. I hope you too see this as a worthy challenge. I want to raise awareness of this issue.
Two thirds of the Māori population live in the poorest areas in New Zealand. This means their health is poorer and they have less access to services than other groups. When Māori do engage with health professionals, their experience is less than satisfactory. We know doctors believe Māori become more unwell and are non-compliant with contemporary treatments. Doctors spend less time per appointment with Māori.
This is backed up by the research of Dr Carla Houkamau from the University of Auckland. She argues that health professionals have unconscious biases which influence their engagement with Māori. But it’s not just doctors, we all carry these biases and apply them unconsciously. You can test your biases at Project Implicit.
I did the test and my biases are pretty bad – but I’m working on it. It made me think about why we are attracted to particular things. My dad wouldn’t buy Japanese cars for example. Bias affects Māori but it also affects other groups such as Pacific, Asian and refugee groups.
Institutional racism is another way to analyse these patterns. Institutional racism is a conscious state, and an entrenched pattern. We think we live on a level playing field even though there is strong evidence to show this is not so. If we’ve known about this for so long, why haven’t we done anything about it? Māori could be the first candidate for change. It’s time for a change, time to get started.
So how are we addressing health equity in the mental health and addiction quality improvement programme? We have to think outside the box – at a national and local level. Locally we should be driven by the needs of the population.
Nationally our team is developing a Treaty of Waitangi equity framework that will be tested over the next months. The system will be guided by Treaty principles and co-design – and have a strong equity lens. Kaupapa Māori will sit alongside the requirements of the Western bio-psycho-social-medical model. The Commission’s model for improvement will help us investigate quality solutions. Whatever the inequity, we need to be there.
Let’s pick two – Māori and Pacific – and start with those populations. The key to unlocking better health outcomes with these two groups is also about working with their whānau. If we work with whānau effectively, we will have a better support system when tangata whaiora leave care. It would reduce the need for seclusion and treatment orders. Māori and Pacific families and communities would feel more connected.
I see connecting care as the most important part of the highway. To connect people and communities to the right services at the right time is really important. I also believe our equity framework will develop into a very important tool. We need to be more innovative. Using co-design will help us get different and better results.
Author: Wi Keelan, kaumatua and clinical advisor for the Commission's mental health and addiction quality improvement programme.