A survey of over 2500 people working in mental health and addiction services has found that, while many feel tāngata whaiora (consumers in these services) are treated with respect, there are challenges in several areas. These include the cultural appropriateness of services for tāngata whaiora Māori, and coordination of care between services.
The survey, Ngā Poutama Oranga Hinengaro: Quality in context (Ngā Poutama), was distributed in August 2018 by the Health Quality & Safety Commission (the Commission), which coordinates the mental health and addiction quality improvement programme on behalf of district health boards (DHBs).
Programme clinical lead Dr Clive Bensemann says the survey gathered information on what frontline staff believe about mental health and addiction services – what works well, and what could be improved.
'This information will be extremely useful in helping the programme work with mental health and addiction services to continue to improve the quality of care people receive. Evidence suggests tāngata whaiora receive better care in an organisation with a strong quality and safety culture.'
The survey found that the highest percentage of staff agreed that:
- tāngata whaiora were treated with respect by their service (77 percent)
- staff worked with tāngata whaiora to co-create a plan of care and support (70 percent)
- tāngata whaiora needs, values and beliefs were actively incorporated in care and support plans (62 percent)
- staff adhered to clinical evidence and guidelines (61 percent).
The lowest percentage of staff agreed that:
- tāngata whaiora care and support was well coordinated between DHBs and non-government organisations (NGOs)/primary care (26 percent)
- the type of work done in their MHA service was well understood by the wider organisation (27 percent)
- there were effective systems for preventing or dealing with intimidating behaviour and workplace bullying (31 percent)
- te reo Māori was used with tāngata whaiora Māori and their whānau in clinical/support sessions where appropriate (31 percent).
In addition to use of te reo Māori, there were several other questions about incorporation of Māori cultural processes and values into services:
- mihi and whakawhanaungatanga were used in sessions with tāngata whaiora and family/whānau where appropriate (40 percent)
- cultural advisors or other cultural supervision were accessed to support working with tāngata whaiora Māori when appropriate (54 percent)
- teams actively incorporated tāngata whaiora needs, values and beliefs in their care/support plans (62 percent).
Overall, mental health and addiction staff in NGOs and primary health care gave a higher percentage of positive responses than those working in DHBs.
Kaumātua and programme cultural advisor Wi Keelan says the survey shows that Māori staff, particularly those working in kaupapa Māori mental health services, were feeling highly positive about their work.
'But there are still challenges with accessing culturally competent care in the mental health and addiction services. The survey results give us an indication for what is required in our future work programmes.
'Use of te reo Māori in services is low, as is the use of the Māori cultural practices of mihimihi and whakawhanaungatanga. This concerns me and is a sign there is more work to be done to achieve equity in mental health and addiction services for Māori. It is important that everyone, both Māori and non-Māori, working in mental health and addiction services contributes to whānau ora for Māori.
'This includes making whakawhanaungatanga and manaakitanga fundamental parts of service delivery. We know that the admission period is a critical time for consumers transitioning into inpatient units. Welcoming tāngata whaiora into inpatient units with mihimihi and pepehā, for example, not only improves consumer experience, but can also lead to reductions in restrictive practices, such as seclusion.'
Dr Bensemann says the feedback about lack of effective systems for dealing with bullying is also concerning.
'Bullying has been reported in several areas of health care, including in mental health services. It is important that services have effective processes in place to prevent and address intimidating behaviour and workplace bullying.'
Dr Bensemann says the Commission recognises the alignment of some findings from Ngā Poutama with the content of He Ara Oranga: report of the Government Inquiry into Mental Health and Addiction. He Ara Oranga has signalled the need for change and a new direction, and highlighted opportunities for improvement.
The full Ngā Poutama report and a copy of the frequently asked questions is available to download from our website.