Suchergebnisse

Background & material: In the last five years a number of studies have been conducted in specialist psychiatric and primary care populations in New Zealand which have allowed comparisons in terms of clinical phenomena and therapeutic experiences between Mâori (the indigenous people of New Zealand) and non-Mâori. These studies were reviewed in terms of the methodology used, their major findings and their implications. Discussion: In specialist psychiatric services Mâori were more likely to present with hallucinations and/or aggression and less likely to present with depression and/or episodes of self-harm. They were overly represented in those with schizophrenia. Mâori were more likely to be involved in acts of aggression and to be secluded, and an equivalent episode of care for Mâori appeared to be significantly more costly than for non Mâori. Other studies, conducted in prison and community-based samples, suggested that Mâori were less likely to access care and, when given a diagnosis of depression, less likely to be prescribed anti-depressant medication. The rates of depression were significantly higher in Mâori (women) and Mâori were also overly represented in those with anxiety and substance misuse disorders. These differences remained even after the sample was standardised for socio-economic status. Further exploration of the genesis and implications of these findings, derived from a strong and relatively well-defined indigenous people, may usefully inform the more general issues of culture and its significance for diagnosis, classification and service use. Conclusions: While the methodologies used and the actual results gained differed across studies, there do seem to be differences in phenomenological profiles at presentation, in the diagnostic patterns, the cost of care, and the therapeutic experiences between Mâori and non-Mâori New Zealanders. These differences may reflect actual differences between certain ethnic groups, which then explain the differences in the experiences of those users, or they may reflect inadequacies on the parts of non-Mâori clinicians, their diagnostic tools and the services in which they operate, in catering for Mâori patients.

Despite the efforts of the World Health Organization to internationally standardize strategies for mental-health care delivery, the rules and regulations for involuntary admission and treatment of patients with mental disorder still differ markedly across countries. This review was undertaken to describe the regulations and mental-health laws from diverse countries and districts of Europe (UK, Austria, Denmark, France, Germany, Italy, Ireland, and Norway), the Americas (Canada, USA, and Brazil), Australasia (Australia and New Zealand), and Asia (Japan and China). We outline the criteria and procedures for involuntary admission to psychiatric hospitals and to community services, illustrate the key features of laws related to these issues, and discuss their implications for contemporary psychiatric practice. This review may help to standardize the introduction of legislation that allows involuntary admission and treatment of patients with mental disorders in the mainland of China, and contribute to improved mental-health care. In this review, involuntary admission or treatment does not include the placement of mentally-ill offenders, or any other aspect of forensic psychiatry.

Background: Family ( whanau) and other carers can play a central part in the natural history of psychiatric service users. Diagnoses or the classification of mental disorders play a significant role in communications between clinicians, psychiatric service users, and family. Despite that centrality, the views and experiences of family on the utility of the present classification systems have been little studied. Aims: This study aimed to document the understanding and opinions of families/ whanau on the utility of diagnostic labels as they observed them being applied to their family members. Method: This is a qualitative study. The families of two cultural groups (New Zealand Maori and non-Maori) of psychiatric service users were interviewed using a structured approach. Results: A number of themes on the utility of the diagnostic systems emerged. The single most powerful message being that how the diagnostic labels were communicated, and how they were utilized in the patient management planning, were of paramount importance. There were some cross-cultural differences. From Maori, there was a particular plea for a greater incorporation of culturally syntonic concepts. Conclusion: Family/ whanau had positive views of the contributions current diagnostic practices make to patient care. The study elicited the view that more contextual issues, and not just phenomenology, should be taken into account in the development of diagnostic systems.

The key areas of development in this study were the criteria for the use of the Hua Oranga, an Indigenous mental health outcome measurement tool for use with Māori, the Indigenous people of Aotearoa (New Zealand). The application of the Hua Oranga was expected to improve the care and treatment of tangata whaiora (consumers) in partnership with whānau (family) and clinicians. The Outcomes Recording Analysis (ORA) database (www.ORAdatabase.co.nz), which receives the Hua Oranga data and generates the Hua Oranga reports was essential to this improvement. This development contributes to the skill and expertise of clinicians in interpreting Māori health information that benefit Māori.

Background
The acceptability of Child and Adolescent Mental Health Services (CAMHS) to Indigenous peoples is little studied. There has been a lack of evaluation tools able to take account of the more holistic approach to the attainment of mental health that characterises Māori, the Indigenous population of Aotearoa (New Zealand). This study aimed to develop such an instrument and establish some of its psychometric properties. Then, to use the measure to establish whānau (family or caregiver) views on desirable CAMHS characteristics.
Method
A self-administered survey, Te Tomokanga, was developed by modifying a North American questionnaire, the Youth Services Survey for Families (YSS-F). The intent of the tool was to record whānau experiences and views on service acceptability.
The Te Tomokanga survey is unique in that it incorporates questions designed to examine CAMHS delivery in light of the Whare Tapa Whā[1], a Māori comprehensive model of health with a focus on whānau involvement and culturally responsive services. This mail or telephone survey was completed by a cohort of 168 Māori whānau. Their children had been referred to one of the three types of CAMHS, mainstream, bicultural, and kaupapa Māori[2], of the District Health Board (DHBs) in the Midland health region, Aotearoa. The Midland health region is an area with a large Māori population with high levels of social deprivation.
Results
The Te Tomokanga instrument was shown to have a similar factor structure to the North American questionnaire from which it had been derived. It identified issues relevant to Māori whānau satisfaction with CAMHS. The work supports the concept that Māori desire therapeutic methods consistent with the Whare Tapa Whā, such as whānau involvement and the importance of recognising culture and spirituality.
The participants were generally positive about the services they received from the three different CAMHS types, which shows good acceptability of CAMHS for Māori. Results found satisfaction with CAMHS was related to whānau involvement and culturally delivered services.
Conclusion
The Te Tomokanga instrument should prove useful in Aotearoa or other similar cultural settings. It is a means of determining the cultural acceptability or improving CAMHS delivery for Indigenous populations.
[1] The Whare Tapa Whā framework relies on a Māori worldview of health, a holistic approach advocating a balance between the four dimensions of the Taha Whānau (family), the Taha Tinana (physical), the Taha Hinengaro (cognitive or intellectual) and the Taha Wairua (spiritual). It is believed if one aspect is in distress then it impacts on the others causing tension and increased risk of poor health. Optimal health requires balance between all four dimensions.
[2] Kaupapa Māori mental health services provide Māori dedicated clinical and cultural workforce for Māori service users.

Within the health research context, indigenous people globally have a commitment to provide their own solutions. Māori, the indigenous people of Aotearoa (New Zealand) value the traditional Pōwhiri process of engagement and participation in mental health research. The practices and protocols within the Pōwhiri process (use in the Doctorate of Philosophy (2010) and Auckland University) are premised on the notion of respect and positive relationships between the tangata whenua (hosts or research participants) and manuwhiri (guests or researchers). This paper briefly describes the Pōwhiri process, which may be a model applicable to research with other indigenous cultures.