Māori mental health: inequity and systemic change
Māori are disproportionately impacted by mental health problems. Dr Cameron Lacey and his team are looking at the reasons for this and how these inequities can be overcome.
Mental health issues are affecting a higher proportion of Māori than non-Māori, according to recent University of Otago projects funded by the Health Research Council.
Dr Cameron Lacey, of Otago’s Christchurch-based Māori Indigenous Health Institute (MIHI), is leading a series of investigations aimed at understanding and improving Māori health.
Highlighting inequity between Māori and non-Māori is just the beginning. The next steps are finding the causes of that inequity and implementing change for a better future.
“Looking for long-term solutions includes developing a new system of integrated care that addresses that whole range of adverse drivers.”
“A number of factors contribute to create an increased risk for Māori,” says Lacey. “These include increased exposure to social disadvantage and psycho-social adversity, which reflect ongoing impacts of colonisation and racism.
“The good news is that these causes can be addressed by reducing poverty and improving access to quality mental health services. It’s going to be difficult to create systemic change, but we should be able to reduce those drivers of inequity.”
Early studies showed that Māori were affected with bipolar illness disproportionally to the rest of the population.
“The psycho-social functioning of sufferers is impacted by the treatment they receive, loss of income, loss of activity, medication that causes weight gain, high blood lipids – put these things together and all bipolar patients are at significant increased risk of complications. But why are Māori more affected?”
To find answers Lacey’s teams began studying Māori with first-episode psychosis, which can be a precursor to more serious long-term mental health problems like bipolar disorder.
Te Uemairangi: pathways to first episode psychosis and outcomes in Māori youth is a collaboration between MIHI with the University of Otago, Christchurch’s Department of Psychological Medicine and the Wellington Department of Public Health.
“These projects would not have been possible without such a large team contributing,” says Lacey. “Colleagues like Dr Ruth Cunningham, Dr Jenni Manuel, Professor Suzanne Pitama, Professor Richard Porter and Professor Marie Crowe give us skills in data-gathering, epidemiology, psychology and hauora Māori expertise among many others.”
They found incidences of psychosis are about double those for Māori than for non-Māori, with Māori youth experiencing first episodes of psychosis tending to be younger, and more likely to live in deprived and rural communities.
Further work is investigating the effectiveness of support service providers and is recording the experiences of youth and their whānau with a view to improve strategies to address needs and counter some of the causes of inequity.
“We’re focusing on understanding the wide range of factors that contribute to the greater exposure to risk experienced by Māori. We’re seeing increasing evidence for diagnostic bias, different interpretations of symptoms, a range of patterns of social adversity prior to the development of psychosis, such as educational difficulties and contact with the justice system, the police and Oranga Tamariki.
“A lot of psychosis research has looked at biological determinants of the illness, but our work is giving us quite another story to investigate.
“We all have some degree of disposition towards different patterns of unwellness. But a lifetime of stresses and adversity and poverty makes it that much more likely that those illnesses will be expressed, adding significantly to the risk for Māori.”
Lacey’s team’s latest initiative, Te Pu Korokoro, aims to improve the physical health of at-risk Māori, who also have a shorter life expectancy than non-Māori.
“If drivers of inequity are social adversity in all its forms, having a mental health system that focuses almost entirely on mental health without considering physical health and all the other needs is not going to lead to a great response.
“Looking for long-term solutions includes developing a new system of integrated care that addresses that whole range of adverse drivers – and in a way that doesn’t exhaust the resources of whānau trying to navigate the current systems to get the best outcome.”
Health Research Council