Te Puawaitanga
Māori Mental Health National Strategic Framework
www.moh.govt.nz/publications/tepuawaitanga
online versionpage 1 of 6 Download this publication in PDF format
Published in April 2002 by the
Ministry of Health
PO Box 5013, Wellington, New Zealand
ISBN 0-478-27000-3 (Web)
ISBN 0-478-27001-1 (Book)
HP 3504
Contents
Wahanga Tuatahi/Foreword
Glossary of Terms
1 Introduction
The strategic framework for the health and disability sector
Looking Forward and Moving Forward
Implementation of strategies
Purpose of Te Puawaitanga
Scope of Te Puawaitanga
Focus is on tangible outputs within the health sector
Key result areas
2 Why Do We Need Te Puawaitanga?
Mental health problems are now the number one health concern for Māori
Patterns of mental illness are different for Māori
Recognition of the effectiveness of mental health solutions developed in a Māori cultural context
This strategy restates the Government’s commitment to improving Māori mental health status
3 Policy Cornerstones for Te Puawaitanga
The special relationship between Māori and the Crown under the Treaty of Waitangi
The New Zealand Health Strategy
Looking Forward and Moving Forward
Building on strengths: a guide for action
The Blueprint for Mental Health Services in New Zealand
A definition of kaupapa Māori mental health services
The Māori Health Strategy
4 A Strategic Direction for Māori Mental Health Services
Guiding principles – a framework for Māori mental health services
Goals and objectives for District Health Boards
5 Table of Goals and Objectives
Goal 1: Provide comprehensive clinical, cultural and support services to at least 3 percent of Māori, focused on
those who have the greatest mental health needs
Goal 2: Ensure that active participation by Māori in the planning and delivery of mental health services reflects
Māori models of health and Māori measures of mental health outcomes
Goal 3: Ensure that 50 percent of Māori adult tangata whaiora will have a choice of a mainstream or a kaupapa
Māori community mental health service
Goal 4: Increase the number of Māori mental health workers (including clinicians) by 50 percent over 1998
baselines
Goal 5: Maximise opportunities for intra- and intersectoral co-operation
References
Glossary of Terms
| CQI | Continuous Quality Improvement. A system for ensuring that the management methods, practices and overall culture of an organisation bring about continuous improvement to the services it offers. |
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| CTA | Clinical Training Agency, a unit within the Ministry of Health, responsible for funding clinical and post-entry training in the health and disability sector. |
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| Cultural assessment | The process through which the relevance of culture to mental health is ascertained. |
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| Cultural effectiveness | A concept which focuses attention on the types of services that will benefit Māori clients. |
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| DHB | District Health Boards (DHBs) fund, provide or ensure the provision of services that protect, promote and improve the health and independence of a geographically defined population. |
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| DHBNZ | District Health Boards New Zealand – provides a national voice for District Health Boards. |
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| FTE | Full-time equivalent staff. |
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| Hua Oranga | A Māori measure of mental health outcome. |
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| HFA | Health Funding Authority (disbanded 31 December 2000, with its functions being distributed between District Health Boards and the Ministry of Health). |
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| MAPO | Māori Purchasing Organisation – works in partnership with funders. |
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| MDO | Māori Development Organisation. |
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| MoH | Ministry of Health. |
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| Tangata whaiora | People seeking wellness, mental health service users. |
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| Tohunga | Person with expert knowledge. |
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| Rangatahi | Youth. |
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| Rongoa | Traditional medicines. |
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| Wananga | Place of learning. |
Introduction
The strategic framework for the health and disability sector
The New Zealand Health Strategy and the New Zealand Disability Strategy together set the overarching guide for planning, developing and funding health and disability services in New Zealand.
A number of more detailed strategies for services, health issues or population groups already exist or are being developed. These strategies provide more detailed guidance for the health and disability sector, particularly District Health Boards which are directly responsible for the health and participation of their local communities, on how to achieve the goals of the New Zealand Health Strategy and New Zealand Disability Strategy. These strategies include the Primary Health Care Strategy, the Māori Health Strategy (He Korowai Oranga), the Health of Older People Strategy, Roadside to Bedside and the Pacific Health and Disability Action Plan.
These more specific strategies provide the basis for other policy initiatives that the Ministry of Health, often in association with other government and sector agencies, develops.
These include:
Figure 1 shows the framework for implementing the Government’s health and disability goals.
Figure 1: Implementing the Government’s health and disability goals
Implementation of strategies
Implementation of the different strategies varies, depending on the aims and objectives of each one. Some strategies have very specific goals and objectives, and have specific funding allocated to them, for example, Reduced Waiting Times for Public Hospital Elective Surgery. Other strategies are prioritised and resourced incrementally, for example, the Primary Health Care Strategy and the IAID.
Their aims and objectives may include:
- providing guidance for District Health Boards on prioritising services with existing funding
- advising DHBs and other providers on new ways to organise and deliver services
- promoting behaviour change among health care providers and the public.
Looking Forward and Moving Forward
In 1994 the Government released Looking Forward: Strategic directions for the mental health services. This strategy indicated a major shift in direction from services dominated by psychiatric hospitals towards community mental health services and teams. In order to ensure the implementation of Looking Forward, in 1997 the Government launched Moving Forward: The national mental health plan for more and better services. The wider scope of Moving Forward allowed for the inclusion of mental health promotion, prevention and primary health care activities. The genesis of Te Puawaitanga: Māori Mental Health National Strategic Framework lies in the ground-breaking work of Looking Forward and Moving Forward.
Purpose of Te Puawaitanga
The purpose of this Māori Mental Health Strategic Framework is to provide District Health Boards with a nationally consistent framework for planning and delivery of services for tangata whaiora and their whanau, so they can meet the Government’s mental health policy objectives for Māori over the next five years.
Scope of Te Puawaitanga
The Government recognises that mental health needs and community capacity will be different in each area, and that community participation in decision-making is the best way of ensuring that services meet the needs of individuals and communities at a local level.
This document sets out the key Government policy statements as strategic five-year goals. These are further developed into five-year objectives, which can be shaped to meet local requirements, and integrated into District Health Board operating plans.
This strategy also recognises the significant developments that have been achieved previously and the need to consolidate these achievements and build on them for the continued advancement of wellness for Māori.
Focus is on tangible outputs within the health sector
The focus of Te Puawaitanga is on producing tangible mental health outputs, which, incrementally, will lead to the achievement of the Government’s five-year goals. Outputs sought vary from explicit inclusion of Māori dimensions in mental health plans and contracts, to measurable increases in tängata whaiora and whanau participation and in the Māori mental health workforce.
The focus on tangible mental health outputs is not intended to downplay the importance of non-clinical strategies. The Ministry of Health supports the position advocated by Mason Durie (1997:2) that good Māori mental health is more than efficient health services. For Māori, good mental health also requires access to the institutions of Māori society such as te reo Māori, land, marae, and ready access to primary health care, education, housing and employment opportunities.
Te Puawaitanga attempts to ensure that Māori mental health services funded through Vote Health include participation in intersectoral responses in support of Māori models of wellbeing.
Key result areas
At a minimum, Te Puawaitanga should result in:
- measurable five-year objectives for Māori mental health in each District Health Board area, which can be costed and aggregated at national level
- specific deliverables for Year 1
- a longer-term monitoring and evaluation strategy that meets the Government’s ‘value for money’ and ‘effective service delivery for Māori’ criteria.
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