THE ORANGA HINEGARO MAORI - MAORI MENTAL HEALTH CONFERENCEAssociate Minister of Local Government
Intro will be covered by Mihi.
It is good to be here, to be able to address all of you here who have shown such passionate commitment to improving Maori mental health. I am sure that your work here over these two days will do much to continue this process.
You here today embody the truth of the saying:
He aha te mea nui o te ao? Maku e ki ake He tangata, he tangata, he tangata.
(What is most important? I will say, 'Tis people, 'tis people, 'tis people'.)
The quality of mental health care comes from the quality of its carers. You who work in mental health are our greatest resource in it. You who work in developing Maori mental health face huge challenges, but you also have great strengths, and potential.
This Government, and I personally, want you to be able to use your strengths. I want you to be able to build on the strengths of your culture, the relationships among your people. Only then can the full potential for providing the best mental care for Maori be realised.
The statistics in Maori mental illness show us we need different ways of doing things. Too often the way we have been doing things has failed too many people. In Maori mental health, I look to those ideas coming from Maori mental health care providers.
You are the people who can best draw on your people's old wisdom and couple it with innovative ways to treat and help people today.
There are already pockets of excellence in Maori mental health care. There are people showing real courage and innovation. We now need to spread that excellence everywhere in this country.
Today I'd like to give an overview of health achievements in New Zealand since the Coalition Government. I think these show we can deliver in Health.
Good things are happening, good things based on values that all New Zealanders share. Now I want this process to extend to providing good mental health care, by Maori, for Maori.
I also want to mention some working principles for health care. These aren't in the Coalition Agreement, but they help create a positive environment in health. They are principles that enable people to do the best job they can, in all areas of health.
Finally, I want to look at the issues around providing, and receiving, good Maori mental health care. I want to talk about the Government's strong commitment to Maori providers.
It is increasingly obvious that Maori are best able to respond to challenges in Maori mental health care. As Health Minister, I want to allow you to do just that.
The Coalition Agreement on Health included four major policy changes. I think we've done pretty well on these, despite all the political frothing.
We have implemented the free doctors' visits and prescriptions for children under six, on time. We have succeeded where every other government has failed, without a fight with the doctors.
The Transitional Health Authority started business on 1 July, and the four previous RHAs have been dissolved. These are the organisations that spend $5.8 billion of public money, and we have made the change without missing a beat.
In the Budget, hospital part charges were abolished.
CHEs are to become non-profit organisations. This is on track for 1 July next year. Reading their balance sheets, as I have had to do rather more often than is good for my morale, one could say they've been non-profit for quite some time already.
As well as these four major changes, we have also successfully completed, on time, a major policy review promised in the Coalition Agreement, under the name of the Steering Group.
This Steering Group could have been a recipe for disaster. We took 13 people from all over New Zealand, all straight from the coal face of the health system, from right across the spectrum of health politics.
Their work, completed on time, showed that there is now a remarkable degree of consensus on health policy. It is not the divisive issue it once was.
Things are happening, things that reflect what the people of New Zealand wanted from this Government. Things that have been welcomed in the health sector.
The inevitable tensions from a new kind of Government haven't stopped me getting on with the job of improving the Health System, or implementing the Coalition Agreement.
Now I'd like to mention some basic working principles for good health care. These aren't in the Coalition Document but they help to bridge the gap between the assertions of politics and workable health policy.
These principles are what can generate lasting, responsive improvements in our Health System.
Improvements that will last longer than any fads foisted upon health from politicians in Wellington. These principles create a positive environment for all working in health care.
Firstly, we want to organise services around the patient. Patients should not have to stumble blindly around the various services. If you identify with Maori culture, that culture must be recognised and valued as part of who you are.
It comes down to treating individuals with respect. This principle is particularly important in mental health care, when personal identity and integrity often feels so threatened.
Secondly, we can improve greatly improve health services with no extra money by building better relationships between the carers, and their clients.
I am talking about the hospital and the GP, the pharmacist and the psychiatrist, the social worker and the whanau.
Again, this principle of building good relationships is particularly important in building good mental health care. Mental illness is marked by stressed relationships. Good relationships are not only sensible, they are part of the healing.
The various carers have different jobs and different funding for doing them. What they do have in common is the people they serve - and that is more important than any differences.
Thirdly, we are looking for local solutions to local problems.
Effective health care is often about knowledge of local social conditions, community habits, and relationships.
What works for Te Atiawa doesn't necessarily work for Ngai Tahu. They are different peoples with different needs.
It's time we developed the flexibility to treat them differently if that's what will work best.
The final principle is that clinical and financial decisions are best made by those with good reasons to get them right.
In my experience, that generally means those closest to the needs. Maori providers have every reason to make the best decisions for their communities. That's why I think they are the most likely ones to do so.
In the past, the traditional, paternalistic models of mental health care too often haven't worked for Maori. Often they haven't worked well for anyone, but in this country Maori have suffered most from lack of appropriate care.
I am not saying that people in mental health institutions have not tried to cater for their Maori consumers. Many of you are working hard and getting good results.
But in other places the very most that has been done has been token grafting. A touch of te Reo here, a bit of tikanga Maori there, and some consultation with Maori just hasn't been enough. It hasn't been enough for Maori to ask for or receive the kind of care they really need.
The story of past inadequacies is told in the statistics. You will know the figures and patterns as well as I do, but it's worth stressing how totally unacceptable they are.
The patterns are that of enforced admission to psychiatric care, when things are at crisis point for the individual, their family, and the community at large.
Yet Maori admitted to hospitals spend 40% less time there than other races, despite their illnesses being more severe. The stays are shorter, but the readmissions are much higher.
The figures about Maori hospitalisation imply that either the preventative and primary care in mental health is just not there for them, or is simply not adequate. They also imply that the treatment received once in care is not appropriate.
Drug and alcohol abuse is a particularly harmful point of entry for mental illness among Maori. Drug psychosis admissions have grown the fastest, making up 21% of all Maori admissions for drug and alcohol reasons. Maori women are also beginning to suffer hugely in this area.
One of the worst things about them is that we fear they have not yet peaked.
Let's just look at drug abuse. If young Maori are suffering more and more from drug abuse, their children will do so too. It's hard to have good mental health when your parents are stoned. This, of course, is not just a Maori problem. The stresses from poor mental health spread out through families to the whanau, and the community at large.
So - we really need to have the best mental health care we can, as soon as we can. That is the only way we can prevent further escalation of mental illness.
This Government has a commitment to Maori providers of health care. It's shown in the funding. For the year 1997/98 the Government is funding Maori provider development with $7.5 million. That will increase by a further $10 million in 1998/99, and another $10 million in 1999/2000.
The National Drug Policy, The National Mental Health Standards, and Moving Forward are all documents that underline the Government's commitment to Maori involvement in Maori mental health care.
More and better services for Maori is a crucially important part of Moving Forward, and very specific targets have been set for this strategic direction.
I am personally very supportive of Maori taking the responsibility of providing health care for Maori. It fits in with all those working principles I mentioned earlier.
It fits in with treating the individual with respect, gearing the services to them, and not what suits the system. Maori should be better able to treat other Maori with that kind of sensitivity.
That is especially so if they are the ones putting the systems in place. It is important to recognise that Maori come from all kinds of backgrounds, and what is appropriate to one person may be unacceptable to another. Being responsive to the needs of each person requires flexibility.
Maori providers are better placed to build up the most useful relationships in providing health care. I've just been looking at the business plan for developing Mental Health Services in Waitemata Health, and that's exactly what this plan stresses. Maori can best create working linkages to their communities.
These working relationships also mean that local solutions can be developed for local problems.
The final principle, that the most suitable people are allowed to make the best decisions, also fits in here. The most suitable people are not always the most academically qualified ones either.
One example often given is that of the diagnosis of schizophrenia being mistakenly given in a case of Mate Maori. Being a highly qualified psychiatrist in this case would not give you the full picture. Maori cultural awareness is also necessary.
These working principles also underline the particular importance of having Maori providers for mental health care. A broken leg is a broken leg in any culture, and the treatment and outcomes are pretty standard.
A great deal of mental illness, its diagnosis and treatment, is culturally determined. Often what's important is the social process around the care as much as the care itself.
It will not be easy for Maori providers. It also won't be easy for non-Maori working in mental health for Maori and non-Maori, all will need to be open to be challenged and to do things differently.
Developing the kinds of services Maori need will take time, hard thought, and determined effort. It will require creativity, innovation, enthusiasm and responsiveness. Relationships must be developed. More qualified people are needed - the academically qualified, the culturally sensitive, and those with plain old common sense and empathy. Better co-ordination of drug/alcohol and mental illness is needed. More primary care and health education is needed.
We also don't want to lose what services are already targeted for Maori, but to enhance these as well. We can't expect instant miracles.
We do expect that Maori providers will use every resource they have the best way they can and to be accountable. Developing good Maori provision in health is a major responsibility, of national importance. As I have already stressed, good mental health in Maori is important not only for Maori but all New Zealanders.
Maori health providers are doing great things already for their people. They start without the baggage of history that most of our other health providers have. They have a burning enthusiasm for their task.
Already, much valuable experience has been gained, and the commitment of the providers has already been shown. I hope the Government's commitment to the development of Maori providers in mental health is equally clear.
The Coalition Government's achievements have shown we can deliver better health care in this country, and will continue to do so. The Coalition Agreement set out the development of competent Maori providers in health as being a critical requirement. This is what we are all working on, right now.
This Government is opening up the system to Maori providers of Maori mental health care. This is a great challenge.
From now on making progress isn't just about the Government's commitment to this idea. It's as much about you in Maori mental health care taking up the challenge, and drawing upon your many strengths. As that example of the Waitemata Mental Services plan shows, you begin at the beginning, and build from there.
Confidence can only be gained through doing. We've reviews, inquiries and reports - all essential, but now it's time to put words into action.
Let me tell you a story.
He ika kai ake i raro
He rapaki ake i raro
(As a fish nibbles from below, So the ascent of the hill begins from below - every journey starts with the first small step forward. Working together must start somewhere.)