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Lotofale Mental Health Clinic: Auckland, New Zealand Lotofale Mental Health Clinic: Auckland, New Zealand Population served: Maori & Pacific Islanders Mental Health Service The University of Kansas School of Nursing: Presented by: Anna Meagher & Jayden Slater Objectives Anna personal objective: To observe the differences in plan of care for patients in an international setting specific to Mental Health in the indigenous population- Maori persons. To decrease anxiety/ depression in Maori males ages 20-30 years old in order to prevent the instance of suicide. Jayden objective: To compare and contrast the similarities and differences between the United States and an international healthcare system. To learn and observe the coordination of care specific to mental health and the Maori/Pacific Islander indigenous population. To grow in my personal and professional understanding of healthcare delivery on a global scale. Background Information New Zealand: North and South Island located in the Southwestern Pacific Ocean Capital City: Wellington, which is located on the Southern >p of the North Island Total populaon of New Zealand: Approx. 4, 762, 473 persons (2018 WorldoMeter) Average life expectancy: according to survey 2015- 17 is life expectancy at birth is 80 for Males and 83.4 for feMales. (StatsNZ, 2018) Photos left to right: skyline of Auckland City, Auckland Sky Tower, map of Wellington Capital of country Background Information Continued... Gender Rao- Male:FeMale = 97:100 Average IncoMe per Household-$105,719 New Zealand Dollars (NZD). Before taxes (StatsNZ, 2018). Poverty level-about every 1 in 7 households are in poverty (about 682,500 people) (StatsNZ, 2018). Educaonal level-New Zealand has 8 state-funded universi>es. In 2017, 51% of the eligible populaon held ter>ary cer>ficates (college degrees) or higher Lotofale Clinic is an outpatient branch of Auckland City Hospital (StatsNZ, 2018). Major sources of eMployMent-Business (finance, insurance, Marke>ng, accoun>ng), Manufacturing, Agriculture, Health/Medicine, Engineering Poli>cal structure-cons>tu>onal Monarchy (under Bri>sh rule), with parliament. The current PriMe Minister of New Zealand is Jacinda Ardern. Cultural Health Beliefs-Standard westernized Medicine prac>ces. Maori have specific health beliefs included in the “Fonofale” Model. ● Health consists of a coMbinaon of factors including cultural and familial prac>ces and physical/Mental/spiritual health. Health Dispari>es- The Maori are New Zealand’s Minority populaon, and therefore are More predisposed to health dispari>es like obesity, diabetes, cardiovascular disease, and others. (StatsNZ, 2018). Bay of Islands, north of Auckland New Zealand Description of Clinical Site: outpatient mental health facility Total population at Lotofale Clinic: 130 - 160 patients average, 155 patients at time of clinical rotation Age: 20-30 years old Gender ratio: 75% male 25% female income/poverty level of the population group Most unemployed, many receive between $100-300 per week from government benefits Educational level: Lotofale serves all levels of education from primary school through university (all classes are affected). Lotofale: Serves New Zealand’s minority population Greenlane Clinic-Lotofale Mental Health Services Cultural health beliefs and behaviors: pacific islander persons and Maori are different! Lotofale works with both and upholds their beliefs and values in their daily practice. Pacific Islanders health beliefs Traditional healing in Maori culture is through an elder or traditional healer. Traditionally, mental health was not believed to be an illness. Lotofale emphasizes the importance of psychoeducation in their care of Maori patients. They explain mental illness to them as a sickness of the brain. Behaviors of pacific islanders: spiritual, prioritize values, family, traditional. specific health disparities noted: Pacific islanders and Maori are marginalized groups in New Zealand. Therefore, they are overrepresented in statistical figures. Marginalized groups including blacks, transgender, Maori and Pacific Islanders statistically have worse outcomes than non groups. Health outcomes like obesity, diabetes, ischemic heart disease and mental illness/suicide are worse for these groups Aggregate Population ● Lotofale Mental Health Clinic ○ 155 at the time of data collection: January 23, 2019. ● Patient population: ○ 20-30 y/o overweight Māori males ○ Health issues including but not limited to: ■ suicidal ideation, depression ■ obesity, diabetes, and high blood pressure Davenport, New Zealand It is important to note that the nurses medications for mental illness- including risperidone, have the adverse effect in making patients overweight. There is a stress for psychoeducation on exercise, diet, and encouraging group walking meets ● Nurses and health care providers lack resources in furthering optimal patient outcomes due to short staffing and lack of government funding/ allocation of money specifically to mental health populations Mental Health Issues and Suicidal Ideation in New Zealand ● Suicide ○ Suicide is the second leading cause of death in non-Maori men and third in Maori Men (Ministry of Health, 2015) ■ Not ranked in the top 5 causes of death for either Maori or non-Maori women (Ministry of Health, 2015) ○ In 2015, for every female suicide there was 2.7 male suicides (Ministry of Health, 2017) ■ 384 male suicides ■ 143 female suicides ○ The highest rate of suicide is among the young adult Maori Male population, ages 19-30 (Ministry of Health, 2017) ○ Mental health is a disease that occurs globally; we happen to be working with the indigenous population of New Zealand ● New Zealand’s Ministry of Health ○ Similar to the United State’s Health People 2020 objectives, New Zealand has a Ministry of Health that creates health objectives for the country ■ SDG’s are goals that are set for social and economic development issues including health and education ■ Both the USA and New Zealand use their platforms of HP2020 and Ministry of Health, respectively, to create and adapt their goals for optimal health outcomes. ○ The NZ Ministry of Health objectives for suicide include: ■ Promote mental health well-being, prevent mental health problems ■ Support families/whānau, friends and others affected by a suicide or suicide attempt The Health Promotion PLAN Weekly Mental Health Support Groups ● Support groups are an important resource for mental health patients to help them address concerns, find a community, seek support, and learn about coping strategies. Vision: A weekly support group to be implemented into the community. It helps promote the conversation, knowledge, and understanding of mental health issues specifically highlighting suicidal ideation among Maori and Pacific Islanders in New Zealand. Benefits:With the help of volunteers, nurses, and various resources like flyers for marketing and cars for transportation, a weekly support group run by trained professionals can be an asset to the mental health community of New Zealand. Auckland City Skyline Viaduct Marina Health Promotion Model The Fonofale Model ● The Lotofale Clinic uses the Fonofale model as a guide to understanding and treating the Pacific Island people in a safe, culturally appropriate, and holistic way. ● The model is both physical and visual in nature. It depicts the values and beliefs that are foundational to the Maori culture. ○ The Foundation: Family ○ The Roof: Culture ○ The Posts ■ Physical health ■ Mental health ■ Spiritual health ■ Other (gender, identity, age, SES, etc) Final Take-Aways Suicide is an increasingly important health issue, both globally and within New Zealand. ● It can affect people of all ages, sexes, education levels, socioeconomic statuses, and lifestyles ● Government does fund healthcare in New Zealand, but more must be allocated specifically to mental health in order to deliver safe, high- quality, and culturally competent care. Highlights of Experience- Anna The most profound professional experience I had in Auckland, New Zealand was the day we were able to tour the inpatient acute care mental health wards at Auckland City Hospital. The mental health units are set up like dorms in college- patients walk the wards and nurses sit in nurses stations that are encased in glass. The most profound personal experience was understanding the culture of zero hierarchy between patient, nurse, and physician. The doctors (who published books and literature on their work) are seen as on the same hierarchy level as the patients are. Auckland City Hospital Anna & Jayden Jayden’s Highlights References Centers for Disease Control and Prevention [CDC]. (July 2017). Global Health: Heart Disease. Retrieved February 26, 2019 from https://www.cdc.gov/heartdisease/facts.htm Mangurian, C., Niu, G., Schillinger, D., Newcomer, J., Dilley, J., & Handley, M. (December 2017). Utilization of the Behavior Change Wheel framework to develop a model to improve cardiometabolic screening for people with severe mental illness. Implementation Science. 12(134). https://doi.org/10.1186/s13012-017-0663-z Pitama, S., Huria, T., & Lacey, C. (2014). Improving Maori health through clinical assessment: Waikare o te Waka o Meihana. The New Zealand Medical Journal, 127 (1393), 107-119. Retrieved February 12, 2019. From doi: 10.3390/ijerph6112843. Stats, NZ (2018). New Zealand Census and Tatauranga Aotearoa. Retrieved 21 February, 2019 From https://www.stats.govt.nz/ .
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