DOCSLIB.ORG

Researchspace@Auckland

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Researchspace@Auckland http://researchspace.auckland.ac.nz ResearchSpace@Auckland Copyright Statement The digital copy of this thesis is protected by the Copyright Act 1994 (New Zealand). This thesis may be consulted by you, provided you comply with the provisions of the Act and the following conditions of use: • Any use you make of these documents or images must be for research or private study purposes only, and you may not make them available to any other person. • Authors control the copyright of their thesis. You will recognise the author's right to be identified as the author of this thesis, and due acknowledgement will be made to the author where appropriate. • You will obtain the author's permission before publishing any material from their thesis. To request permissions please use the Feedback form on our webpage. http://researchspace.auckland.ac.nz/feedback General copyright and disclaimer In addition to the above conditions, authors give their consent for the digital copy of their work to be used subject to the conditions specified on the Library Thesis Consent Form and Deposit Licence. Mental Health Policy Transfer and Localisation in Samoa and Tonga: International Organisations, Professionals and Indigenous Cultures Timothy Philip Fadgen A thesis submitted in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Political Studies University of Auckland 2013 Abstract This thesis explores the development of mental health systems in the Pacific Island Countries (PICs) of Samoa and Tonga through an examination of several policy transfer events from the colonial to the contemporary. Beginning in the 1990s, mental health became an area of global policy concern as reflected in concerted international organisation and bilateral aid and development agendas, most notably those of the World Bank, World Health Organization, and the Australian Agency for International Development. Tonga and Samoa both reformed their respective mental health systems during these years, after relatively long periods of stagnation. By undertaking a comprehensive investigation of the respective governments’ policy- and law-making processes from 2000-2007, this thesis identifies three distinct levels of policy implicated in mental health system transfer processes from developed to developing nations: (1) colonial authority and influence; (2) decolonisation processes; and (3) the global development agenda surrounding health systems. I use the policy transfer literature to explain these policy outcomes and expand it to include consideration of the historical institutional dimensions evidenced by contemporary mental health systems. These policy levels include (1) formal policy transfers, which tend to be prescriptive, involving professional problem construction and the designation of appropriate state apparatus for curative or custodial care provision; (2) quasi-formal transfers, which tend to be aspirational and involve policy instruments developed through collaborative, participatory processes; and (3) informal transfers that tend to be normative and include practices by professional actors in delivering service merged with traditional cultural beliefs as to disease aetiology as well as reflecting a deep understanding of the cultural context within which the services will be delivered. I conclude that informal policy transfer through information-sharing, training and social networks effectively delivered the values of the respective mental health systems many years prior to formal or quasi-formal transfers. The informal transfers involved medical professional policy entrepreneurs influencing service delivery practices to their respective community-based service visions. These informal transfers were marked by a high degree of hybridisation of international and indigenous mental health best practices. Formal and quasi-formal policy transfers, by contrast, occurred only with the direct intervention of foreign experts. i Dedication I wish to dedicate this thesis to several people, without whom the past several years’ research would not have been possible and this work would never have developed. First and foremost, Meg: for your constant support, patience and love. Last but not least, shortly after embarking on this journey, Edie and Eoin Fadgen joined the family and I wish to thank them for the joy and purpose they provide. Thank you from the bottom of my heart. ii Acknowledgements I wish to recognise the important contribution of my doctoral adviser Dr Jennifer Curtin. Her attention, focus, thought, comments and care have made all the difference in completing this thesis. I wish to acknowledge the very kind assistance of Dr Sailau Suaalii-Sauni of Victoria University and Dr ‘Ema Wolfgramm-Foliaki for their very kind assistance in making introductions to various individuals in Samoa and Tonga, respectively. In addition, the Prime Minister’s Offices of Samoa and Tonga as well the Samoan and Tongan Ministries of Health, Tonga’s Ministry of Education, the National Museum of Samoa Archives, the New Zealand National Archives and especially the Legislative Assembly of Samoa’s Speaker’s Office and Parliamentary Library and Tonga’s Parliamentary Speaker’s Office and Parliamentary Library for their kind assistance in gathering original documents for this research. I wish to acknowledge Melanie Boutin, John Wiinikka, Dana Prescott, Guy Charlton, Sailau Suaalii- Sauni, Tim Tembensel, Maria Rublee, Joe Atkinson and Jon Pierre for reviewing the thesis and ideas at various stages of development and for their helpful feedback. I especially wish to thank my sister, Megan Roman, and Paul Vincent for their meticulous assistance proofreading the manuscript. I would also like to thank Sala Mataele for help with translating Tongan parliamentary debate transcripts. Finally, I wish to acknowledge and express my profound gratitude to the University of Auckland for their generous support of this research over the past several years. iii Table of Contents Abstract ......................................................................................................................... i Dedication ..................................................................................................................... ii Acknowledgements ...................................................................................................... iii Table of Contents ......................................................................................................... iv List of Tables ............................................................................................................... vii List of Common Abbreviations ................................................................................... viii Glossary ....................................................................................................................... ix Chapter 1 ...................................................................................................................... 1 Introduction ................................................................................................................... 1 1.1 Situating the Thesis ........................................................................................................................ 3 1.2 Thesis Outline .................................................................................................................................. 4 1.3 Summary ........................................................................................................................................ 13 PART I: Mental Health Policy Transfer: Background, Theory and Method ................ 15 Chapter 2 .................................................................................................................... 15 Mental Health Policy: Setting the Thesis Context ...................................................... 15 2.1 What is Mental Health? ................................................................................................................ 16 2.2 The Cultural Dimension of Mental Health .................................................................................. 17 2.3 What Makes Up a Mental Health System? ............................................................................... 20 2.4 Can the Mental Health Policy Context Be Understood through Institutionalism? ................ 21 2.5 Mental Health Policy Development at the ‘Policy Core’: North America and Western Europe ...................................................................................................................................................... 27 2.6 The Global Mental Health Context ............................................................................................. 35 2.7 Conclusion ..................................................................................................................................... 38 Chapter 3 .................................................................................................................... 41 Policy Transfer ........................................................................................................... 41 3.1 Explaining Policy Migration: Diffusion, Lesson Drawing, Convergence and Policy Transfer 41 3.2 The Policy Transfer Framework .................................................................................................. 52 3.3 Conclusion ....................................................................................................................................
Load more

Recommended publications
  • Changing Mental Health Legislation in the UK† Tony Zigmond
    Advances in Psychiatric Treatment (2008), vol. 14, 81–83 doi: 10.1192/apt.bp.107.005116 Editorial Changing mental health legislation in the UK† Tony Zigmond Abstract Following devolution, the mental health acts of the constituent countries of the UK are diverging in their provisions. This editorial describes three significant differences between the new Mental Health (Care and Treatment) (Scotland) Act 2003, which came into effect in Scotland in 2005, and the Mental Health Act 2007 for England and Wales. Devolution, in relation to mental health law, has It has been argued that we should not have come of age. The Mental Health (Care and Treat- any separate mental health legislation and that ment) (Scotland) Act 2003 is very different both the mental capacity legislation, with perhaps from its forerunner in Scotland and from the Men- some additional safeguards, should be the basis tal Health Act 1983 for England and Wales, even as for all non-consensual treatment (Zigmond, 1998; amended by the Mental Health Act 2007. Should Szmukler & Holloway, 1998). The proposals for the report of the Bamford Review of the legislative Northern Ireland are in line with this approach. The framework in Northern Ireland (Bamford Review of College in England and Wales took the view, as had Mental Health and Learning Disability (NI), 2007) already been accepted in Scotland, that the criteria be accepted and turned into a mental health act then for determining capacity as set out in the Mental we will have a third, very distinct, piece of mental Capacity Act 2005 are too narrow for use with people health law with in the UK.
    [Show full text]
  • The Need for a Rights-Based Public Health Approach to Australian Asylum Seeker Health Jo Durham1* , Claire E
    Durham et al. Public Health Reviews (2016) 37:6 DOI 10.1186/s40985-016-0020-9 REVIEW Open Access The need for a rights-based public health approach to Australian asylum seeker health Jo Durham1* , Claire E. Brolan1,2, Chi-Wai Lui1 and Maxine Whittaker1,3 * Correspondence: [email protected] Abstract 1Faculty of Medicine & Biomedical Sciences, School of Public Health Public health professionals have a responsibility to protect and promote the right to School of Public Health, The health amongst populations, especially vulnerable and disenfranchised groups, such University of Queensland, Herston as people seeking asylum and whose health care is frequently compromised. As at Road, Herston, Queensland 4006, Australia 31 March 2016, there was a total of 3707 people (including 384 children) in immigration Full list of author information is detention facilities or community detention in Australia, with 431 of them detained for available at the end of the article more than 2 years. The Public Health Association of Australia and the Australian Medical Association assert that people seeking asylum in Australia have a right to health in the same way as Australian citizens, and they denounce detention of such people in government facilities for prolonged and indeterminate periods of time. The position of these two professional organisations is consistent with the compelling body of evidence demonstrating the negative impact detention has on health. Yet in recent years, both the Labour and Liberal parties—when at the helm of Australia’s Federal Government—have implemented a suite of regressive policies toward individuals seeking asylum. This has involved enforced legal restrictions on dissenting voices of those working with these populations, including health professionals.
    [Show full text]
  • International and Regional Influences on Tonga's
    INTERNATIONAL AND REGIONAL INFLUENCES ON TONGA’S MENTAL HEALTH ACT Timothy P. Fadgen* Abstract In 2001 Tonga adopted a new mental health law as part of an overall health sector reform process. This was only the third iteration of a statute designed to address the island Kingdom’s mental health sector since 1948. International actors had considerable influence over the form and substance of each of these law changes with only minimal input from the indigenous mental health sector. Moreover, this article will situate the 2001 Act as falling short of international best practice at the time of adoption. The circumstances of how these laws came to be adopted in Tonga play an important role in understanding the law’s proper context within national medico-legal institutions. Given the long gaps in time between policy change at the statutory level, this article will then argue that practitioner application and court interpretation of Tonga’s constitutional rights will likely be the source of any broadening of protections for individuals with mental illness in the near term. Two recent decisions that have implicated Tonga’s Mental Health Act will be discussed. These cases each raise natural justice concerns within the mental health context. This article will conclude that because the law was largely the product of international intervention and was not guided by the development of a local mental health policy setting forth the indigenous aspirations or guiding principles of the mental health system in Tonga, future reforms should follow such a formula and in the interim, advocates should appeal to natural justice to secure their client’s rights are protected in the area of mental health court practice.
    [Show full text]
  • Sepiuta Lopati
    Prevalence of ear disease and its associated hearing loss among primary school children in Tonga: urban versus rural. Sepiuta Lopati ORCHID ID: https://orcid.org/0000-0001-9720-8235 Submitted in complete fulfilment of the requirements for the degree of Master of Surgery by research. July 2020 Department of Otolaryngology The University of Melbourne Abstract Background. Ear disease and hearing loss among children are significant world- wide health problems that potentially cause speech and language development delay, social isolation, and academic failure. The prevalence is highest in low- and middle- income countries including the Pacific island countries where epidemiological data and resources are limited. National programs to raise awareness and detection rarely existed in most Pacific island countries. The purpose of this case study was to determine the prevalence of ear disease and associated hearing loss in primary school children. The data will be used as informed evidence to develop a propose strategies to address ear and hearing problems among primary school children in Tonga. Methods. This was a cross sectional population- based study which used otoscopy, tympanometry and pure tone audiometry to determine the prevalence of ear disease and hearing loss in 10 urban and 12 rural primary schools in Tongatapu. Results were collected on a digitised form from 489 students (88% of total selected population) class 1 to 6 (5 to 14 years of age) and data were analysed using quantitative statistical and mixed model method. Results. Wax was the most common ear problem found in 54.6% (267 students) of the primary school children both partial and occluded wax and more common in urban children (31%) as compare to rural (24%).
    [Show full text]
  • THE RIGHTS and WRONGS of the PSYCHOPATH in CRIMINAL LAW: HOW MODERN SCIENCE MUST RESHAPE OLD POLICY. © Jasmine Nicolson* INTROD
    THE RIGHTS AND WRONGS OF THE PSYCHOPATH IN CRIMINAL LAW: HOW MODERN SCIENCE MUST RESHAPE OLD POLICY. © Jasmine Nicolson* INTRODUCTION Psychopaths have long been enshrined in both popular culture and in law as the face of evil and danger;1 their classic characteristics of callousness, impulsivity, and remorselessness have helped to cement the conceptual link between psychopathy and violent crime.2 Psychiatrists from the 19th century, with all the equipment they had available at the time, made sweeping generalisations about the nature of the disorder. Pinel described patients who appeared without delusions or psychosis, as mentally unimpaired but engaged in impulsive acts of ‘instincte fureur’.3 Prichard built upon this definition to develop the concept of ‘moral insanity’. This term has evolved since its original intent – coming from the original French, ‘moral’ was taken to mean ‘emotional’ rather than ethical – and so the original ‘moral insanity’ was a ‘madness’ of emotional disposition and social ability, but without hallucinations or delusions.4 The concept has since evolved to include a lack of comprehension and appreciation of ethics and morality,5 but ultimately the M’Naghten rules in 1842 forged the legal defence of insanity, which required a clear presence of delusion, rather than a mere lack of morality.6 Both jurisdictions of England and Scotland have since built upon this to include an inability to 1 Cary Federman, Dave Holmes, and Jean Daniel Jacob, "Deconstructing the Psychopath: A Critical Discursive Analysis," Cultural Critique 72, no. 1 (2009). 2 Eric Silver, Edward P. Mulvey, and John Monahan, "Assessing Violence Risk among Discharged Psychiatric Patients: Toward an Ecological Approach," Law and Human Behavior 23, no.
    [Show full text]
  • Decision-Making Behaviour Under the Mental Health Act 1983 and Its Impact on Mental Health Tribunals: an English Perspective
    laws Article Decision-Making Behaviour under the Mental Health Act 1983 and Its Impact on Mental Health Tribunals: An English Perspective Nicola Glover-Thomas ID School of Law, University of Manchester, Manchester M13 9PL, UK; [email protected] Received: 21 February 2018; Accepted: 20 March 2018; Published: 24 March 2018 Abstract: In England and Wales, the Mental Health Act 1983 (MHA 1983) provides the legal framework which governs decisions made concerning the care and treatment of those suffering from mental disorders, where they may pose a risk to themselves or others. The perspective of the patient and the care provider may conflict and can be a source of tension and challenge within mental health law. Through access to a mental health tribunal, patients are offered the apparatus to review and challenge their detention. With detention rates under the mental health legislation rising exponentially, this is having a knock-on effect upon tribunal application numbers. As there is a legal requirement to review all cases of individuals detained under the MHA 1983, understanding the key drivers for this increase in detention is essential in order to understand how to better manage both detention rates and the upsurge in tribunal caseloads. With the increase in overall activity, mental health tribunal workloads present significant practical challenges and has downstream cost implications. Keywords: detention; caseload; mental health tribunal; Mental Health Act 1983; decision-making; risk; costs 1. Introduction Mental illness costs the UK economy £100 billion a year (Johnson 2016; McCrone et al. 2008). In 2012, the Her Majesty’s (HM) Government spent £126 billion on health (HM Treasury 2011, p.
    [Show full text]
  • Public Health Association of Australia
    FSANZ Amendment (Forum on Food Regulation and Other Measures) Bill 2015 Public Health Association of Australia Submission on the Food Standards Australia New Zealand Amendment (Forum on Food Regulation and Other Measures) Bill 2015 Committee Secretary Senate Standing Committees on Community Affairs PO Box 6100 Parliament House Canberra ACT 2600 [email protected] Contact for PHAA Michael Moore CEO 30 October 2015 20 Napier Close Deakin ACT Australia, 2600 – PO Box 319 Curtin ACT Australia 2605 1 T (02) 6285 2373 F (02) 6282 5438 E [email protected] W www.phaa.net.au FSANZ Amendment (Forum on Food Regulation and Other Measures) Bill 2015 Contents Executive Summary ...................................................................................................................... 3 Introduction ................................................................................................................................ 3 The Public Health Association of Australia ...................................................................................................... 3 Vision for a healthy population ....................................................................................................................... 3 PHAA’s Mission ................................................................................................................................................ 4 Priorities for 2014 and beyond .......................................................................................................................
    [Show full text]
  • Australia in 2030: What Is Our Path to Health for All?
    SUPPLEMENT 3 May 2021 Volume 214 No 8 www.mja.com.au Australia in 2030 What is our path to health for all? PP255003/00505 Approved Post Print Journal of the Australian Medical Association MJA2_v214_s8_cover.indd 1 4/16/2021 7:14:53 AM Australia in 2030: what is our path to health for all? Coordinating Editors: Dheepa Jeyapalan, Lewis Keane and Cara Büsst This Supplement was sponsored by Citation: Backholer K, Baum F, Finlay S, et al. Australia in 2030: what is our path to health for all? Med J Aust 2021; 214 (8 Suppl): S1-S40; doi: 10.5694/mja2.51020 MJA2_v214_s8_Title.indd S1 4/19/2021 12:44:26 PM Australia in 2030 Contents S5 Our path to health for all: Australia in 2030 Jane Shill, Cara Büsst, Kellie Horton, Kirstan Corben, Sandro Demaio S7 1. How Australia improved health equity through action on the social determinants of health Sharon Friel, Fran Baum, Sharon Goldfeld, Belinda Townsend, Cara Büsst, Lewis Keane S12 2. Aboriginal and Torres Strait Islander connection to culture: building stronger individual and collective wellbeing Summer M Finlay, Karla Canuto, Kootsy Canuto, Nadia Neal, Raymond W Lovett S17 3. Physical determinants of health: healthy, liveable and sustainable communities Billie Giles-Corti, Anthony Capon, Annemarie Wright, Patrick Harris, Anna Timperio, Andrew Butt, Melanie Lowe, Belen Zapata-Diomedi, Carmel Williams, Tahna Pettman, Lucy Gunn S22 4. Health promotion in the Anthropocene: the ecological determinants of health Rebecca Patrick, Fiona Armstrong, Anthony Capon, Kathryn Bowen, Selina N Lo, Aileen Thoms S27 5. Disrupting the commercial determinants of health Alexandra Jones, Jennifer Lacy-Nichols, Phil Baker, Anne Marie T Thow, Jane E Martin, Mike Daube, Kathryn Backholer, Belinda Townsend S32 6.
    [Show full text]
  • Does Mental Health and Guardianship Legislation in Western Australia (WA
    Does mental health and guardianship legislation in Western Australia (WA) protect elderly persons from human rights abuse, and ensure procedural and substantive justice? Neville Francis Hills The University of Western Australia This thesis is presented for the degree of Doctor of Philosophy of The University of Western Australia The work presented in this thesis was performed in the Law School 2016 Thesis: Doctor of Philosophy – Mental Health Law Declaration This is to certify that this thesis does not incorporate, without acknowledgement, any material previously submitted for a degree or diploma from any university and that, to the best of my knowledge and belief, does not contain any material previously published or written by another person except where due reference is made in the text. Signed Name Neville Francis Hills Date December 1, 2016 i Thesis: Doctor of Philosophy – Mental Health Law Abstract This thesis addresses matters affecting the liberty, rights and welfare of older people in Western Australia (WA). Restriction of personal liberty to choose where to live, and who to associate with, is usually only permitted under criminal law, following legal processes. Mental health legislation also permits restraints on freedom of individuals, subject to legal oversight of the process. Admission into an aged care facility may restrict a person’s liberty, if placed in a locked area which they cannot leave without staff assistance. Laws regulating these procedures should be fair, open to scrutiny, and meeting international standards of law and good practice. In 2015 there were 16,350 Commonwealth funded aged care beds in 263 facilities in WA.
    [Show full text]
  • Pacific Ncd Summit Pacific Ncd Summit
    PACIFIC NCD SUMMIT Translating global and regional commitments into local action 20 –22 June 2016, Tonga Programme U N D P Empowered lives. Resilient nations. Table of Contents Page Summit Taskforce……………………………………………. 2 Summit Partners……………………………………………… 2 Welcome…………………………………………………………. 3 Objectives………………………………………………………… 4 Important Information…………………………………….. 4 Agenda…………………………………………………………….. 5 Keynote Address……………………………………………… 8 Speakers' Presentation Summaries………………….. 9 1 Summit Taskforce Dr. Siale ‘Akau’ola, Tonga Ministry of Health (Chairperson) Ms. Potesia Cocker, Tonga Ministry of Health (Secretary) Hon. Fanetupouvava’u Tu’ivakano, Tonga Ministry of Foreign Affairs Ms. ‘Ilaisipa ‘Alipate, Tonga Ministry of Foreign Affairs Ms. Elsie Fukofuka, Tonga Ministry of Foreign Affairs Mr. Saia Misinale, Tonga Prime Minister’s Office Mr. Sisitoutai Tonga, Tonga Ministry of Police Ms. Monica Tu’ipulotu, Tonga Health Promotion Foundation Ms. Iemaima Havea, m-Health project Sr. Seilini Soakai, Tonga Ministry of Health Sr. Afu Tei, Tonga Ministry of Health Sr. Falahola Vakasiuola, Tonga Ministry of Health Mrs. Fusi Kaho, Tonga Ministry of Health Ms. ‘Esiteli Tu’i, Tonga Ministry of Health Dr. ‘Ofa Tukia, Tonga Ministry of Health Mr. ’Eva Mafi, Tonga Ministry of Health Dr. Lisiate ‘Ulufonua, Tonga Ministry of Health Dr. Sione Talanoa Latu, Royal Physician (Adviser) Lord Tangi-‘o-Vaonukonuka, Former Minister for Health (Adviser) Summit Partners The Pacific NCD Summit would not be possible without the support of the following partner agencies: 2 Malo e lelei! Welcome! We are pleased to welcome you to the Pacific NCD Summit, jointly organised by the Government of Tonga and the Pacific Community (SPC). NCDs – primarily heart disease, cancers, lung disease and diabetes – have reached epidemic proportions in the Pacific and are creating a ‘human, social and economic crisis’.
    [Show full text]
  • Public Health Association of Australia Submission on COVID-19
    Public Health Association of Australia submission on COVID-19 Contact for recipient: Committee Secretary A: Department of the Senate PO Box 6100, Parliament House Canberra ACT 2600 E: [email protected] T: (02) 6277 3892 28 May 2020 Contact for PHAA: Terry Slevin – Chief Executive Officer A: 20 Napier Close, Deakin ACT 2600 PHAA submission on COVID-19 Contents Preamble 4 The Public Health Association of Australia ............................................................................................ 4 Vision for a healthy population ............................................................................................................ 4 Mission for the Public Health Association of Australia .......................................................................... 4 Introduction 5 Context 6 Assessing the response through the WFPHA lens ................................................................................. 6 Sustainable Development Goals (SDGs) ................................................................................................ 6 Training and role of public health professionals ................................................................................... 7 Equity .................................................................................................................................................. 8 One Health .......................................................................................................................................... 9 Response 10 Coordination between Governments
    [Show full text]
  • Republic of Kiribati WHO Library Cataloguing-In-Publication Data
    Human Resources for Health Country Profiles Republic of Kiribati WHO Library Cataloguing-in-Publication Data Human resources for health country profiles: Republic of Kiribati 1. Delivery of healthcare – manpower. 2. Health manpower - education. 3. Health resources - utilization. I. World Health Organization Regional Office for the Western Pacific. ISBN 978 92 9061 668 9 (NLM Classification: W76 LA1) © World Health Organization 2014 All rights reserved. Publications of the World Health Organization are available on the WHO web site (www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: [email protected]). Requests for permission to reproduce or translate WHO publications –whether for sale or for non-commercial distribution– should be addressed to WHO Press through the WHO web site (www.who.int/about/licensing/ copyright_form/en/index.html). For WHO Western Pacific Regional Publications, request for permission to reproduce should be addressed to Publications Office, World Health Organization, Regional Office for the Western Pacific, P.O. Box 2932, 1000, Manila, Philippines, fax: +632 521 1036, e-mail: [email protected]. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.
    [Show full text]