Pacific Models of Mental Health Service Delivery in New Zealand (“PMMHSD”) Project Clinical Research and Resource Centre Waitemata District Health Board Auckland Francis Agnew Fuimaono Karl Pulotu-Endemann Gail Robinson Tamasailau Suaalii-Sauni Helen Warren Amanda Wheeler Maliaga Erick Tevita Hingano Helen Schmidt-Sopoaga The Mental Health Research and Development Strategy is a partnership between the Ministry of Health, Health Research Council of New Zealand, and Mental Health Commission. Published in September 2004 by the Health Research Council of New Zealand, PO Box 5541, Wellesley Street, Auckland, New Zealand; Telephone 09 379 8227, Fax 09 377 9988, Email [email protected]. This document is available on the Health Research Council of New Zealand website http://www.hrc.govt.nz and the Mental Health Research and Development Strategy website http://www.mhrds.govt.nz ISBN 0-908700-35-0 “…I believe that our Pacific people understand in our own way what discrimination and stigma is, through their own personal experience, can help see people for who they are, that they aren’t just being mental health [consumers], they are actually consumers who have communities, who have value outside of the label that’s forced on them.” (Pacific mental health consumer). “As Pacific Island people we are still very community minded, we are not from the capitalist world. There is a danger of working too much from our heart, with our calculating financial cost and all that. We need to balance it. But I think they [Pacific mental health service providers] are very much…working from the heart in a way that people who were brought up under the capitalist system are not…and I think those are the things that make us, makes our [Pacific] service uniquely Pacific and makes it work well, because you can connect.” (Pacific family member). “…One most significant and very important [thing] I see, is the culture.[…] It is not only the way we talk but [the] way of bringing people together and talk about our own understanding of the sickness.” (Pacific Service Provider Participant). “For the Native person to be whole, the physical, the mental, the emotional, the spiritual all have to be in the circle. All those things have to be in balance for a person to be healthy. […] I want to see our Native ways of knowing, learning and teaching recognized. We need to ensure that our Native ways are being taught as well as the ways of the western world.” (Patricia Longley Cochran, Executive Director of the Alaska Native Science Commission). “Defining mental health is almost as tricky as defining spirituality. It is another elusive concept and like spirituality, an utterly subjective experience. For me, it means knowing who I am and accepting that. Mental health is the state of freedom which comes from accepting one’s self and taking responsibility for one’s actions. It is many other things as well of course – acceptance of others as they are, acceptance of life as it is, knowing when and how to change and when and how to let go.” (Julie Leibrich, 2001). i About the Team Dr Francis Agnew: (MBChB, FRANZCP, FAChAM). Consultant psychiatrist and Service Director of Isa Lei Pacific Mental Health and AOD Services, Waitemata District Health Board (WDHB) and Lotofale Pacific Mental Health Services, Auckland District Health Board (ADHB). Chair of ALAC Pacific Reference Group and co-chair of the Cook Island Health Network. Member of Ministry of Health Pacific Reference Group, Mental Health Research and Development Strategy Steering Committee, Mental Health Workforce and Development Programme Committee, Health Research Council Pacific Mental Health Awards Committee and the CRRC Governance Board. Senior Lecturer (Hon), Social and Community Health, Faculty of Medical and Health Sciences, University of Auckland. Born in Wellington and grew up in Porirua and is of Cook Island Māori descent. Fuimaono Karl Pulotu-Endemann: (RcompN, PostGradForensicPsychCare). Health Consultant for Pacific mental health and sexual health for the last 10 years. Involved in policy development and Pacific mental health services/workforce development. Amongst his many roles he is a board member on the Mental Health Commission, Alcohol Advisory Board New Zealand (ALAC), the Hutt Valley District Health Board, and is Chair of the Community and Public Health Advisory Committee. Born in Apia, Western Samoa and holds an Ali'i (High Chief) title of Fuimaono from Salani, Western Samoa. Dr Gail Robinson: (MBBCh, FCPsych(SA), FRANZCP, GradDipBus(NVn), FAChAM). Co-Director, Clinical Research and Resource Centre (CRRC) and Senior Clinical Advisor, Pacific Mental Health and AOD Services, Mental Health Services Group, Waitemata District Health Board, Auckland. Clinical Lecturer (Hon), Department of Social and Community Health, Faculty of Medical and Health Sciences, University of Auckland. Tamasailau Suaalii-Sauni: (LLB, MA-Hons – Sociology). Senior Researcher, Clinical Resource and Research Centre (CRRC), and Lecturer, Department of Sociology, University of Auckland. Born in Saoluafata, Samoa; raised in Auckland, New Zealand and is of Samoan descent. Dr Helen Warren: (PhD, RcompN). Senior Researcher, Clinical Research and Resource Centre (CRRC), Mental Health and AOD Services, Mental Health Services Group, Waitemata District Health Board, Auckland. Lecturer, Social and Community Health, Faculty of Medical and Health Sciences, University of Auckland. Amanda Wheeler: (BSc BPharm, PGDipPsychPharm, PGCertPubHealth). Co-Director, Clinical Research and Resource Centre (CRRC), Specialist Mental Health Pharmacist, Mental Health and AOD Services, Mental Health Services Group, Waitemata District Health Board, Auckland, and Senior Clinical Lecturer (Hon), School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland. Maliaga Erick: (DipofSW, CQSW, GdCertMentalHealth(DD)). Senior Community Support Worker with Lotofale Pacific Mental Health Services. Pacific Advisor to the Mental Health Advocacy Coalition, Reference member to the Mental Health Commission. Born in Nuie, lives in Auckland and is an active member of the Nuie community. Tevita Hingano: (BN), working towards completion of a PostGradDipBus(Health Management) at the University of Auckland. Manager for Community Services for Pasifika Healthcare in West Auckland. Previous nursing experience in Inpatient and Community mainstream and Pacific mental health services and Pacific researcher Clinical Research and Resource Centre (CRRC). Tongan born and raised. About the Team iii Helen Schmidt-Sopoaga: BSc, PostGradDip(Sc), working towards completion of MHSC. Currently working as an alcohol and drug worker in the South Auckland CADS. Previous roles in the alcohol and drug field and as a Pacific researcher in Clinical Research and Resource Centre (CRRC). New Zealand-born of Samoan descent. iv About the Team Our Thanks Gathering the information for this report would not have been possible without the generous help and support of a large number of people. We would like to express our deepest gratitude to all those who took part in all of the activities necessary to compile this report. To the members of the initial Fickling Centre fono in Auckland 2002, the team acknowledges your collective contribution to kick-starting this journey – fakaue lahi. To all of the consumers, their family members and the Pacific mental health service providers (from our matua, through to our community support workers and to our managers) who gave so generously of their time and knowledge – meitaki, fakaue lahi, malo ‘aupito, vinaka vaka levu, faafetai tele lava…our warmest and most sincere thanks to you all! We note a particular thank you to Lotofale, Pacific Canterbury Trust, PaCH and Health Pasifika for allowing us the use of their venues during our various fono meetings – meitaki maata. To the members of our Reference Group, Fuimaono Karl Pulotu-Endemann, Hemi Lesatele, Vito Malo (Nonumalo), Dr Francis Agnew, Dr Sandy Simpson, Karlo Mila-Schaaf, our sincerest and warmest thanks, vinaka vaka levu, for your commitment and wise counsel. To the matua who supported the team and to Auimatagi Epa who undertook the formal blessing of the project, malo ‘aupito, faafetai, for your support, especially for the cultural blessing you gave us. To our project translators and translation editors, faamalo atu, your work contributed immensely to the rigor of our findings. To our overseas correspondents and Māori informants, who also gave generously of their time and knowledge, faafetai tele lava, many warm thanks to you all. To our report editor, Nikki Holmes, we also thank you for your invaluable feedback, your comments have made this document much tighter. Finally, to our CRRC colleagues and administrative staff, faafetai tele lava for your smiles, your collegial support and/or willingness to assist in the many administrative tasks required to make this project work. Our Thanks v Glossary of Acronyms and Key Terms ADHB Auckland District Health Board DHB District Health Board DSW Department of Social Welfare GP General Practitioner (usually medical) MoH Ministry of Health MHC Mental Health Commission NGO Non Government Organisation WDHB Waitemata District Health Board WHO World Health Organisation The following terms/concepts/phrases are for the purposes of this research used in the following manner: Consumer refers to those persons with the mental illness. It does not include families of those persons. This meaning is adopted to keep in line with that used predominantly by the participants of this