In September 2001 the Mental Health Commission published Cultural Assessment Processes for Māori: Guidance for Mainstream Mental Health Services. In 2003, to assess the impact of this guidance and to develop advice on practical implementation of cultural assessment, they commissioned a project in two phases: first a phone survey of managers and kaumatua /kaimahi in acute units and, second, the development of advice from Moe Milne, an experienced Māori mental health practitioner, based on her knowledge, experience and visits to the five DHBs with the largest Māori populations.
The aims of the project were to:
- Raise the profile of the Commission’s publication Cultural Assessment Processes for Māori: Guidance for Mainstream Mental Health Services (the guidance) and consider its impact
- Encourage mainstream mental health services to apply the guidance
- Share examples of good practice among mental health services.
To achieve these aims the project involved:
Phase 1: A phone survey of district health board (DHB) acute inpatient units (conducted by Brora Ltd) assessing the extent to which cultural assessment has been implemented at this intake point for mental health services.
Phase 2: A short programme of visits by Moe Milne (of Te Moemoea), an experienced mental health practitioner and trainer with extensive experience in cultural assessment, to identify and document good practices.
Phase 3: Development of a paper presenting the results and offering practical advice.
All 21 DHBs’ mental health managers were sent briefing papers outlining the project and of those, 20 nominated people to be surveyed by telephone. Most mental health managers nominated a manager/team leader in their mainstream inpatient unit (IPU) and a kaumatua or kaimahi responsible for cultural assessment in that unit. These mainstream and Māori nominees were then contacted and mutually acceptable times were set for the telephone survey.
Prior to the interview all nominees were contacted by telephone and e-mailed a copy of the briefing paper and the survey question. One of the interviewers spoke Te Reo Māori and the approach to engaging interviewees encouraged open sharing of information.
The survey was field tested and estimated to take 30 minutes. Respondents were assured of confidentiality, which is being respected by producing only national aggregate results.
Nominees were very responsive and welcomed the opportunity to share information about cultural assessment in their service. The average time of most interviews exceeded 30 minutes, with some taking up to an hour and a half. Some DHBs chose to interview in combination (mainstream and Māori) where others had small groups from teams contribute to the interview. In two DHBs the manager/team leader was Māori and represented both Māori and mainstream. Three DHBs presented only Māori for interview. Nominees surveyed included: kaumatua and kuia, clinical leaders, charge nurses, team leaders, whaimanaaki and kaitakawaenga.
Following the interview, a record was sent to those interviewed, with a request for them to make amendments. Once returned these final records were then analysed to provide a national report.
Observations from Moe Milne
Moe is of Ngati Hine and Ngapuhi nui tonu descent. Her pakeha whakapapa comes from her father who was Irish and French. Moe is a registered psychiatric nurse, and was Māori manager for the Northland Area Health Board, locality manager for Northern Regional Health Authority and Kaiwhakahaere (Māori manager) for the Health and Disability Commission. She has worked as a psychopaedic nurse and in general nursing. Moe is also a certificated teacher and has worked in both mainstream classes and within Te Reo Māori education/teaching.
The Commission asked Moe Milne to describe examples of good cultural assessment practice and provide advice for improvement drawing on her experience, her knowledge of services generally and on field visits to five DHBs with the largest Māori populations. This involved discussions with tangata whaiora, kaumatua, kuia, kaimahi, Māori clinicians, team leaders and managers across a range of both adult and child and adolescent services in community and inpatient settings.