Why Is New Zealand’s Mental Health System Failing Māori and Pacific Communities?

A new study published today in the New Zealand Medical Journal found while Māori and Pasific communities had the highest rates of depression and anxiety in the country, they were diagnosed far less than those of other ethnicities.

Mental health workers VICE spoke to say that the results come as no surprise. A cultural gap between, mostly white, medical professionals and the people they are supposed to be helping is making it difficult for Māori and Pacific youth to ask for help.

The paper looks at 15,822 New Zealanders who responded to the 2014/15 New Zealand Attitudes and Values Longitudinal Study. Participants answered the Kessler scale: a survey designed to measure mental distress, and were also asked whether they'd been diagnosed with anxiety or depression. The groups who recorded the highest levels of mental distress were Māori, Pacific and Asian New Zealanders—but these groups also had the lowest rates of diagnosis with depression and anxiety.

Of those groups, Pacific communities tended to be the most under-diagnosed and least engaged with the health system. Pacific and Māori communities both tended to have high levels of mental distress, but "Pacific peoples exhibit lower rates of actual diagnosis and mental health service use than Māori," the researchers found.

The authors concluded that "there is an ethnic inequality in diagnosis". The research comes on the same week as a United Nations report into the use of restraint and isolation in mental health units, which found Maori are secluded four times more often than non-Māori, and for longer periods. It's published on the same day as a study that finds young Pacific men are among the most at risk in the country of suicide.

So why aren't the most at-risk groups getting access to the health system? According to the research, people of colour in New Zealand face a number of barriers including stigma, cost, and cultural divides.

"Among Pacific peoples, factors such as costs, transport and language barriers are likely to contribute to their low utilisation of healthcare services and under-diagnosis."
They add: "perhaps due to the lack of cultural competence among doctors, many Pacific peoples report experiences of low-quality service in primary healthcare."

Mental health educator Mike King told VICE there were still significant cultural divides between Maori and Pacific young people and the professionals offering help. "Would you want to come forward to that if you're a suicidal young man or woman, is that the environment that you'd want to go into?" he asks.

"These professionals are completely un-relatable—it's not their family, it's usually some lovely white person, very highly educated very highly skilled," King says. "What we need is all these well meaning academics and lovely people to actually train some people from these communities to talk. Find people that the kids can connect with."

"I appreciate you've done all of this hard work and it took you years to get whatever letters you've got after your name and stuff, but if the people you're trying to help don't feel a connection with you it's a complete and utter waste of time isn it?"

But even for those who overcome hurdles and stigma to contact the mental health system, there can be other barriers to getting care—including the possibility that doctors aren't as attuned or attentive to the symptoms of people of colour.

Studies from the United States have found black patients are only half as likely to be prescribed pain medication as white patients when all other factors were accounted for.

The latest New Zealand research notes that patients' ethnicities can also influence the ability of physicians to accurately detect mental health problems. For example American physicians were less likely to detect depression in African-American or Hispanic patients displaying the same symptoms.

"Likewise, New Zealand physicians may be less likely to recognise mental health problems in Pacific and Asian peoples," they conclude.

Shaun Robinson, chief executive of the Mental Health Foundation, says that "Clinicians who don't have appropriate cultural training might be less likely to recognise the signs of depression in Māori and Pacific Islanders, too."

"Institutional racism is prevalent in New Zealand and continues to form barriers to Māori and Pacific Islanders accessing the care they need."

He called for the integration of powhiri, karakia, mihihimihi and kai into the mental health system. "We know these practices are effective and useful," he says. "The presence of Māori and Pacific Islander staff, appropriate cultural assessment and the fostering of tino rangatiratanga for tangata whaiora and their whanau can help to reduce these inequalities."

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