Best health outcomes for Maori - Medical Council of New Zealand

In some cases, the whänau may need to discuss the
options before making a decision, and time should be
allowed for this to occur, unless (as in the case of an
urgent amputation) this could place the patient at risk. 50
If the whänau request that the body parts, tissue or
substance be returned to them, this should be done
unless there is an overriding safety concern. 50 In this
case, the concerns should be explained to the whänau
and patient, so that it is clear the decision was not an
arbitrary or unreasonable one. In every case, provide
explanations on handling and disposal of the material(s).
2. Anaesthesia
In common with most patients, Mäori are concerned
that they will be accorded proper respect and dignity
while anaesthetised in the operating theatre. At the
same time, many Mäori may also have spiritual concerns
about the status of the wairua during anaesthesia and
how the life source is being protected and preserved.
They may wish for whänau members to be present or
karakia to be said, in order to ensure that their spiritual
as well as physical welfare is being properly looked
after. Pre-operative discussions with the patient and
whänau should ascertain what concerns they may have
as well as how those concerns may best be addressed.
As always, frank, open conversations ahead of time
can, when sensitively handled, prevent many problems
from developing.
2 Best health outcomes for Mäori: Practice implications
3. Mental health
Mental illness remains a serious health issue for Mäori,
and the rate of psychotic illness among Mäori has
been said to indicate a “culture under siege”. 57 First
admissions to psychiatric institutions are higher for
Mäori than Päkehä, with roughly 20 percent of all Mäori
admissions related to drugs and alcohol. 53 In addition,
more Mäori are committed to hospital involuntarily,
under the Mental Health Assessment and Treatment
Act, which increases the likelihood that the patients will
consider the hospitalisation experience as punitive rather
than therapeutic. 53
The increase in diagnosed mental illness among Mäori
holds for both genders. Mäori women are at higher risk
of alcohol and drug abuse and of being admitted to a
psychiatric facility than non-Mäori women, while Mäori
men are more likely to be treated in a forensic care
setting, to be diagnosed with schizophrenia, and to
spend less than half the time in hospital for this
diagnosis than non-Mäori. 53
The psychiatric readmission rate for Mäori is twice
that of European New Zealanders, and Mäori are
diagnosed with schizophrenia at higher rates than
Päkehä. 53 Worryingly, this may not reflect the true
rate of schizophrenia among Mäori, as many of these
patients recovered rapidly and did not follow the
longer-term course of schizophrenia. 53 This suggests
that lack of understanding about these Mäori patients,