Whanau Oranga Hinengaro: Northern Region Maori ... - Network North

WHANAU
ORANGA
HINENGARO
Tawhiti rawa to haerenga ake te kore haere tonu
Nui rawa au mahi te kore mahi nui tonu
We have come too far not to go further
We have done too much not to do more
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WHANAU ORANGA HINENGARO

Contents
Whanau Oranga Hinengaro
Plan Refresh
Executive Summary 4
Background 5
Aim 6
Te Tiriti o Waitangi Statement 7
Priciples 7
Scope of the Plan 8
Te Rau Hinengaro 8
Northern Region Demographic profile 9
Implications of demographic trends 9
Structuring the Plan: 10
The 4-Rs Framework for the Achieving
Whanau Oranga Hinengaro
The 4-Rs Framework Summary 12
1: Right Response: Kia Tika Te Urupare 12
2: Right Way: Kia Tika Te Ara Whaiornga 16
3: Right Place: Kia Tika Te Wahi 19
4: Right Time: Kia Tika Te Wa 20
Conclusion 21
Appendix 1: Ministry of Health 22
Stepped Care Aproach
Appendix 2: National documents given effect
through the enactment of this plan 23
Appendix 3: Key ations identified from the 24
Northern Region Māori Mental Health and
Addictions Implementation Plan 2006-2008
Appendix 4: Te Rau Hinengaro: 25
The New Zealand Mental Health Survey 2006:
A Summary of findings pertaining to Māori
Appendix 5: Northern Region Demographic Profile 26
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Whanau Oranga Hinengaro – Plan Refresh
Tawhiti rawa to haerenga ake te kore haere tonu
Nui rawa au mahi te kore mahi nui tonu
You have come too far not to go further
You have done too much not to do more - Ta Hemi Henare
Executive Summary
This Whanau Oranga Hinengaro: Northern Region Māori Mental
Health and Addictions Plan 2010 – 2015 recognises the many
opportunities for improving outcomes for tangata whaiora and
their whanau by supporting and influencing all those organisations
contributing to the development of mental health and addiction
services. These include the Ministry of Health (develop good policy
and facilitate intersectoral collaboration), Public Health Services
(health promotion and prevention), Primary Health Care (mild to
moderate mental illness), Mental Health Services (severe mental
illness), and NGO/Iwi services (support services).
Of particular relevance in the current environment is the focus on
primary care and its role in the overall health sector. The needs of
most people with mild to moderate mental needs are met in a primary
care setting and the Government has signalled that this position will
be strengthened. While integrating services and working together
across primary health care and secondary and social sectors is the
approach being encouraged and supported as a cornerstone of
health care provision, the infrastructure of the primary health sector
requires further development so as to be prepared for mental health
responsibilities.
However, it must be recognised that the gains made by investment in
services engaged with tangata whaiora with more serious conditions
must also be maintained and strengthened to ensure tangata whaiora
can access clinical expertise across all levels of need.
Māori knowledge, resources and people have an important and
distinctive contribution to make to mental health service provision
and this is recognised in the plan along with the need to embrace
innovation, opportunity and the development of kaupapa Māori
services for tangata whaiora.
Effective Māori mental health gains require culturally responsive
services, systems, training, education, relationships and
infrastructure. A dedicated Māori approach that draws from but is
not limited to western and clinical paradigms is required. To this end,
it relies heavily on a shared approach from the mental health sector
as a whole. Orienting the health sector to respond effectively to Māori
mental health needs will require the commitment of the wider mental
health workforce, and advanced competencies for mental health
practitioners. Such an approach will also contribute positively to
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opportunities of potential that a Māori led mental health focus brings.
It will also inherently require a shift in thinking and practice. (E Ara
Tauwhaiti Whakarae).
Service providers are ‘enabled’ when the policies, systems
and strategies that underpin their activities provide appropriate
mechanisms for service development and delivery. This plan
recognises the opportunities for service development within the
Whanau Ora and new primary care models. These are designed
to achieve more personalised, patient-centred care which match
interventions to the cultural and clinical needs of tangata whaiora.
Whanau Oranga Hinengaro is a framework for meeting the needs of
tangata whaiora through strategies that deliver the right response
to their mental health needs in the right way, at the right time and
in the right place. This includes understanding and implementing
Māori aspirations around workforce development, building effective
linkages between primary, secondary, tertiary and Māori/iwi
providers, integrated and intersectoral initiatives and responsiveness
frameworks.
The 4R Framework includes the following strategies through which to
describe the 4 pillars of service delivery and to measure achievement
of progress. The 4R’s include the right response, the right way, the
right place and the right time.
Background
In 2002 the Northern DHB Support Agency (NDSA), on behalf of the
four Northern Region District Health Boards (DHBs) commissioned
the preparation of a Northern Region Māori Mental Health and
Addictions Plan. In 2004, Whanau Oranga Hinengaro, the Regional
Māori Mental Health and Addictions Plan 2004 was endorsed by the
regions four DHBs.
In 2006 the Whanau Oranga Hinengaro Northern Regional Māori
Mental Health and Addictions Implementation Plan 2006-2008
was developed to provide regional direction to the sector towards
achieving outcomes of the 2004 Plan.
A review of progress against the goals and objectives outlined in
the Whanau Oranga Hinengaro Northern Regional Māori Mental
Health and Addictions Implementation Plan 2006-2008 informed
the development of this plan and is appended. Please refer to the
separate document. In addition, the key considerations identified
from this previous Plan are appended as they are relevant to this plan
refresh (Appendix 1).
This Whanau Oranga Hinengaro Northern Regional Māori Mental
Health and Addictions Strategy and Implementation Plan 2010 – 2015
refreshes the previous regional plan. It celebrates and builds on
current achievements within the sector, aligns with a number of new
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significant local, regional and national documents and re-affirms the
aspirations gata a and their whanau towards achieving better health
outcomes over the next five years and beyond.
Aim
The overall aim of Whanau Oranga Hinengaro Northern Regional
Māori Mental Health and Addictions Strategy and Implementation
Plan 2010 – 2015 is:
Whanau Ora: Māori families supported to reach their maximum health
and wellbeing, and provides an overarching principle for recovery and
maintaining wellness.
This is consistent with the Vision statement contained in the original
Plan and restated in the Implementation Plan:
To provide an integrated range of mental health services for tangata
whaiora and their whanau so that they may achieve Whanau Ora.
It supports the stated Government aim for a system that actively
supports whanau to live longer, enjoy a better quality of life without
experiencing discrimination, and to be well informed about mental
health and wellbeing. It also aims to achieve an environment in which
tangata whaiora have a choice of services that are responsive to and
confidently address their clinical and cultural needs.
Te Tiriti o Waitangi Statement
The DHB recognises and respects the Te Tiriti o Waitangi as
the founding document of New Zealand. Te Tiriti o Waitangi
encapsulates the fundamental relationship between the Crown and
iwi. It provides the framework for Māori development, health and
wellbeing.
The New Zealand Public Health and Disability Act 2000 requires
DHBs to establish and maintain processes to enable Māori to
participate in, and contribute towards, strategies to improve Māori
health outcomes. References to Te Tiriti o Waitangi in this document
derive from, and should therefore be understood in this context.
As Crown agents, DHBs will demonstrate how Treaty
responsibilities are implemented through innovative strategies that
apply the principles of Partnership, Participation and Protection.
These principles are promoted by the Ministry of Health to provide
direction to the health sector. Our commitment is therefore
consistent with national Ministry of Health policy within He Korowai
Oranga – The Māori Health Strategy.
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Co-operative Rangatiratanga and
Kawanatanga
The DHBs have a range of Memoranda of Understandings with Iwi
that outline the principles, processes and protocols for working
together at governance and operational levels. In order to achieve
rapid progress towards equitable Māori health outcomes, parties
recognise the value of co-operative rangatiratanga and kawanatanga
as the means to achieve equitable Māori health outcomes.
Whanau Ora
DHBs work in partnership with Iwi to achieve a Whanau Ora approach
to health services and whanau empowerment.
Key Principles
The principles and assumptions that underpin Whanau Oranga
Hinengaro have been confirmed by the Sponsors. They are that the
Plan:
• Acknowledges the significant work underway by iwi in
positioning, strengthening and implementing health
service activities in line with the overall iwi development
plan. This plan will give effect to the iwi based solutions
work under development in the sector.
• Is underpinned by a recovery focus where recovery is
defined as “…happening when people can live well in
the presence or absence of their mental illness”
(Blueprint, 1999, p1).
• Describes four pillars of service delivery (right response,
right way, right place, right time) that promote best
practice for achieving positive outcomes for tangata
whaiora and their whanau.
• Is committed to promoting the distinctive contribution
that Māori knowledge, models of wellness and people
can make to Whanau Oranga Hinengaro. In doing so it will
respect the integrity of Māori knowledge and traditions,
including te reo me ona tikanga, and recognises that
they have an important contribution to make to mental
health services for Māori.
• Recognises that services must be responsive and flexible
to meet the changing needs of tangata whaiora and their
whanau and are delivered in ways that demonstrate
respect and offer hope.
• Advocates for the growth of capacity and capability
within the Māori mental health and addictions workforce
• Advocates for an holistic approach to recovery where the
whole person, including their physical and mental health
needs, are considered in their entirety.
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• Places tangata whaiora at the centre of service design
and delivery
• Recognises that all tangata whaiora have whakapapa
(direct familial relationships) and tatai hono (extended
familial relationships), which binds them to a potentially
caring whanau and community.
• Frames initiatives for mental health service provision
in the northern region. While local actions will support
the regional initiatives they are not explicitly mentioned
in this plan.
• Recognises the contribution of other initiatives that
contribute to Māorii mental health gain but are not part
of this plan. For example research initiatives around
Māori mental health.
The principles underlying the plan are to improve outcomes for
tangata whaiora by ensuring equity of access, effectiveness, value for
money, high-quality services and an intersectoral focus.
Scope of the plan
This plan covers both Kaupapa Māori services (i.e. by Māori for
Māori) and all other mental health and addictions services that are
likely to be accessed by Māorii. It makes explicit the need for Māori
models of care that promote whanau ora and wellness for tangata
whaiora. It recognises that many tangata whaiora access general
services on their journey to wellness and endorses the need for these
services to be responsive to the needs of Māori and their whanau.
The plan applies to the whole continuum of mental health and
addiction care and promotes the need for general services to improve
cultural competencies to ensure their services are not only clinically
safe but also culturally appropriate. Tangata whaiora need to be
supported at all levels of need from mild, moderate and severe
presentations, across a continuum of care. Please refer to Appendix
1 for the Ministry of Health Stepped Care Approach.
The plan is congruent with national strategies (refer Appendix 2).
The plan also derives from strong regional collaborative process,
and supports the Northern region DHBs working together in the
interests of coordinated planning, economies of scale and efficiencies
in service delivery and support. Regional solutions will assist with
issues of population mobility across DHB boundaries, effective
application of scarce workforce resource, and effective use of
potentially vulnerable specialist services.
Te Rau Hinengaro
The most recent evidence of mental health and addictions prevalence
and incidence in the New Zealand context is available from Te Rau
Hinengaro − The Mental Health Survey (Oakley Browne et al 2006).
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The survey included 2,595 Māori individuals, and captured the
diversity of Māori across a range of demographic, social, economic
and cultural indices. Importantly the survey design enabled the
participation of sufficient numbers of Māori to allow estimates of
acceptable precision for this group.
The summary of findings is presented in Appendix 3.
Northern Region Demographic Profile
Māori make up fifteen percent (15%) of the total population in New
Zealand (2010-11).[1] By the year 2021, this is estimated to rise to
sixteen percent (16%). The total population of Māori in the Auckland/
Northland region is 223,365, thirteen percent (13%) of the whole
region.
Thirty-seven percent (37%) of Māori live in Counties Manukau
DHB, twenty-three (23%) in Northland DHB, twenty-four (24%) in
Waitemata DHB and sixteen (16%) in Auckland DHB. Please refer to
Appendix 3 for graphical representation of these percentages, and
age banding.
Age distribution spread indicates that 43% of the Māori population is
less than 20yrs, 52% are between 20yrs and 64yrs and only 5% are
above the age of 65yrs.
Life expectancy is lower for Māori than their non-Māori counterparts.
[2] A Māori man can expect to live only 70.4 years compared to 79
years for a non-Māori man. Māori women also have lower longevity
at 75.1 years compared to 83 years for a non-Māori woman.
The NZ Deprivation Index shows that Māori are also overrepresented
in the more deprived areas of New Zealand. Appendix 4 details
graphs of deprivation index information.
Implications of demographic trends
Demographic trends characterising the Māori population will need
to be considered for service delivery and configuration in the region.
These include
• The rate of population growth is relatively high
(compared with the total population). An increase
in total numbers of Māori will generate a greater need
for services that meet Māori cultural needs (as well as
clinical needs)
• The median age is relatively young (22 years).
A youthful Māori median age suggests the need for
youth-oriented mental health services capable of
meeting the particular needs of this cohort.
• The population is ageing. Despite the youthfulness
of the population, the proportion of older whanau
members is also growing with increased life expectancy
1 All population figures, unless otherwise stated, are projected from the 2006 Census and sourced
from Ministry of Health.
2 New Zealand Life Tables: 2005-07, (Statistics New Zealand, 2009), p13.
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for both men and women. In this respect the Māori
population is not ageing at the same rate as the
non-Māori population, although in the same direction
suggesting an increased need for mental health services
that are responsive to the needs of older Māori.
• The population is mobile (both nationally and
internationally). The trends towards a growing and
ageing Māori population will be similarly matched by an
increasingly mobile population. Around 25 percent
of Māori live in the greater Auckland area with a higher
percentage residing in Northland. This amplifies the
need for a Māori and non-Māori workforce equipped to
meet the mental health needs of Māori.
The demographic transitions described above will inevitably impact
on regional mental health service provision for Māori and require
adaptations to meet changing needs. The dynamic nature of
Māori society will need to be accommodated in mental health service
provision.
Structuring the Plan: The 4-Rs Framework for
Achieving Whanau Oranga Hinengaro
The 4-Rs Framework is an approach to mental health and addiction
services delivered across the continuum of care, agreed to by the
Sponsors of this Plan refresh.
The core of the 4-Rs framework is the selection of practices within
mental health settings that ensure that the right response to the
needs of tangata whaiora is applied in the right way at the right place
at the right time leading to recovery for tangata whaiora. Recovery is
defined as “…happening when people can live well in the presence
or absence of their mental illness” (Blueprint, 1999, p1). This implies
a role for both service providers and service users. The 4R’s Whanau
Oranga Hinengaro framework helps to link science and matauranga
Māori to practice and communicate it to stakeholders.. The 4 R’s, as
described, are based on clinical evidence and applied research, and
underpinned by culturally appropriate approaches. They also reflect
the government’s aim of better, sooner, more convenient health care.
This plan recognises that even when mental health services deliver
the right response to the needs of tangata whaiora in the right way, at
the right time and in the right place, outcomes for tangata whaiora are
also influenced by the wider determinants of health. The framework
and actions in this plan fall within the larger contexts of overall health
and therefore comprise an interlinked subset of the overall health
of tangata whaiora. This includes physical, emotional, spiritual and
whanau health. In addition the 4-R framework actions are situated
within the wider context of the society in which tangata whaiora live.
The 4-Rs therefore, are not independent of the wider social systems
or sectors which influence wellness.
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To be considered “best”, the practices outlined in the framework
must harmonise with the overall factors that comprise the overall
determinants of health. They must also be shaped by and be
acceptable to the practitioners and recipients of the practices. While
the perspectives of all these stakeholders must be reflected in the
service goals, it is tangata whaiora themselves who determine what is
‘right’ for them.
For tangata whaiora the inclusion of Māori models of wellness is an
important part of ‘right’ responses to their mental health needs. So
the underpinning of a particular response needs to include both a
clinical perspective and a tikanga Māori perspective.
This plan acknowledges the important interface between science
and matauranga Māori (incorporating Māori models of wellness and
tikanga best practice) and the limitations to our application of such
knowledge. By valuing the western and Māori contributions to mental
health the plan presents an excellent framework for ensuring ‘right’
recommendations for mental health and addiction services.
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4-Rs Framework Summary
Right response
Kia tika te
urupare
Right way
Kia tika te ara
whaioranga
Right place
Kia tika te
wahi
Right time
Kia tika te
wa
Ensure culturally
competent [3] service
delivery
Ensure clinically safe
service delivery
Ensure responses
are underpinned by
appropriate policy and
properly resourced
services
Use quality information to
inform service planning
Increase efficiency of and
options for self/whanau
management approaches
Ensure mental health and
addiction services are
responsive to the unique
cultural needs of Māori
Develop innovative service
delivery models that
support whanau ora.
Improve regional
performance by
sharingbest practice
approaches between
DHBs
Improve quality and
performance
Ensure value for money
Ensure service
development improves
Māori access to mental
health and addiction
services.
Strengthen the viability
and sustainability of
kaupapa Māori mental
health and addiction
providers
Deliver services in the
setting most convenient
and comfortable to the
service user (marae,
home etc)
Early intervention /early
access to services for
tangata whaiora of all
ages.
Ensure appropriate
and timely movement
between primary,
secondary, tertiary care to
support a recovery focus
for tangata whaiora
Build Māori workforce
capacity and capability by
integrating with general
and Māori specific
workforce development
plans in the sector.
Promote effective referral
pathways
Ensure services align
with iwi perspectives of
Māori mental health and
addiction.
1: Right Response: Kia Tika Te Urupare
Improving the responsiveness of Māori and non-Māori services is
essential to meeting the current and future mental health needs of
tangata whaiora and their whanau. The northern region remains
committed to ensuring the ‘right responses’ to the mental health
needs of tangata whaiora are informed by quality information,
underpinned by appropriate policy, delivered by well resourced
services and promoted by a capable workforce.
Barriers to, and facilitators of, access to health care for Māori
have been identified at four levels of the health system: system,
organisation, human resource, and individual or community. While
direct and indirect financial costs are often seen as key barriers
to health care for Māori, research and evaluation has found that if
services are not culturally appropriate then, even if they are free,
they may not be fully utilised by Māori. Cultural appropriateness, in
turn, rests on the tailoring of services to be more in tune with Māori
through the engagement of Māori and culturally competent non-
Māori staff. This will require both education and commitment to
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3 Where competence is a function of knowledge and practice and the fusion of cultural and clinical
elements in practice, as per the Takarangi Competency Framework and Let’s Get Real, Working with Māori.

Māori health gains, as well as guidance through leadership and policy
at a national level.
The responsiveness of the health system to the current status of
Māori health can be monitored in many ways; for example, the
analysis of Māori/non-Māori disparities in terms of mortality and
morbidity. Tangata whaiora feedback provides valuable input into
how a health organisation and health personnel can facilitate
Māori access to health care. Therefore clinically safe and culturally
appropriate service delivery underpins this plan’s approach to the
‘right response’ to the needs of tangata whaiora and their whanau.
plan’s approach to the ‘right response’ to the needs of tangata
whaiora and their whanau.
(Adapted from He Ritenga Whakaaro: Māori Experience of Health Services 2009)
Strategy
Actions
Role
Completion
Date
1.1 Ensure culturally
1.1.1
competent [4] service
delivery
Equip mental health and addictions staff to provide culturally
appropriate services to tangata whaiora in both Māori and general
mental health and addictions organisations
DHBs
Ongoing
1.2 Ensure clinically safe 1.2.1
service delivery
Promote clinician-led service management
DHBs
Ongoing
1.2.2
Embed safety in a clinical and tikanga sense in the skills of health
professionals and systems of care to improve outcomes for tangata
whaiora and their whanau.
DHBs
Ongoing
1.3 Ensure responses
are underpinned by
appropriate policy and
properly resourced
services
1.3.1
1.3.2
1.3.3
Submit regional responses to government-led mental health policy
reviews and strategy development
Provide a regional perspective for DAP planning for mental health
Promote the importance of appropriate funding to properly resource
mental health service provision (MoH, DAP, DHB boards).
Regional
Regional
DHBs,
Regional
As required
Annually
As required
1.3.4
Encourage innovation and information sharing to deliver better mental
health and addiction services within existing funding.
DHBs,
Regional
Ongoing
1.3.5
Maximise opportunities to improve service delivery for tangata whaiora
within whanau ora funding and implementation frameworks.
DHBs,
Regional
Ongoing
4 Where competence is a function of knowledge and practice and the fusion of cultural and clinical
elements in practice, as per the Takarangi Competency Framework and Let’s Get Real, Working with Māori.
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1.4
Use quality information to
inform service planning
1.4.1
Ensure robust and consistent ethnicity data is captured and used to
inform service planning
DHBs
Ongoing
1.4.2
Information provided by service providers should align with national,
regional and local information requirements (e.g. MHINC PRIMHD)
DHBs,
Regional
Ongoing
1.4.3
Ensure proper and consistent use of new technology enabling tangata
whaiora information capture across and between services, consistent
with regional and national information intiatives.
DHBs,
NGOs
Ongoing
1.5 Increase efficiency of and
options for self/whanau
1.5.1
management approaches
1.5.2
Support services that promote mental health and well-being, and
prevent mental illness and addiction
To the extent where possible promote self/whanau management
approaches and raise awareness and understanding of practical
support among whanau, friends and communities.
DHBs,
NGOs
DHBs,
NGOs
Ongoing
Ongoing
1.5.3
Ensure that culturally relevant information on mental health and
addiction services is available for tangata whaiora and their whanau
and the communities in which they reside.
DHBs,
NGOs
As required
1.5.4
Develop service exit criteria to avoid service dependency.
DHBs,
NGOs
As required
1.6 Link with the Northern
Region Māori Mental
1.6.1
Health and Addictions
Workforce Development
1.6.2
Plan to build workforce
capacity and capability 1.6.3
1.6.4
Enhance the traditional knowledge base of all Māori mental health staff.
Develop an active workforce development programme to train
Māoripractitioners in indigenous models of health.
Engage with tertiary training providers to integrate Māori indigenous
knowledge frameworks into mental health training.
Increase the number of Māori working in mental health and addiction
services, especially in high need areas.
DHBs,
Regional
Regional
Workforce
Coordinator
Regional
Workforce
Coordinator
DHBs
Ongoing
Ongoing
As required
1.6.5
Determine the principles for kaupapa Māori peer support services and
an implementation plan for purchase, infrastructural development,
training and delivery, consistent with DHB prioritisation processes.
DHBs
Regional
Ongoing
1.6.6
Ensure appropriate data is collected across the Māori mental health
and addictions sector to inform workforce planning and forecasting.
Regional
Workforce
Coordinator
Ongoing
1.6.7
Where national workforce information gathering and profiling of the
Māori mental health and addictions workforce is undertaken request
that the information be captured and analysed regionally to identify
regional workforce gaps especially in high need workforce areas.
Regional
Workforce
Coordinator
Ongoing
1.6.8
Ensure appropriate supports are in place for primary mental health
care workers, including practice nurses and nurse practitioners,
covering a framework for professional development, training
pportunities, clinical supervision, opportunities for peer support and
mentoring, information sharing, and case management support,
consistent with DHB prioritisation processes and wider primary care
initiatives.
DHBs
Ongoing
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1.6.9
Develop the role of practice nurses and nurse practitioners so they can
play a wider role in primary mental health care
DHBs
Ongoing
1.6.10
Consider the development of core competencies for all staff working in
mental health and addictions utilising learning modules in
Lets Get Real.
DHBs,
NGOs
Ongoing
1.6.11
1.6.12
Develop the competencies of all practice terms of integrated family
health centre teams working in mental health
Promote training and education in mental health to develop and maintain
the core mental health competencies of the wider health workerforce.
DHBs
DHBs,
NGOs
Ongoing
Ongoing
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2: Right Way: Kia Tika Te Ara Whaioranga
The Primary Health Care Strategy and the new Government’s
priorities for Better, Sooner, More Convenient Primary Care has
signalled a desired outcome of the new primary care environment
as ‘single system, personalised care’. It is expected that the ‘right
way’ of achieving this will be through the development of new
service delivery models, such as Integrated Family Health Centres
(IFHCs), which focus on the integration of some specialist services
into primary care; better integration between primary and secondary
services and between primary health care and social services;
more personalised care; stronger support for self care; and better
coordination of care for people with multiple chronic conditions and
high needs families and whanau. The new primary care and whanau
ora environments are expected to provide significant opportunities for
better coordination and integration of mental health and alcohol and
other drug (AOD) services within multidisciplinary primary care teams.
Strategy
Actions
Role
Completion
Date
2.1 Ensure mental health and
addiction services are
responsive to the unique
cultural needs of Māori
2.1.1
2.1.2
Support kaupapa Māori services to identify, develop and utilise
evidence based kaupapa Māori models of care
Support general mental health and addictions services to identify,
integrate and utilise evidence based kaupapa Māori models of care
NGOs
DHBs,
NGOs
Ongoing
Ongoing
2.1.3
Support general mental health and addictions services to link with
kaupapa Māori and iwi providers who can advise on culturally
responsive service provision.
DHBs
Ongoing
2.1.4
Implement Treaty responsiveness training in general mental health and
addictions services.
DHBs
Ongoing
2.1.5
2.1.6
Embed tikanga best practices in provider arm services
Ensure service specifications reflect expectations for the use of
kaupapa Māori models of care
Planning &
Funding
DHBs,
NGOs
Ongoing
Ongoing
2.1.7
Develop and implement culturally focused programmes that contribute
to recovery including the promotion and use of te reo me ona tikanga
in treatment services for tangata whaiora.
DHBs,
NGOs
Ongoing
2.1.8
Increase wananga and other fora that promote the understanding and
use of Māori healing practices
DHBs,
NGOs
Ongoing
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2.2 Develop innovative 2.2.1
service delivery models
that support whanau ora.
Promote the understanding that mental health is integral to new service
delivery models such as integrated family health centres (IFHCs) which
focus on the integration of primary, secondary, social and related
services, or marae-based health centres.
Role
DHBs,
Regional
Completion
Date
Ongoing
2.2.2
Strengthen service navigation by enhancing the primary mental health
care function and developing complementary intra and
inter-organisational capacity and capability.
DHBs
Ongoing
2.2.3
Improve service coordination across general practices, specialist mental
health and addiction services, social services, NGO and community
services.
DHBs
Ongoing
2.2.4
Support NGOs to partner with and develop strong collaboration with
PHOs, IFHCs and other primary health care providers. Equally these
providers should seek collaborative relationships with NGOs.
DHBs,
Regional
Ongoing
2.2.5
Develop, implement and evaluate new approaches to planning and
funding processes to improve outcomes for tangata whaiora.
DHBs,
Ongoing
2.2.6
Improve mental health literacy
DHBs,
NGOs
Regional
2.3
Improve regional
performance by sharing
best practice approaches
between DHBs
2.3.1
2.3.2
Explore options to expand and share best practice guidelines for
clinicians to ensure clinical and cultural competence for service
provision to Māori i.e. clinical networks
DHBs and NDSA will collaborate to identify and review current best
practice guidelines for mental health and addiction services and explore
opportunities for regional service planning.
DHBs
DHBs,
Regional
Ongoing
Ongoing
2.3.3
Re-establish the Māori sector group on the NNC as a working group to
oversee direction, planning, implementation, monitoring and reporting
on the refreshed plan.
DHBs
Regional
Ongoing
2.4 Improve quality and 2.4.1
performance
Services and clinicians should regularly seek feedback from tangata
whaiora on whether the intervention is improving their wellbeing and
meeting their goals
DHBs
Ongoing
2.4.2
Ensure that tangata whaiora have opportunities to provide feedback on
how services can be enhanced to meet their needs.
DHBs,
NGOs
Ongoing
2.4.3
Ensure that tangata whaiora are included in training on strengths,
recovery philosophy, whanau ora and wellness planning to enable them
to get the most benefit from services.
DHBs,
Regional
NGOs
Ongoing
2.4.4
Ensure the active participation of Māori in all areas of mental health and
addiction service planning and service development
Planning
& Funding
Ongoing
2.4.5
Increase the capacity and capability of Māori providers to deliver
effective mental health and addiction services for tangata whaiora and
their whanau.
DHBs,
NGOs
Ongoing
2.4.6
Invest in resources (physical, information, financial and human
resources) to enhance service provider performance.
DHBs,
NGOs
Ongoing
2.4.7
Support providers to improve systems to meet certification, auditing,
contract specifications and quality standards used in the sector.
Planning
& Funding
Ongoing
17

Role
Completion
Date
2.5 Ensure value for money 2.5.1
Review service delivery and determine opportunities for improved
collaboration and integration between providers for improved
outcomes and value for money.
DHBs
Ongoing
2.5.2
Explore opportunities for more cost effective interventions for tangata
whaiora with mild to moderate mental health and/or addiction
problems e.g. E-therapies, supervised self management
DHBs
Ongoing
2.5.3
Encourage service providers to take a stepped care approach to
service provision so that treatment that is most effective yet least
resource intensive is delivered.
DHBs,
NGOs
Ongoing
2.6
Promote effective referral
pathways
2.6.1
Ensure primary care providers understand the pathways available for
tangata whaiora who do not respond to first time treatment and the
entry criteria for different services.
DHBs
As required
2.6.2
Support activities that encourage ease of return to primary care as the
hub for tangata whaiora care with continued access to supports when
needed.
DHBs,
NGOs
As required
2.7
Ensure services align
with iwi perspectives of
Māori mental health and
addictions
2.7.1
2.7.2
Maintain regular liaison with iwi development plans
Ensure mental health and addictions perspectives are represented in
DHB iwi relationship structures.
DHBs,
NGOs
DHBs
Ongoing
As required
18

3: Right Place: Kia Tika Te Wahi
Settings in which tangata whaiora access mental health and addiction
services differ greatly from other settings with which they are familiar.
They often require tangata whaiora to become familiar with new
rituals, practices and language. This must change. Places that are
geographically accessible and that reflect the cultural experience
of tangata whaiora will improve access and promote engagement.
Furthermore service placement must encourage integrated care
where treatment is driven by a comprehensive understanding of
tangata whaiora in their social context. They must also consider
a broad range of issues including cultural considerations, physical
health needs and educational and occupational needs. Care must
be taken that service integration actually improves overall outcomes
rather than shifting them or creating different interface tangata
whaiora, it is important that the services are based on the needs
of tangata whaiora, not the services. problems. Where service
integration is possible and desirable, for example the co-location
of a range of different services accessed by tangata whaiora, it
is important that the services are based on the needs ot tangata
whaiora, not the services.
Strategy
Actions
Role
Completion
Date
3.1 Service development to
improve Māori access
to mental health and
addiction services.
3.1.1
3.1.2
Ensure tangata whaiora have a greater choice of services by expanding
and developing kaupapa Māori mental health and addiction services
where needed in the region.
Ensure general mental health and addictions services provide real
choice for tangata whaiora by promoting service choices to tangataora
and carers, on the basis of full understanding of the services available
to them and the implications of these decisions.
Planning
& Funding
DHBs,
NGOs
Ongoing
Ongoing
3.1.3
Improve referral pathways so that tangata whaiora are receiving the appropriate
level of intervention along the continuum of care.
DHBs,
NGOs
Ongoing
3.1.4
Seek integrated care models that co-locate services used by tangata
whaiora to improve service access and engagement
Planning
& Funding
Ongoing
3.2
Strengthen the viability
and sustainability of
kaupapa Māori mental
health and addictions
providers.
3.2.1
3.2.2
Review service providers across the region and invest in capacity
building initiatives that improve services for Māori, consistent with DHB
prioritisation processes.
Ensure an appropriate geographic spread of kaupapa Māori NGO and
other service providers across the region.
Planning
& Funding
Planning
& Funding
Ongoing
Ongoing
3.3
Deliver services at the
setting most convenient
and comfortable to the
service user (marae,
home etc).
3.3.1
Ensure service development planning reflects a commitment to service
provision that is convenient and comfortable to the service user.
Where service delivery is not possible the service should be able to
articulate a rationale for this.
Planning
& Funding
Ongoing
19

4: Right Time: Kia Tika Te Wa
Getting things right for Māori earlier, through responsive and effective
public health and primary care services, means we can look forward
to a sector that promotes greater equity and reduces the burden,
impact and severity of mental illness for tangata whaiora, whanau,
hapu , iwi and the wider Māori community (Te Puawaiwhero).
Facilitating care for Tangata Whaiora at the right time includes a
stepped care approach to service provision where the treatment
that is most effective is the first and easiest to deliver. It will be least
resource intensive, least intrusive, least compulsory and most likely
to enable a return to their life and whanau quickly. It also recognises
that treatment is a dynamic process and the timely movement
between services/ levels of care enables tangata whaiora to receive
the most appropriate treatment at all stages of their journey.
Strategy
Actions
Role
Completion
Date
4.1
Early intervention /early
access to services for
tangata whaiora of all
ages
4.1.1
Promote mental health competencies in primary care which enable
early intervention for tangata whaiora
Primary
Care
Ongoing
4.2
Ensure appropriate
and timely movement
between primary,
secondary, tertiary care to
support a recovery focus
for tangata whaiora
4.2.1
4.2.2
Tangata whaiora should have access to interventions of varying levels
of intensity depending on their needs at any given time as per the
stepped care service model.
Tangata whaiora who are referred elsewhere should continue to be
supported by a member of the primary care team
Primary
Care
DHBs
Ongoing
Ongoing
4.2.3
Tangata whaiora who return to primary care are able to access to the
resources to assist them in maintaining wellness.
Primary
Care
Ongoing
4.2.4
Raise general awareness of mental health so that access to early
intervention services is possible to reduce the impact and severity of
mental illness and addiction related issues.
Public
Health
Ongoing
4.3
Tangata whaiora and
their whanau develop
knowledge to assist them
to navigate the system for
most effective outcomes.
4.3.1
Develop training for tangata whaiora, whanau, staff and the wider
community as appropriate to improve understanding of the
components of the recovery journey e.g wellness and illness, treatment
and self care, strengths and effective problem solving
DHBs
Ongoing
20

Conclusion
This Whanau Oranga Hinengaro: Northern Region Māori Mental
Health and Addictions Plan 2010 – 2015 sets out and reaffirms
a vision for effective mental health and addiction services in the
region, including a stronger focus on the development of firstcontact
services as the core co-ordinator of people’s health care. It
operates within an overarching framework of seeking to improve
outcomes for tangata whaiora and their whanau and aims to achieve
equity between tangata whaiora and others accessing mental health
services.
A commitment to work in a more inclusive and collaborative manner
with general practice, NGOs, and all other primary, secondary, tertiary
and kaupapa Māori mental health and addiction stakeholders is
shaped and implemented in a way that builds on the strengths of
current provision.
It frames strategies and actions within a best management practice
framework where the right response is provided to tangata whaiora
in the right way at the right time and in the right place to promote
whanau ora.
The approach is aspirational in as much as it encourages innovative
approaches to service development to better understand and meet
the needs of tangata whaiora, and also conservative, in its focus on
achieving its aims within a climate of fiscal restraint.
It celebrates the gains made over many years with an eye to the
challenges and opportunities ahead.
21

APPENDIX 1: MINISTRY OF HEALTH STEPPED CARE APPROACH
The diagram below illustrates the stepped care approach to mental
health service provision and shows the continuum of care that
supports tangata whaiora at all levels of need from early intervention
through to specialist mental health and addictions support.
Stepped care approach to primary mental health care
(Source Ministry of Health)
22

APPENDIX 2: NATIONAL DOCUMENTS GIVEN EFFECT THROUGH
THE ENACTMENT OF THIS PLAN
These documents include but are not limited to:
• The New Zealand Health Strategy 2000 and
• The New Zealand Disability Strategy 2001 provides
the overall direction for improving the health and
wellbeing of people living in New Zealand including
Māori and mental health.
• The Primary Health Care Strategy 2001
• He Korowai Oranga: Māori Health Strategy 2002 sets the
direction for Māori health development and places
whanau ora as central to mental health, wellbeing and
recovery.
• Whakatutuki te Oranga Hauora Mo Nga Tangata katoa:
Achieving Health For All People 2003.
• Te Tahuhu – Improving Mental Health 2005 – 2015
broadens the Government’s interest in mental health,
expanding to cover not only people who are severely
affected by mental illness but all New Zealanders, and
draws together government interests in mental health
and addiction. The ten leading challenges articulated in
Te Tahuhu provide the platform for advancing whanau
ora and recovery for tangata whaiora.
• Te Kokiri: The Mental Health and Addiction Plan 2006 –
2015 implements Te Tahuhu and the ten leading
challenges. It is the Government’s most recent policy
statement on mental health and addiction, and joins
Looking Forward (Ministry of Health 1994) and Moving
Forward (Ministry of Health 1997) as part of the National
Mental Health Strategy.
• Te Puawaiwhero: The Second Māori Mental Health and
Addition National Strategic Framework 2008 - 2015
Whanau Oranga Hinengaro also links with Māori workforce
development initiatives in other areas of health areas such as Raranga
Tupuake: Māori Health Workforce Development Plan (Ministry of
Health, 2006) and Kia Puawai Te Ararau: the Māori Mental Health
Workforce Development Strategic Plan (Te Rau Matatini, 2006).
23

APPENDIX 3: KEY CONSIDERATIONS IDENTIFIED FROM THE
NORTHERN REGION MĀORI MENTAL HEALTH AND ADDICTIONS
IMPLEMENTATION PLAN 2006-2008
The developmental phase of the (Implementation) plan identified a
number of key factors which need to be kept in mind:
• Tangata whaiora experience and endurance through the
recovery journey has a valuable contribution to
strengthening our communities.
• The status of Māori mental health and addictions is
linked to the historical erosion of those conditions which
promote security of identity for Māori.
• All tangata whaiora have whakapapa (direct familial
relationships) and tatai hono (extended familial
relationships), which binds them to a potentially caring
whanau and community.
• Whanau ora has been placed at the centre of health
strategies for Māori. Whanau themselves require special
care and support to be effective to meet the demands of
achieving Whanau ora.
• Whanau ora-orientated systems, services and funding
models need to be developed which contribute to
effecting significant change.
• Māori communities include whanau groupings and their
connections to hapu and iwi are accessed through a
range of other networks including urban locality,
workplace, schools, marae and specific interest or social
identity groups e.g. takatapui, kapa haka. These groups
need to be recognised and included in responding to the
needs of tangata whaiora and whanau.
• There is a growing body of knowledge that supports
Māori cultural development and restoration as a key
component to the well-being journey of Māori.
• The care and treatment of people with mental health
disorders remains stuck at a level which is out of
touch with the needs of a dynamic, resilient, energetic
and charismatic Māori society.
24

APPENDIX 4: TE RAU HINENGARO: THE NEW ZEALAND MENTAL
HEALTH SURVEY 2006: A SUMMARY OF FINDINGS PERTAINING
TO MĀORI
• The prevalence of mental disorders in Māori was 50.7%
over their lifetime (before interview), 29.5% in the past
12 months and 18.3% in the previous month.
• The most common 12-month disorders among Māori
were anxiety disorders (19.4%), mood disorders (11.4%)
and substance use disorders (8.6%). The most common
lifetime disorders among Māori were anxiety disorders
(31.3%), substance use disorders (26.5%), mood
disorders (24.3%) and eating disorders (3.1%).
• Lifetime prevalence of any disorder was highest in
Māori aged 25–44 (58.1%) and lowest in those aged 65
and over (22.7%). The lifetime prevalence of disorder
among Māori females was 52.7% and among Māori males
was 48.4%.
• In Māori with any 12-month disorder, 55.5% had only
one disorder, 25.7% had two disorders and 18.8% had
three or more disorders.
• Among Māori with any 12-month disorder, 32.5% had
some contact with a provider of services. This was
divided among mental health specialist services (14.6%),
general medical services (20.4%) and non-healthcare
providers (9.1%).
• Of Māori with any mental disorder, 29.6% had serious
disorders, 42.6% moderate disorders and 27.8% mild
disorders. Health care contact increased with severity. Of
Māori with serious disorder 47.9% had some contact with
health services compared with 25.4% of those with
moderate disorder and 15.7% of those with mild
disorder.
• Lifetime suicidal ideation was reported by 22.5% of
Māori, with 8.5% making suicidal plans and 8.3% making
suicide attempts. Māori females reported higher rates of
suicidal ideation, suicide plans and suicide attempts
compared with Māori males across lifetime and
12-month periods.
• Compared with Pacific people and the Other composite
ethnic group (i.e., non-Māori non-Pacific), a higher
proportion of Māori had 12-month anxiety, mood,
substance use and eating disorders. After adjusting for
age, sex and socioeconomic correlates, differences
remain between Māori and Pacific people for mood
disorders and substance use disorders and between
Māori and Others for substance use disorders.
(Source: Te Rau Hinengaro The New Zealand Mental Health Survey
2006)
25

APPENDIX 5: NORTHERN REGION DEMOGRAPHIC PROFIILE
Thirty-three percent (33%) of Māori in New Zealand live in the
Auckland/Northland region. The ethnic distribution in the region is
shown in the table below. Northland has thirty-two percent (32%)
Māori, Counties Manukau seventeen percent (17%), Waitemata ten
percent (10%) and Auckland eight percent (8%).
26
5 These percentages are based on population data from Statistics NZ (Census 2006). They have been used instead of the MOH
figures because they also include Asian & European population data. These breakdowns acknowledge the following limitations.
1) Includes all of the people who stated each ethnic group, whether as their only ethnic group or as one of several ethnic
groups. Where a person reported more than one ethnic group, they have been counted in each applicable group.
2) All figures are for the census usually resident population.
The Categories Don’t Know, Refused to Answer, Response Unidentifiable, Response Outside Scope or Not Stated have not been
included in the above graphs.

The graphs below show the Māori population (blue) compared to
other ethnic groups in each DHB. There is a greater percentage of
Māori (27%) in Northland than in any of the metro DHBs.[5]
27

28
The following graph shows the age breakdown of the Māori
population. The majority of the population in each DHB is aged
between 20 and 64. In Northland and Counties Manukau there is a
smaller gap between this group and the 0-19 population indicating a
generally more youthful population than in Waitemata and Auckland.
There is only a small percentage of Māori over 65 years. Overall,
43% of the Māori population is between 0 -19, 52% is between 20-64
and only 5% are over 65 years.

The index ranges from one to ten, with one being the least
deprived suburbs and ten the most. The graphs below compare
the percentage of each ethnic group in each decile.[6] There are
only 3.4% of Māori living in decile one suburbs compared to 13%
of European and 8.2% of Asian people. The percentage of Māori
steadily increases as the deprivation does, the opposite pattern to
that in the European/Pakeha and Other ethnic groups graph.
6 Graph formats, ethnic groups and percentages from Atlas of Socioeconomic Deprivation in New Zealand NZDep 2006,
(Ministry of Health, 2008), p23
29