Common Mental Disorders Depression - New Zealand Doctor

Chapter 1 Background
psychiatric phenomena are at risk of misinterpreting their significance, 23 and might,
for example, ignore spiritual experiences or regard them as pathological. 22,24
Models of mental health are now embracing more holistic views, with an acceptance
of the significant impact that social, economic and environmental factors have on
wellbeing, an awareness of diversity and a recognition that mental distress is part of
common human experience. 25 Even so, utilisation of Mäori and Pacific communitybased
mental health service providers, such as kaumätua (koroua/kuia), tohunga and
traditional healers, requires a level of understanding of theoretical and methodological
differences on the part of most New Zealand health practitioners. 22,26,27
Cultural barriers to mental health care
Mäori
As a group, Mäori have poorer health status than non-Mäori, regardless of their
level of education, income or occupation. 28 Mäori have a high prevalence of mental
disorders 29 and tend to access mental health services at a later stage of illness
and with more severe symptoms. 28 Disparities in outcome have been attributed to
different variables including historical, economic, cultural and social factors, and
both interpersonal and institutional racism. 30,31 There is also evidence that ineffective
communication between provider and patient contributes to some of the disparity in
Mäori primary mental health outcomes. 15
Although the burden of addressing disparities cannot be taken up solely by health
practitioners, they need to be aware of the context within which they are delivering health
care to Mäori, and the potential barriers to, and facilitators of, the delivery process. 11
Pacific peoples
Pacific peoples in New Zealand are also relatively disadvantaged across most social,
economic and health indicators and their health status falls about midway between
that of Mäori and non-Mäori groups. 32 Pacific peoples have a high prevalence of
mental disorders and suicidal behaviour, compounded by significant underutilisation
of health services. 33 Prevalence rates of mental disorders also appear to increase as
a function of time spent in New Zealand. 34 Pacific people frequently present late to
services, 33 and report difficulty accessing culturally appropriate care and information. 33
In addition, Pacific people may face language barriers. 35 Doctors responding to the
National Primary Care Medical Survey rated 22% of Pacific people attending primary
care as lacking fluency in English. 36 The language used in health care interactions can
pose particular difficulties, 37 and there can be difficulty in ensuring confidentiality when
interpreters are used. 33 As with Mäori, provision of acceptable and accessible services
must be a priority in this vulnerable population.
Identification of Common Mental Disorders and Management of Depression in Primary Care 3